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Scot: When you get to a place where you're ready to care about your health, sometimes it can be really, really overwhelming. Where should you start? There are a lot of different messages out there in the world, but if you could only do one thing . . . Because let's face it, we're not going to become a completely different person. We can only do one thing at a time. What should that one thing be? What's that first step?

So today, on the podcast, we're going to help you figure out that first step, whether you're just starting out, or maybe you've made some progress and you're wondering what is next. This is "Who Cares About Men's Health." We give you information, inspiration, and a different interpretation of men's health. We're just some guys trying to figure it out on our own as well, so we have these conversations about health hoping that they will be valuable to you as well.

So my name is Scot Singpiel. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm here and I'm ready to talk about that one thing.

Scot: All right. We're calling it "The Hierarchy of Health." And also always sharing his experience, Mitch Sears. Welcome.

Mitch: Hey. Yeah, one thing? That's what we . . .? All right. Okay, I'm here.

Troy: One thing. Starting point.

Mitch: All right. Starting point, okay.

Scot: Probably is not going to be your only thing, but it's going to be your first thing, right?

Mitch: Sure. Okay.

Scot: All right. So I want to kind of be clear on this, and we want to be clear as we're talking about it, because one of the things we really try to do here is talk about stuff we know, like evidence-based. This is based on research. This is information we know. But then also we talk about our own experiences and how that manifests in the real world. So we're going to try to be sure that we're indicating what is what when Dr. Madsen goes through this hierarchy of health with us.

And another thing that I think is important to point out too that we've discovered through the process of this podcast is when we talk about health on this show, we're talking about it in terms of reducing a chance of disease, living a longer and more satisfying life, and just generally feeling better.

It's not becoming more athletic, or more ripped, or building muscle, or losing fat for aesthetic purposes, although that could be a side effect. But it's more about just being healthier.

So, Dr. Madsen, I'm going to throw out the things that we're going to talk about today and I want you to rank these in the most important order, and then we're going to talk about that a little bit.

So, first of all, one of the things we talk about is the Core Four. If you kind of focus on these things, it can go a long way. And that's your emotional health, your nutrition, your activity, and your sleep.

And then we haven't talked about this a lot, but really we should: other things that men tend to do that might not be healthy that you might want to evaluate, such as smoking, alcohol use, nagging health issues, and genetics.

So we're going to rank those. Do you have any to add to that list, Dr. Madsen?

Troy: I do.

Scot: You do?

Troy: Yes.

Scot: Oh, so there's another one, okay.

Troy: There's another one. Yep.

Scot: And where does it fall in the hierarchy? Is it towards the top?

Troy: It's about halfway down.

Scot: About halfway in.

Troy: Yes.

Scot: Any idea what that might be, Mitch?

Mitch: No, I have no idea. I'm just sitting here, I'm like, "That's it, right? Those are the eight things I need to be worried about." And now there's . . .

Troy: This list is so comprehensive, I know.

Mitch: . . . a ninth one.

Troy: Yeah, I'm going to make it nine. We're going to make it nine.

Scot: Well, what's awesome about this list is it really does kind of help narrow down what is the first thing you should do. So, without any further ado, Dr. Madsen, our hierarchy of health. If you want to take that first step to a healthier lifestyle and you're at square zero, what's the first thing? What would be the biggest impact for your dollar?

Troy: I know what you think it's going to be, and it's not going to be that.

Scot: Smoking.

Troy: Nope, it's not smoking. I'm going to say the number one thing. So let's say you're a total couch potato, you don't do anything, your diet is horrible. Let's say you smoke, you drink a lot alcohol, you know nothing about your genetics, and you have all kinds of nagging health issues. The number one thing I would say that will have the biggest impact on your health that is the most practical thing to do is activity.

Scot: Really?

Troy: That's where I would start, and I'll tell you why, Scot. There was a study that came out recently, evidence-based. This looked at exactly those people, and it compared people who did nothing to people who had minimal activity, short bursts of energy, two minutes long, maybe three times a day, just taking the stairs instead of the elevator, shoveling snow, things like this. Not big activity. They found that people who engaged in these short bursts of activity had a 50% reduction in heart disease and cancer risk over about seven years.

Mitch: Wow.

Troy: Fascinating, I know. Major impact.

Mitch: Because we're not even talking the 30 minutes three times a week of activity.

Troy: No.

Mitch: We're talking just 10 minutes? What are you saying?

Troy: We're talking just take the stairs. That's all it was. So that's why I say that's your starting point. If you do nothing else, take the stairs, shovel the snow, do something to get your heart rate up for two minutes three times a day. That alone will have a dramatic impact. Fascinating study, really well-done study.

Scot: And just to be clear, more impact than quitting smoking, if everything else is equal?

Troy: I'm going to say yes. Quitting smoking is absolutely going to reduce your cancer risk. I can't say for sure that, in seven years, it will reduce your cancer risk by 50%. Maybe we'll find something out there that suggests that.

I'm looking at seven years. They were seeing this impact seven years, not a long time down the road, major impacts on health. And again, you're starting super low, and just adding something to it. But just adding that little bit makes a huge difference. So that's why I'm going to say activity over smoking because of the shorter-term benefits they saw in a lot of this risk reduction.

Mitch: Wow.

Scot:All right. And of course, we know activity has so many other impacts on the rest of our health, right? That activity . . .

Troy: Exactly.

Scot: . . . can help us feel emotionally better too. It can help us sleep better. I don't know if you're like me, but for me, if I get my activity in, I tend to find, and this is just me, that I will eat better. I don't know why, but I'm more likely to make better choices when I eat.

Troy: And that's why I put activity at the top, because I think a lot of these things follow when you get more active. Then you're going to be more motivated to quit smoking because then you can be more active. So I think it then kind of feeds into itself. So if I said start anywhere, just start with activity. And with the activity, start incredibly small. Just take the stairs. That's it.

Scot: Just start moving a little bit more.

Troy: Move a little bit more, yep.

Scot: Try to walk around the block.

Troy: That's right. Walk around the block.

Scot: All right.

Troy: Small amounts of activity.

Scot: All right. Well, already I'm surprised, Mitch.

Troy: That's what we do. We aim to surprise.

Mitch: You were so sure.

Troy: We aim to surprise on this podcast.

Scot: All right. Hierarchy of health, first thing is activity, and that's just adding in a limited amount of activity. What's the second thing then you might want to consider doing?

Troy: I've got to have smoking here, because you're exactly right. Yeah, smoking, huge health impact. If you can drop smoking, your risk of cancer is going to drop, your risk of lung disease, all kinds of health issues.

And again, if you're starting to get active, I think it makes it easier to quit smoking just because it gives you a little extra motivation, probably improves your mental health, maybe makes moving away from smoking a little bit easier. But that would be next on the list.

Scot: Mitch, I don't want to speak for you, but maybe . . .

Mitch:Oh.

Scot:. . . you can jump in. "No, please, Scot, speak for me." Maybe you could jump in here. So, to me, one of the things I love about the fact that activity was the first thing suggested and that some research showing that just even a small amount of activity, if you were getting none, can make such a huge difference in your health, that sounds a lot more achievable than quitting smoking.

Mitch: Oh, yeah.

Scot: Smoking, that's a major thing.

Troy: That's why I started with activity too. Sorry, Mitch.

Mitch: Sure. No, go ahead.

Troy: That's why I kind of put activity first, because I think it's a win, like, "I got that. I did it. I'm more active. Let's tackle smoking."

Scot: So part of it is mental. You get those little small wins.

Troy: Yeah.

Mitch:Having, I guess, both quit smoking and starting to do my activity on this podcast with both of them, training for the Who Cares 5k was . . . it was work and it was a big shift in my life. But we're not talking an addictive substance that I needed patches on my body and sucking down chocolate cinnamon bears, etc.

I think for me, at least, smoking was the kind of keystone. Once I was able to pull that out, it was easier for me to get exercise because my lungs didn't hurt. And it was easier to feel better, and my sleep went better. It was something that was really kind of holding me back with a lot.

But at the same time, if the activity really does give you that much more benefit, it was a whole lot easier for me to start being more active in my day-to-day than it was to quit smoking. Not to say it's impossible. I don't want to sound like whatever. It's just hard. It's really hard, especially if you've tried it before.

Scot: And let's take this moment to celebrate, Mitch. How long have you been cigarette free?

Mitch: Oh, the math . . . I think we're three.

Scot: That's so incredible.

Mitch: Three years now.

Scot: Yeah, that's so awesome.

Troy: All you have to do is just think how long has the pandemic been going on and then you just add about four months to that.

Mitch: I made it through.

Troy:Right before the pandemic, yeah.

Scot: Mitch, another question about smoking and activity for you. Did you find when you were trying to quit smoking that doing something like getting out and walking helped manage any of the addiction at all, took your mind off it for like a couple seconds? I can only imagine you're constantly thinking, "I want a cigarette," and you're constantly playing this game of "How can I distract myself for another five minutes to not want a cigarette?"

Mitch: So, in my case, one of the things that I did try doing is . . . not only did I do the cessation aids, which I highly recommend. If you've tried quitting smoking before and it didn't quite work, talk with your doctor, get the patches, get the gum. Not that it's easy, but it made it for me, someone who had to do it seven, eight times to actually stick to it, man, that stuff really, really helped.

But yeah, there was something about . . . During that time period, I started taking walks. For me, when we talk about nicotine addiction, it is not just the cigarette. We know the cigarette is bad. We know it's bad for our health. But it was also a time to take a break from everything and go outside and sit for 5, 10 minutes, and then come back inside and just kind of reset.

And when you suddenly lose that cigarette, you've got to make sure you're still doing those types of things. So if that break from the every day, and if that getting outside, walking around a little bit is a part of why it's so hard to quit, I just started walking around the block.

This was before I started jogging. This was before I whatever. But I would go out the front door, I would just do one lap, come back in, and it helped a lot actually, surprisingly.

Scot: Incidentally, it should be mentioned, people trying to quit and not being successful multiple times is the norm. If you're in that situation, if it's been six times, try seven times.

All right. The health hierarchy, Dr. Madsen. We've hit starting with some activity. Then we've moved to smoking, quitting it, or at least reducing maybe as a first step so it's not quite overwhelming, if you can just even reduce it. What's number three?

Troy: So number three is going to be nutrition. And here, we're just going to keep it really simple. Ideally, in terms of science, you're going to switch to where you're eating the Mediterranean diet. Lots of great science there. But let's just keep it really simple and let's just say you look at your diet, and you say, "My diet is not good at all." Start with just stopping drinking soda. That would be my number one recommendation on diet.

And in terms of evidence, tons of evidence showing you reduce that sugar intake, just so much sugar in sodas, you're going to see big benefits very shortly in terms of weight loss, and certainly in the long term, in terms of cancer, risk of heart disease, those things.

Scot: Also, a lot of sugar in your body is not good for your organs, from what I understand.

Troy: Yeah, exactly.

Scot: It's just really hard on them. It's like this sugar bath, which isn't a great thing for your organs.

Troy: Yeah, exactly. And again, if you're looking to go all in on that in terms of really switching your diet, then work toward the Mediterranean diet. Increase your fruits, vegetable intake, legumes, nuts, whole grains, those sorts of things. That's the ideal, but again, we're starting just saying, "Hey, I've got to start somewhere." I would say start with sodas. Try and reduce, and that's a quick way to get your sugar intake down a lot.

Scot: And if sodas aren't the issue, I think . . . So there's been some debate on the show, I remember. But one of my takeaways about nutrition is this debate of "Do you deny yourself or do you add? Do you subtract or do you add?" Do you try to eliminate the stuff that you think is bad, or is it better just to go, "You know what? Every meal, I'm going to try to eat a serving of vegetables. I'm not going to change anything else. I'm just going to add a serving of vegetables"?

I mean, I don't know. Some people might do better at subtracting. Some people might do better at adding. But that would be another maybe next step. How can you add in some of those healthy things Dr. Madsen talked about just even once a day? Again, don't overwhelm yourself.

All right. The hierarchy of health. We started with activity, we moved to smoking, and then working on your nutrition, especially if you're drinking soda to get rid of that, or add in something healthy. What's the next one?

Troy: So I would say the next one is something we've talked a lot about this past year, and that is emotional health. I think you're going to get benefits to your emotional health as you do these other things, but the more you are able to improve your emotional health, that will then feed back into these other things you've already been working on and, I think, make you a lot more successful.

And of course, there are the health benefits simply to improving your emotional health, reducing symptoms of depression. But that then feeds into more activity, better diet, and you're getting all the health benefits from those things as well.

Scot: I want to try to nail down what does that even mean then, improving your emotional health? What's a concrete thing a listener can do?

Troy: Well, certainly if you are suffering from severe depression or anxiety, I think it's worth talking to your primary care provider, being referred to a mental health professional. If you feel like maybe you're not at that point, there are certainly online resources. We've talked a lot on our show about mindfulness and resilience and working on those sorts of things as well.

So I think it's looking at your outlook on life, looking at your general mood throughout the day, those sorts of things, and just saying, "Hey, where am I right now? Do I feel like things can be better? Okay, great. Do I need to get some additional help for this from outside individuals, or is this something where we can engage in practices like we've talked about, like gratitude journaling or . . ."

Scot: Box breathing.

Troy: Box breathing, yeah, exactly. Those kinds of strategies where maybe you don't feel like you're at the point where you need to go see a mental health professional.

Scot: Mitch, do you have some thoughts on this? As I look at this list, you've overcome most of these.

Troy: I know. It's remarkable.

Mitch: Overcome. It is all a process, and I'm still working on it all.

Scot: I know you are.

Mitch: So emotional health. See, that's just kind of it too. I don't know if I am the everyman with that particular situation. We have found some stuff with . . . We'll talk about it more this season, a recent ADHD diagnosis that I got in adulthood, a generalized anxiety disorder, etc. I was at a much different place than I think the average person, just kind of not feeling super great, or wishing they had a more positive outlook, etc.

But I can tell you that the first step, the very first step is always either talking to someone you really trust about what's going on in your mind, or talking to a doctor. That's what started my whole line down it. I was at a physical checkup getting my yearly physical, and I'm just like, "I'm not feeling right. My thoughts are not what I want them to be. I'm tired all the time, etc." And they at least were able to give me resources and a direction to start.

I really think that's where you need to start, is talking to at least someone in your life, get some perspective, whatever, someone you trust. Or number two, talk to a doctor and the doctor should be able to help you in the right direction.

Scot: And on the podcast, we do talk about all of these things we discussed, the Core Four, and even stuff like smoking or alcohol use. They're all interrelated, right? They all point back to emotional health in one way, shape, or form. For example, too much alcohol will make me anxious the next day.

So I think when you start improving some of these other things, some of that emotional health might start to improve. I have not found myself quite in the same situation as you, Mitch, where things such as just taking a 10-minute break during the day and just not consuming any media . . . That maybe can be another one, right? Try to eliminate social media. That made a huge difference for me. I limit it a lot more than I used to. Or just taking a break and just being there with your thoughts and just being in the quiet can reset you for a little bit later.

Troy, do you have anything you'd like to add to that? Are we ready to move on to the next in the health hierarchy?

Troy: Well, I'm so excited for the next one. I don't know. This is the wildcard. We're at the halfway point. This is the one you didn't suggest that I'm just going to throw in. And this is one we just had an episode on: health screenings. So this is one where this is definitely going to make a difference on your health.

We talked about colonoscopies. Certainly, if you're a woman listening to this show, mammograms. Prostate cancer screening, something to discuss with your primary care provider. There has been a little bit of controversy in terms of prostate cancer screening and we have talked about that on the show as well. But I would say health screenings.

And one of my wake-up calls was a cholesterol screen. To see my numbers in my 20s really was a wake-up call, and then led me to make a lot of these other changes we've made.

So it can certainly help to prevent disease, it can identify early disease in terms of cancer risk, and it can also potentially prompt you to make additional changes to avoid future disease.

Scot: Motivate you, which is another big part of this equation. A lot of us know the things we need to do, but sometimes we're just not motivated to do them until we get that little wake-up call, like you did with your cholesterol. I did with my fasting glucose.

Mitch: Sure. And that's one of the big things for me that really kind of changed the game, is not just talking on the podcast. I think that was a huge part for me. Just talking about my health was a big first step for me. But actually calling the number and being like, "Hey, what do I need to do to get a PCP? What do I need to do to get a primary care person?"

And just being able to have my primary contact with my health not be the instacare or the emergency room, to have it be someone who I see on a regular basis, who checks in, who I have enough of a relationship with that I can ask those "oh, one more thing that I'm curious about or I wonder about." They're the people that have the know-how and the specialty to help you, right?

And if you're just kind of struggling on your own, getting that first set of screenings and starting that relationship with a PCP can really help with a lot of these.

Troy: Exactly. And that's a big part of that, too. It's the screenings and then it's having a primary care provider who you can go to with those questions and go to with emotional health issues. Certainly, they can have resources to quit smoking, all those things as well.

Scot: The health hierarchy on "Who Cares About Men's Health." What is the next one if you could only work on one thing? We're getting pretty deep now.

Troy: I know. This is getting tough here at the end. I feel like it's getting a little bit tougher to kind of slice these and rank them. But I'm going to say reducing alcohol use.

So if you're at a moderate or high-risk range in terms of alcohol use, reducing that. Alcohol use increases your future risk of cancer. It becomes a little tricky because, certainly, you've heard of studies where alcohol use at . . . A low range of alcohol use can reduce your risk of heart disease.

That being said, multiple societies have stated if you don't drink, don't start drinking alcohol to reduce your risk of heart disease. More and more of these studies are saying, "Well, it reduces your heart disease risk, but even at a low level increases your risk of cancer."

But bottom line is if you're drinking at a moderate to heavy range, work on reducing that at least down to a low level.

Scot: That surprises me alcohol is so low. I thought it would be right up there with smoking. Why is it so mid to low pack?

Troy: Great question, Scot. It became tough to rank these and that's probably why.

Scot: So the difference between these at this point might be just really negligible.

Troy: I don't know. It's tough. Clearly, smoking is a no-brainer. I feel activity is a no-brainer because so much follows. I feel emotional health, once you address that, is going to help all those other things. So we kind of hit the big guns there.

I put alcohol down a little bit lower on the list. There certainly is cancer risk associated with alcohol. There's no question there are long-term risks associated with moderate to heavy use.

Scot: Yeah, like liver disease. What are some of the other diseases alcohol moderate to high use can cause? Potentially ending up in the ER with you because of trauma?

Troy: Yeah, exactly. That's probably the number one thing I see, is just the trauma associated with alcohol use.

Scot: It can really impact somebody's emotional health.

Troy: Yeah, exactly. And that again becomes a challenge because there's so much interplay here, and a big piece of emotional health may be alcohol use. It may be as you address your emotional health that your alcohol use reduces.

And we had one guest on the show who talked specifically about that, who talked about his alcohol use and how he then was able to address a lot of the underlying issues with anxiety and PTSD, a lot of what he experienced working for the fire department. And then he found that his alcohol use reduction followed.

So maybe that's why I put it a little bit lower, because I feel like if you're addressing some of these issues, sometimes the alcohol use is used to cope with anxiety or frustrations with your health. And as these other things improve, I think in many cases, not all, but in many cases, the alcohol use, the reduction may follow.

Scot: I do know if I'm more active and I'm watching my nutrition, I tend to use less because I'm full and I don't want to. And I'm also like, "Hey, I'm engaged in some activity doing some healthy things, so I'm going to just kind of . . ." Not quit, but I'm just a little bit more moderate in my usage, I would say.

Troy: Yeah, exactly. I mean, you talked about how you go out on your back porch and you drink your tea now instead of drinking a beer, and you're engaging mindfulness there.

Scot: I also always had a rule . . . well, I didn't always have a rule. I developed a rule that I cannot have that after-work drink or whatever until I've eaten a meal. Eat first. And a lot of times, then when I'm done, I don't feel like the beer, which is what I tend to want to drink.

Troy: Exactly.

Scot: One more thing I think that's worth bringing up. Even though we're building this hierarchy, I think it can be adjustable depending on what your main issue is that you need to deal with. Maybe nutrition moves up higher because you have a lot of body weight that you need to lose that is threatening your health. That and activity would be the two things.

So I think keep in mind that maybe this is flexible depending on the person's situation. And that's where a conversation with your doctor might occur.

Troy: Exactly.

Scot: All right, Troy. What's next on the hierarchy?

Troy: I put this low on the list because it's something I just am so bad at, so I just wanted to make it so it's not a high priority. It's sleep.

Scot: To make yourself feel better.

Troy: Yeah, it makes me feel better. It's not that important because I put it low on the list, so it couldn't matter that much.

Scot: But it is important.

Troy: It is important. There's no question it's important. And again, I put it a little bit lower on the list because we're talking about priorities in terms of hierarchy and things to tackle before trying to tackle other things. But I feel like if you're addressing a lot of these other things, hopefully, this sleep improvement follows. Not always the case.

Mitch, we've talked about your struggles with sleep and addressing all of these other things and just seeing the sleep not improve. But I think the hope would be if you're exercising more, you're eating better, mental health is improving, that your sleep is going to improve as well. That's why I would just say don't try and tackle that right off the bat.

Mitch: Do I want to disagree? No. It's accurate. He's right.

Troy: Please, disagree.

Scot: You want to disagree with the doctor?

Mitch: That's where I'm at. It's like, "Let me just tell you."

Troy:I'm just the ER doctor.

Scot: That was a test, Mitch. You absolutely can disagree.

Troy: Please do. I'm open to feedback.

Mitch: No, but it is true. Sleep was something I was concerned about, but it was lower on the list. And it has improved with getting some things figured out. But it was a lot worse when I was still smoking, when I was drinking every single night, when I was not getting any activity. I had full-blown insomnia. Could not fall asleep, stayed up until like 4 or 5 in the morning, and just kept going.

And once I got those other things figured out, I could at least fall asleep. Now the quality of the sleep, that's what I'm kind of working on now with my shaky legs, etc. But I went from not being able to fall asleep, feeling tired all the time, to being able to fall asleep by increasing and improving some of those other aspects.

Troy: I guess it's a good question, though. If you had started from the start and gone to see a sleep expert and had addressed the underlying sleep issues, do you think it would have been easier to quit smoking and easier to address mental health issues just because you were more well-rested? I don't know.

Mitch: I don't know. That is a hard question.

Scot: It is. And there's no research on that, Troy?

Troy: I don't know. There's probably something out there somewhere, but it is tough. Again, in my mind, I feel like if you can address these other things, hopefully the sleep falls into place. I just think it's hard to just say, "I'm going to sleep, and I'm going to sleep better, and I'm going to improve my sleep hygiene, yet I'm smoking, and I'm anxious, and my diet is horrible, and I'm drinking a lot." It's hard to start with sleep. That's the way I thought about it.

Scot: Yeah. So you're pointing something out. This is a hierarchy, what you should focus on first, but that does not discount how important sleep is.

Troy: Exactly.

Scot: We know good sleep definitely can reduce the chance of disease and has a lot of other health benefits. Just simply saying to try to take care of some of these other things first, and hopefully sleep will take care of itself. If it doesn't, like with Mitch, then you need to kind of investigate, "Why am I still not sleeping? I tend to be doing these other things right. So what can I do to improve that sleep?"

Troy: Exactly. I look at this as a hierarchy not in terms of what is the most important thing on this list to your health, but if you are just not doing . . . You just feel like, "I've got to start somewhere," where do you start?

Mitch: I like that.

Scot:All right. We're getting close to the end here. What's after sleeping?

Troy: We're getting there. Nagging health issues is next. So once you've gotten through all these things . . . And again, you could argue, "Well, if I address that nagging health issue, I could exercise more." But I feel like you've started exercising, you're at least moving, you've got that short burst of activity, and then maybe you increase to 30 minutes three times a week.

And then as you address those nagging health issues, maybe they're orthopedic issues or just other things that have been on your mind that you've just wanted to get checked out, then I think it helps you get to the next level in terms of that activity, or whatever these things may be holding back on the list in terms of what we've already talked about.

Scot: Yeah. So the activity, you would start doing some limited activity. But then if you find, "Wow, if I try to do 15, 20 minutes, my knee starts killing me and I just can't walk," then to go to that next level of activity, you'd want to take a look at whatever nagging health issue you have.

Troy: Exactly. I think it's rare that those nagging health issues would limit us so much that we can't just take the stairs. But then I think as you get more active, then you may need to address those just to be able to get to that 30 minutes three times a week, or even beyond that.

Scot: But if it is getting in the way of activity, we know that activity is that one big thing, so maybe you might want to start addressing that health issue, which would probably involve some physical therapy, which is activity anyway, right?

Troy: Exactly.

Scot: All right. We're to the last one now, aren't we?

Troy: We're to the last one. What's left?

Mitch: Genetics.

Troy: Genetics is left. I just put it at the bottom because I think genetics is more interesting, and that's how I found it. I found it more just fascinating. When I learned my family history of migraines . . . And this was after our episode on migraines that my cousin contacted me.

Mitch: Oh, really?

Troy: Yeah, we did our episode on migraines. My cousin just happened upon the podcast and heard that episode and texted me and said, "Our grandmother had migraines, and she would refer to them as her sick headaches."

Scot: I love that.

Troy: And her mother had her headaches and referred to them as her sick headaches. And they would just have to go in a dark room and seclude themselves for a while, and then they would come out. Back in the early 1900s, migraines were not . . . It was funny to hear, or interesting to hear that history.

So I find genetics more . . . it can be certainly informative. It can affect some of those health screenings we talked about if you have a strong family history of heart disease or cancer. So it plays into that as well, and it will probably come up as you're looking into those health screenings.

But if it hasn't come up at that point, I think beyond that, again, it becomes interesting and it helps you understand maybe a little bit better some of the challenges you're facing or have faced as you've addressed these other issues. But it's certainly not something I would start with . . .

Scot: Start with.

Troy: . . . on this hierarchy. Yeah.

Mitch: All right. I am going to disagree with the doctor here.

Troy: Go for it. Please do it.

Mitch: For me, this list, I literally worked top to bottom with what you were talking about. I started with getting a little more activity and realizing I couldn't breathe right, and so I got rid of smoking. So I went down the list.

But it's that last bit of genetics that has unlocked a lot of stuff in this last year, right? The chronically low testosterone in my family, the ADHD diagnosis, which apparently is very much part of my family history, etc. There were a lot of pieces for me that not only fell in, but butterfly-effected through everything else but I didn't have that information.

And it's not necessarily something that came up in everyday routine screenings. I had to go to specialists. I had to whatever. To be fair, I checked everything off and then figured those out.

But there is a part of it that if you know you have a history of something, maybe go check that out. Man, not a day goes by these days that I'm like, "I wish I knew this before. I wish I knew this first." Man, oh man, I went through a lot of struggle and spent a lot of time that if I had known that this was a possibility in my genetics, if I had known, had a better family history, etc., I could have skipped a lot of these steps.

Troy: Interesting. So do you wish you had known that from the start, and that would have helped guide your journey a little bit more?

Mitch: Yes. So we'll talk more when we do the ADHD episode. But one of the things I'm finding, and when I talked to my new psych specialist and everything who's working on it with me, one of the first things they said was, "So how many times have you tried quitting smoking?" And I'm like, "What?" I didn't even bring that up, right? I thought we were here to talk about how I'm scatterbrained, whatever.

And the response was, "Well, actually, there is evidence and research that smoking and nicotine can be used as a self-medication for undiagnosed ADHD people with dopamine deficiencies." And so it's just like, "So you're telling me because my brain is wired differently it's harder for me to quit?" "Oh, yeah. I would have told you to take Chantix from the start." And it's just like, "Oh."

I had so many emotional breakdowns and everything, and it was all because . . . And I'm reading these very nice messages online about people sharing their own strategies. But I'm like, "It's not that easy, y'all." And come to find out it was actually because there's something wired up there differently. So that's kind of the look-back.

You're right when we're talking about order of operations, biggest bang for your buck. But if you know that you have a family history of something, I would just advocate for maybe checking that out, too. I didn't know. I did not know, so it was the last thing on the list to check off and it's been the most impactful in my health in the last year.

Troy: That's interesting. So, yeah, maybe that's a good starting point then of understanding your genetics more.

Scot: I don't know. That might also speak to . . . We're making this list just as a general rule, right?

Troy: Yes.

Scot: Some of the things you've been finding . . . For many people, and we don't know the numbers, obviously. This is one of those things I'm speculating on. For many people, going through this in this order very well might get them to the point they want to be. But a small percentage of people, you included, fortunately or unfortunately, however you want to look at it, there were some other things going on that you weren't aware of.

Troy: And again, that's kind of how I looked at it. It maybe then helps you fine-tune that focus. You've already focused on some aspects of your mental health, and then you feel like you've made some progress, and then you understand your genetics more and you're like, "Oh, wow. Okay, now I understand better the challenges I faced in addressing that issue," which is kind of what you experienced. But that being said, I totally get it if you understood from the start . . .

Scot: Yeah, I do too.

Troy: . . . the challenges with addiction or whatever in your family. I think it helps you in terms of being more patient with yourself as you were then trying to tackle those challenges for sure.

Mitch: Well, I'm going to blow up this whole idea and say the number one thing you should probably start doing is talking to one another about your health.

Troy: There we go.

Mitch: There we go, right? Just talking about what's going on, talking to other guys, talking to your family. I don't know. I think that that could be a really great first step.

Troy: That is a great first step. That's not on the list. We should have put that. Just start talking about your health first and then you can start with some action after that.

Scot: Troy, thanks for The Hierarchy of Health. I think this is a good roadmap for somebody to kind of go down regardless of the place they are in their journey. If they've already implemented some activity, but they're smoking, that would be a good next step. Have you reduced those sodas? Can you introduce some perhaps healthier choices into your diet? Are you looking at that emotional health? Are you getting the health screenings, watching the alcohol use, sleep, nagging health issues, and genetics?

So I think that's a very useful tool. Again, I'm going to iterate maybe that might change for you. But it's a starting point, right? And at least outlines some things as opposed to having it be all the choices. Now you have a small list of choices, and your instance might be a little bit different and you might start somewhere else.

This was this really good. Any takeaways, Troy? I mean, you kind of walked us through it, so I don't know that you have any takeaways. But sometimes when you talk about this kind of stuff with other people, you develop some new knowledge. So did you get anything out of this, or not really?

Troy: Yeah, my takeaway is it was fun to think through it and fun to prioritize this. But I'm guessing if you had 10 different doctors do it, they'd all have different orders on this list.

Mitch: Oh, really?

Troy: I can't pretend to be an expert on this. And I think anyone is going to look at this list and, depending on their specialty and even their personal life and personal interests, would maybe . . . Maybe someone else puts emotional health number one. I'm sure we've had guests who would do that.

So that's my takeaway. You may disagree. Please disagree. But I think it's a nice summary of so many things we've talked about on the show. And again, I think the takeaway is to decide where you want to start, go for it, start small, work your way through these things, and then revisit them and then continue to revisit them to improve in each area.

Scot: Mitch, jump in with yours.

Mitch: I kind of tried to do all these at once last year, or the last couple years, and you guys have on multiple occasions been like, "Hey, maybe that's too much. Are you not feeling overwhelmed? Etc." And I was, looking back.

Prioritizing, taking small steps, improving one thing or another, I think just take it from this one person who tried to fix all their health at one time, it was a lot. It was a lot and very, very overwhelming. Find out what is the biggest impact on you and focus on that first, and then go from there.

Scot: In trying to make it simple, sometimes it can make it complicated again, right? Because we had a list of nine different things. So I think my last thing, and what's worked for me, is just try to find maybe one of those things that you can sustain and then make it part of your daily routine. And then try to move on to the next thing when you're feeling better.

And if, for whatever reason, you're having difficulty trying to get that one thing, maybe try something else or figure out, "Well, why am I having a hard time trying this one thing?" And then that will lead to another problem you can solve.

Just solve one of them at a time. You don't have to make perfect progress on that one thing. Just make some progress and then maybe try something else. And like Mitch said earlier, it's all a work in progress, isn't it?

Mitch: Yeah.

Scot: Yep. It's not just something you can take for granted. It's not just something that happens unless you're actually paying attention to it, doing things actively, or talking about it, unfortunately.

So, gentlemen, thank you very much for getting together for our weekly conversation. If you are listening, what's the one thing you're going to do? Pick one, try it, and if you want to let us know how it goes for you, you can reach out to us at hello@thescoperadio.com. 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: Today, we reflect. You're really killing the mood when you laugh. Who was that?

Troy: It was Mitch.

Mitch: I'm sorry. You're just so serious. Oh my god.

Troy: That wasn't me.

Scot: Killing me.

Troy: Scot is really trying. Come on, Mitch.

Mitch: I know.

Troy: Scot is trying really hard.

Scot: I'm going to say it again. Today, we reflect. Each of us is going to come up with our top three episodes from 2022. It's a best of the best and maybe a good place to start if you're listening to the "Who Cares About Men's Health" podcast for the first time. Maybe we're going to talk about an episode you missed, and we will make you want to go back and check it out.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. My favorite episodes are the ones where I talk about me. I also bring the BS to the show. Countering my BS with his MD, it's Dr. Troy Madsen.

Troy: Hey, Scot. We've had so many great episodes it was tough to choose from, but it was fun to think about.

Scot: And Mitch Sears. We had a lot of episodes about him this year.

Troy: We did.

Mitch: Yeah, not my favorite ones. But we did a lot this year too, so I'm really excited to revisit a couple of these.

Scot: Good. Was this hard for anybody else, picking out specific episodes that you were going to name your favorite, or that were the most meaningful for you this year?

For me, it was a little difficult because I think for me it was more of the entirety of the year, and all the information and everything that triggered my thinking. Some of this stuff I can't put back to one episode. It might have been a couple episodes that helped lead me to someplace that I was at. Anybody else have a hard time, or no? Troy?

Troy: I didn't. I just specifically looked for episodes where I thought, "This changed something I do." Like, I can point to a specific change. And it was surprisingly easy. So it was fun to go back and see what has changed as a result of guests we've had.

Scot: How about you, Mitch?

Mitch: Actually, no. There are episodes in the past year that I listen to again. I revisit to kind of get one perspective or another again, and remind myself of one idea or another. No, I just picked the three that I play over and over again.

Scot: That's awesome. All right. Here we go. Our top three episodes. Each one of us is going to come up with three episodes. I'll go ahead and start with Episode 103, "How Emotional Availability Can Improve Your Life."

Mitch: Oh, with Kirtly Jones? Sure.

Troy: I did not pick that one, but I almost did.

Scot: Did you? All right.

Troy: Almost did.

Scot: So, for me, that episode was good. And again, it kind of brought some thoughts that I've had in my mind together and helped me on this journey. First of all, to start to pay attention to my emotions and acknowledge them as real. There's more than anger, and there's more than nervousness.

Mitch: There's a whole wheel.

Scot: And understand that it's okay to have these emotions and it's okay to acknowledge them and it's okay to feel them, and it doesn't make you any less a man or any weaker.

And also, we all experience these emotions differently. We all handle these emotions differently depending on who we are. And there's no shame in that. It all has to do with our background and how we've experienced them before and what tools we were given by our parents and other people in our lives.

And the thing that really changed it for me, though, was in my interactions now, and this was a suggestion by Dr. Jones, I don't tell the person how they're feeling. "Oh, you seem angry." I'm curious. "I noticed something is a little off today. Do you want to tell me about it? Is there anything I can do to help?"

So just opening myself up to asking somebody about how they're doing without assigning to it and then asking them to define what it is and asking permission if they want to talk about it has been a kind of a game changer in some of my relationships. I feel a lot more confident when I can ask that question as opposed to what I used to do, was ignore it.

Mitch: Sure.

Scot: Just ignore it, right? Because it's scary. It's scary to ask those questions, because what if it's about you?

Mitch: Oh, no.

Scot: What if it's an emotion you're uncomfortable with? And I think a lot of us guys can be uncomfortable with other people's emotions.

Troy: Right. Yeah, like you said, the anger piece of it was really interesting because she pointed out anger is often a manifestation of deeper emotions. And the challenge for us is identifying what those deeper emotions are leading to anger. Yeah, I agree, that was a game changer.

Scot: So we can actually do something about it.

Troy: Yeah.

Scot: All right. Favorite episodes. Troy, you are number two.

Troy: So my favorite episodes, I'm going to go with Kirtly Parker Jones as well. And I'm going to start with the obvious one for me, and that was "Tips For Expecting Dads."

Mitch: Oh, sure.

Troy: Episode 109. I mean, how could I not go with that? It was just basically an episode for me, which I really appreciated. She gave such great advice. And it was as we were moving toward the third trimester that we had that episode, so a lot of things she talked about I thought about through the third trimester, a lot of things as we were there in the hospital awaiting the birth of our child, and as our baby was born. My mind went back to that episode quite often. So she was very insightful. Great advice. Really appreciated it.

Scot: What was it that that episode helped? Can you give us a specific example?

Troy: I think, again, it kind of got back to the emotional availability piece that we talked about in the other episode, but also there were specifics about what to expect in terms of the pregnancy itself that I found very helpful.

But also just that general theme of, number one, being emotionally available, and number two, being willing to experience and express those emotions myself. We talked about, "How are you going to feel when your baby's born? What if you feel like crying? Are you going to be okay with that?" And I was okay with that. I did. I wasn't sobbing.

Scot: Oh, no.

Troy: Of course not. My eyes might have teared up a little bit. And we talked, too, about kind of putting aside the doctor piece and just being there and just being a dad, and that's what I tried to do. I mean, I was tempted to go into doctor mode there and overthink everything and watch everything that's happening and get nervous, but I was like, "Hey, I'm just here. I'm just a dad." And it was nice to do that.

Scot: Just enjoy the moment. If somebody is not a doctor and they don't have that kind of baggage, just really just try to be in the moment and enjoy it.

Troy: Yeah, exactly.

Mitch: Troy, do you think you would've had that same approach to the entire experience had you not had a moment to talk with Kirtly Jones?

Troy: I think I might've approached it a little more clinically, like I said. So it was nice to have that, just to have my mind go back to that and have that as a reminder to myself, like, "Hey, we've talked about this. I'm ready for this. I don't want to go into this and be a doctor here." Not trying to bark out orders, but just trying to be there to . . . I didn't want to overthink things. I think that's kind of what it came down to. So it was nice just to be there, just be a husband, be a dad, and just enjoy the moment.

Scot: All right. Mitch, your favorite episode?

Mitch: So the first one we're going with Episode 106, "Robb Has a Heart Attack." And what I really liked about this one was not only did it feature a friend who's become a role model and a real supportive character in my own health journey . . . I mean, we chit-chat about . . . I've never had before a friend who's like, "Hey, just got back from the doctor and this is what happened." It's like, "Oh, wow. Great. Like, thanks for sharing that." There's this really interesting back and forth that happens.

But more importantly, talking through the episode, health is something to be grateful for, right? Health is something that is not necessarily guaranteed even if you're the healthiest guy, kind of like Robb was. He was extremely healthy and he still got hit with this very intense heart attack, right?

And the line that has always stuck out to me . . . Right now I'm back in physical therapy because I've hurt my ankle again, and any time I'm getting frustrated with my workouts, with that kind of stuff, etc., the quote that he said was, "Even in my workouts, they're less 'I have to go to the gym' and more 'I get to go to the gym' or 'I get to go for a walk.'"

And I just love that takeaway in the conversation that we had. It's just this idea that health is not some gold star that you get for working really, really hard. It is something that you are . . . There is a certain amount of luck and it's a privilege. It's something to enjoy when you have it. And that is something that I really, really appreciated.

Troy: Yeah, and it really hit home to me when you talked about getting on the treadmill after the heart attack.

Scot: Oh, yeah.

Troy: And how he kind of teared up just the fact that he was on a treadmill and exercising. It was just so meaningful to him. That was really cool to hear that.

Mitch: Oh, yeah. And compare that to Mitch of like years ago where I'm on a treadmill hating every single minute of it.

Troy: Exactly.

Mitch: And then it's like, "Oh, man. Yeah, I get to do this."

Scot: Cool. All right. Round number two. Each one of us has three episodes from 2022 that we liked, and this is round number two. Mine kind of dovetails into yours. Mine is Episode 120, which we just did not too long ago, "Just a Bunch of Dudes Being Grateful."

Mitch: Yeah.

Scot: Was that on your list, Troy?

Troy: It was a great one. It's not, but that was a great one.

Scot: Yeah. And it is just a mindset that I get to exercise, that gratefulness mindset that "This is something I can do and it's something that I enjoy," not "It's something I have to do."

How fun was it on that episode hearing what other people were grateful for? It was fun to do, and it was fun to listen to, and just all of us talking about the things we were grateful for, it was infectious. And I felt good after doing that episode, right?

Troy: It was fun.

Scot: And it made me think about power. How we talk about things and the way we frame things is really super powerful. And we talk about how you can set up your own gratitude practice, and I've done so. I was doing it before that. But it's just really cool when you go out and you start recognizing more and more things in your life that you're grateful for.

I'm grateful that I live a half mile away from this park that I can spend time with my dog in. It's a great place to play Frisbee. I never would've thought of that before I was doing my gratitude journal, but it makes me smile every time I'm walking there, and I get to spend some time with him, right? So that's pretty awesome.

It was so much of a fun episode hearing other people and talking about it. I don't know how I'm going to do this, but I might start throwing this topic of gratefulness, like "What are you grateful for?" into conversations with friends. And like I said, I don't know how, but once you start doing it, it is a little infectious and it's fun.

Troy: Yeah, that was a fun one. I loved just having everyone on there, just so many people from the past years that we've talked to. It was just, number one, fun to bring them all together in one place, but like you said, really fun to hear their perspective on gratitude and the things they are grateful for.

Mitch: Yeah, it was really cool.

Scot: All right. Troy, your number two?

Troy: Okay. Number two for me, Episode 113, "Anxiety - The Hidden Tiger of the Mind."

Mitch: Oh, man.

Troy: Scott Langenecker. Was that on your list too, Mitch?

Mitch: It's on my list too. It's okay. We can talk about it.

Troy: I won't steal your thunder because it's on . . . Yeah, we can talk about it together because that's your next one too. I think, for me, he just had so many good insights into anxiety and what leads to anxiety and ways to address it.

I've mentioned it before, but anxiety is one of those things, one of those emotions in my life that I'm trying as much as I can to reduce it. And I've talked about it before. I've sometimes even leaned on anxiety as a motivator, and I don't want to do that. And so it was so good to hear his perspective on how you can reduce anxiety.

Number one, how do you identify it, which is super important when you're feeling anxious. Number two, how do you reduce it? And so I think it kind of relates to other episodes we've had as well talking about anxiety. But I think that one really got down to the crux of the issue and coping strategies and ways to hopefully try to reduce anxiety in your life, which I found very helpful.

Mitch: Yeah. So Episode 113, this is on my list too. There was something about understanding why we have it, right? There was something that I really appreciated that Dr. Langenecker brought in where it was just like, "This helped cavemen survive. There's a reason all of us have it in one way or another."

And so as someone who has struggled for most of their life with anxiety, to have that kind of perspective of, "This isn't a pathology. This isn't 'you're sick.' This isn't 'you have a problem with you.' It's just everyone has it. How do we experience it? How do we manage it?"

I actually incorporated clips from this episode into my lecturing I do at the community college, and we did a whole section on speech anxiety. They had to give a speech in front of the class and a bunch of people were very, very nervous to do it. And we talked about anxiety, what it is, what causes it, how we feel it, how we can trick it, how we can breathe and manage it. Man, oh, man, just to see them respond, to give them that kind of perspective and understanding was extraordinarily satisfying.

Troy: That's cool. That's really cool you incorporated it. I love that you actually took clips from that. I mean, there's so much that you could just re-listen to and quote from what he said.

Mitch: And that's just it. I wish I had had this perspective younger. I wish I had had this perspective earlier in my life being like, "Hey, worrying about stuff or feeling these types of sensations does not mean that there's something wrong with you. It's just something that happens and it's something that is there to help protect us. And if we can understand it, we can have a better relationship with our own mental health," which is way cool.

Scot: It was on my list as well for the reasons . . .

Troy: No way.

Scot: Yeah, for the reasons you . . .

Troy: Well, that makes it easy.

Scot: Yeah, it does, right? We'll wrap this thing up here in short form.

For all the reasons that you both said. I know that, Mitch, you've struggled with anxiety. And for some that struggle with a higher form, more anxiety than others, you might have to get some sort of other medical attention. It's not just necessarily something you can manage on your own.

Mitch: Yeah, anxiety disorders.

Scot: Right. So I don't want to oversimplify it because I know that it's been a lot more severe for you. But for me, also understanding that this had a purpose and then in our modern world, when we get anxious about things to an extent where it kind of makes us not want to act, it's just our warning system that's kind of gone wrong, right?

And knowing that and being able to go, "All right. Let's just really take a look at this situation. Is this threatening to me?" and being able to work through that and figure out if it is or not, that made me feel a lot better.

And just knowing that it's just natural. It's just like if you go swimming, you're going to get water in your nose, right? If you do certain things in your life, you should have some anxiety and it's not necessarily a bad thing. It just happens. And it might be because you want to do really well. So how do you manage it so you can continue to do the thing you want to do really, really well?

One of the things Dr. Langenecker had talked about, I don't know if you remember, is that your ability to handle that might change as you get older, and that's okay.

He told a story about firefighters. That's a very physically and emotionally demanding job, and being able to deal with that can change over time. I'd imagine, Troy, you could speak to this as well. There are not a lot of old firefighters, right? And there's a reason for that. And it's okay. Just like we physically aren't able to do the same things we used to do, sometimes mentally we can't. You have to change.

Troy: Yeah, that was great. Very insightful. Like both of you said, I love that he said, "We all experience this. You're not abnormal because you experience it." So I think that's a great takeaway.

Mitch: And just to echo what you were saying, Scot, as someone who has kind of dealt with anxiety disorders in the past and stuff, it doesn't belittle it in any way, shape, or form. It just makes me think of it differently, right? Why am I medicated? Well, it's because my system is too hyper-tuned. It's not that I'm sick. It's not that I'm broken. It's just I have a very sensitive system, and that's so much of a better approach to thinking about it than, "I'm broken, I'm wrong, I'm oversensitive."

Troy: It's like Spidey-Sense almost. Your Spidey-Sense is a little too strong.

Troy: That's right.

Scot: It's telling you things are dangerous when they're not. All right. Troy, what's your number three?

Troy: Okay, number three. We're going to jump back all the way to January of this past year, and it is Mitch "Project 50."

Mitch: Oh, no. That's the one you chose?

Troy: That's the one I chose and I'm going to tell you why. Like we talked about then, the whole Project 50 I found, I just couldn't put that much time in. But the thing I loved about it was that idea of working on a new talent every day.

Mitch: Oh, sure.

Troy: That was really cool. And so I went back actually to an old talent. I talked about piano playing, but I will say that episode stuck with me. In March, I purchased a trumpet.

Mitch: What?

Troy: I purchased a trumpet.

Mitch: Are we starting a ska band?

Troy: We're starting a ska band. I played the trumpet in junior high school and dropped it after that. Never really played it again. Never picked it up. I don't even know where my old trumpet is, but I said, "I'm going to get a trumpet and I'm going to learn to play this thing again." And at this point, I play the trumpet just about every day.

Mitch: Oh, that's awesome.

Troy: Granted, I don't think Laura is thrilled about that.

Scot: Or the new baby.

Troy: She actually likes it. She kind of likes it. At least she acts like she likes it. She seems to enjoy the trumpet. I don't know that the neighbors love it. But I play the trumpet every day now and I really enjoy it. So that piece of it stuck with me, and I've stuck with that since then.

Scot: What songs do you play?

Troy: I've just got this book of popular songs. A lot of them are '60s songs and stuff, and so I just play through that. I've picked out the songs in that that are easy enough that I can play it on the trumpet and just kind of cycle through it. I'll play two or three songs a day and just pick it up, and it's just fun to pick it up and play it. It's cool.

Scot: That must make you happy.

Troy: It is. It's fun, yeah.

Mitch: I just find it so interesting because just a month or two after that episode, we had the "Mitch fails the Project 50." I don't remember what we called it. But it's so fascinating because we tried the Project 50 Challenge. You rolled your eyes at some of the requirements. I could not keep up with a lot of stuff. But that hour of no phone, I still do it to this day, that morning startup, whatever, the reading non-fiction to educate myself every day. Even if something doesn't quite work, 100% of it, at least try it out. We're just figuring out what works for us, right?

Troy: That's what I thought was cool about it. You can try it or you can modify it and do it, and then after you're done, "This is what I liked. This is what I took from it." That's kind of how I approached it. So that was the thing for me, was the talent piece. And it sounds like for you, the no phone thing and all that. Yeah, I thought it was cool.

Scot: You can find one gold nugget in each episode. It's worth it. That's what I like to say. Mitch, what is your third?

Mitch: So my third is one that I actually have favorited on my Spotify playlist and everything. And it is Episode 104, "Letter From your Past Self."

Scot: What?

Mitch: I know.

Scot: You both rolled your eyes at me when I brought that up.

Mitch: And I will continue to roll my eyes publicly every time you bring it up. But today I just want . . . There is something about . . . And I think the gratitude episode is going to be right in there with it. But as someone who struggles with mental health, as someone who is constantly working on it, I cannot tell you how much being able to go back and hear positive words being spoken aloud of both to myself, from myself, to things that you said to yourself.

If I'm in a funk, I will just play that episode. And there's something about just going through that practice and hearing other men be positive with one another. It gets me out of my funk, and I love that.

And I think the gratitude episode is going to be that same way. It's something that I don't think we do too often. We joke about things, we don't treat ourselves very seriously, etc., and just to know that we could do that and to hear those types of words, I come to it a lot.

Scot: So being kind to yourself. That was one of the rules, that you had to be kind to yourself or . . . I can't remember. That's the part of it you really like, is saying nice things about yourself.

Mitch: Well, it sounds oddly simplifying. But we spend so much of our time being so negative and hard on ourselves, to be able to have an authentic appreciation for yourself is very powerful.

Scot: And hearing Troy also do the same thing was good for you. That came off wrong, Troy. I mean, you're laughing, but we liked listening to other men talk about gratitude. It's nice to hear other men talk about themselves positively or being kind to themselves.

Troy: Oh, I thought you were joking because I didn't get my letter. I timed mine for a year from when I wrote it, so I didn't have a lot to say.

But your letter, I thought, was very insightful and really profound in so many ways. I thought it was really cool to listen to. And I wish I could write a letter as well written and insightful as yours was. That was a fun episode.

Scot: All right. And before we go, I want to just throw one last thing in from my perspective. I've really enjoyed, Mitch, the "

Mitch: It's Complicated" series that we've done with your health journey. Just hearing you go through this health journey as you've kind of been trying to uncover what it is that has been giving you issues throughout your life has just been so motivational and so informative. And the fact that you're sticking with it, it just is . . .

I've really enjoyed that, so thank you for being brave enough to talk about all of those things, which is really . . . I think if anybody gets the award, the bravery award on this podcast, it's Mitch. Troy and I, I think, are still a little guarded, right?

Troy: Yeah, without question.

Mitch: Someone has got to say it. I'm sorry. We don't have these conversations and I wish that there was one other person out there talking about this kind of stuff. So I'm going to talk about mine.

Scot: And I love that you do that.

Troy: No, it really is. I think it's helped so many people and I appreciate your insights and your experience. I draw a lot from what you've gone through and what you've talked about, and I think it's helped me open up a little bit more too. So I appreciate that.

Scot: And it's what this podcast is about. It's about men opening up, talking about their health, talking about their concerns, the things that stress them out or the things that they're happy about, or proud about, or grateful for. We don't have these conversations enough. So hopefully this podcast gives you some tools and gives you some inspiration to want to have those conversations in your life as well. And if not, just maybe listening to these has been helpful as well.

Gentlemen, as always, it's been a great 2022. I look for forward to new episodes in 2023. We'll do this at the end of 2023 and see where we're at. I bet you it's going to be in a different cool place.

Thank you 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, Mitch. Troy's got an announcement that he wants to make, something he wants to tell us.

Mitch: Oh, really?

Scot: Are you excited about it?

Mitch: I'm quite excited. I always love surprise announcements.

Scot: All right, Troy. What's the big announcement?

Troy: Well, Mitch, I'm going to preface this by saying, do you remember that episode we did a while ago about Dr. Turok's male contraceptive gel?

Mitch: Yes.

Troy: It doesn't work.

Mitch: Oh, no.

Troy: I'm just kidding. I was not part of his study. But I'm having a baby. My wife and I are having a baby.

Dr. Jones: Yay. Congratulations.

Troy: This is our first child.

Dr. Jones: Congratulations. Oh, are you in for a ride.

Troy: Oh, I don't think I have any idea what I'm in for. I'm extremely excited. Yeah, honestly couldn't be more excited, but definitely a bit nervous. Baby is due in September. We are just super excited. And I have to tell you the way we announced this baby, and I think, Scot, the way you found out.

Scot: I mean, I'd kind of call it finding out. There were still a lot of questions.

Mitch: Exactly.

Troy: Like, "Really, is this a joke?" Yeah, so we ran . . . Laura had this all planned out. When she told me, I came home from this late shift at 3 in the morning, and she gave me this gift bag that had the positive pregnancy test, said, "Hey, it's an early birthday present." I opened it and was like, "You've got to be kidding me. Wow."

And so, anyway, she had planned this out. We had already planned a marathon. She ran in a shirt that said, "Baby's first marathon," and then sent the picture out to the family and it took them forever to figure it out. I had to then send a close-up of the picture, and still no one responded.

And then I had to say something that says, "I promise this is not a late April Fool's joke," because it was April 2nd. And finally my sister-in-law, not any blood relatives, my sister-in-law figured it out and said, "Wow, you're having a baby." So baby is on the way. We're super excited. Yeah, due in September.

Dr. Jones: Wow. That is going to be wonderful. It's wonderful.

Scot: Today on "Who Cares About Men's Health," we thought maybe you might be able to use a little bit of help. I think as guys . . . I don't know. I can only speak for myself and men that I've observed. It seems like during that nine months we are like, "Well, we don't really have much to do."

Troy: Yeah. "This is easy."

Scot: But maybe we should be looking for something to do. I don't know. So that's what we're going to talk about today. It's the "Soon to be Dad" episode. "Who Cares About Men's Health" is about information, inspiration, and a different interpretation of men's health. Today's crew, as usual, he brings the MD, Dr. Troy Madsen, and dad-to-be.

Troy: That's right. Bringing the MD and bringing the baby soon.

Scot: Bringing the MD and the D-A-D.

Troy: D-A-D.

Scot: I bring the BS. My name is Scot Singpiel. And Mitch Sears just generally makes the podcast better. Mitch, how you doing?

Mitch: I'm doing pretty good. I'm excited for Troy.

Scot: All right.

Troy: Thanks, Mitch.

Scot: And Dr. Kirtly Jones is an OBGYN. She is part of our scoperadio.com family. She does the "7 Domains of Women's Health" podcast. And she is an expert on this sort of thing, not only the technical aspects, but also from maybe what your partner might want. Any dad-to-be support mechanism that you might be offering? I don't know. We're going to find that out.

So, Dr. Jones, do you find that the statement I made about guys during those nine months just kind of think, "Well, I really don't have much to do," true or not? Should we be thinking that? What's your take on that?

Dr. Jones: Well, it can be, but you shouldn't be thinking that. So in the first trimester, and we don't know exactly where Troy and his partner are in their trimesters, it can be pretty rocky because there can be a lot of nausea. And so, when someone is throwing up all the time and they can't eat, there are things . . . First of all, you feel a little guilty because you are half of this creation, but not the part that throws up all the time.

There is something called couvade syndrome where men experience all the symptoms of the pregnancy. They even go into labor. There's a special hut for them. So in some cultures, the men act out all the symptoms of nausea, and vomiting, and back pain, and you name it, and then labor. And then the women just go on about their lives and work in the fields, etc., and raise the kids.

So men can walk away and we know all over the world men walk away from a pregnancy, leaving the pregnant person to deal with all of it. But if you're a pair, and if you're listening to someone throw up all morning, it would be, "What kinds of things can I bring to you? What kinds of things can we have in the house that might make your tummy settle a little bit better?" That's kind of helpful. "I heard that ginger worked for you. I've been reading up about this. Can I bring you some ginger?"

Scot: Troy, would you like to practice that? I'd like to hear you say that.

Troy: I'm just fascinated by this couvade syndrome. So these are men who are actually experiencing all the symptoms of pregnancy? And they're not doing this consciously, it sounds like. They're actually experiencing this.

Dr. Jones: Yeah. It's not a common thing. It's in some cultures and not in others. So clearly there are issues. Some partners want to go over the top and order everything by the time they're 12 weeks, and you've got hundreds of dollars of baby carriers. Guess who gets to pay for it, maybe?

So how much are you going to be in the physical domain? And in the physical domain, your partner is probably going to be experiencing whatever she might be experiencing, but being supportive, like, "Can I help you lift that? I know your back has been really sore. This is getting farther in pregnancy."

If she says, "Gee, I want to go skydiving," you're not going to say, "Is that the best idea?" There are some things that she won't do with you or she won't feel like doing with you.

So by trimester, first trimester is nausea, vomiting, the things that happen physically that you could be helpful with in terms of just saying, "Oh, gosh, that's so awful," and maybe, "Tell me what I can do to help."

Scot: Let me jump in quickly. So we also sent an email around to some women who just recently had babies in the office. And the thing you just said was one of the answers that came back. It said, "I think, for me, it's knowing how . . ." This is what they wish that their husbands knew.

"I think, for me, it's knowing how difficult pregnancy can actually be for women. There were some days I couldn't get out of bed because I was so tired or sick, and my husband didn't really understand at first what was going on. He thought I could just do the same things I did before pregnancy. Eventually, he got it, but pregnancy can do wild things to your body that I think a lot of men don't understand."

Dr. Jones: And it can do wild things to your emotional life as well. So people can feel overwhelmed. They can cry easily. Things about mommy hormones. So just being understanding that things are not going to be the same, and the pregnancy is just the first nine months of the rest of your life that's not going to be the same.

Troy: That's encouraging.

Scot: I was going to say we're like three minutes in. How do you feel now?

Troy: I know. I'm kind of speechless really. But we are in the second trimester now, so things . . .

Dr. Jones: Things are pretty good now.

Troy: Yeah. Laura really had a great first trimester. Definitely the fatigue and nausea. I tried to offer what I could. I'll tell you, just being the very independent person that she is, she did go out and buy all of those things for nausea herself, and I should've done that for her, but . . .

Dr. Jones: No, no, no.

Troy: Yeah, she had her stockpile.

Dr. Jones: You can just say, "Wow, good for you. You're doing an amazing job."

Troy: Right. But yeah, certainly she had plenty of nights where she was just very, very tired, and just fatigued, and didn't have a lot of energy, and just needed a lot of sleep.

It is definitely a process, though, of understanding that and really trying to kind of understand exactly what the other person is feeling, and the emotional impact of this as well. Like you said, definitely a process of trying to figure that out, especially for someone who's going through this for the first time.

Dr. Jones: Women lose their entire sense of their bodies, and some people relish this whole transformation of their body, but some people don't. "Gee, does this baby make me look fat?" So I think it's how do you approach the change in your beloved's body? And mostly you just say, "I think you look strong. I think you look wonderful."

Women often feel quite insecure about the changes in their body, and it's appropriate because they've been invaded, and just being supportive in how they may not feel quite themselves. "What can I do? What can I do to help?"

And then, of course, in the third trimester, when someone is carrying 20 . . . It's like carrying a fanny pack that's got 25 or 30 pounds on your . . . not on your fanny, but in front of you. So you could imagine carrying a 30-pound pack on your waist in front of you. It puts you off balance, and your back can get sore, and you have reflux, and you have heartburn. Some people have problems with carpal tunnel and other things. It's just saying, "What can I do to help? What can make it better?"

Scot: Troy, practice that. Let's hear you.

Mitch: Right now, I want to hear it.

Troy: Yeah. What can I do to help, and what can make it better?

Scot: Yeah. There you go.

Troy: There you go. Yeah. And I think for me, too, a lot of it has been trying to just even identify those things without having to even ask that question. Just looking around and saying . . . As we've talked about before on this podcast, we tend to have a lot of animals at our house. We foster a lot of animals. It's her job. She's the director of an animal rescue group. So just trying to say, "Hey, I'm just going to clean up after these animals and do what I can here to help out."

I find it's a little bit of a tough balance because, like I said, Laura is a very strong, independent woman, and I don't want to come off as patronizing in any way either, like saying, "Well, you're pregnant. You really shouldn't be lifting that," things like that. She's going to lift these animal crates, and she's going to do this stuff. So I do find it is a little bit of a balance there too of . . .

Dr. Jones: Oh, absolutely. And if someone is getting cranky, all you need is someone telling you what you should be doing or shouldn't be doing. By the way, do you foster cats?

Troy: We do.

Dr. Jones: Great. Do I need to give you the toxo talk?

Troy: We're well aware. Yes. I've been cleaning all the litter boxes and . . .

Dr. Jones: There you go.

Troy: Yeah. I am the designated poop scooper in this home. Litter boxes, dog poop, you name it. That's my specialty.

Scot: Troy, we brought Dr. Jones on not just so we could tell you what we think you should do, but so you could also ask questions. I mean, why have a podcast if you're not going to utilize it to your own benefit once in a while? Lord knows we've done it with this one, so . . .

Troy: Oh, I know.

Scot: Did you have anything that you wanted to ask Dr. Jones about? She is really the expert on all of this.

Troy: So many questions. As I've read about pregnancy, I kind of feel like we're in the eye of the storm right now. It sounds like the first trimester obviously can be pretty rocky, and Laura did great and did not really have any significant vomiting, but some nausea, fatigue. And now everything just feels good, and everything is going well. What's coming up next? What's the third trimester going to be like?

Dr. Jones: Oh, it's that 30-pound pack that's hanging off your belt. So, number one, if everything is going well, and her blood pressure stays wonderful, and she doesn't have any leaking of her amniotic fluid, and it's a perfectly healthy pregnancy, it still is . . . people tend to feel a little bit more fatigued. It's hard to find a nice place in bed, because you're kind of rocking and rolling trying to find a nice place.

And of course, she's going to be very pregnant in the hottest months of the summer, and so finding a cool space in your bedroom is going to be important if she wants it.

And then when it gets to lifting the 30 pounds that's on her waist, and then anything else, just say, "How can I help? What can I do?"

So I think probably she's strong. Anybody who just ran a marathon in pregnancy is very strong, and she's probably going to cruise through her third trimester really well. Not all women do that. For some women, they have back pain, headaches, carpal tunnel, swelling feet, things that make them feel enormously uncomfortable, and then there's labor.

Troy: Probably the most intimidating part to me is thinking about that process, labor, and what to expect there, and how do you deal if there are complications. And again, the challenge for me is I just see everything that goes wrong with everybody's lives.

Scot: In the ER, yeah.

Troy: In the ER, yeah. I do, and I see the bad outcomes. I will tell you, I had a very emotional experience recently, and it's just crazy the timing of this, of caring for a baby who just was delivered right outside the door of the ER. With a baby on the way, that's something else. I mean, you try to push your emotions aside.

And fortunately, everything went beautifully, could not have gone better. But 6 a.m. on a night shift to have that happen. So I definitely have felt the impact of this emotionally where before I might not have felt that as much. I was like, "Oh, wow."

Dr. Jones: So you felt different?

Troy: Oh, yeah. No question about it.

Dr. Jones: So you already are emotionally a new guy. You're a new guy because of what's happening.

Troy: Oh, without a doubt.

Dr. Jones: And it wasn't a cognitive choice. It just happened.

Troy: Yeah, without question. So I guess in terms of when labor comes and when that time comes, what do we expect at that point? What do I expect as a father-to-be, and how can I be supportive through that process?

Dr. Jones: Well, I think that's another situation where you're going to need to take your partner's lead on this. For some women, they want to take classes, they want their husband there doing back massage, they want someone helping them do counting with them.

My husband actually, as a neurologist, had some experience in hypnosis. So he and I practiced hypnosis, and he did hypnosis through the first 20 hours of my labor until the 11.5-pound baby was really not going to fit, and we had the baby, had a C-section.

But he was right there for me. And it was hard watching someone who's completely in control all the time and needs to be in control lose it. So it's just being there. But let her ask you. Let her tell you.

The paradigm that you see on TV, which I've seen so many times, is the couple are working together, they're doing great, and then she gets in this magic situation called transition when it's just before she's ready to push, and she's screaming, "Get out of the room. I never want to see you again. Don't you dare touch me." You guys have seen that on TV, haven't you?

Scot: Oh, yeah.

Troy: I've seen it in person, yeah. In emergency medicine, I've had to deliver at least 10 babies. I spent a month on OB, and I've seen it all. So when I say I've been there . . . But it's so different as a healthcare provider, and then when you're there and seeing this person you love and you care about go through this, I think that's the challenging part.

Dr. Jones: It is.

Troy: How am I going approach this? And obviously, there's that part of me that can very easily switch into clinical mode and doctor mode, and I don't want to do that. I don't want to try and be the doctor in the room and trying to be very unemotional or clinical. But at the same time, I'm concerned that I will feel a little overwhelmed by this as well.

Dr. Jones: You will, and you should. It's overwhelming.

Scot: Overwhelming how?

Troy: I'm sure I'm going to experience a lot of anxiety going into this and, "Is everything going to go well? How are things going to turn out?" Certainly a lot of very deep empathy for Laura as she's going through the labor process, and just wanting to do anything I possibly can to ease that process for her, and wanting to be available to her to whatever I can offer.

Yeah, there's going to be that excitement leading up to it, just the anticipation of this new baby. I'm concerned about feeling overwhelmed with this. Like I said, I'm the kind of person who likes to keep my emotions in check, no doubt.

Scot: If you are moved to cry . . . Are you going to be in the room during the delivery?

Troy: Oh, I'm sure I will, yeah. I joked with Laura that I'm going to deliver the baby, but she didn't like that idea. I told her, "I'm an expert. I've done this. Trust me."

Dr. Jones: Ten times.

Scot: Is that because you want to save some money? Is that what you're trying to do?

Troy: Exactly. We're going to save a little cash on this kid, avoid the hospital copay.

Scot: That's right. Some guys do their own plumbing. Troy delivers his own kids.

Troy: "I got this. I got this."

Scot: If you find yourself emotional, like where you might cry because it's such a beautiful moment, are you going to fight that back, or are you going to let that happen? And, Dr. Jones, what do you think about that? Is that what a guy should do or not?

Troy: Scot, I would love to tell you I'm just going to let the tears flow, but I know myself too well, and I'm going to try and hold them back. I'm going to do the same thing I did when we first had our ultrasound at 14 weeks, and I saw that baby and that image of the baby. Laura looked over at me, and I sure tried to hold them back. And afterwards she said, "Were you crying?" I said, "No, I wasn't. Of course not. Why would I do that? Eh, maybe a little bit." So I'm sure I'll try and hold it back.

Dr. Jones: Well, even if you do, you can say, "Well, I'm overwhelmed." You don't have to let the tears fall if they're not right for you. I mean, we've seen it all. And sometimes the experience is totally scary. It is very scary. And of course, I'm a former OB, so I also think of all the things that can go wrong. And a first baby, it just never always goes as you hope. It's just a little different in some way than you hope.

But what you want is you want to be with a team that you completely trust, and that's the biggest thing. Whoever is there with you, wherever you choose to have this baby, you want to be with a team that's going to be there for you. So you don't have to be the doctor in the room.

Scot: Now we're going from Troy being DIY to Troy recruiting like he's the general contractor. He's recruiting his crew. Going around to his friends.

Troy: I've already done that. As soon as Laura told me that night, the next morning I emailed someone I know well who's done lectures for our residents, who has been the OB for several of my friends and colleagues, and I emailed her that first morning and said, "Please, I'm scared." I didn't say, "I'm scared," but I'm sure she could tell I was scared. I was like, "Will you be our OB?" And she was wonderful and got right back to me. Yeah, I'm very happy to be working with her and have her caring for us and for our baby.

Dr. Jones: Good. Well, I think that you are . . . you know what's going to happen. You're going to let her run the agenda as she's pregnant in terms of asking you for what you need, and letting her know that, within the limits of you taking weird hours and call, you're going to be there for her.

And then what happens is after the baby is born, the first couple of months, where there's a baby up all the time, do you help out with that? Does she help out with that? How much breastfeeding are you going to do?

Scot: Yeah, Troy, do you help out with that?

Troy: I'm planning to, trust me. I'm all in on this, and she's made it clear I'm helping out with this too.

Mitch: I mean, he's already a poop scooper.

Troy: I'm already a poop scooper. Diapers are going to be easy. That's going to be a piece of cake. That will be a relief from what I usually have to deal with.

Scot: Dr. Jones, I cut you off a little bit there. You were leading into breastfeeding. Where's Troy's involvement in that, though? He can't help there, can he?

Mitch: Yeah, that's actually one of the questions from our new moms, was how do men help during that process?

Dr. Jones: Well, they can bring the baby. So if they're not co-sleeping, and there are lots of opinions about whether babies should sleep in the bed, but if the baby is in a crib nearby, you go get the baby, you can change the diapers for the baby, the mom can breastfeed and put . . . How you work that out is a rhythm that every couple establishes.

Troy, you're used to sleep deprivation. And maybe your partner is really good at it, maybe she's not. So how you begin to juggle that is something that each couple finds their own way. I'm sure you're going to do great. That's the reality, is when there's love, you guys will do just fine.

Troy: Yeah. Again, for me going into this . . . And we've talked a bit about how this is going to look once the baby is born, and how all that works. That's kind of the approach I'm trying to take. I'm going to be available. I'm very fortunate that working through the university, I do get paternity leave. I'm absolutely taking it, and I want to do everything I can to help Laura, whatever it means in terms of sleep deprivation or getting up in the middle of the night.

And like you said, my hope is just that we can figure out how that works and how that looks exactly over those first couple of weeks. And I guess that'd be my question, too. Do most couples then . . .

Dr. Jones: Couple of months.

Troy: It's a couple of months to find that pattern? Okay.

Dr. Jones: Well, the baby is always changing. So they call the first three months of a baby's life who's born at term the fourth trimester, because they are still on truly autonomic phase. They just sleep, and poop, and eat, and that's about all they do. And then at about 2.5 to 3 months, they come up with a smile and then everything is perfect as soon as they smile at you.

But it's hard because just when you think you've got Plan A, the baby has changed, and then you have to say, "Oh, I guess we're going to work with Plan B." It's just being flexible.

It's being aware that moms don't always feel on top of their game emotionally after a baby is born. They can feel kind of overwhelmed. They can feel like their independence is gone. Some women have postpartum. Everybody gets baby blues. It's a period of a day, or two, or maybe even a week when they say, "Oh, this is really hard." But postpartum depression affects a lot of women, 20%, when Mom's mood isn't really enough, isn't up to the task, and she needs more support.

You just kind of have to be aware and ask her, "How are you feeling? Is there anything I could do for you today?" As long as you're talking, as long as you're emotionally available to each other, you'll do it fine. It's amazing. It's the last refuge of the rank amateur of this parenting thing.

Troy: The last refuge of the rank amateur.

Dr. Jones: Right. So do you know if you're having a boy or a girl?

Troy: This is a girl.

Dr. Jones: Congratulations.

Troy: A baby girl on the way.

Scot: Really?

Troy: Yeah, a baby girl.

Dr. Jones: Wow. Congratulations, It's just magical. It's going to be just magical. Not that boys aren't magical too. They both are.

Scot: Are you sure about that? I was wondering this morning, I was like, "I bet you they're going to have a boy."

Mitch: Yeah, same.

Scot: I mean, might want to double-check that.

Troy: We've got another ultrasound coming up shortly, so we'll have them take another look, make sure they got it right. They seem pretty confident.

Scot: Yeah. So there was one other one. It's "Should new dads go to the appointments during pregnancy and after?"

Dr. Jones: I think that's what the partner wants. My husband was a resident. I was not going to have him . . . This was in the old days when residents never, ever, ever . . . they didn't have an IV, and if they didn't have . . . straight out of the operating room. They did not miss a day. So I was not going to ask him to go to any of my appointments. I think you do what she wants.

Troy: Yeah. And she's asked me to go, and I've been able to go with her. So, again, yeah, you're right. I think it just depends on your situation.

Scot: And what's your role in those appointments then? Is it just to be there? Is it to remember things that have been talked about?

Troy: I mean, I think my role has been more just to be there with her, and I really have tried not to . . . Again, avoiding going into doctor role. I've been trying to just be there as husband and future father and just be there with her. I've tried not to ask a lot of questions or anything like that. Let her ask the questions she wants to ask. Let her OB talk to her, and not feel like she has to be talking to me because I'm the other doctor in the room or anything like that. But yeah, it's really been just being there. And that's what it's been so far, just being there with her and she . . .

Dr. Jones: Well, if you have a question, it's a good thing. I mean, I really liked it when husbands had questions. So if you have something to ask, then it's appropriate to ask.

Troy: Yeah, for sure. And the good news is everything has been so straightforward so far. I really haven't had to ask anything, and Laura has asked the questions I think that needed to be asked.

Scot: Oh, you're grading her now?

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

Scot: She's asked the questions that she needed to ask.

Troy: I had my checklist in my mind and she passed.

Mitch: Backseat doctoring.

Troy: Not at all. I mean, I think they were just questions that we talked about beforehand that she had. And that's probably why I'm there too, because she may have had some questions in her mind. But yeah, we really have talked a lot about those things beforehand, and she's asked me questions.

And then in this case, I don't want to be the doctor to my baby or to my wife, so I've just provided my opinion but have tried not to steer the conversation when we're with the OB.

Dr. Jones: Of course. You're a natural already.

Troy: I wish. I feel far from it. Like I said, I feel inadequate. That's how we started this episode. That's probably a good summary.

Dr. Jones: Thank you for using your words.

Troy: Yes. I feel inadequate. That would be the absolute best word to describe how I feel.

Scot: Congratulations, Troy.

Troy: Thank you.

Scot: Yeah. On behalf of Mitch and myself, this is your baby present.

Dr. Jones: Oh, great.

Troy: I could not have asked for a better gift. This is my man shower. You guys just held a man shower for me. I couldn't have asked for a better man shower.

Scot: Yes. Dr. Jones, thank you so much for being on the podcast and talking to our nervous new dad, and thanks for caring about men's health.

Dr. Jones: What a treat. Talk to you soon.

Troy: Thank you.

Dr. Jones: Bye.

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: You know, you're not just eating for yourself. You're actually eating for 39,000,000,000,001. What? Well, today we're going to talk about the microbiome and men's health.

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men's health. He brings the MD. It's Dr. Troy Madsen.

Troy: Hey. I'm excited to hear what's inside me. I'm curious and excited.

Scot: All right. I bring the BS. My name is Scot Singspiel. He brings the mics. He is Mitch.

Mitch: Are we talking about poop again?

Scot: No. We're talking about the . . .

Mitch: I mean, he's here.

Scot: Well, maybe. I mean, our guest is Dr. John Pohl. He's a gastroenterologist.

Mitch: I know. He's back.

Scot: And just like marathoners can never stop talking about marathons, gastroenterologists are going to probably mention poop in a conversation.

So, Dr. Pohl, it's great to have you on the show.

Dr. Pohl: It's so great. Thank you for allowing me to be speaking with you guys today.

Scot: All right. So first of all, I'm just curious, John, are all gastroenterologist experts on the biome, or is it just you? For me, the biome wasn't something I even knew about until kind of just recently, right? And I don't know how widely known the biome is and what it does. Most gastroenterologists, are they experts on it, or mildly know, or what's that look like?

Dr. Pohl: Well, I mean, I think we've all known for a while that poop has bacteria in it obviously.

Scot: There we go. We got it out of the way, Mitch.

Dr. Pohl: We got that done.

Mitch: Good. Thank you.

Dr. Pohl: I think that people really didn't start thinking about the microbiome until about 20 years ago, maybe 25 years ago. And people started realizing that the type of bacteria you had in your intestine and other parts of the body as well really affected health outcomes.

Scot: So normally, we think of bacteria as bad things, but these are good bacteria.

Dr. Pohl: Right. And most bacteria in your body don't care that you're there. They're not good or bad. That's the biggest group. The next group of bacteria, they're probably beneficial. And then the smallest group is the bacteria that are probably harmful.

Scot: What is the microbiome then exactly?

Dr. Pohl: So I like to think of our intestinal tract like a coral reef. It's like a big Jacques Cousteau episode. So instead of the thousands of species of fish, and crabs, and things like that, we have bacteria.

What's really fascinating to me, and I know we're going to talk a little bit about bacteria and health outcomes, but there's also the microbiome in the gut associated with fungus. Very helpful as well.

And then the thing that is really exciting right now is called the virome, which are all the trillions and trillions and trillions of viruses that interact with the bacteria that probably affect the whole microbiome as well.

So you're just dealing with just literally trillions of entities affecting your health.

Scot: And in the stomach, the microbiome, does it primarily help with digestion? Is that kind of why it's there?

Dr. Pohl: Well, the stomach has stomach acid, so you really don't get a microbiome there. Now, that's a very interesting question because if someone is on an acid blocker for a long period of time and they don't have any stomach acid, they can get bacteria in there, which sometimes can cause problems.

But you're mainly dealing with small intestinal absorption. So your small bowel absorbs food, and your large bowel, your colon, kind of helps to collect what's leftover and makes you poop. And that is where the action takes place, in the small intestine.

Scot: And that's where the microbiome is?

Dr. Pohl: Well, it's all the way through. I mean, you even have microbiome in your skin, in your ears, in your nose, obviously. But the main thing, where the vast majority of the bacteria are present, is in your small and large intestine.

Scot: So I've had this little theory, and tell me if this little theory is crazy or not, that when I eat or any of us eat, not only are we eating for ourselves for the nutrition that we get out of it, but we're actually trying to eat to keep this microbiome healthy because it does have such impacts on our overall health and how we digest food and absorb nutrients. Is that true?

Dr. Pohl: That's exactly right. And then the weird thing philosophically to think about it is "What does it mean to be me?" If you're supporting your gut health and all the trillions of bacteria, what are we? But that's a whole other story. That's something I find fascinating.

Troy: No, it is fascinating. And I don't know the answer to that. What percent of our body mass is really bacteria and all these living organisms that are just a part of who we are and affect who we are? I've even heard just affect the way we think, all those sorts of things as well. So it is very fascinating.

Mitch: Is anyone else feeling itchy?

Troy: Yeah, exactly. Going to drink some anti-bacterial hand sanitizer or something.

Mitch: Yeah, with another gross-out episode.

Troy: But I think it does. It kind of creeps people out to hear that. And like you said, John, it's something that it seems that we've really started to recognize a whole lot more over the last decade or so.

How often does this really play into what you do on a daily basis, though? It's kind of interesting to know, like, "Wow, we have this microbiome," but in terms of what you do in treating disease and talking to patients about their bowel health, all those sorts of things, how often does the microbiome come up? And along with that, how often are you actually doing things to try and potentially change that or make it healthier?

Dr. Pohl: In terms of what I do as a pediatric gastroenterologist day to day, I probably talk about the microbiome quite a bit in certain settings. Some of the big things I see are diseases associated with gut inflammation, whether it's infectious or inflammatory.

So let's talk about things that are infectious. So there is an infection C. diff or Clostridioides difficile, which is associated with chronic antibiotic use where you can get very bad diarrhea that sometimes doesn't respond to antibiotics. And if you're not responding to antibiotics, we actually have approval at our Primary Children's Hospital to do colonoscopies, and we put donor stool into the colon. We clean out the colon and put donor stool and that gets rid of the C. diff.

Troy: So let's pause there just for a second.

Scot: Yes, please.

Troy: Mitch, did you catch that?

Mitch: I sure did. I sure did get that. Thank you. Yeah.

Troy: In layman's terms or layperson's terms, you're talking about taking poop from another person and then taking that . . .

Dr. Pohl: We use a parent.

Troy: From a parent, interesting. And then inserting that stool sample, that poop, from a parent into the child's intestines.

Scot: And with the thought that you're getting those good bacteria. I mean, you told us that not all . . . But the beneficial bacteria in there to overpower the bad bacteria.

Dr. Pohl: That's exactly right. And in terms of other things you can do, we will use probiotics for other diseases as well. There's some very good evidence that patients that have inflammation on the left side of their colon, so the part of the colon that kind of empties right into your rectum and anus, if it's fairly mild . . . For example, with ulcerative colitis and sometimes with Crohn's disease, there are certain probiotic regimens that you can give that can keep you in remission.

Some of these are extremely expensive regimens. And they are not prescriptions, so you have to pay for them. But that's actually very helpful as well, which I find very interesting.

Other things to think about are, in children, there is some evidence that giving probiotics with healthy bacteria are helpful in terms of getting eczema and atopy of the skin.

And then something that you guys deal with in terms of the adult world there really are some interesting data out there. In terms of people who have coronary artery disease, it puts them at risk for heart attack. Eating food that is high in animal fat increases what are called phosphatidylcholines, which can increase your risk of atherosclerosis. And also having a very good gut biodiversity in the intestine is very helpful in terms of protecting against adult-onset diabetes, also known as type 2 diabetes. So there are some really fascinating data out there.

Troy: Yeah, the more you hear about the microbiome, the more I think that eventually . . . Obviously, we talk so much about genetics, and genetics is the future of medicine. I almost kind of think that we're going to start moving more toward microbiome. You talk about all these effects. Like you were saying, heart disease. And maybe I've seen something at some point about Alzheimer's. I don't know. That kind of rings a bell, but maybe you've seen something there. But so many varied diseases that are affected just by these bacteria in our body.

Dr. Pohl: Yeah, there does appear to be an association, not very clear, between dementia, ALS, Parkinson's with the microbiome and brain outcomes. What's really interesting is there appears to be some type of association between the vagus nerve, which is one of the longest big nerves that goes down from your brain, down the side of your esophagus, into your intestinal tract, in terms of what happens in the microbiome and signaling to the brain. And that can lead to increased inflammation in the brain.

And so there does appear to be an association with things like Alzheimer's, dementia, and your type of microbiome. But these are very difficult studies because we don't know what these people were eating before they did the stool studies or got small intestinal fluid to see what was going on.

So the point being is that there appears to be an association, but we need a lot more information before people just start taking tons of probiotics for this, because I think it would be the wrong thing to do.

Troy: So apart from probiotics, anything else you recommend just from a dietary standpoint to have the healthiest microbiome you can have?

Dr. Pohl: Yeah, so the first question is should you take probiotics? And I generally say no, unless it's specific conditions, mainly because there's so much variation in terms of what type of bacteria you're getting and how much is in each capsule or little packet. It's not very regulated.

So there are certain situations where I might recommend it. For example, taking it for traveler's diarrhea and things like that, certain mild types of inflammatory bowel disease.

So that goes back to one of my simple truisms in life is if you want to live longer, eat less and exercise more. There is a lot of evidence that being mildly athletic, and I'm just talking simple cardio, such as just simple walking, really tends to predispose you to more healthy type bacteria. No one really knows why that is, but exercising tends to self-select for more healthy bacteria.

Now, at that time, you may be deciding to eat more healthy, and that may be part of the issue. But there appears to be a benefit from exercising and how it influences your microbiome.

And then diet. What's really helpful in that setting is, again, not the bacteria, but how you're feeding your bacteria. So giving things that are called basically prebiotics. You can buy prebiotics over the counter, but why do that when you could just eat healthy? So fruits, vegetables, beans, whole grains, very simple groups are highly effective in giving you a better, healthier microbiome, specifically things like garlic and onions and leeks, asparagus, bananas, seaweed. Seaweed has become more ubiquitous in our diets and grocery stores. That's another way you can find things very helpful as well.

Scot: What about fermented foods? I've heard fermented foods like yogurts and horseradish. Not horseradish. I don't know what.

Mitch: Kimchi or whatever.

Dr. Pohl: Absolutely.

Mitch: I live with someone who has five jars right now of foul-smelling things that are fermenting wildly in hopes of improving the probiotic. Is this accurate? Is this a good thing to be having in my home?

Dr. Pohl: Right. Maybe I'm wrong. I just don't think you should eat things that stink. That's just a big thing for me.

Mitch: Cool. I'll take that to the bank.

Dr. Pohl: You're exactly right. So the foods you're mentioning often have what are called short-chain carbohydrates, which are basically fiber-type supplements, fiber-type derivatives, and that's very healthy for the bacteria in your small intestine.

The way I look at it is very simple carbohydrates get absorbed very, very quickly and metabolize very quickly. They don't reach deep into your gut, and that's why you need some of these other foods that I'm talking about.

The only reason I bring up being careful about fermenting your own food is there have been some examples . . . and this is super rare, but just keep in the back of your mind that some of the fermentations end up producing toxic byproducts. So if you don't know what you're doing, you just need to be careful because there have been case reports of toxicity with some of these items, self-made fermentations.

Scot: As men, what do we do that either hurts or helps our microbiome? Are there any particular things that men do? Maybe we eat too much meat. Is that good or bad for microbiome? Are there other things?

Dr. Pohl: Oh, yeah, I think I think that's exactly right. So I think men often have a problem with their diet and just eating healthy. In all I've said, I haven't provided anything super complicated. Make sure you're increasing the amount of fruits and vegetables and whole grains and beans in your diet. It's helpful.

Americans are terrible at exercise. When I talk to people about this, I'm not asking people to be marathon runners. I'm asking them to walk in their neighborhood for 40 minutes, three to four times per week. That does appear to be protective.

Strangely, and for reasons that are not entirely clear, sleep really affects the microbiome. If you're not getting enough sleep, you tend to get the more inflammatory-type bacteria. So that's a big deal as well.

And then excessive alcohol use really affects your microbiome in detrimental ways, which can cause downstream problems, like cardiovascular health and diabetes. Same with tobacco use.

Scot: And let's say that somebody maybe . . . I mean, I don't know. Would you know if you had an unhealthy microbiome? And if so, you decided, "You know what? I'm going to start rebuilding. I'm going to start eating healthy, do the right things." How long does it take to rebuild that? Is that days, weeks, months, years?

Dr. Pohl: So no one is exactly sure. It probably would take days, to be completely honest with you. Your intestinal microbiome has a lot of what they call plasticity. Often you can really injure it in terms of removing bacteria from your intestine and it'll come back healthy very quickly. We see this with some of the bad bacteria that you can get, like salmonella or shigella. After it clears, it can come back very, very quickly.

I don't think there's ever a need to check your microbiome. There are labs that will check your microbiome for you. Some are trusted. Many, in my opinion, should not be trusted in the least bit and you're spending hundreds if not thousands of dollars.

But the simple way around that is to say, "Okay, I'm going to do aerobic exercise, I'm going to a well-balanced diet, I'm going to try to get sleep, and I'm not going to do excessive alcohol or tobacco use." And you can pretty much be guaranteed your microbiome will be healthy.

Troy: I love it, John. You just quoted, essentially, more or less, what we refer to here as the Core Four. And we just keep coming back to it. It's so great. And we just came back to the Mediterranean diet as well. I mean, it sounds like you're basically talking like Mediterranean diet is optimal for your microbiome.

Dr. Pohl: Absolutely.

Troy: Like you said, get your sleep. Make sure you're eating well. It makes a huge difference.

Dr. Pohl: Absolutely. These little critters in your intestine, whether they be fungus or bacteria or viruses, are all there to help you. It's not just your gut health. You have to think about your whole body holistically. There appears to be evidence that it can affect coronary artery disease and reducing your risk of heart attacks with a healthy microbiome. Potentially prevention of adult-onset or type 2 diabetes.

And just like you talked about, there appears to be pretty interesting evidence that there's some aspect of dementia prevention and perhaps prevention of anxiety or depression. Again, those studies are hard to do, but there is some intriguing evidence.

Troy: Wow. So even mental health. That's incredible.

Dr. Pohl: Absolutely.

Scot: So bottom line, just like Troy said, it's the Core Four. We don't necessarily know how much the microbiome impacts our health. We know to some extent it does. But what's really the downside of trying to get a little bit more exercise, trying to eat a little bit more healthy?

Dr. Pohl: That's right. And don't do any type of fecal stuff at home.

Scot: Okay.

Troy: Don't eat poop. Just don't do it.

Scot: Do you hear that, Mitch?

Mitch: I hear it.

Scot: Okay. Don't do fecal stuff at home.

Mitch: On it.

Scot: And on that note, I guess we wrap up the show. Thank you very much, Dr. Pohl, for being on "Who Cares About Men's Health."

Dr. Pohl: Thank you. It's been a real pleasure.

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: Troy, I've got a question for you.

Troy: Yes.

Scot: Are you emotionally available?

Troy: If I even knew what that meant, I would know how to answer it. Let's start with that first. I don't even know what you're asking me, Scot. Am I available to your emotions? I don't know.

Scot: Mitch, are you emotionally available?

Mitch: I guess it's how . . . I think I'm more emotionally available than I once was, but again it's . . . Yeah, I don't know, man. Maybe.

Scot: Troy, it sounds like Mitch knows what that means.

Troy: I know. Mitch apparently got past Step 1, which I haven't.

Scot: We might have to defer to him. This is "Who Cares About Men's Health," giving you information, inspiration, and a different interpretation of men's health. "Emotional Availability: I Guess It's a Thing." That's the name of this episode.

Today's crew. He brings the MD. It's Dr. Troy Madsen.

Troy: I'm trying to be available to you, Scot. Yes, I am here physically. I don't know that I'm emotionally available, but I am physically available today.

Scot: The BS to his MD, that's what I bring to the show. My name is Scot Singpiel. And he just generally makes the podcast better, it's Mitch Sears.

Mitch: How are you doing today, Scot?

Dr. Jones: Very nice.

Mitch: Look at me. Emotionally available. Boom, boom, boom.

Scot: And that lady voice you hear on this very manly podcast is one of my most favorite people ever. She is the host of one of our sister podcasts or brother podcasts. I don't know if they have a gender really. But "The Seven Domains of Women's Health." You can find that on thescoperadio.com. It's Dr. Kirtly Parker Jones. Welcome, Dr. Jones.

Dr. Jones: It's an honor to be here.

Scot: All right. Troy, I'm going to tell you how we ended up at this place of emotional availability. We were on Dr. Jones' podcast about men and crying, which, conveniently, when we told you about it, you're like, "Oh, I've got something that day."

Troy: I promise I did have something that day.

Scot: Yeah, I'm sure you did have something.

Troy: I did.

Scot: So Dr. Jones brought up . . . she said, "You know what?" We said, "We'd love to have you on the show. What could we talk about?" And she said, "Well, why don't we talk about emotional availability in men for their partners?" And Mitch and I are both like, "Yeah, that sounds great." And then Mitch and I both went to Wikipedia to find out what that meant, and we still don't know.

So, Dr. Jones, let's start right there. What does being emotionally available mean? And how does that tie back into health, men's or otherwise?

Dr. Jones: Great question. It might mean things to different people differently, but I would consider that emotional availability is a state of mind where you are able to recognize the emotions in your own self. Then you might be willing to express them, label them, and help regulate them. And then, with the practice of understanding your own emotions, you are more able to understand, or at least listen, to the emotions of your partner.

So, developmentally, it's been suggested that because girls are raised to be like their mothers -- now these are old-fashioned developmental theories -- they are more tied in with their mother's emotional state. Boys are raised to be more like boys, therefore not like their mother and therefore somewhat distant.

So you can say that the issue of emotional availability is a new one, but it's as old as "men are from Mars and women are from Venus." It's the difference between men and women. And I think that those sexual stereotypes need to be thrown away because there are certainly women who are not emotionally available and there are lots of men who are.

Troy: So why is this referred to as emotional availability? Because it sounds like it's a lot more . . . like you said, really the first step is it's more emotional awareness, like understanding our own emotions, and I guess then it makes us available. But sounds like it's a lot of awareness involved.

Dr. Jones: It is. You have to be emotionally available to yourself first. So there's some work to be done or you need to raise them that way in terms of your children. There's a great Crosby, Stills &Nash song, which none of you have even heard because you're too young. "Teach your children well, their father's hell did slowly go by." So I think we need to teach our children to be emotionally available by our own examples and by verbalizing how we are feeling, and so our children can feel.

Once you are emotionally available to yourself, then you are more willing to be emotionally able to listen to, reflect, work with your partner's emotions.

Now, I consider it kind of a girly whine. "You're not emotionally available to me." But in fact, if you're not emotionally available to yourself, this concept of emotional intelligence, then a lot of anger, fear, anxiety goes unaddressed, and it makes people sick. Their immune system doesn't work so well. Their blood pressure goes up. A lot of chronic diseases in men might be tied to inner frustrations, anger, fear, anxiety that they aren't labeling, expressing, and able to process.

Now, when you live with someone, it's nice to be able to at least empathize when circumstances make them sad and reflect on them. You might ask your partner, "Would you like me to be emotionally available to you?"

Scot: Oh, boy.

Troy: Yeah, that was going to be my next question for you. How effective is this really? And do you recommend it? I totally get being aware of our own emotions and recognizing them and acknowledging them, but it seems like it may not go over super well if we're saying to our partner, "You seem really angry right now." I don't know. "I sense a lot of anger."

Scot: As Dr. Jones was talking, Troy and Mitch, I'm sensing this recurring theme that we've talked about, right? That sometimes as men, we don't recognize what our emotions are. We don't label them. We don't really think, "Well, why am I feeling this?" We don't sit with them. We don't want to deal with them, right? And we know the detriment that has on our health, but I'm starting to see that maybe that could have detriment on relationships, which ties back in to emotional health again.

Before we get to Troy's question, Mitch, you wanted to ask something?

Mitch: Oh, yeah. As you were explaining being emotionally available to yourself, it really kind of rung true with me because I've been starting my own little mental health journey. And one of the things that I kind of ran into is one of my very first meetings with my latest therapist was like, "Hey, I have a tightness in my chest. I don't know what I'm feeling. I can't think straight, whatever." And it took him talking me through the physical sensations to recognize the emotions that I was feeling. He's like, "You sound like you are anxious. You sound like you are worried. You sound like you're whatever." It's like I couldn't even recognize that in myself, right?

And what was interesting about it is that constant anxiety, that constant kind of stress and worry that I was experiencing, but not recognizing, I wasn't aware enough to figure something out to fix it.

And secondly, it was taking a real impact on my health. I was having everything from problems with clenched jaws, to higher blood pressure, to all sorts of issues that immediately started to change as soon as I started to at least recognize the emotions and was able to start problem-solving, which I think is the step I was trying to jump to without even recognizing what the problem was, like a typical man.

Dr. Jones: Wow. Mitch, that's amazing.

Scot: Do you feel a little like a Neanderthal that you're like . . .

Mitch: Yes.

Scot: . . . "What is this strange emotion? Oh, it's anxiety."

Mitch: I do.

Scot: To me, it sounds silly, but you know what? I found myself in that same situation, too. It's kind of crazy, isn't it, that we wouldn't know what these emotions are?

Mitch: Well, I felt dumb and embarrassed almost. Luckily, I love and trust my therapist, but there was this kind of situation where it was like, "Ugh, what do you mean? Of course, it is." I've been dealing with this for a year now, and, "Oh, of course it is. Duh."

Dr. Jones: Well, remember, for men, they may have had it modeled. So the only primary emotion, which is love and happiness, and fear and anxiety, but the only one you may have seen exhibited in your life was your father's anger, or maybe your mom wasn't available either. So that's the only one you've got that you might actually have a label to, because you saw the men around you get angry. And that one you get, but there's a lot more inside.

Primary emotions are ones that immediately cause a physiologic response. And if you have the physiology, but you don't have the word, then you can't really dig down into why this is happening. Is it good or is it bad? I mean, I hope you kind of know when you're happy.

Mitch: Sure.

Dr. Jones: I hope that one comes up and you're like, "Wow. I feel happy," instead of, "Gosh, why does my chest feel a little bigger and why do I feel I can have more air? Oh, maybe I'm happy."

So you may not have had it modeled for you. It may not have been taught to you, or bad things could have happened when you were growing up that made you stuff everything down. So, for men and for women, the difficulty of being emotionally available to yourself is that you either didn't have it modeled or you stuffed it someplace because it hurt.

And those kinds of things in a relationship . . . I think your concept, Troy, if you say, "Gee, you look like you're angry," what I have learned from my husband and a 50-year relationship is that I cannot guess what he's emotionally feeling because sometimes I guess wrong and it does not go well.

So if I say, "How are you feeling?" or, "Are you feeling something hard right now?" then he might tell me. I want someone that when I start to cry or when I get upset about something can come over and at least put his arm around me. He doesn't have to say, "Oh, I see you're so sad because something has happened to our son," or your car isn't working, or whatever. At least I want him to come over and recognize that I am feeling sad or I'm feeling anxious or worried, and he'll put his arm around me, which says, "I know you're not feeling very good right now and I'm here for you."

So that's what being emotionally intelligent . . . I want him to at least recognize when I'm in emotional distress. And likewise, if he's in emotional distress, I'd rather not walk around the house on tenterhooks thinking, "Oh my God, what is wrong? Is it my fault? Is it his fault? Whose fault is it? Did I do something wrong?" It's better for me to kind of know.

You don't get to 50 years together unless you've kind of, sort of worked things out, unless you're just strapped down and you have no choice.

Troy: It sounds like then you're saying in terms of emotional availability, it's one thing for us to identify the emotions in ourselves, but it's maybe not the best idea to try to identify the emotions in others. But at least make ourselves available to them and at least tell them that maybe something seems off and at least open the door if they want to talk about those emotions that they're experiencing.

Dr. Jones: Exactly. Because if you come up to me and say, "Gosh, I think you're angry," that's going to piss me off.

Scot: No, no, no.

Troy: Even if you are angry.

Scot: It's always a question. "How do you feel about that? How are you feeling?"

Troy: Exactly.

Mitch: One of the things that I had trouble with for a long time is I'd be . . . I'm a chronic projector, and I'd be like, "Are you mad at me?"

Dr. Jones: Exactly.

Mitch: "Are you mad that I did something like this?" Then I'm also assuming, right? I'm assuming you're feeling a certain way and I'm also assuming that it's my fault, right? And that's not a good dynamic to have with anyone.

Dr. Jones: No. Don't assume that you know what they're thinking. But being emotionally available means, "I feel like something is hard right now. Can we talk about it?" or, "Is there something I can do to help you with this sense at being unease, lack of ease?" "Well, yeah, the planet is exploding and there's global warming and we're getting shot in streets and . . ." "Wow. Yeah, boy, that is awful. Do you want to talk to me about that some more?"

Scot: So what I'm getting here, emotional availability, first of all, as men, we have to begin to recognize our own emotions and identify things other than anger.

And I loved what you said. A lot of times we talk about when you need to seek a health professional, whether that be a licensed clinical social worker or somebody else. And a lot of times, as men, we talk about to have some tools to deal with things.

But I think another thing that Mitch just pointed out is to maybe start recognizing emotions that we've never been taught about as men before in some instances. A lot of men maybe have, and I think things are getting better. I don't know if you'd agree or not, Dr. Jones.

Dr. Jones: I do.

Scot: Yeah, as we move forward. I can speak from my own experience. I came from very stoic people. So I probably don't know half the things I feel most of the time. So the first thing you've got to do is recognize your own emotions, and then that's when you can start to become emotionally available to somebody else. Show us what that might look like.

Dr. Jones: Well, how it might look like in yourself, it's what I call the RULER project, which we've done a podcast on actually, which is recognize that you're feeling something that's uncomfortable or something. You're feeling something. Understand what it was. What was the trigger that made you feel that way? Can you label it? Can you give it a word? Can you explain it or express it to others?

That's the step that . . . if someone in my family were upset and they said, "I'm just feeling upset. I'm feeling so sad," or, "I'm feeling really angry," those are the kinds of things that really help someone not get in your way. Or, "Can I help you with that?" or, "What can I do to make this better?" which you probably can't, or, "I want to hear about this because you're important to me."

That's what it looks like when someone is able to say, "This is what I'm feeling and it doesn't feel good," or, "This is what I'm feeling and it feels really good," or, "I'm really happy. And it makes me anxious because I'm so happy."

And then the other person is able to then say, "That explains why you've been stomping around the house all day," or whatever. That kind of opens up a little bit of a dialogue so that people can value each other.

And for guys, in particular, for who modeling emotional intelligence has not been really made clear to them, there's been a lot of shame. So if you feel anxious or if you feel sad or if you feel fear, it's not been okay.

When I look at the uber sort of masculine men on movies, those guys are just . . . I think of the new Jack Reacher. I think, "Wow. I would never want a relationship with that guy. I see his anger. Boy, oh, boy. But I don't see anything else in him."

So I think that many people, men and women, are looking for a long-term relationship, which means, "I want someone to be part of my emotional life, not just my physical life. Not just my cooking or the house that we share. It needs to be a little bit more than that."

Now, once again, not all women are terribly emotionally available, and some men are very. And for some women, they may attach themselves. Women say, "Well, why do I pick these guys? Why do I keep picking these guys?" Well, they also may have this kind of distance modeled for them in their father and it's all they know.

Or they think that not showing emotions is strength and they want to attach themselves to strength because they are anxious. They're not self-confident. They want that burden laid on the guy in their relationship or the other person in their relationship. And having one person be the strong one and the other one being the emotional one. That's kind of hard. You ought to share this stuff.

Mitch: I had a question kind of relating back to mine. I love the RULER technique. I think that, for me, I really appreciate acronyms and strategies and whatever. But that L, that label, I have run into feelings that I don't have a name for, and the best I can do . . . And it's probably modeling and I have to work with my specialist to kind of figure out what it is. But you come up with, "I feel oogie. I feel meh. I feel blah."

And so is there . . . I don't know. I just feel like such a novice here where it's just like, "Is there a guide?" Is there something that I can see all the feelings I could be having or emotion should I should be having and I can kind of point to that.

Troy: It's like the pain chart, the little kid pain chart. "That's my pain right there."

Mitch: The sad face.

Troy: The sad crying face. Yeah. We need the equivalent for men's emotions or something.

Dr. Jones: Well, there actually is an emotional wheel.

Mitch: What?

Dr. Jones: So the people who looked at primary emotions say, "These are the ones that have physiologic consequences and they're immediate." So they happen to you even before you can give it a label. It just is an immediate response fear. Maybe love, happiness, anxiety, you know when it happens because it happens so fast. There are secondary emotions which are combinations of primary and secondary emotions.

Now, what they might feel like? Any strong emotion can raise your pulse and raise your heart rate. Although true Agapeic love, I think, actually can make your . . . I mean, the love of a child, the love of a very good friend can bring your blood pressure down. Holding hands with someone that you love, that actually brings your blood pressure and your pulse down. And they've done this in MRIs and they've looked at what parts of the brain are activated.

Getting a good therapist is a really . . . You say, "I don't know what the name is I'm feeling, but this is how I feel. This happened to me, and this is why I felt like that." If you could say how you feel and you understand what made you feel like that, you might be able to come up with words.

Oogie, I need a little help with oogie. I got oogie. I can kind of feel oogie. I feel oogie below my diaphragm. It's not above my diaphragm. I don't feel it in my heart. I feel it below my diaphragm. Well, what were the things that made you feel oogie? If you told me what made you feel that way, I might be able to put a label on it.

But there is a very beautiful wheel, emotional wheel, that gives people a . . . I can send you guys a link for this and you can work on it, if you'd like. You can spin it around, see how you feel.

Scot: How do you start that conversation if you're the partner and you're thinking . . . Well, actually it could go either way, right? So you're the partner and you're thinking, "You know what? I would like to explore this idea of emotional availability in my existing relationship." Or you're the partner that maybe you're thinking, "I wonder if my partner actually would find more satisfaction in the relationship out of this." I mean, it could work either way. How would you start to progress forward? Because even that name carries baggage, right? Emotional availability to some people could sound . . .

Dr. Jones: It does. It means somebody isn't. It means blame, blame, blame already.

Scot: Or it could just be like, "Oh, that's touchy-feely, I'm not into that."

Dr. Jones: Well, you can just say, "I've been thinking about this." Either one, the person who's got more emotions or the person who's got less emotions, "I've been thinking about this and our relationship is important to me. I do or don't want it to be . . ."

"It's uncomfortable when you cry at the table, but I don't want to shut you off or I don't want to be blocked off from you. So I'd like to learn how to talk about this." This is the guy who sees his wife cry about stuff or his girlfriend or his boyfriend or whatever, and he just doesn't get it. But he loves this person. So, "I see you cry and I need some help. I need some words. Are you willing to work with me about that?"

And then if you're the person with more emotions, "I've been thinking about this and I love you and our relationship is really important to me, but I need to feel that you're tied with me to the things that I feel strongly about. Can we talk about it? I cry at the table because I'm sentimental. All we have to do is talk about my family or our son, and I start to cry, and I don't want you thinking it's sad because it's not sad. It's sentimental. Can we talk about what words I use and how it might make me feel and what I want from you when I feel like this?"

So I think it's better than rather than saying "you" words . . . You guys already know this. "You do this, or you don't do this, or you are feeling this." It says, "This is the way I feel. And can we talk about it?"

I think it would be good if we had a long-term relationship based on the support of each other's feelings, not just our physical needs, or our financial needs, or our spiritual needs, or you name it. I'll go through all the 7 Domains without you guys even knowing it.

Troy: See, Dr. Jones, I want to take a moment here just to put this in perspective. Our most recent episode was on poop.

Dr. Jones: Yeah. And you know what? Your emotions can come right through with your poop, because people who are really anxious can get diarrhea.

Troy: I'm just saying this is hard even for me to think about it. So I am empathizing with any man out there right now who is listening to this and hearing you say these things and saying, "These are things we can say to our partners." This is a stretch. This is tough.

And I agree. I have definitely taken the approach of, for whatever reason, you kind of push emotions down. And it's hard to acknowledge those emotions in a partner and ask them to express those emotions. I think maybe we are afraid of what they're going to say, or we're afraid of being responsible for those emotions or triggering those, or whatever it might be. But yeah, this is a lot harder to talk about than poop. I'll say that.

Scot: So, Troy, question.

Troy: Yes.

Scot: Question for you, Troy. All those things that Dr. Jones just said, if that was coming from your spouse, would you, as a man, with your history, cringe a little bit? Would you be like, "Oh, boy, here we go. I don't know about this. This sounds pretty intense"?

Troy: I would cringe a bit. Yeah. I will say, honestly, I feel like . . . and maybe Laura will disagree. She'll listen to this and be like, "No, you haven't." I will feel like I've made progress there.

I think, like you said, Dr. Jones, the key to this is just acknowledging your own emotions. Often, I've really tried to acknowledge more, "Okay. When am I feeling anger? When am I feeling anxiety? And what's the root of that?" And a lot of times it gets down to, "Oh, I'm sad and it's coming across as anger," or, "I'm anxious. I've got a shift coming up in the ER and I'm feeling anxious about it. And that's coming across as, again, maybe as anger." It seems like a lot of these things come out in men as anger, and I've definitely felt that in myself.

Dr. Jones: They do.

Troy: But again, hearing you say those things, I think, for me, emotional availability has been trying to be more aware of my emotions, and often what the root of . . . Even what may seem the emotion, there's a deeper root to that. And then be willing to express that and talk about it. But it's hard.

Dr. Jones: It is, but the work is worthwhile. Maybe Mitch can even speak to this. It gives you a much broader palette with which to paint the tapestry of your life. When you have some words, some colors to explain the things that you've seen . . . You have a powerfully rich life, Troy, in what you've seen and how you deal with that, the words you use or how you color that, what an amazing life you would lead if you had a little bit of contact with those.

Mitch: And from my perspective to "man it up a little bit" is another tool in the toolbox, right? No, if you don't have the right socket, you can't fix a certain thing on your car.

And so, for me, I knew that I was not in a good place and it wasn't until I was able to actually recognize, discuss, and talk about, even to myself just in my head, the emotions I was feeling, there was no way for me to actually start to work to fix it.

And so if that's the very baseline of at least my . . . Yes, I'm living a more full life. Yes, yes, yes. I feel it every day. But for a part of me, not feeling like garbage all the time and being able to know that I'm taking active steps to fix it, and all it took was a bit of acknowledgement and a bit of vocabulary, has been night and day within the last year.

Dr. Jones: Yeah. Amazing.

Scot: Would you say that there are two aspects . . . I'm picking up two aspects of emotional availability. I think Troy has kind of hit on one, right, which is a man's ability to talk about what they're feeling, thinking, etc. But it's also a person's ability, whether a man or a woman, to be receptive to the emotions of another person. And we haven't really hit on that as much. How can somebody start to work on that?

Dr. Jones: Well, I think once you've learned . . . getting back to starting with yourself, if you can forgive yourself . . . When you say, "This emotional response is normal. It's natural. It's real. I'm an intact human person, and I forgive myself because I felt angry or sad or whatever," then when you realize that someone is feeling that way . . .

In fact, it's often not about you. I think you're afraid you're going to get the downstream effect if you recognize, or at least, "Gee, it looks like things are harder. I feel like you're having a hard day. What can I do for you?" And if they break down and cry, then just go put your arm around them. You don't have to do anything bigger than that for a start. And then if they unload all of it, just say, "I'm listening. I hear you." That may be all that it takes.

Scot: So instead of avoiding it and pretending that's not going on in your life, maybe just acknowledging it would be a good first step.

Dr. Jones: Or don't analyze it. "Boy, I got into trouble." "Oh, I see why you're so angry." "Boy, you could be angry because your dad did this and then your boss did that and you're feeling inadequate. Boy." No, that does not go well because that's all those "you" words. "You're feeling this and you're doing that."

Say, "Wow. I'm so sorry. Can I sit with you a little bit? Talk to me about it." Don't try to analyze. Let them use their words. Just let them know that you're seeing and you're hearing and you want to be there with them, whatever they're feeling. You're not going to run away from it.

Scot: Let's wrap this up. Troy, what did you take away from the episode and what's something that you're going to try based on what you learned today?

Troy: You're putting me on the spot, Scot.

Dr. Jones: Never, never, never do it.

Troy: I know there's someone is listening to this episode.

Mitch: Oh, no.

Scot: What does that somebody want to hear?

Troy: This is really putting me on the spot. That someone probably wants to hear that I will say exactly what Dr. Jones said. Number one, I will not say "you." I will not use a lot of "you" words, which I sometimes have a tendency to do, like say, "You seem angry," or, "You seem sad." And rephrasing that as . . . I wish I could remember exactly how you said it.

Scot: That would be helpful.

Troy: Yeah. "Something seems off." I will say it that way. I'll say, "Something seems off. Is there anything you want to talk about?" Maybe rephrasing things that way and being willing to say that, first of all, and then saying it the right way.

Scot: How about you, Mitch?

Mitch: I feel good that I'm kind of on a journey. I keep using that word. It's so overused. I'm just glad to know that the kind of work that I'm doing right now can lead to a more colorful, more interesting life, and recognize that, as an individual, I feel a lot more than just anger, right? And being able to recognize that, talk about that. I'm hoping that my relationships can be a lot stronger.

Dr. Jones: Yeah, and especially your relationship with yourself. The inner voices that you have that aren't always supportive, they're not always nice voices that you hear, and saying, "Wait a minute. That's not me. That's my inner voice that's saying, 'You're not good enough,' or you're this, that, or the other." Being able to forgive yourself for when you feel a certain way so that you can process and move ahead and take a deep breath. Take 10 deep breaths. It's just a lot easier. You will find yourself feeling better. Mitch, you put it better than I possibly could.

Scot: I think the thing I'm going to take away is I tend to ignore other people in my life, meaning when . . . I don't want to ask, "Hey, something doesn't quite seem right. You want to tell me about it?" because I'm afraid of what I'm going to hear, right? I'm not going to be able to deal with "I'm sad" or "I'm angry" or "I'm whatever." But I think I'm going to try to be brave, and I think I'm going to try to start acknowledging that and doing that and seeing how that works out for me.

Dr. Jones: Be brave. I think about that.

Troy: I like that. Yeah.

Dr. Scot: The firefighters who ran toward the burning building of 9/11. Be brave. Being available is being brave.

Scot: We'll do that, right? Men will run towards the danger like that. But if we think that somebody we care about is angry at us? Oh, man, we're not going to bring that up.

Troy: And I'm also going to say I will not tell whoever this individual is, who I happen to be speaking to, that I'm running toward the burning building on 9/11.

Mitch: Oh, no.

Dr. Jones: Don't do that.

Troy: That would not go over well, but it's a good analogy. We do have to be brave.

Scot: Well, Dr. Jones, I think this is a step in the right direction hopefully for any guy that wants to maybe become more in touch with their own emotions or be more supportive of the emotions of those in our lives. And sometimes our best lessons on the men's health podcast come from wise women such as yourself. So thank you for caring about men's health and being on the show with us today.

Dr. Jones: You're so welcome. It's been great.

Scot: Hey, congratulations. You made it this far. You even made it beyond the end. This is Scot from "Who Cares About Men's Health," and it just dawned on us that if the topic we talked about in this podcast is something that's important to you, and you'd like to perhaps get some emotional availability in your relationships, and you don't know how to have that conversation with your partner, use this podcast as a tool.

Tell them you heard it. Let them listen to it. That way you're starting from some sort of a common place. And then let the discussion go from there. So use this podcast as a tool and share with somebody in your life that you think could benefit from it.

All right. That's it. For real, we're gone this time. Thanks for listening. Thanks for caring about men's health.

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

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

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

Mitch: I don't know about nagging.

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

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

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

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

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

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

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

Dr. Pohl: Please do.

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

Dr. Pohl: They talk about it.

Scot: Yeah, that's right.

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

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

Troy: They'll tell you.

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

Mitch:Nice.

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

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

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

Troy: Yeah. Ten minutes.

Scot: That's also just insane. Congratulations.

Mitch:Wow.

Troy: Thanks, Scot.

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

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

Troy: Yeah.

Scot: Were you doing 4.5 miles an hour?

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

Scot: For 26 miles.

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

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

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

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

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

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

Mitch: Never in my life whole.

Scot: For any period of time.

Mitch: Zero. Zero time.

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

Mitch: For real?

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

Mitch:Oh my god.

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

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

Troy: Mitch does not think it's appropriate.

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

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

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

Troy: Maybe how firm it is, the consistency.

Scot: All right.

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

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

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

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

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

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

Scot: Wow.

Mitch:No.

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

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

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

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

Scot: Okay. Just describing it would be enough?

Dr. Pohl: Yes, that's fine.

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

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

Scot: I want to know if . . .

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

Scot: Yeah. Actually, hold on.

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

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

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

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

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

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

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

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

Troy: That's right. Bristol.

Scot: And it's from England, right?

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

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

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

Dr. Pohl: Kind of like Oktoberfest.

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

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

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

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

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

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

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

Dr. Pohl: Right.

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

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

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

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

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

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

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

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

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

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

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

Mitch: What?

Troy:Wow, every eight weeks?

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

Troy: Seriously.

Scot: That would be amazing.

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

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

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

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

Troy: And do you recommend fiber supplements as well?

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

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

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

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

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

Troy: I know all too well.

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

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

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

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

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

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

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

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

Dr. Pohl: Oh, absolutely.

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

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

Troy: Like taquitos?

Mitch: No. They're gas station food.

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

Mitch: I do know taquitos.

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

Troy: It's coming out.

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

Scot: Yeah, sure.

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

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

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

Dr. Pohl: Well, that is concerning.

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

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

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

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

Dr. Pohl: That needs to be checked out.

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

Scot: The untalked about epidemic of constipation.

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

Mitch: Oh my god.

Troy: That doesn't seem healthy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Troy: That's good to know.

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

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

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

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

Mitch: They're eating Takis like crazy.

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

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

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

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

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

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

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

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

Dr. Pohl: Probably. Yeah.

Scot: Do protein powders make it stinky?

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

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

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

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

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

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

Troy:Oh, that's too cool.

Mitch: Oh, no.

Troy:That's pretty cool.

Mitch: Why? Why would we do this?

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

Mitch: No.

Troy: I'm fascinated.

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

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

Mitch: No.

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

Mitch: No, it's perfect.

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

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

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

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

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

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

Dr. Pohl: I appreciate it.