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Dr. Galli: Most of us take for granted the things that we see as normal and expected. So hopefully, we've at least parked the thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from?

Scot: All right. Welcome to the podcast "Who Cares About Men's Health." What we've got here are some guys who care about their health, and they're not afraid to talk about it either. We get this bad rap. Guys don't care or want to talk about their health. That's not true, proving it right now.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I'm glad that for the first time in the history of this podcast I actually sound better than Scot on this, and I care about men's health.

Dr. Galli: And I am Dr. Nick Galli. I'm an associate professor at The U in the Department of Health and Kinesiology, and I care about men's health.

Scot: So today, we're going to talk about a force. It's a force that controls us as men, and a lot of us don't even know it, but it's this invisible force that impacts how we think about our health, our body, and it could be responsible for a lot of bad health decisions. It's reinforced in magazines, TV shows, movies, social media, and communities. We cannot get away from it. As a matter of fact, the World Health Organization thinks it's the reason why men tend to live six to eight years less than women, this invisible force. What is it?

Troy: Dark matter.

Scot: Kind of. It's the notion of what makes a man a man, the forces called masculinity. Nick is an expert in this topic. I actually did for my master's program a research paper on masculinity and men's health, and what I found was fascinating. I don't know about you guys, but I hate the thought that anybody or any force is controlling what I'm doing.

Troy: Especially if it's shortening our life by six to eight years. I had no idea. Wow.

Scot: Yeah. Isn't that crazy?

Troy: That's crazy.

Scot: So, before we get going, Nick, maybe you can give us a definition of what masculinity is, because it's not a real thing. It's what's called socially constructed. It's just something that we as people made up.

Dr. Galli: Yeah. Let's say it's sort of the set of attitudes, beliefs, behaviors that dictate how men should behave, what they should think, what they should value. And as you said, Scot, it's pervasive. We're primarily talking about Western cultures and even more primarily the U.S. It cuts across everything that we do.

Scot: So an example of this and how it might impact our health is somebody offers you a steak or a salad and you take the salad, what happens? What happens if you've got your guy friends around?

Dr. Galli: Well, of course, it depends, but yeah, you're going to get . . . I mean, when I think back to when I was sort of in the prime of . . . Because it changes, right? So, for me, when I was in my late teens and in my 20s and spending a lot of time with my guy friends, now you're immersed in that. And so, for sure, you'd get some looks.

I mean, even on that specific topic, I remember going out to lunch and dinner with my guy friends and it was almost, "How much fatty food can you eat?" Like, it was a challenge. Everything is a challenge in the world of masculinity. Everything is a competition, including how much you can eat.

Troy: Nick, I wonder how much of this is learned, how much of this is just the fact that as a man you've got testosterone and testosterone tends to lead men often maybe to be more risk-taking or maybe more competitive. I don't know. I mean, are there certain elements there versus . . .

Dr. Galli: I think there's a biological component, but that becomes accentuated for sure by messages that begin very early on.

Troy: And by masculinity then, are we talking about . . . again, is it the way we're interacting with others? Is it the expectation I have for myself? Is it just this idea that I can't show emotion? What is it about this that's kind of the core element of it? And getting to that, what is it about it that's so detrimental that's really shortening our lifespan?

Dr. Galli: Well, I think too, before we go much further on it, true experts and scholars in gender studies and masculinity would probably argue that there are multiple forms of masculinity. And the kind that we're talking about here today and that tends to be especially problematic is sort of that dominant, what we call a very . . . this is a very scholarly term . . . hegemonic masculinity. Hegemonic is just a fancy way to say dominant.

I think one of the tasks and one of the goals is to try to diversify. There's nothing inherently wrong with masculinity, femininity, but building in some flexibility into those concepts that there's not just one way to be masculine or one way to be feminine.

What's problematic about this dominant form that, as Scot alluded, seems detrimental to our health is that, yeah, we box ourselves in as men into a certain way of being, and that's fueled by things that we see and expectations that we hold of ourselves and that others hold of us. And really, what needs to happen, and this is maybe skipping ahead to more practical, is there needs to be a much more flexible conception of what it means to be a man in society.

Scot: And that's difficult, right? Because I bet you we could all tell our stories . . . I don't know. I can only speak for myself I guess, but I grew up in a ranch environment in western South Dakota and there was a certain kind of way that guys were supposed to be there, which is all just created in our own brains. There's nothing inherent about a lot of it. And I didn't fit in, right? I was a little bit more sensitive. I was a little bit more delicate. I wasn't a big muscular guy, right? I didn't like to ride bucking broncs and bulls and I didn't like to fight. So that made me less than.

Dr. Galli: Absolutely.

Scot: And I spent a lot of my life, and I still think about it to some extent, but not as much, trying to come to terms with, "Oh, I'm not a man. I don't look for a chance to . . ." Like, if somebody gets in my face, I don't get right back in their face. That's not how I choose to handle it. Maybe I choose to talk it out. That's not manly, right? That doesn't fit that masculine definition. So, for a long time I've . . . and especially then comparing myself to my dad who was all those things.

Dr. Galli: Well, thanks for sharing that, and I think that speaks to one of the earlier manifestations of how this can become problematic, is when we see young boys in school who maybe prefer different types of activities that aren't perceived as masculine or act in ways that aren't perceived as masculine, and then they can become the subject of bullying. We know well the consequences of bullying on mental emotional health.

Scot: And also just my own emotional health not living up to this ideal.

Dr. Galli: That you're not good enough. That you don't . . .

Scot: Exactly.

Dr. Galli: . . . meet that standard. I relate. I mean, where I grew up in a mid-sized city in central California, at my high school, for the boys, there were sort of two ways to be popular: one if you were a tough guy and/or two, if you were good at sports, and physical sports particularly, so football or the mainstream sports. If you couldn't check either of those boxes, you were sort of on the fringes of popularity or of acceptance.

Troy: Scot, it's interesting to hear you talk about that because I think I too . . . I mean, I didn't grow up in a ranching community. I grew up in a coal mining community, a small town. And as a skinny nerdy kid, middle school was miserable. I got beaten up. Not just bullied, but physically beaten up by kids in school and it was awful.

Scot: Wow.

Troy: And that kind of stuff sticks with you. I think probably over my entire life that element or that definition of masculinity, that's probably affected me.

And it's funny. I think back to two years ago, Scot, when you approached me and said, "I want to do a men's health podcast. Will you co-host with me?" It was like this sense of this imposter syndrome, like, "Who am I to talk about men's health? I am not a manly man."

And obviously, as we do this podcast, you realize that masculinity or that sense of the manly man, that's not who most men are. I don't think that's really who most men are. I think, like you said, Nick, that's the image that's out there and that's what we feel we should be. But you look at the men you know in your life and the men work with, most men are not that way.

Dr. Galli: If we were to all Google "men's health" right now, what would come up is probably very different than the things that we're discussing today. I mean, there's even a magazine called "Men's Health," and what do you get in that magazine? You get chiseled muscular bodies, very much an aesthetic and physical version of what health is.

Scot: Yeah. And not only that, but you get these attitudes of a man in "Men's Health" is great in the bed and takes care of his woman, and just all of these images and these thoughts that . . .

Troy: Well, not just takes care of his woman, takes care of multiple women. If you read "Men's Health" magazine, it's like . . . yeah, that's been my image of men's health is "Men's Health magazine. How often do you see a thin guy on the cover of "Men's Health" magazine? It's usually dudes who are just totally ripped and built and just these massive dudes.

And all the articles there, it's about that. It's about living a lifestyle. Not all of them, but a lot of them have to do with maximizing that lifestyle, live hard/play hard, work hard/play hard lifestyle, and a certain element of sexual prowess or whatever else some of these articles . . . and so it's a . . .

Dr. Galli: This makes the battle even harder, right? Because now we have sort of the big media hijacking the concept of men's health. Not just masculinity, but men's health, and selling it to the masses.

Scot: Yeah, it's that either/or, right? So it doesn't leave you any in between. It's either you're working out and you're doing high intensity exercise and you're eating just perfectly, or if you can't live up to that ideal, which sometimes I think I can't do that. So then it's just like, "Well, why even bother if that's not what I'm going to get?" So I think it's a little dangerous that way as well.

Troy: For sure.

Scot: Hey, Nick, I want to share another little aspect and then I want to kind of steer the transition of the conversation into how maybe each one of us can claim our own form of masculinity, because I think ultimately that's what we should be able to do.

So I can't speak for Troy, but I wasn't very confident and I lacked confidence for a long time in my life because I didn't fulfill this ideal of masculinity. And that can lead to mental health issues. That can lead to feelings of inadequacy. But I have noticed, too, that there are some men that are very confident in themselves and they might not fulfill that norm of hegemonic masculinity, but yet they create their own, right? To some extent, showing control and restraint in not doing all those dangerous behaviors can be a form of masculinity.

How exactly does that work and what are your thoughts on developing your own version of it? And then how are you confident in that version as you interact with the rest of the world?

Dr. Galli: That's a big question.

Scot: Hey, listen, I gave you a little bit of warm-up to get to this point. So I figure you should have all the answers by now.

Dr. Galli: Okay. There's not going to be a simple answer to this, but there are forces at play. I think two of them come to mind, as I think about folks who are sort of able to transcend what we've been talking about here.

One is just time and maturity. The young adult males are the ones who are kind of most at risk I would say for really trying to live this ideal that can be dangerous. As we get older, we care less about what other people think, we have different priorities, and so it becomes easier as we get into more middle adulthood to just sort of be our own person and not give a crap about what people say I should be. Now, that said, there are definitely some people who struggle with that. So I think time and normal development is an asset.

And then I think another asset that some folks have are support of influence and people in their family who are just unconditionally okay with a boy being how they want to be, and for that matter, a girl being how they want to be. Of course, there are forces outside the family, but that primary family tends to be the most powerful force for a lot of kids. And I think that goes a long way.

And as a young boy, if you want to play with Barbie dolls, that's fine. If you want to watch "My Little Pony," that's fine, or whatever. That's what it was when I was a kid growing up.

I think it seems very subtle, but when you are surrounded by folks who are just okay with you being you and not making snide comments or forcing you to be something that you don't want to be, then I think that allows for the possibility of just, as you said Scot, being comfortable in your own skin, even if that doesn't align with what you're seeing of other boys and men.

Troy: And I guess though, Nick, as we talk about this . . . I mean, certainly there are some elements of masculinity that are valuable, but at what point do you feel like that truly becomes toxic? We talk about masculinity or toxic masculinity. When does that sort of thing become toxic? And are we talking toxic to others, toxic to ourselves? How does that play into it?

Dr. Galli: Yeah, I think both. I mean, any time that somebody has fully internalized . . . I think of heavy drinking, womanizing, or having multiple partners and not exhibiting safe and thoughtful sex behaviors, over-imbibing in alcohol, drug use, steroid use, not going to see the doctor on at least a yearly basis because "I'm invincible." I mean, I think it's all about the behaviors, and underlying that is the thought that, "I am impervious to a lot of these issues, and also I don't need to talk about what's bothering me because that would suggest weakness."

And going back to something you said there, Troy, too about some of the advantages, I do think there are advantages, and in many ways I think our society is set up to favor and advantage men who do exhibit these dominant traits. So it's reinforcing, right?

Look at who we see as CEOs and in leadership positions. And that's starting to change, but it tends to be men. And there are some positive characteristics for sure. There are also positive characteristics of . . . and I keep pointing to femininity as sort of the other side of the coin here. Things that we associate with femininity that are also very positive, such as compassion and having a nurturing side, sort of those stereotypical feminine qualities, that many men feel like, "Well, that's not what I'm supposed to do." So they deny themselves the opportunity to explore that side of who they can be.

But in many ways our society is set up to really favor folks who exhibit these dominant alpha male qualities.

Troy: And it seems that in terms of just where masculinity truly becomes detrimental, it may be that it's that masculinity at the point where we really try and push away any sort of feminine qualities within ourselves, any sense of nurturing, any sense of emotion, those kind of things and . . .

Dr. Galli: Except for anger. Anger is okay. Anger is okay for a man.

Troy: It's okay for a man.

Scot: I think that's the only emotion, isn't it?

Dr. Galli: When a woman is angry, oh, there's something wrong. It's so true, right?

Troy: Yeah, but it seems though that that often . . . as I'm hearing you talk about this and talk about these different elements, it seems that when masculinity really becomes an issue and a problem, it is when we, like you said, take that masculinity to the extreme in terms of risk-taking, detrimental behaviors, in terms of how we treat others and interact with others, and then we push aside anything that would be associated with that feminine element, again the nurturing, the caretaking, all those sorts of things.

Scot, as you talked about, the years lost on our life, I would imagine that those are the things that really caused those years to drop off when we are pushing aside our ability to feel emotion and ability to care, and nurture, and those sorts of things, and then add on to that the risk-taking behavior and everything else there. That seems like that combination is what is truly toxic and what really hurts us.

Scot: As we wrap this up, here are a couple of my takeaways, Nick, and I'd love to hear yours as well. So I think the goal of this particular episode is just for those that weren't aware that this is an invisible force in one's life that is actually impacting your decisions or how you feel about yourself, just to become aware that it's out there and it's a thing. I think, obviously, awareness is the first thing.

And then I think developing your own definition of what you are as a person. Maybe just abandon the notion of men and women. What are you as a person? And I'm guessing that the super toxic masculinity individuals have dropped off this episode way before this point. So we're not talking to them necessarily.

Dr. Galli: But we could be talking to parents of children who have a role in shaping them.

Scot: Yeah. I mean, the way you shape them could either empower them to go out and accomplish great things, and feel good about themselves, and be mentally well off, or it can burden them if we're forcing those types of things, I suppose, on kids.

So I think becoming aware and I think realizing that it's okay to be you. I tend to be more sensitive, I tend to be more thoughtful, I don't react and come to anger as quickly as maybe some men, I don't believe in fighting. That's okay. That's my outlook on life, and that's fine.

Troy: Have you ever been in a fight, Scot? I'm just curious.

Scot: Actually, I never have, believe it or not.

Troy: Like a physical fistfight? Not even in elementary school?

Scot: No. I was a "doorman" at a bar for a couple years, and I never got in a fight.

Troy: You were a bouncer.

Scot: I know, right?

Dr. Galli: A bouncer. Yeah.

Troy: Scot is like the world's worst bouncer.

Scot: Actually, I wasn't.

Troy: He's like, "It's all right, guys. Let's talk this out."

Dr. Galli: He's actually willing to talk and . . .

Troy: I know. I was just joking. Yeah, you're totally breaking the mold of the bouncer. You're like the negotiator. I love it. That's great.

Scot: Nick, any final thoughts or takeaways from this episode? What do you hope that it accomplished today?

Dr. Galli: Oh, yeah. Raising awareness primarily. I talk about internalizing, and I think most of us take for granted the things that we see as normal and expected. So hopefully, we've at least sparked a thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from? Maybe more men or women willing to have conversations, like we just did right now, about these topics.

Troy: Obviously, we say, "Be yourself." Sometimes that's hard because it's like, "Well, yeah, but there are different elements of myself." I think it's be your best self. There are elements of masculinity that are, I think, good.

Scot: Yeah, but it's also tough to sometimes be yourself if you're not in the environment. There's no way as a young man I would have been able to buck the trend, I don't think, of what was expected of me. I don't know. Maybe there could have been had I been more confident.

Troy: Still.

Scot: You've just got to try the best you can.

Troy: Yeah, embrace the best of these things and don't . . . I think that's it, too. Again, getting to that thing about, "Well, these things are associated with femininity in terms of emotion and caretaking and all that," but if that's part of you, embrace it. Embrace that and just . . .

I think one takeaway too, like I said, Scot, is just that most men are not that stereotypical man. I think that's been one thing that's come to me in terms of this podcast as we talk to so many experts. It's just opened my eyes and I look at the people I work with, and the patients I see, and all these things. Most men are not the stereotypical manly man that we sometimes think we should be, and that's not the norm. Maybe what's held out there is what we should become, but that's not what most men are.

Scot: And there's a certain strength . . . I guess if I was to give advice to young Scot, like how you could still be yourself and be in an environment where there's a different definition of masculinity, I think . . . and I could be completely full of crap and might get the crap kicked out of me. I think there's a certain strength in knowing who you are and owning that and making no apologies for it.

I think you can stand up to people, most people. I mean, there are going to be outliers, like anything, but I think there's a certain strength in that. And I think if you do it enough and you're resolved enough, that can help.

Nick, what do you think? Am I completely crazy?

Nick: I think for the most vulnerable people, which is kids and adolescents, they need support from parents, from teachers, from church leaders, because . . . I mean, when you're 8, 10, 12, 14 years old, we could be delivering this message to them all day, "Love who we are, own it, be okay with it," but they need to see more than that. And they need role models who they can look up to, who are confident, but also caring, but also strong, but also compassionate. They need to see that, I think, to really buy in.

Troy: Yeah. And it's a lot easier as an adult I think to do that than as a kid with the perils of just the peer groups and all that. That's a tough place to be.

Scot: Yeah. As an adult, you to some extent can choose where you go. As a kid, you can't. You have to go to this place called school and everybody's thrown in there, and it's just a big old free-for-all. But I can avoid the type of people I want to avoid in my work life.

Troy: Yeah. It's a lot easier, but for those listening who you're an adult, you can embrace that. And if you're in a work . . . because there are certain work environments where I think it's difficult. I think certain work environments it may be difficult to truly be who you are, and maybe certain co-workers, but you can always find a new job or even switch professions, or all those sorts of things.

I think it's a lot easier as an adult, but I think that's probably the point, is to really embrace that, embrace who you are, and not feel like you have to fit a certain mold that's held out there.

Scot: Yep. Realize that masculinity is a thing. It's not a real thing. It's just created by all of us in society that have come to these assumptions, and these assumptions can be challenged, and you can define your own way.

One of the things I love that you said, Nick, is question why we call things normal. I think that can even go beyond this notion of masculinity. Why is this considered normal? Do I subscribe to this thought that this is normal? What are my thoughts on it? When you start asking those questions, I think you can start really kind of building your own confidence and go in your own way.

Nick, thank you very much for this conversation. Appreciate it as always for being on the podcast, and thanks for caring about men's health.

Dr. Galli: Absolutely. Thanks for having me.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or maybe it's just a random thought that's kicking around in our brain that we need to let free. Troy, do you have any random thoughts you need to set free?

Troy: Totally random thought, Scot. I am . . . and you probably are too. But I'm kind of a grammar nerd. So this is a grammar issue that has really bothered me and I've got to get your insight on this. So if I sent you a text message yesterday, how would you say that phrase? "I text you yesterday" or "I texted you yesterday"?

Scot: The thing that feels natural and normal is "I texted you yesterday."

Troy: I know. Me too. I mean, text has become a verb. It's a noun. A text is a noun. It's become a verb. In our daily usage it's become a verb. But people say "text" all the time, like, "Oh, I text you last week," "Oh, I text you yesterday," "Oh, I text . . ." And they're not saying texted, they're just saying text. I looked this up. I'm like, "What's the proper use of the verb text if I sent you a text yesterday, if I texted you?" And there is no proper use because it's just this noun we've turned into a verb, and we're all just using it. Some people are saying, "I texted you," and some people are saying, "I text you." Probably the best way to say it is, "I sent you a text message yesterday."

Scot: Yeah. I mean, if it's a noun, that's how you would say it.

Troy: Yeah, be on the lookout. Now it's going to start driving you crazy. You're going to hear people saying it all the time, like, "Oh, I text you this picture," or, "I text you this whatever." And you're like, "Text me right now, or you texted it two hours ago?"

Scot: I'm just going to leave this here. Thunder Jalili, our nutrition expert, has talked a couple times about time-restricted eating. So there's a lot of confusion when it comes to fasting because it can mean a lot of different things, but time-restricted eating is just taking the time that you allow yourself to eat during the day and keeping it limited to 12 hours or 10 hours or 8 hours so then you have a fast between then and when you eat again.

I started doing this when COVID first started, just before COVID first started. I've actually loved it. I felt great. I felt clear in my brain. I slept better. So I've started doing that again after Thunder came on, and it's only taken a couple days and already I feel so good.

Troy: Oh, nice.

Scot: So if you've ever considered time-restricted eating, there's also a documentary out there I just watched. I'm going to say right now that this documentary probably only needed to be about 40 minutes long, and it's an hour and a half. So you can just fast forward through the stuff you're not interested in.

Troy: One of those. I've seen too many of those documentaries.

Scot: Right? But it's called "Fasting" and it's on Netflix.

Troy: Nice.

Scot: First of all, go back and listen to some of our Thunder episodes. But if you're interested in time-restricted eating and fasting in general and why it works, you might want to check out that Netflix documentary.

Troy: So what are you restricting yourself to? Ten hours or 12 hours? What's your . . .

Scot: Yep. I've started it at 12, and I'm going to see how that goes. Now, Thunder has said that's a good maintenance kind of timeframe. And then in a couple of weeks I think I'm going to move to 10 or 8 because I have some body fat that I'd like to lose. So I decided to start with 12 because I thought that was doable, and then I'm going to try to get it 10 or 8. That's the plan.

Troy: Nice. That's great.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55-SCOPE. That's 601-55-SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This is a transcript for the main segment of the show. You can read it if you like, but we encourage you to subscribe and listen for the full experience. It's more fun that way.

Dr. Galli: Most of us take for granted the things that we see as normal and expected. So hopefully, we've at least parked the thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from?

Scot: All right. Welcome to the podcast "Who Cares About Men's Health." What we've got here are some guys who care about their health, and they're not afraid to talk about it either. We get this bad rap. Guys don't care or want to talk about their health. That's not true, proving it right now.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I'm glad that for the first time in the history of this podcast I actually sound better than Scot on this, and I care about men's health.

Dr. Galli: And I am Dr. Nick Galli. I'm an associate professor at The U in the Department of Health and Kinesiology, and I care about men's health.

Scot: So today, we're going to talk about a force. It's a force that controls us as men, and a lot of us don't even know it, but it's this invisible force that impacts how we think about our health, our body, and it could be responsible for a lot of bad health decisions. It's reinforced in magazines, TV shows, movies, social media, and communities. We cannot get away from it. As a matter of fact, the World Health Organization thinks it's the reason why men tend to live six to eight years less than women, this invisible force. What is it?

Troy: Dark matter.

Scot: Kind of. It's the notion of what makes a man a man, the forces called masculinity. Nick is an expert in this topic. I actually did for my master's program a research paper on masculinity and men's health, and what I found was fascinating. I don't know about you guys, but I hate the thought that anybody or any force is controlling what I'm doing.

Troy: Especially if it's shortening our life by six to eight years. I had no idea. Wow.

Scot: Yeah. Isn't that crazy?

Troy: That's crazy.

Scot: So, before we get going, Nick, maybe you can give us a definition of what masculinity is, because it's not a real thing. It's what's called socially constructed. It's just something that we as people made up.

Dr. Galli: Yeah. Let's say it's sort of the set of attitudes, beliefs, behaviors that dictate how men should behave, what they should think, what they should value. And as you said, Scot, it's pervasive. We're primarily talking about Western cultures and even more primarily the U.S. It cuts across everything that we do.

Scot: So an example of this and how it might impact our health is somebody offers you a steak or a salad and you take the salad, what happens? What happens if you've got your guy friends around?

Dr. Galli: Well, of course, it depends, but yeah, you're going to get . . . I mean, when I think back to when I was sort of in the prime of . . . Because it changes, right? So, for me, when I was in my late teens and in my 20s and spending a lot of time with my guy friends, now you're immersed in that. And so, for sure, you'd get some looks.

I mean, even on that specific topic, I remember going out to lunch and dinner with my guy friends and it was almost, "How much fatty food can you eat?" Like, it was a challenge. Everything is a challenge in the world of masculinity. Everything is a competition, including how much you can eat.

Troy: Nick, I wonder how much of this is learned, how much of this is just the fact that as a man you've got testosterone and testosterone tends to lead men often maybe to be more risk-taking or maybe more competitive. I don't know. I mean, are there certain elements there versus . . .

Dr. Galli: I think there's a biological component, but that becomes accentuated for sure by messages that begin very early on.

Troy: And by masculinity then, are we talking about . . . again, is it the way we're interacting with others? Is it the expectation I have for myself? Is it just this idea that I can't show emotion? What is it about this that's kind of the core element of it? And getting to that, what is it about it that's so detrimental that's really shortening our lifespan?

Dr. Galli: Well, I think too, before we go much further on it, true experts and scholars in gender studies and masculinity would probably argue that there are multiple forms of masculinity. And the kind that we're talking about here today and that tends to be especially problematic is sort of that dominant, what we call a very . . . this is a very scholarly term . . . hegemonic masculinity. Hegemonic is just a fancy way to say dominant.

I think one of the tasks and one of the goals is to try to diversify. There's nothing inherently wrong with masculinity, femininity, but building in some flexibility into those concepts that there's not just one way to be masculine or one way to be feminine.

What's problematic about this dominant form that, as Scot alluded, seems detrimental to our health is that, yeah, we box ourselves in as men into a certain way of being, and that's fueled by things that we see and expectations that we hold of ourselves and that others hold of us. And really, what needs to happen, and this is maybe skipping ahead to more practical, is there needs to be a much more flexible conception of what it means to be a man in society.

Scot: And that's difficult, right? Because I bet you we could all tell our stories . . . I don't know. I can only speak for myself I guess, but I grew up in a ranch environment in western South Dakota and there was a certain kind of way that guys were supposed to be there, which is all just created in our own brains. There's nothing inherent about a lot of it. And I didn't fit in, right? I was a little bit more sensitive. I was a little bit more delicate. I wasn't a big muscular guy, right? I didn't like to ride bucking broncs and bulls and I didn't like to fight. So that made me less than.

Dr. Galli: Absolutely.

Scot: And I spent a lot of my life, and I still think about it to some extent, but not as much, trying to come to terms with, "Oh, I'm not a man. I don't look for a chance to . . ." Like, if somebody gets in my face, I don't get right back in their face. That's not how I choose to handle it. Maybe I choose to talk it out. That's not manly, right? That doesn't fit that masculine definition. So, for a long time I've . . . and especially then comparing myself to my dad who was all those things.

Dr. Galli: Well, thanks for sharing that, and I think that speaks to one of the earlier manifestations of how this can become problematic, is when we see young boys in school who maybe prefer different types of activities that aren't perceived as masculine or act in ways that aren't perceived as masculine, and then they can become the subject of bullying. We know well the consequences of bullying on mental emotional health.

Scot: And also just my own emotional health not living up to this ideal.

Dr. Galli: That you're not good enough. That you don't . . .

Scot: Exactly.

Dr. Galli: . . . meet that standard. I relate. I mean, where I grew up in a mid-sized city in central California, at my high school, for the boys, there were sort of two ways to be popular: one if you were a tough guy and/or two, if you were good at sports, and physical sports particularly, so football or the mainstream sports. If you couldn't check either of those boxes, you were sort of on the fringes of popularity or of acceptance.

Troy: Scot, it's interesting to hear you talk about that because I think I too . . . I mean, I didn't grow up in a ranching community. I grew up in a coal mining community, a small town. And as a skinny nerdy kid, middle school was miserable. I got beaten up. Not just bullied, but physically beaten up by kids in school and it was awful.

Scot: Wow.

Troy: And that kind of stuff sticks with you. I think probably over my entire life that element or that definition of masculinity, that's probably affected me.

And it's funny. I think back to two years ago, Scot, when you approached me and said, "I want to do a men's health podcast. Will you co-host with me?" It was like this sense of this imposter syndrome, like, "Who am I to talk about men's health? I am not a manly man."

And obviously, as we do this podcast, you realize that masculinity or that sense of the manly man, that's not who most men are. I don't think that's really who most men are. I think, like you said, Nick, that's the image that's out there and that's what we feel we should be. But you look at the men you know in your life and the men work with, most men are not that way.

Dr. Galli: If we were to all Google "men's health" right now, what would come up is probably very different than the things that we're discussing today. I mean, there's even a magazine called "Men's Health," and what do you get in that magazine? You get chiseled muscular bodies, very much an aesthetic and physical version of what health is.

Scot: Yeah. And not only that, but you get these attitudes of a man in "Men's Health" is great in the bed and takes care of his woman, and just all of these images and these thoughts that . . .

Troy: Well, not just takes care of his woman, takes care of multiple women. If you read "Men's Health" magazine, it's like . . . yeah, that's been my image of men's health is "Men's Health magazine. How often do you see a thin guy on the cover of "Men's Health" magazine? It's usually dudes who are just totally ripped and built and just these massive dudes.

And all the articles there, it's about that. It's about living a lifestyle. Not all of them, but a lot of them have to do with maximizing that lifestyle, live hard/play hard, work hard/play hard lifestyle, and a certain element of sexual prowess or whatever else some of these articles . . . and so it's a . . .

Dr. Galli: This makes the battle even harder, right? Because now we have sort of the big media hijacking the concept of men's health. Not just masculinity, but men's health, and selling it to the masses.

Scot: Yeah, it's that either/or, right? So it doesn't leave you any in between. It's either you're working out and you're doing high intensity exercise and you're eating just perfectly, or if you can't live up to that ideal, which sometimes I think I can't do that. So then it's just like, "Well, why even bother if that's not what I'm going to get?" So I think it's a little dangerous that way as well.

Troy: For sure.

Scot: Hey, Nick, I want to share another little aspect and then I want to kind of steer the transition of the conversation into how maybe each one of us can claim our own form of masculinity, because I think ultimately that's what we should be able to do.

So I can't speak for Troy, but I wasn't very confident and I lacked confidence for a long time in my life because I didn't fulfill this ideal of masculinity. And that can lead to mental health issues. That can lead to feelings of inadequacy. But I have noticed, too, that there are some men that are very confident in themselves and they might not fulfill that norm of hegemonic masculinity, but yet they create their own, right? To some extent, showing control and restraint in not doing all those dangerous behaviors can be a form of masculinity.

How exactly does that work and what are your thoughts on developing your own version of it? And then how are you confident in that version as you interact with the rest of the world?

Dr. Galli: That's a big question.

Scot: Hey, listen, I gave you a little bit of warm-up to get to this point. So I figure you should have all the answers by now.

Dr. Galli: Okay. There's not going to be a simple answer to this, but there are forces at play. I think two of them come to mind, as I think about folks who are sort of able to transcend what we've been talking about here.

One is just time and maturity. The young adult males are the ones who are kind of most at risk I would say for really trying to live this ideal that can be dangerous. As we get older, we care less about what other people think, we have different priorities, and so it becomes easier as we get into more middle adulthood to just sort of be our own person and not give a crap about what people say I should be. Now, that said, there are definitely some people who struggle with that. So I think time and normal development is an asset.

And then I think another asset that some folks have are support of influence and people in their family who are just unconditionally okay with a boy being how they want to be, and for that matter, a girl being how they want to be. Of course, there are forces outside the family, but that primary family tends to be the most powerful force for a lot of kids. And I think that goes a long way.

And as a young boy, if you want to play with Barbie dolls, that's fine. If you want to watch "My Little Pony," that's fine, or whatever. That's what it was when I was a kid growing up.

I think it seems very subtle, but when you are surrounded by folks who are just okay with you being you and not making snide comments or forcing you to be something that you don't want to be, then I think that allows for the possibility of just, as you said Scot, being comfortable in your own skin, even if that doesn't align with what you're seeing of other boys and men.

Troy: And I guess though, Nick, as we talk about this . . . I mean, certainly there are some elements of masculinity that are valuable, but at what point do you feel like that truly becomes toxic? We talk about masculinity or toxic masculinity. When does that sort of thing become toxic? And are we talking toxic to others, toxic to ourselves? How does that play into it?

Dr. Galli: Yeah, I think both. I mean, any time that somebody has fully internalized . . . I think of heavy drinking, womanizing, or having multiple partners and not exhibiting safe and thoughtful sex behaviors, over-imbibing in alcohol, drug use, steroid use, not going to see the doctor on at least a yearly basis because "I'm invincible." I mean, I think it's all about the behaviors, and underlying that is the thought that, "I am impervious to a lot of these issues, and also I don't need to talk about what's bothering me because that would suggest weakness."

And going back to something you said there, Troy, too about some of the advantages, I do think there are advantages, and in many ways I think our society is set up to favor and advantage men who do exhibit these dominant traits. So it's reinforcing, right?

Look at who we see as CEOs and in leadership positions. And that's starting to change, but it tends to be men. And there are some positive characteristics for sure. There are also positive characteristics of . . . and I keep pointing to femininity as sort of the other side of the coin here. Things that we associate with femininity that are also very positive, such as compassion and having a nurturing side, sort of those stereotypical feminine qualities, that many men feel like, "Well, that's not what I'm supposed to do." So they deny themselves the opportunity to explore that side of who they can be.

But in many ways our society is set up to really favor folks who exhibit these dominant alpha male qualities.

Troy: And it seems that in terms of just where masculinity truly becomes detrimental, it may be that it's that masculinity at the point where we really try and push away any sort of feminine qualities within ourselves, any sense of nurturing, any sense of emotion, those kind of things and . . .

Dr. Galli: Except for anger. Anger is okay. Anger is okay for a man.

Troy: It's okay for a man.

Scot: I think that's the only emotion, isn't it?

Dr. Galli: When a woman is angry, oh, there's something wrong. It's so true, right?

Troy: Yeah, but it seems though that that often . . . as I'm hearing you talk about this and talk about these different elements, it seems that when masculinity really becomes an issue and a problem, it is when we, like you said, take that masculinity to the extreme in terms of risk-taking, detrimental behaviors, in terms of how we treat others and interact with others, and then we push aside anything that would be associated with that feminine element, again the nurturing, the caretaking, all those sorts of things.

Scot, as you talked about, the years lost on our life, I would imagine that those are the things that really caused those years to drop off when we are pushing aside our ability to feel emotion and ability to care, and nurture, and those sorts of things, and then add on to that the risk-taking behavior and everything else there. That seems like that combination is what is truly toxic and what really hurts us.

Scot: As we wrap this up, here are a couple of my takeaways, Nick, and I'd love to hear yours as well. So I think the goal of this particular episode is just for those that weren't aware that this is an invisible force in one's life that is actually impacting your decisions or how you feel about yourself, just to become aware that it's out there and it's a thing. I think, obviously, awareness is the first thing.

And then I think developing your own definition of what you are as a person. Maybe just abandon the notion of men and women. What are you as a person? And I'm guessing that the super toxic masculinity individuals have dropped off this episode way before this point. So we're not talking to them necessarily.

Dr. Galli: But we could be talking to parents of children who have a role in shaping them.

Scot: Yeah. I mean, the way you shape them could either empower them to go out and accomplish great things, and feel good about themselves, and be mentally well off, or it can burden them if we're forcing those types of things, I suppose, on kids.

So I think becoming aware and I think realizing that it's okay to be you. I tend to be more sensitive, I tend to be more thoughtful, I don't react and come to anger as quickly as maybe some men, I don't believe in fighting. That's okay. That's my outlook on life, and that's fine.

Troy: Have you ever been in a fight, Scot? I'm just curious.

Scot: Actually, I never have, believe it or not.

Troy: Like a physical fistfight? Not even in elementary school?

Scot: No. I was a "doorman" at a bar for a couple years, and I never got in a fight.

Troy: You were a bouncer.

Scot: I know, right?

Dr. Galli: A bouncer. Yeah.

Troy: Scot is like the world's worst bouncer.

Scot: Actually, I wasn't.

Troy: He's like, "It's all right, guys. Let's talk this out."

Dr. Galli: He's actually willing to talk and . . .

Troy: I know. I was just joking. Yeah, you're totally breaking the mold of the bouncer. You're like the negotiator. I love it. That's great.

Scot: Nick, any final thoughts or takeaways from this episode? What do you hope that it accomplished today?

Dr. Galli: Oh, yeah. Raising awareness primarily. I talk about internalizing, and I think most of us take for granted the things that we see as normal and expected. So hopefully, we've at least sparked a thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from? Maybe more men or women willing to have conversations, like we just did right now, about these topics.

Troy: Obviously, we say, "Be yourself." Sometimes that's hard because it's like, "Well, yeah, but there are different elements of myself." I think it's be your best self. There are elements of masculinity that are, I think, good.

Scot: Yeah, but it's also tough to sometimes be yourself if you're not in the environment. There's no way as a young man I would have been able to buck the trend, I don't think, of what was expected of me. I don't know. Maybe there could have been had I been more confident.

Troy: Still.

Scot: You've just got to try the best you can.

Troy: Yeah, embrace the best of these things and don't . . . I think that's it, too. Again, getting to that thing about, "Well, these things are associated with femininity in terms of emotion and caretaking and all that," but if that's part of you, embrace it. Embrace that and just . . .

I think one takeaway too, like I said, Scot, is just that most men are not that stereotypical man. I think that's been one thing that's come to me in terms of this podcast as we talk to so many experts. It's just opened my eyes and I look at the people I work with, and the patients I see, and all these things. Most men are not the stereotypical manly man that we sometimes think we should be, and that's not the norm. Maybe what's held out there is what we should become, but that's not what most men are.

Scot: And there's a certain strength . . . I guess if I was to give advice to young Scot, like how you could still be yourself and be in an environment where there's a different definition of masculinity, I think . . . and I could be completely full of crap and might get the crap kicked out of me. I think there's a certain strength in knowing who you are and owning that and making no apologies for it.

I think you can stand up to people, most people. I mean, there are going to be outliers, like anything, but I think there's a certain strength in that. And I think if you do it enough and you're resolved enough, that can help.

Nick, what do you think? Am I completely crazy?

Nick: I think for the most vulnerable people, which is kids and adolescents, they need support from parents, from teachers, from church leaders, because . . . I mean, when you're 8, 10, 12, 14 years old, we could be delivering this message to them all day, "Love who we are, own it, be okay with it," but they need to see more than that. And they need role models who they can look up to, who are confident, but also caring, but also strong, but also compassionate. They need to see that, I think, to really buy in.

Troy: Yeah. And it's a lot easier as an adult I think to do that than as a kid with the perils of just the peer groups and all that. That's a tough place to be.

Scot: Yeah. As an adult, you to some extent can choose where you go. As a kid, you can't. You have to go to this place called school and everybody's thrown in there, and it's just a big old free-for-all. But I can avoid the type of people I want to avoid in my work life.

Troy: Yeah. It's a lot easier, but for those listening who you're an adult, you can embrace that. And if you're in a work . . . because there are certain work environments where I think it's difficult. I think certain work environments it may be difficult to truly be who you are, and maybe certain co-workers, but you can always find a new job or even switch professions, or all those sorts of things.

I think it's a lot easier as an adult, but I think that's probably the point, is to really embrace that, embrace who you are, and not feel like you have to fit a certain mold that's held out there.

Scot: Yep. Realize that masculinity is a thing. It's not a real thing. It's just created by all of us in society that have come to these assumptions, and these assumptions can be challenged, and you can define your own way.

One of the things I love that you said, Nick, is question why we call things normal. I think that can even go beyond this notion of masculinity. Why is this considered normal? Do I subscribe to this thought that this is normal? What are my thoughts on it? When you start asking those questions, I think you can start really kind of building your own confidence and go in your own way.

Nick, thank you very much for this conversation. Appreciate it as always for being on the podcast, and thanks for caring about men's health.

Dr. Galli: Absolutely. Thanks for having me.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or maybe it's just a random thought that's kicking around in our brain that we need to let free. Troy, do you have any random thoughts you need to set free?

Troy: Totally random thought, Scot. I am . . . and you probably are too. But I'm kind of a grammar nerd. So this is a grammar issue that has really bothered me and I've got to get your insight on this. So if I sent you a text message yesterday, how would you say that phrase? "I text you yesterday" or "I texted you yesterday"?

Scot: The thing that feels natural and normal is "I texted you yesterday."

Troy: I know. Me too. I mean, text has become a verb. It's a noun. A text is a noun. It's become a verb. In our daily usage it's become a verb. But people say "text" all the time, like, "Oh, I text you last week," "Oh, I text you yesterday," "Oh, I text . . ." And they're not saying texted, they're just saying text. I looked this up. I'm like, "What's the proper use of the verb text if I sent you a text yesterday, if I texted you?" And there is no proper use because it's just this noun we've turned into a verb, and we're all just using it. Some people are saying, "I texted you," and some people are saying, "I text you." Probably the best way to say it is, "I sent you a text message yesterday."

Scot: Yeah. I mean, if it's a noun, that's how you would say it.

Troy: Yeah, be on the lookout. Now it's going to start driving you crazy. You're going to hear people saying it all the time, like, "Oh, I text you this picture," or, "I text you this whatever." And you're like, "Text me right now, or you texted it two hours ago?"

Scot: I'm just going to leave this here. Thunder Jalili, our nutrition expert, has talked a couple times about time-restricted eating. So there's a lot of confusion when it comes to fasting because it can mean a lot of different things, but time-restricted eating is just taking the time that you allow yourself to eat during the day and keeping it limited to 12 hours or 10 hours or 8 hours so then you have a fast between then and when you eat again.

I started doing this when COVID first started, just before COVID first started. I've actually loved it. I felt great. I felt clear in my brain. I slept better. So I've started doing that again after Thunder came on, and it's only taken a couple days and already I feel so good.

Troy: Oh, nice.

Scot: So if you've ever considered time-restricted eating, there's also a documentary out there I just watched. I'm going to say right now that this documentary probably only needed to be about 40 minutes long, and it's an hour and a half. So you can just fast forward through the stuff you're not interested in.

Troy: One of those. I've seen too many of those documentaries.

Scot: Right? But it's called "Fasting" and it's on Netflix.

Troy: Nice.

Scot: First of all, go back and listen to some of our Thunder episodes. But if you're interested in time-restricted eating and fasting in general and why it works, you might want to check out that Netflix documentary.

Troy: So what are you restricting yourself to? Ten hours or 12 hours? What's your . . .

Scot: Yep. I've started it at 12, and I'm going to see how that goes. Now, Thunder has said that's a good maintenance kind of timeframe. And then in a couple of weeks I think I'm going to move to 10 or 8 because I have some body fat that I'd like to lose. So I decided to start with 12 because I thought that was doable, and then I'm going to try to get it 10 or 8. That's the plan.

Troy: Nice. That's great.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55-SCOPE. That's 601-55-SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you 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: Just go to facebook.com/WhoCaresMensHealth.com. That'll get you there.

Mitch: No.

Scot: No?

Troy: Dot com.com/.com.

Scot: You don't have to have a Facebook page, Troy.

Troy: You just threw it in several dot coms.

Scot: All right, take two. I love how the guy that doesn't even have a Facebook page is lecturing me on how I did it wrong.

Troy: I know too many dot coms when I hear it. I know that much.

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

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

Dr. Galli: I'm Dr. Nick Galli, an Associate Professor in the Department of Health and Kinesiology at the U, and I care about men's health.

Scot: Today's show is called "Perform Like a Pro." So whatever it is that you do when there's that moment that you've got to do it and you've got to do it well, but maybe you don't all the time, are there some things that we can learn from professional athletes and how they have to perform when they're on the spot? And that's one of the things Nick does. Do you continue to work now, still with the U.S. Olympic speed skating team?

Dr. Galli: I do. Yeah. I'm a performance consultant for short track and long track national speed skating teams. They're based out here in Kearns, Utah.

Scot: Yeah. And you were at the Olympics four years ago?

Dr. Galli: Yeah, almost. Yeah, two and a half years ago in 2018.

Scot: So they've got their own physical coaches and probably their speed skating coaches, but they take you along to help with the mental performance aspect. Do I have that right?

Dr. Galli: Correct.

Scot: I sure hope so, because this is the whole basis of this episode. So some of the other things that Nick does not only consulting the U.S. Olympic speed skating team, he's a certified consultant for the Association of Applied Sports Psychology. He has a PhD in the psychological aspects of sports from University of Utah, a master's in sports study, a degree in psychology. He's a professor and a researcher at the University of Utah, and the last time I think you got a full eight hours of sleep was like six years ago. Sounds like you're awfully busy. You getting that sleep you need, because it is one of the core four?

Dr. Galli: Yes. I think I do a pretty good job with that.

Scot: So when you're working with athletes, what are some of the mental things that you encounter with these high-level performing athletes?

Dr. Galli: In some ways, it's very similar to the challenges that a lot of us face every day in our other roles, but these athletes, they spend the majority of their time across several years preparing for this thing, you know, really this once every four years thing, and for some of them, they'll only get one opportunity for it. So, you know, it's this they have everything dialed in, but there's still the matter of can I bring my best performance when it matters the most.

And in a sport like speed skating, there's a lot of differences between a normal performance, certainly a practice and performing at a world championships or Olympics, because it's not a big spectator sport. So all of a sudden you have eyes on you, there's more media, there's just more buzz about the performance than you're used to, and it feels different. And so, you know, being able to acknowledge that, recognize that, even welcome that, but also just, you know, do your thing. That's the trick.

Scot: Do these athletes get inside their own head, like I get inside my own head when it's time to do it?

Dr. Galli: Absolutely.

Scot: And what does that look like? What are some of the things that you run into there that you have to work them through?

Dr. Galli: Sometimes it's a matter of, oh, it just doesn't . . . I don't feel 100% perfect today. This thought that they have to feel 100% perfect or look at that guy or look at that guy or look at that lady, you know, look how good they look going around the track or how good they look warming up or, you know, in a sport, like speed skating and there's some others too.

Ooh, my equipment doesn't feel totally dialed in, You know, there's these just little seeds that under stress can, you know, become much larger issues if the athlete's not prepared to deal with them.

Troy: And what's the . . . yeah, I guess I kind of imagine this scene before, you know, an event. I'm wondering, are people just like super anxious? Do they look pretty chill or they just have headphones on relaxing? Like what's the usual vibe in that sort of scenario?

Dr. Galli: It's a range. For some, you wouldn't know by just looking at them, you know, that they're nervous. Some are pretty casual. Some will isolate. Generally, you are going to see a more intense look in the hour or two before they have to get to the line. And for the most part, at that point, the work is done and the athletes are just, you know, most folks other than maybe their coach, you kind of lay off of them and let them do their own thing.

Some do like to socialize a little bit more, and that's actually part of the challenge that we deal with is it's an individual sport, but all these athletes train as a team and they also have to learn how to deal with one another on these high-pressure days, because some people will like a little bit of small talk and chat. Others just don't want to be messed with at all. And so we have to help them learn about each other's tendencies and preferences as well.

Troy: That's what I wondered. Yeah. I read a book recently and it talked about Michael Phelps' routine prior to events and, you know, he'd have this period I think about . . . . Well, he had the exact same routine he would go through every time and then, you know, had about a period, I think, of an hour where he just, you know, got his music in. And then when the time came, he would step on, there was the same process. So I just wondered if that's something speed skaters incorporate that you see, or if it's just kind of a range.

Dr. Galli: The good ones do. The good ones do. I mean, in terms of like within-person, right, they're going to be doing the same thing again and again because that's what's comfortable. And at the same time, they're also flexible and know how to adjust if they have to, because, at an event like the Olympics, things never go completely as planned.

Scot: So you talked about, you know, some people just look completely chill, like they're not even phased by it. Is that because they've done training with a coach like yourself, or is that more of a personality thing? Or can it be a combination of both? Is this a skill you can learn?

Dr. Galli: Absolutely. It's a skill you can learn. There are some who are gifted. I mean, we have some athletes who actually require very little work with me. We might chat on about specific things that come up, but, you know, they've been fortunate to have the genetics and the life experiences that have empowered them to really know how to control their emotions and focus. And so, you know, they may be nervous on the inside and that's okay, but they're also in some ways unfazed, and some are just kind of gifted in that way and others need a lot more help.

Scot: You said that the really good athletes do the same things. They have a sequence of events. They do the same things over and over again. Why is that? What is it about that sequence that's powerful?

Dr. Galli: Well, I think some of it is, you know, as simple as these are the things that I need to do to feel ready. I've got to eat, have these nutrients. My body has to get warmed up in this way. I've got to prime myself for performance. So some of it is just like it's what works, but there's also the psychological effect of this is what's familiar, this is what's comforting.

And that's something I preach to our athletes. You have to find that sequence of events early, and you have to be using it even in, you know, benign situations like, you know, go into practice so that when you bring it to a foreign environment or an environment that's very different, when everything else feels unfamiliar, the routine still feels familiar and comforting.

Troy: And one thing I heard too along those lines in this, like I said in this book I read, they talked about how when Michael Phelps, who was like, by the time he was on, you know, up there ready to start his race, you know, he was already, you know, 90% of the way through his routine. Like his previous routine, everything had been successful in that, the race was just the next step in that.

So it was almost like, you know, this preconditioning something he imagined many times in his mind, the success in the race, following his success and going through this routine beforehand. So I thought that was kind of interesting that it, you know, kind of played into that of saying, "Hey, you know, I've already succeeded up to this point. Now I just go out and do my race and I finish it up."

Dr. Galli: One interesting thing about him was that he had a coach who really knew and understood what Phelps would need to be able to do. I mean, he knew that Phelps obviously was physically gifted, but he also knew what type of preparation Phelps needed mentally so that he would be totally unfazed.

So Phelps' coach would really test his focus. He would break his goggles, hide the backup pair. I mean, and these are only things that you would only do if you had a pretty solid relationship, of course, with your athlete, because sometimes we'll throw this stuff out, you know with the coaches and athletes I work with, but, of course, you have to be careful when you do things like that.

But he wanted to make sure that Phelps not only would be prepared in the event of kind of an unthinkable circumstance, but also as importantly was that Phelps knew in his mind that he could handle anything that might come up because sometimes it's the fear of what might come up that actually holds you back more than something that actually does come up.

Scot: They would . . . the goggles thing. Would he do that in . . . he wouldn't do that during competitions. That was practice, right?

Dr. Galli: I think practice. I'd have to go back . . . maybe like a lower-level competition. No, probably not like the most important.

Troy: In the Olympics. Hey, let's mess with Phelps, guys.

Scot: That's not the time.

Troy: No.

Scot: All right, Nick, let's pivot this here for a second. Now you work with athletes who, you know, like you said, prepare for four years for one performance. The rest of us sometimes have to perform. We know that maybe we'll get another shot, but still, it's, you know, just as stressful. Troy, do you have any instances in your life where you have to perform like a pro while you have to go and just, you have to get it right.

Troy: Yes, I do.

Scot: Now, you're an ER doc, so I'd imagine that that's probably going to be your story.

Troy: The answer is yes.

Dr. Galli: No, not really.

Troy: Yeah. It's pretty chill at my job. It's pretty low stress. Yes, I do. Obviously, I have a lot of very high-stress scenarios I deal with, but there's one in particular that I think for me, you know, certainly raises my anxiety and I think across the board raises people anxiety.

And if there's one time I have to perform and I just have to get it right is intubation. So intubation is a procedure where you stick a breathing tube into someone's throat down through their vocal cords. Typically, I'm doing that if a person is unable to breathe, you know, they're struggling, or they're so out of it, either from a head injury or some reason that I have to put that in to protect their airway.

And it's a high-stress procedure. I mean, it's one of those things, oftentimes, you know, people are really, sick or else there's a lot of chaos in the room, it's in traumas, but it's . . . yeah, I think if there's one procedure I would say where it's like, okay, let's do this and let's get this right, that's it.

Scot: And you probably already have that figured out after your years in the ER, I'd imagine,

Troy: You know, I do, but it's one of those things I practice it on a regular basis. And the reason I do that is for exactly these reasons. It's one of those things when you're in that situation, you just want it to feel like, okay, I've done this, I've done it many times. I'm comfortable with this.

And, yeah, there are a lot of different variables that can go into this. Maybe this person is actively vomiting. Maybe they have blood coming up from their stomach, you know, stuff I'm having to deal with. But when it comes right down to the procedure, I want to feel comfortable with it.

But it's . . . yeah, it's one of those things, when I was in residency, it was probably the most anxiety-provoking thing for me was being comfortable intubating and doing that, because essentially, when I do that procedure, I take away a person's ability to breathe. I give them a medication that paralyzes them, and the only way they're going to be able to breathe if I can squeeze a bag and squeeze air into their lungs. And if that bag doesn't work and I can't get air into their lungs, I got to get some way to get a tube in there. So it's something that often has to happen quickly and you have to get it right.

Scot: You practice this? Like, you'll just go in on your own time. Like an athlete would practice their sport and practice this procedure?

Troy: I practice it every day. And this is a funny thing probably for even my colleagues if they heard me say this, but it is a procedure, like I said, over the years caused enough anxiety for me. I practice it every day, and I have a little simulation, you know, sort of things I have that I just go through that muscle memory of, okay, here's the laryngoscope. I get my laryngoscope, I get my endotracheal tube. These are the medications I'm giving. I preoxygenate, give them oxygen before the procedure. Just to walk through that process and I spend a couple minutes every day just practicing it.

And I know it's again if my colleagues are listening to this are probably laughing, but it's one of those things. It is the procedure probably in my profession that can go south pretty quickly and as is probably the most anxiety-provoking procedure. So yeah.

Scot: Producer Mitch, why don't you grab a microphone and join us? So the plan on this show is for each one of us to talk about, you know, that moment that we have to perform like a pro, but I don't want to follow that one. So Mitch, what yours?

Mitch: You're going to make me follow it?

Scot: Yeah. Maybe we don't. Maybe we just go to Nick's advice at this point, because I have a feeling Troy does a lot of the things that Nick might recommend. Like what's yours? What's yours, Mitch? Go ahead. I'll do mine.

Mitch: For me, I always try to . . . I maybe even over practice. I find myself preparing for when I give my lectures in class. So I teach at the community college these days, and I'm teaching a new course that I haven't taught before. And it's a curriculum that I haven't done myself, and I find myself having even nightmares sometimes about like, oh no, am I going to say the wrong thing? Am I going to sound stupid? Am I not going to remember some of the facts that I'm trying to share?

And so I find myself reading the content over and over and over again. But for me, at least, I don't know if it's actually helping. I find myself still kind of stumbling every now and then when . . . you know, I had a student ask, quiz me on some riot that I did not remember that was in a strange sidebar in the textbook I didn't get. So I don't know.

Scot: All right. Mine is kind of silly, but so difficult words to pronounce or difficult names stress me out. And I've been in performance long enough that when I see one, I will practice it before it's showtime. I will say it out loud numerous times. And then in the moment leading up to where I know on the sentence before now I'm in the sentence, I'm coming up on that word, I'm going to screw it up. And a lot of times I do, and I really wish that I could get away from that because I just totally psych myself out.

So, Nick, let's go over just kind of all three of these stories and give us some tips on what regular people, Troy excluded because he's like some sort of superhuman, ER doc.

Troy: I'm not.

Scot: What regular people . . .

Troy: I'm far from and that's why I practice every day.

Scot: What regular people can do in these situations where they have to perform to maybe, you know, help them not necessarily guarantee, but help them, you know, do better.

Dr. Galli: Yeah. I mean, and as I hear these three stories, it's great because there's contrast there. There are some similar things that would benefit all three of those scenarios, and then I think there's also a slight variation there unique maybe to Troy's experience.

One thing that there really is no substitute for is to prepare and practice, and that's what Troy was saying. You have to make sure that you feel comfortable and confident in what you're tasked with doing, and you also have to try it out maybe in different circumstances and situations with distractions, without distractions, maybe handicap yourself.

You have to really not only to keep it interesting for yourself, but also just to make sure that there's some transfer from, you know, the practice to the performance, and that's something I talk with my athletes a lot about is that's great that you can go out there and nail it in a very casual, low-key environment, but why don't we try and amp up the energy and practice a bit so that it more closely simulates what you're actually going to feel and see in a competition. So no substitute for preparation and varied preparation.

Troy: Yeah. I always enjoy the stories like a football team is practicing with the loudspeakers out there, just with this loudest like it can possibly be, so they can't hear anything. And, you know, like you said, it's one thing to do it in a low-pressure situation where there's no crowd noise or not that intensity of it, you know, some sort of Olympic event, but certainly something else when you throw those variables in.

Dr. Galli: The way I describe it is, you know, we're never probably going to be able to completely replicate the emotion that comes with high-pressure performance in a practice setting. And at the same time, we're never going to be able to make that high-pressure performance setting feel like a practice setting, but is there a way that we can . . . and if you could see me right now, I'm using my hands. Is there a way we can take that high-pressure situation, make it feel a little bit more comfortable, and take the really low-pressure settings and make them feel a little less comfortable so that, you know, we close the gap between them and they're not such different situations.

Scot: So number one there is prepare. It applies to Mitch. It applies to myself. It applies to Dr. Madsen Troy. What are some other tips that you would have?

Dr. Galli: Another tip would be to just, you know, take a new perspective on the situation. And I think even for Troy, I mean maybe especially for Troy, it's like, yeah, this is a big deal and it's very important, but again, this is also a really privileged position to be in, to be trusted to essentially save people's lives, or for Mitch, you know, it's a privilege to be able to sort of guide the learning process, or for Scot, it's a privilege to be able to, you know, give people a voice and educate the listeners.

So, you know, being able to take a step back and think about your situation in less of a threatening way and more of a way that, hey, this is a challenge that I look forward to tackling.

Troy: That's great, yeah. I love that advice because then it is sort of takes it off you. It's like, hey, this is not all about me. This isn't all about my performance. This is about someone here. Think about the people you're trying to reach out to, the people they're trying to help. I'm trying to help this person, or I'm trying to reach out to these people or connect with them, and I think that I agree. I think that really helps performance is like, hey, you know, this isn't about me. It's about me helping them, and this is about them.

Scot: Yep. I wonder if that perspective too might contain . . . sometimes I get a little self-involved. I don't have quite the right word, but I think, "Oh, I'm the DJ, I'm the one interviewing. I should get this right." And maybe that is a little, maybe I should take it a little less seriously that way maybe.

Dr. Galli: In psychology, we call that shoulding on yourself.

Scot: Well, I'm covered in should.

Dr. Galli: Can we leave that in?

Scot: Yes. We're leaving that in. So prepare, develop a new perspective so it doesn't seem quite so threatening. It's more of a privilege. What else do you have there?

Dr. Galli: Where we start to diverge a little bit, for Scot and Mitch in that situation, you know, I feel it's appropriate to, you know, make sure that you're also, you know, enjoying the experience, having fun with it, being a bit lighthearted.

I think that looks a little bit different in Troy's circumstance, because certainly you can't make light of the situations that you find yourself in, but I think have fun or enjoyment maybe it means something different. In that setting, it's more being fully immersed. You know, it's that flow experience of like, you know, the balance of skill challenge, and really, you know, just feeling at one with what you're doing.

So it's not like ha-ha this is fun, giddiness necessarily, but it's more like this is, you know, what I was put on this earth to do, this is what I was meant to do, and I am lost in this right now. So I still think it's about getting fulfillment and enjoyment, but it maybe looks differently across those situations.

Troy: It's interesting though, Nick, you mentioned that. And something I noticed, when I started my training in medicine, is that we would be in very, very high-intensity situations like codes. So you've got people you're doing CPR and you're doing these procedures, intubation, central lines, like all these high-pressure things, trying to get someone back to life essentially. And people would be cracking jokes sometimes. I mean, they were focused on the task, but, you know, it was almost like this pressure relief valve.

Dr. Galli: Yeah. That's true. They were talking about the possibility of my wife, you know, before having our first child, you know, for, in case of a C-section, you know, talking about do you want the doctors listening to music and chatting? And she was adamant that, "No, I don't want that. I want them to be focused." And my input was, "Well, you know, if that's what they do, then that's what you should want them to do." So I'm glad you brought that up.

Scot: It kind of comes back to the Michael Phelps thing, right? Trying to create some sort of normalcy in abnormal situations. Something that's familiar and comfortable.

Dr. Galli: Yep.

Troy: One of the more surreal experiences for me in med school was being at Johns Hopkins, you know, in inner-city Baltimore. And being in the surgery suite, doing these kind of high-intensity surgeries with the chief of surgery there, and he's got country music jamming. He had his favorites, Garth Brooks jamming there while we're in surgery, you know, in the operating room. And that's how he performed his best is, you know, having something like that to diffuse the tension a little bit.

Scot: All right. So prepare, try to bring a new perspective, think of it in a less threatening way, have fun, be lighthearted, or try to get into the task that you're doing. If you're Troy, get into that flow state, just be totally in the moment. It sounds like what you're talking about there. And how about a fourth one? How about one more?

Dr. Galli: This is where I feel it will be interesting to get Troy's take on this one as well, where it diverges also. I think as a teacher, as a host, I think it's okay to be vulnerable. And, you know, Mitch, I can really relate to your story because teaching is something I do a lot of and I've done a lot of for the last decade. And I can remember early on feeling like, man, I cannot make a mistake in that room. I'm going to kill my credibility.

But actually, you know, almost always I did know more, I was mostly one step ahead of my students. But the other part of it was at some point I let go of, okay, this is 2020, Dr. Google is really in charge of the facts. Everybody has access to the facts and the dates. That's not my job anymore. My job is to help my students learn how to ask the right questions and to think about things in different ways.

That takes a lot of the pressure off, and it's not my job to always get it right. But when I get it wrong, it is my job to acknowledge that I was wrong and talk about why I might have been wrong, and how we can get the right information.

Be okay being vulnerable, be okay with that. And I'm not saying try to make a mistake, but acknowledge that you're human. People appreciate that. People appreciate when their teachers are, when there's that power differential knowing that, like, that person's human too and that they're going to make mistakes.

And then similarly, Scot, for you, even if you've prepared for the name, there's still some trepidation about I might get this wrong. So it's okay. I think when you're going to introduce somebody to sort of couch it in, "Okay, I want to make sure I get this right. Is it . . ." And then you almost sort of build in some leeway to you're acknowledging that, like, you're not totally sure you have this and maybe you do nail it and then you look great. And if you don't, at least you didn't give the sense that, oh, you thought you knew it and then you didn't know it.

Scot: Or didn't care or whatever.

Dr. Galli: Or didn't care. Now I think, and this is maybe where I'll be interested in Troy's point of view, if I was in the kind of situation that Troy finds himself in, I really want to be talking myself up a little bit more and making sure that I understood for myself I'm the best person to be doing this right now. This person needs me, and I'm going to deliver because that's what I do. And, you know, there's not maybe as much room for that outward expression of vulnerability in the ER. But let's hear Troy's take on that.

Troy: Yeah. That's an interesting point you make Nick, and it's funny, something I have learned to do over my career and I have consciously tried to do, and I've told myself is allow yourself to make mistakes. And by that, I mean recognize that I will make mistakes and feel comfortable apologizing for that or reaching out in those situations where I've made a mistake.

I used to beat myself up over those things. I used to expect perfection of myself. And if someone contacted me and pointed out a mistake, I would sometimes become very defensive, and I think that affected my performance.

So honestly, I think that, you know, you talk about not expecting perfection of yourself. I think being able to acknowledge when you make mistakes and feel comfortable doing that, then helps performance because, you know, you say to yourself, "Yeah, I could make a mistake," but at the same time, like you said, you tell yourself, you know, "I've got this. I'm comfortable with this, I'm going to give this my best shot and do my very best with this." And then, you know, again, I think the outcome is often better than if you're just telling yourself, "I can't screw this up. I can't screw this up," when you're thinking that.

Dr. Galli: And there's degrees of mistakes. I guess maybe that's what I was missing there. And that's kind of the nuance that goes with different, you know, fields of expertise. In my mind, it's like, wow, you can't afford to make any mistakes, but really there's also a range even in the work that you do.

And I like what you said about kind of combining the, yeah, I've got this, I'm trained for this, I'm ready for this. And you know that you might slip up, but you've also got a team around you to help you, and you know that you're good enough that most mistakes or slipups you make, you're going to be able to rectify those.

Troy: Exactly. Yeah. And that's what I think is helpful. You don't want to make the big mistakes. You don't want to do it.

Dr. Galli: Which could happen because you're guarding against, you know, some mistakes. That's sometimes what happens.

Troy: Yeah, exactly. Or because you're so focused on the little things and not screwing those things up that, you know, you kind of lose the forest for the trees, that kind of thing, where it's just you get so worked up about the small stuff that you'll lose that big picture and like, hey, this is what really matters.

Scot: So some solid advice, I think, from the athletic world to the personal world. So prepare, try to take a new perspective, have fun, be lighthearted if at all possible, or at least in the moment. And then be okay, be vulnerable, realize that you might make a mistake. If it's a high stakes situation, you know, then realizing you might make a mistake, it's save somebody's life, because now you're going to start to account for it. So that's good.

Mitch, do you have anything you'd like to add? Do you feel a little bit better going in the classroom tomorrow? Are you going to be able to use any of this, do you think?

Mitch: I think so. I think that the idea of, you know, being able to be vulnerable and, you know, I don't have to know anything. That's right, Dr. Google exists. So why am I putting so much pressure on myself to be absolutely perfect? It is. It's really helpful.

Scot: All right. And Troy, you learn a little something today?

Troy: Oh, absolutely. Yeah. I think just talking through these things, it kind of helps reinforce for me a lot of, you know, a lot of what I think. I've learned the hard way honestly. A lot of this stuff has just been stuff, you know, over time I've just said, "Hey, I got to find a better way to deal with this. I've got to find a better approach." And so it's nice to have, you know, really, I think for anyone listening, have Nick just summarize this stuff that's been sort of a long process for me to try and learn.

Scot: Nick, you have a podcast that you participate on as well called "Becoming Headstrong." You talk about a lot of this kind of stuff.

Dr. Galli: Yeah, absolutely. Myself and three colleagues of mine. We put out three episodes a week, and they're typically very short, 5 to 10 minutes, and it's sort of designed for the athlete, but also just the regular person and tips on how to perform your best when it matters most.

Scot: All right. So check that out wherever you get podcasts, "Becoming Headstrong." Nick, thank you so much for being on the show, and thank you for caring about men's health.

Time for odds and ends on "Who Cares About Men's Health?" And we've got one item that we want to talk about. The Urology Q and A, where we asked for your questions for our urologist, went so well we've decided we're going to do it with a sports medicine doctor this time, because I know that there's a lot of people that have different types of orthopedic, muscular issues, bone issues, those sorts of things that they might want to learn a little bit more about.

Troy, I need you to clarify though what does a sports medicine doctor do and, you know, help our listeners too so they can start thinking about the kind of questions to ask.

Troy: You know, it's interesting. I think sometimes people misunderstand a little bit what they do because it's called sports medicine. So I think people think, well, these are for athletes, like high school, college, you know, whatever. Really the best way to think about sports medicine is just orthopedics doctors who don't go to the operating room. It's kind of like John Smith, our urologist, who described himself as a non-operative urologist. He's a urologist who doesn't work in the operating room. He sees patients in clinic.

Sports medicine, same kind of thing. They don't go to the operating room, but they'll do all sorts of procedures in clinics. So if it's anything you would want to see an orthopedic surgeon for anything to do with the bones, the joints, the muscles, the ligaments, the tendons, you know, your neck, your back, any sort of bony or muscular structure, that's what they do. That's their specialty.

Scot: All right. So I have cramps in my calves, sports medicine doctor could help me with that?

Troy: Absolutely. Cramps in your calves, back pain, knee pain, wrist pain, you know, anything like that. That's what they do.

Scot: All right. Mitch, what would you ask a sports medicine doctor?

Mitch: I slept weird and I feel old and because now everything hurts.

Scot: Oh, that's something that you could ask a sports medicine doctor?

Troy: They might want some more specifics, Mitch.

Mitch: All right. Well, we'll get a referral.

Troy: What hurts? Your neck? Your back? Everything hurts. We do get that in the ER occasionally like, "Okay, let's start somewhere. Like help me out here."

Scot: What about like tingling extremities, like randomly tingling? A sports medicine doc would understand that because they look at nerves and musculature, right?

Troy: Yeah. They would understand that, you know, sometimes tingling we think with more neurologic things, but if it's more just like tingling in one hand, absolutely. If it's like tingling all over your body, that's a little bit more neurologic. So, but yeah, like tingling in your hand, like weakness in your hand.

Like I've got this pain in my left hand that I finally got x-rayed and I didn't break it. I thought for sure I'd broken my hand, but, you know, that's the kind of thing I'd see a sports medicine doctor for. I've had this pain for two years. What do you think it is? What should I do about it?

Scot: Even though it wasn't even sports-related so that's good.

Troy: It was sports-related.

Scot: Oh, it was. What'd you do?

Troy: Or if it wasn't, I fell while I was trail running, but it's like one of those things, but I could say it's not because every time I type a lot, I feel it in my thumb. So yeah, so maybe it's . . . yeah, even though at this point it's nothing related to sports, they'd be great people to ask about that.

Scot: Okay. So you can ask your questions by a lot of different ways. The way that would be cool is we have this listener line. You can record your message at 601-55SCOPE that 601-55SCOPE. If you want to email us, you can do hello@thescoperadio.com and you could also do it at our Facebook page, facebook.com/WhoCaresMensHealth. Did I cover all the ways to get ahold of us, Mitch?

Mitch: Yes.

Scot: They're increasing. There's more and more of them. So it really you're taxing my memory here. Mitch keeps going, "We should let our listeners contact us this way." Like, who cares?

Troy: Maybe we should just give out our personal numbers. Let's just throw it out in there too.

Scot: Troy's cell phone number is . . .

Troy: Here's my number.

Mitch: You can follow us at TikTok. No, let's never get onto TikTok.

Scot: All right. So get those questions to us, and then next week, we will have them on the show. Just going to leave this here. It might be something to do with health. It could be something totally random. Troy, do you want to start, or you want me to start? I know you told me last time you feel the pressure of always going first. So I, you know.

Troy: I'm ready. I am ready. Trust me. I listened to what Nick said, and I prepared and I visualize what I'm going to say.

Scot: All right, go for it. Let's hear it.

Troy: I'm going to say it. So I'm just going to leave this here. You know, Scot, we've had Thunder on here, and one of my favorite episodes we've done was hidden sugars. So I tried to use hidden sugars to my advantage. Before I go out on a long run, it's funny like, you know, if you're running, you really fuel yourself with sugar. I don't know if you did that when you did your marathon, but, you know, you eat a lot of gels. You drink Gatorade. It's really just a lot of sugar.

And before I run, I like to have something with sugar in it and something with a high concentration of sugar. So I tried to find the one thing that's reasonably palatable that has a ton of sugar in it that I could eat before I run. And I didn't want to be eating candy, I didn't want to be eating gels. Guess what I found, best stuff to have before you run?

Scot: Wow. Okay. So a good food with hidden sugar that's not candy. It's not a sports bar. There's nothing like that. I'm just going to say, like a yogurt. Was that it?

Troy: Applesauce.

Scot: Oh, okay.

Troy: Cinnamon applesauce. Ounce for ounce, the cinnamon applesauce I found has the same amount of sugar as a Mountain Dew. It's remarkable.

Scot: Wow. That's crazy.

Troy: It's crazy. This is stuff that people are putting in their kids' lunches for school. Like, hey, here's your serving of fruit for school. Ounce for ounce, same amount of added sugar. I'm talking added sugar. Yeah. There's the natural sugar from the apple in there. This is the stuff that's added on top of it. And you can find variations across brands, but this is one of the most popular brands of applesauce. But like I said, I've used it to my advantage. That's what I eat before I run now. It tastes good. Sits well on my stomach. But the flip side of that is prior that episode with Thunder, you know, I never would have thought about this, but I looked at applesauce because of some of the stuff he told us about some of these foods we never would think of with sugar, and I was amazed at how much sugar was in it.

Scot: Just going to leave this here, do you have any white crew socks, Troy?

Troy: I have just kind of short ankle socks. I do not wear the white crew socks.

Scot: I've worn those pretty much my whole life. I think I might be retiring white crew socks for good.

Troy: Please tell me you wear white crew socks with like Birkenstocks.

Scot: No, I don't.

Troy: And shorts.

Scot: I wear them in the appropriate times, but I might be off white socks forever. I'm down to my last few. And it's hard to find a pair anymore because the levels of dirtiness don't match. So I might have one that's . . .

Troy: It's a bit more like a gray sock now.

Scot: One that's a little bit more white than the other.

Troy: Gray-ish, yeah.

Scot: They're starting to get pretty thin in the bottom. So I might be getting socks, other types of socks at other places, so I might be off white crew socks.

Troy: Well, you know, Scot, I don't know what this says about this podcast or about us, but this is now the second time one of us has used socks for our just going to leave this here.

Scot: It's the one fashion thing I think guys have permission to talk about.

Troy: Exactly.

Scot: We can talk about socks.

Troy: We can talk about our socks. Well, I've got black socks now. I went with the black socks, the black kind of ankle socks and I like them. They feel good. They're nice.

Scot: Yeah. And they hide the dirt so that's good.

Troy: They're great for dirt. Yep.

Scot: All right. It's time to wrap this up with the things that people say at the end of podcasts because we're at the end of ours. Go ahead, Troy.

Troy: Thanks for listening. Be sure and subscribe. You can subscribe anywhere you get your podcasts, whether it's Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you. We'd love to hear from you. You can contact us at hello@thescoperadio.com or reach out on Facebook, facebook.com/WhoCaresMensHealth.

Scot: And the phone number if you want to reach out now, this is not toll-free, but if you're calling on a cell phone, a lot of cell phone, you know, have unlimited long distance, it's 601-55SCOPE, 601-55SCOPE. And if you have any feedback, leave a message right there. Thanks for listening and thanks for caring about men's health.

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

When trying to lose weight and get in shape, it's easy to become focused on number. For some it's the number of calories we consume. For others it's the number we see on the scale. Some of us focus a lot on our body composition or body fat. What percentage of our body is fat and how can we get that number down.

For Scot, one of his major turning points in his life was when he found out his body fat percentage. He had assumed he had been putting on some weight, but didn't realize just how much. He went to a professional to get his body composition measured, and was shocked to find he was sitting at 29% body fat.

Knowing that number led Scot to make a lot of serious changes in his lifestyle. He worked hard to get that number down. It was a benchmark for him that he finds crucial to defining his level of health and fitness. Knowing his body fat and seeing it drop because of his efforts is a great motivator for him.

Meanwhile, Troy has never had his body fat tested. Troy is not a "numbers guy." He doesn't sweat his calories. He doesn't weigh himself daily. He's never weighed his food to make sure he gets the perfect portion size. Instead,Troy focuses on how he looks in the mirror and how his body feels throughout the day.

Troy wonders if framing your health around a number like body fat percentage could ultimately be stressful, demotivating, and detrimental to everyday people. Too Much Body Fat is a Bad Thing

Don't be mistaken, too much body fat is a bad thing. According to Nick Galli, a high body fat percentage is a reliable indicator of a slew of serious health problems including:

• Heart disease
• Stroke
• Certain types of cancers
• Osteoarthritis
• Fatty liver disease
• Kidney disease

A high body fat percentage often indicates a high amount of visceral fat which sits under the skin and around the organs. For men, this fat often will form around the stomach. If a person has too much visceral fat surrounding their organs, the fat will interfere with how well those organs function.

A simple rule of thumb: if you can keep the amount of excess fat in your body down, your overall health will be better. Body Fat is Only a Part of Your Health

Nick Galli has worked with everyday people and elite athletes. He works to help them achieve their health goals and stay motivated. Nick believes that body fat is a superior metric for assessing your health than body weight alone, but it shouldn't be the only thing you focus on.

"Any time a number is involved, we run the risk of becoming a slave to that number," says Nick.

Becoming fixated on a single body metric can lead to bad thinking. The perception of success or failure in health can become tied to how that one number is doing. This can lead to an unhealthy relationship with a number like body fat percentage. A person may become overly rigid in their behaviors to control that number, which can lead to mental health problems and even physical problems.

For example, when considering body fat, genetics is still a factor. Some people's body's are predisposed to have a higher body fat. They're perfectly healthy, but their measured number is higher than the average. No matter what they do, they will never be able to get their body fat percentage down to the "acceptable range" prescribed by the Center for Disease Control.

And that's okay. Health isn't just a single number. Too Much Weight Loss Can Be Worse Than Being Heavy

If you're trying to lose weight and are using body fat percentage as your goal, be careful. It's easy to assume that the lower that body fat number goes, the healthier you will be. This is not the case.

Yo-yo dieting is a term to describe when a person adopts a strict diet to lose a lot of weight in a short amount of time, then gain that weight back once they stop dieting. This is not a healthy way to lose weight. According to Nick, research has shown that losing and gaining a large amount of weight is actually worse for your body than being consistently overweight. Yo-yo dieting puts a lot of stress on your body and should be avoided.

Additionally, having too little body fat can be just as dangerous - if not more so - than being overweight. How to Measure Your Body Fat

There are plenty of ways to measure your body composition, each with their own strengths and weaknesses:

• Skinfold Caliper Pinch Test
  The pinch test is one of the oldest methods of testing a person's body fat percentage. Folds of skin are pinched by a professional at different sites all over the body. These folds are then measured by a caliper. All the measurements are placed into an equation which provides a relatively accurate body fat percentage. It's relatively quick and pretty reliable.

  There are a few downsides to the pinch test. It requires another person to do it reliably which can be inconvenient. The results may vary depending on the skill of the person conducting the test. And it can be uncomfortable to be pinched and measured.

• Smart Scale
  Smart scales and other handheld body composition devices rely on bioelectrical impedance to measure your body fat. These devices send a very small electrical current through your body and uses the signal to calculate how much fat is present in the body.

  These devices are relatively affordable, easy to use, and the technology is pretty reliable in modern devices. While they may not be as accurate as a professional test, these devices are a great way to track your weight loss progress day to day.

  For the most reliable measurements with these devices, consistency is key. Make sure you repeat the same conditions every time you step on that scale. Wear the same amount of clothes. Take the measurement at the same time of day. Decide whether you'll measure before or after breakfast. If the situation is inconsistent, your numbers will be inconsistent.

• Girth Measurements
  Body fat can also be estimated by using what are called girth measurements. A professional will measure different parts of your body and use equations to calculate your body composition. This includes measuring wrists, forearms, hips and waists. The hip to waist ratio is the most common.

• Bod Pod or Air Displacement Plethysmograph
  The gold standard of body composition testing is the Air Displacement Plethysmograph - commonly called the Bod Pod. This device is a giant egg shaped bod that the person climbs into wearing a speedo and swim cap. The device uses the displacement of air within the device to give an extremely accurate reading of your body composition in a quick and painless way.

  While the Bod Pod does give the most accurate numbers available, the test can be expensive and hard to access.

  Regardless of how you choose to measure your body fat, it's important to remember that there will be day to day fluctuations in your body. Have multiple data points and keep an eye on your weight loss trends.

Nick Galli works to help athletes and regular people get motivated to be healthy. He's in favor of helping people find whatever method works best for them to make the changes they want. Whether it be Scot's focus on measurable metrics or Troy's quality of life approach.

Every person is different. It's important to find the motivational strategy that resonates best for the individual and fits best with their lifestyle. For some people, constantly measuring body fat can be very stressful. For others finally seeing that number go down can be exhilarating.

Find the method that works best for you. Recognize the discrepancies in your health. Identify where you are and where you want to be. Then come up with stair step goals and a strategy to help you achieve them.

Healthcare professionals, dietitians, personal trainers can all help you best identify your health discrepancies and help you come up with an effective strategy to reach your goals.

Most importantly, don't only focus on the numbers. Focus on the way you're feeling and the satisfaction you get from working towards getting healthier. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot explains why books make for the worst gifts and Troy is delighted to be a part of this podcast. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

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.

As an ER doctor, Troy has a very stressful job. The type of stress that can be overwhelming at times. The type of stress that follows him home. He's had to learn the hard way to manage his stress.

Troy takes his stress on in two major ways. First, he breaks down big tasks into small, more easily managed chunks, then takes them on one at a time. Secondly, he finds time every day to meditate on the problem facing him. He thinks through whatever is bothering him during his daily runs.

There are plenty of strategies to deal with stress, but Troy and Scot wanted to hear from a professional in stress management. Nick Galli is a health coach and professor of health kinesiology at the University of Utah. He works with elite athletes, but he assures us his advice can work for anyone.

One of the first things to consider is that doing anything out of the ordinary can be stressful in its own right. So whatever activity you use to destress should be kept close to what you enjoy doing already. Nick's stress relieving activities include working out, reading books, and watching Netflix. He builds at least an hour into his day to make sure he does something he enjoys and let go of some anxiety.

Each of us are dealing with our own unique stressors. As such, the best strategies for stress management are individualized. But there are some general strategies that can help.

It can be easy to be hard on yourself when you make a mistake. Your inner monologue can get nasty fast. The things you say to yourself can be so negative you'd never feel comfortable saying them aloud, let alone to another person.

Nick urges everyone to practice self compassion and be mindful of how you treat yourself when things get rough. Keep in mind some of the following things to help you be a supportive force for yourself:

• You are not alone. Millions of people in the world are dealing with similar or worse problems. It's life.

• Be productive with self-talk. Have good conversations with yourself. Talk through the problem. Explore solutions. Tearing yourself down doesn't help.

• Talk to yourself like you'd speak to others. If a friend or loved one came to you with a problem, you wouldn't immediately get down on them. Treat yourself and your problems with the same support you'd give others.

In addition to treating yourself supportively, other stress management strategies include:

• Talk to someone about it
• Write a daily journal about what's going on
• Designate 5-10 minutes a day of "worrying time" to honor your anxiety, but in a structured way that doesn't derail your day

Nick explains that mindfulness is one of the most important skills to develop to be able to manage stress. For Nick, mindfulness has two key characteristics we all should work on.

First, being mindful means being present. Not only physically in the moment, but mentally and emotionally. So much of a person's stress is either about things that have happened in the past, or being anxious about things in the future. Worrying about bad things that may never happen keeps you from living in the present and enjoying life.

The second, more difficult part, is to be present in a non judgemental way. We are very good at judging ourselves. Being mindful means to judge your own thoughts in a more neutral way. Remove the judgement from what you're thinking and doing. This neutrality can help you figure out what is causing your emotions and what to do with them.

Nick suggests narrating your own life to practice mindfulness. Pretend you're Morgan Freeman and describe your actions and feelings aloud as you go about your day. It may seem ridiculous, but for many of Nick's patients it's a great exercise to start exploring your own mindfulness.

If you own an Amazon Echo, you may sometimes get the feeling it's listening to everything you say, all the time. Well a new experimental tool may use that always listening feature to save your life.

According to an article from STAT news, a new feature is in development to allow the Echo smart speaker to listen for and identify agonal breathing. This type of struggled breathing, with long pauses, is one of the big signs that someone's heart has stopped beating and they may be going into cardiac arrest.

Time is of the essence with a heart attack. The idea of a device that can detect the emergency and get help fast is great, but does it really work?

Troy is suspicious after looking at the data. Yes, the device has been shown to detect agonal breathing, but the study only looked at 35 households. Of the 200,000 clips analyzed, the device had a 0.2% false positive rate. That may seem small at first glance, but in actuality, that meant the device incorrectly reported that someone was going into cardiac arrest 400 times. That's a big error for a device that would be calling an EMT to your home to save your life.

The technology has some serious potential to save a lot of lives, but it's not there just yet.

Say you're out hiking in the wilderness and mistakenly step a little too close to a rattlesnake. It strikes out and bites you. Should you go to the ER?

Yes. Simple answer. If you are bitten by a rattlesnake, seek help immediately.

The problem with rattlesnake bites is that a majority of them are "dry bites," which mean the snake released no venom. Unfortunately, you won't know if it was dry or not until the symptoms of the venom start. And by the time those symptoms start, you may be in a serious life threatening situation.

In other words, go to the ER with any rattlesnake bite. Symptoms can take 30 minutes to a few hours to appear depending on your physiology, the amount of venom injected, and the location of the bit.

If you find yourself far from help while bit, stay calm and get to help as quickly and efficiently as possible. And under no circumstances should you do the following:

• Do not cut the bite
• Do not attempt to suck the venom out
• Do not put a tourniquet on the bite

These common first aid tips will actually make the situation much worse.

Stay as calm as you can and seek help fast.

On this episode's Just Going to Leave This Here, Troy has been scrolling on Zillow and dreaming about a bigger home, even though studies have shown a larger house doesn't make you any happier. And Scot shares a video of his new pet - Reginald Rat Pants - a rat that has been eating his protein powder.

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

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.

You're in a situation where you know that there's some health changes you want to make, whether it's your diet or your activity level, drinking, smoking, something like that, but you just can't quite seem to make those changes and it can be hard. Nick Galli is a health coach and Assistant Professor of health, kinesiology, and recreation at the Department of Health at University of Utah. He also works with high-level athletes.

Nick Galli had always considered himself a healthy person. He prioritized physical fitness, he diet seemed alright, he was a club athlete all through college. But in his 20's he went in for his physical. The results surprised him.

"I got the blood draw and my readings came back everything was way high. My cholesterol, my triglycerides, a lot of the bad stuff," Nick explains, "I think I went through a little bit of a denial at first. I thought, "No way." Because, you know, I'd always considered myself a pretty healthy, prioritized physical fitness. My diet wasn't great, but it was okay. So that would have been my turning point."

Nick first tried making some changes to his diet, but saw very little change in his blood work after six months. He worked with his doctor to find a solution.

"So then it was going on a small dose of a statin, which was really weird because I think I was still in my 20s. I'm like, "Well, this is crazy." Ten milligrams or something, which I still take. And it's only been in the last few years where I feel like I've really gotten a handle on the dietary part of things and my numbers, the last two times that I've had them checked have both been both times been in the normal range."

Sometimes improving your health isn't just lifestyle choices. Nick had always considered himself "the healthy one" but due to his genetics, diet and exercise wasn't enough. Sometimes, genetics can keep you from being at that optimal level.

Troy agrees, "I think that's the point. We can do everything we can, but genetics are a huge factor in so many of these things and sometimes you need to accept that and address it. And I think we all kind of have these wake-up calls. But like you said, it's a process and addressing it and reevaluating and reassessing"

Nick Galli is a health coach, helping people make positive changes in their lives. When he's working with a client, he has a few strategies to help them become motivated, and stay motivated to improve their health.

"I think the first thing that's important to do is get a sense for what their life context is, because it's not a one-size-fits-all," says Nick, "Different approaches will work with different people or resonate with different people, depending on, for example, their living situation. Are they single? Are they in a relationship? Do they have children? Are they surrounded, as you mentioned by, you know, social support?"

"I also get a sense for how ready they are. And then figure out because for most people, making a big change immediately isn't going to work. They might make that change and then we get a short-term result, but it's not for the long haul. We've got to think about little things that maybe that person can be doing that don't feel like a lot of work but that can over time make a big difference."

One of the most impactful things a person can do to improve their health is to be more active. But finding the motivation to exercise can be difficult. Nick explains why:/

"Exercise is a good one, because I think people have this picture, especially if they haven't done much of it, of exercise is a very rigid. I've got to go to the health club. I've got to go there three or five days a week and spend an hour there."

According to Nick, one of the best strategies is to change the perception of "exercise." Reframe exercise as "physical activity." Simple changes can lead to real results. Park further away so you walk farther in the parking lot. Take the stairs instead of the elevator. Go outside and work in the garden or play with your kids.

One size does not fit all when it comes to changing habits. When working with clients Nick works to help them find a personal strategy you can do on your own.

"I'll always say, you know, before the next time we meet, "Give this a shot." Or I'll ask them before we leave, "Okay, what's one thing you're going to try to do differently and pay attention to how that makes you feel?" We all hope that they make the change and they feel great. But also sort of warning them, "This might feel this might not feel good at first because it's out of your comfort zone and that's okay."

Changing your lifestyle habits can be hard. It brings you out of your comfort zone. You may slip up now and then. What's important is to commit to making the change and giving it an honest effort. Troy shares what he's heard:

"One thing I've heard that seems to work is just to try it for 30 days. It may be uncomfortable but it seems that that 30-day period is often the key to really try something, see if it's going to work to change the habit and then reassess at that point. Do you have a time frame where you tell people, "Hey, do it for this period of time, give it a chance, it may not be comfortable at first, but let's give it some time"?

"I definitely use that concept," says Nick, "I don't know that I've ever specifically used, you know, 30 days as a benchmark. That makes sense in a lot of ways. I'll often say for physical activity, "Even if you don't feel like doing it, commit to 10 minutes." Because we know that in as little as 10 minutes, you can get benefits. "If after 10 minutes you don't want to do it anymore, go home and sit on your couch." And usually, you know, people will. So I think it's kind of a momentum principle. It puts a finish line on it, and it's also very reinforcing when the person makes it to 30 days."

If it doesn't work for you after an honest effort, it's time to try something else. Giving yourself an out is important to staying motivated, but it's crucial you really try a strategy before moving on to the next. Scot shares his own unique approach to getting to the gym.

"I used to do that to the gym. I still do. Like, "I don't feel like going to the gym. All right, you just got to drive there. You got to go inside, you got to swipe your card and you got to do one exercise. And if you decide you want to go home at that point, go home." I've never once gone home at that point."

Nick shares a few key tips you can try in your own life. Whether it be exercising more, drinking less, quitting smoking, improving your diet; the strategy is the same:

• Don't make sudden or huge changes. Stick to small, easily attainable changes. The will add up.

• Look at where you are, and go from there. Don't assume that you can go from being a couch potato to running a marathon. Take stock of your situation and make gradual improvements.

• Get started today. Don't put off your lifestyle changes indefinitely. Commit to changing one small, easy thing this week.

Apple has released a new sensor on it's Apple Watch that is meant to detect atrial fibrillation, or AFib, when worn. AFib is a quivering or irregular heartbeat that can be a sign of blood clots, stroke, or even heart failure. A great thing for someone to know, right? But does it actually work?

Troy has experienced this first hand in the ER, "I'm seeing these people in the ER who come to me and say, 'Hey, my watch picked up this abnormal rhythm. What do I need to do about this?' They can show me on their watch what they're seeing. And then they say, 'I'm concerned about this. What do I do?'"

As an emergency doctor, he immediately starts treatment right?

"Usually not. There's this new study that just came out that looked at these watches and looked at how many people had AFib. I think the number was about 0.5% had episodes of AFib. But when they looked at those individuals and they did additional testing, where we can send people out on actual heart monitor, they found that about a third of those patients who came in saying, 'My watch picked up AFib,' only about a third of those actually had AFib. There were a whole lot of false positives."

So, the device detects Afib in less than 1% of people who wear it. And of that small percentage, two thirds of are false positives. What's a person to do if their watch goes off?

Troy is hesitant to make a firm suggestion, but he says to look for other symptoms other than just what your watch is telling you, including:

• During the AFib event did you feel lightheaded or like you were going to pass out?
• Did the AFib event last longer than 10 minutes?
• Has the AFib been repeatedly happening for a few days?

If you're experiencing any of those symptoms, you should go to the ER.

Ultimately, the Apple Watch AFib sensor has the potential to catch a serious medical problem, but the technology is not yet perfect. If you Apple Watch reads an AFib event, be sure to look for duration, frequency, and other symptoms to determine if you need to go to the doctor.

On this episode's Just Going to Leave This Here, Scot reveals he has very special blood he wants to donate and Troy can't get enough dogs. Here are some highlights:

Scot: Plus, also I have baby saving blood.

Troy: You do?

Scot: I've been told.

Troy: You have special blood.

Scot: I don't know what that means exactly. I guess I have a lack of some sort of a something in my blood that most people have in their blood that they're not able to use for young children that don't have fully developed immune systems.

Troy: So you are a rare specimen? [...] I love dogs. We are dog lovers, animal fosters. I think there's a lot of health benefit to having dogs. I just drove out to Vernal yesterday and transported from . . . there are some dogs from their shelter to our rescue group in the Heber area. There's so many great dogs out there. If you're looking for a dog, please adopt a shelter pet.

Scot: Absolutely healthy. We've adopted dogs, and as a result we would walk a half hour every day. It was something we never would do before. And I know there can be emotional and mental health benefits to pets as well. So that's great.

Troy: I agree. We'll find some article on this to talk about because, like I said, I feel strongly about it. And it's, I think, a fun topic to talk about.

Scot: Well, you save dogs. I save babies.

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Interviewer: You want to start exercising more? Well, here are some tips how you can stick with it this time. That's next on The Scope.

All right. So it's your new year's resolution to start exercising again, and here are three things that might get in the way of your success and how you can overcome them.

Nick Galli is a health coach and an assistant professor of Health Promotion and Education in the Department of Health at University of Utah. Nick, when somebody comes to you and says they want to exercise more and you start working with them towards that goal, what are some of the common things that you see that might get in the way of their success?

Nick: Well, Scot, I think first off, there are a lot of things. To boil it down to three, the first one I would probably be on the lookout for is lack of time. Or more specifically, a perception of lack of time. Oftentimes, you will hear people cite lack of time as a reason that they don't exercise, but when you really get them thinking there's usually at least small blocks of time that they do have throughout their day.

The research shows that we can achieve benefits in as little as 10-minute bouts of physical activity. So if you've got 10 minutes somewhere in your day, maybe that means getting up 10 minutes earlier, 10 minutes less of social media, you can probably figure out how to fit exercise in. So what I would like to do with folks who are having a hard time is have them map out their schedule, open their calendar and see exactly what are they doing, how are they spending their day and how might they be able to modify that to fit exercise in.

Interviewer: Yeah, and find something that maybe they're doing that they look at it and go, "Well, this probably isn't as important of a priority as exercise."

Nick: Right. You might sort of a rank order, "Okay, how important is this?"

Interviewer: Yeah, yeah, all right. So perceived lack of time is a big barrier so you've got to look for that time, maybe hard schedule it in your calendar, whatever you got to do. What's number two, like when you run into some issues?

Nick: Number two I would say is a very narrow definition of what counts as exercise. Around this time of year, the health clubs are going to be hitting the marketing hard, they want to get new members in. If you haven't exercised before, it's easy to get the impression that exercise has to be at a health club, at one of these commercial gyms that we see, and that's not for everybody. Not everybody works best that way, in that setting, on those machines.

So I like to try and work with clients on thinking about, "Hey, what is it that you can do to just get your body moving?" It's that simple. It doesn't have to mean going to the gym. It could mean taking a walk. It could mean doing some gardening. I mean, it could mean a lot of things. What can we do to just move your body, get your heart rate up? That counts as exercise.

Interviewer: That seems like a kind of a low bar but that's still enough, huh?

Nick: Absolutely. Ten minutes.

Interviewer: Ten minutes.

Nick: Ten minutes a day getting your heart rate up. Better than nothing at all, for sure.

Interviewer: All right. Number two, that's good. Exercise doesn't have to be going to the gym and getting on the treadmill or lifting weights. I mean, if you like that, great. But it could be taking the dog for a walk, so that's good.

Nick: It could be yoga. I mean, a lot of folks think about other ways of taxing your body.

Interviewer: Sure. Go snowshoeing if you want to.

Nick: Yeah.

Interviewer: Play Frisbee.

Nick: We live in, probably, the greatest outdoor state in the country.

Interviewer: Right.

Nick: Those kinds of things.

Interviewer: Exercise everywhere, all right. So don't have that narrow idea of what exercise is. Broaden that out. What about number three? Something that gets in the way of somebody reaching their goal of exercising more.

Nick: Number three, I think it probably becomes more of a problem once the person begins. We know drop-out is pretty high. Half of folks who start an exercise program have dropped out within six months, so I would say number three is unrealistic expectations. That could be unrealistic expectations for changes to the body, unrealistic expectations of what the individual can handle.

I've seen folks be really excited and enthusiastic, and they go in and do this really high-intensity workout for a week and now they can't get out of bed. That's no fun. That's not very reinforcing and that's a major cause of folks saying, "This isn't for me."

So really, and this is where if you're going to exercise in the traditional way, it can be really useful to have a professional helping you out, someone who knows a bit about the physiology of exercise and the body, and can tell you where to start and can assess you and get you on a program that's right for you, it's not too much, not too little. To know that there are changes happening even if they're not always visual changes. The changes in the mirror do not happen within the first couple weeks, they happen over time.

But physiologically, there are changes that are happening. You're getting stronger in your muscles, your heart's getting stronger, your lungs are getting stronger, all those things are happening. So a good personal trainer will be able to assess measures of functional change separate from measures of aesthetic change, which we all love but those are the changes that sometimes take a little longer.

Interviewer: What about in general? So when you are in a workout routine. We talked about three things that could get in the way of somebody continuing. In general, obstacles come up. What's a good way of dealing with those? Because we can't hit everything, right?

Nick: No. Have a plan if you can. Think about obstacles, if you can have that kind of foresight to imagine things that might come up. Things will come up, things with work, things with family. You might get sick or injured. Be prepared for those, have a plan. Maybe that means you have to modify what you do, maybe that means you have to be, "Okay, for a few days I have to take some time off." So I think having a plan is probably the most important, and realizing that just because you fall off for a couple days, that doesn't mean all is lost.

Interviewer: Yeah, you don't have to quit.

Nick: No. You don't have to quit.

Interviewer: Just get back into it.

Nick: Exactly.

updated: January 12, 2022
originally published: January 3, 2017

Interviewer: It's great to eat healthy but what if you are eating too healthy? On the verge of obsession. You're always watching what you eat. Counting all the calories, and tracking all the carbs and proteins. You may think your diet is good for you but it can actually result in unhealthy consequences. That's next on The Scope.

Announcer: Medical news and research from university Utah physicians and specialists you can use for a happy and healthier life. You're listening to The Scope.

Interviewer: We're here with Dr. Nick Galli Assistant Professor at the Department of Health Promotion and Education. Can you explain a little bit about the differences between an eating disorder and eating too healthy? Because we've always identified an eating disorder with food is bad, I hate food. Right? But if you love food and you think all of this is a healthy way for me to intake food but it gets to the verge that it's just unhealthy at that point.

Dr. Nick Galli: I think we want to be careful about diagnosing something with an eating disorder simply based on what they eat I think it's more about if they have rules about what they can eat and is there diet becoming overly rigid. It's great to eat healthy. The problem comes when the person is telling themselves they can't ever eat this, I can't ever eat that. And being overly restrictive. One of the movements in the last ten years or so has been toward intuitive eating. And that's listening, getting in good touch with your body listening when your body tells you I need some salt, I need some sugar. You know, I need that cookie right now. Being okay with that, and if we can get in touch with our body and what our body needs, we're less likely to the old binging where I haven't had a cookie but in a moment of weakness I'm going to eat ten of them. And so and then you feel guilty

Interviewer: And they feel guilty.

Dr. Nick Galli: And then they feel guilty. So getting into the mindset that there's no such thing as a bad food. There's you know, all food has something in it that's okay for you it's just moderation and it's certainly there's certain foods that you really want to eat in moderation. And we should not be going to McDonalds everyday, probably, you know? But there's nothing wrong with having a McDonalds cheeseburger every now and then. It's much easier said than done in terms with getting in touch with what your body need because we're not use to doing that in our society. We're very fast paced. We just kind of eat. I mean we're eating while were doing three other things. We don't even think about what we're eating.

Interviewer: Snacking on it.

Dr. Nick Galli: Or snacking or watching TV. We're not in tune with our body. Some would say that if you could become an intuitive eater, you're more likely to eat healthfully.

Interviewer: For those people that just are all always consciously watching what they eat they have that mindset of this has this many calories, I shouldn't be eating this cookie, this salad has too much dressing, there just always watching what they eat and think it's healthy. Because I do that sometimes too. But can that be unhealthy for me to always be constantly be watching what I eat.

Dr. Nick Galli: I think it takes some of the joy out of eating.

Interviewer: Okay.

Dr. Nick Galli: It's funny because we've in now and recent years, it's now become required that everything you buy has the caloric content

Interviewer: Yeah you're always looking at those things too. Those numbers.

Dr. Nick Galli: That was change was supposed to be a good thing right

Interviewer: Right

Dr. Nick Galli: Oh well now we all know. And I think it can be an okay thing it's just there is a line between what becomes somewhat obsessive where you're counting to the calorie of what you're eating and how much in it just becomes again, I go back to just becomes too rigid. So there's nothing wrong with watching what you eat and you know, wanting to put good things into your body. But there is something wrong when you start saying I can never have this. Or restricting yourself constantly and just realizing that as long as I'm living at an active lifestyle and getting a good balance of food that I can a little bit of dressing, I can have that cookie, it's okay. And again when you have that belief you're much less likely to have that binge that we've talked about.

Interviewer: Gotcha. Okay.

Dr. Nick Galli: I would never want to discourage someone from watching what they but eating is also should be something enjoyable and social and we should take the time to savor what we eat and we shouldn't be forcing ourselves to eat things we don't like.

Interviewer: Right

Dr. Nick Galli: Just because we think they're healthy, we need to be thinking about appealing to our taste buds and to be aesthetic so the food and all of these things and it becomes counter productive when we get so rigid and picky about what we eat. And then at some point most people can't adhere to that over time, at some point you just can't take it anymore.

Interviewer: Then another health issue comes along.

Dr. Nick Galli: Exactly and then we start talking about obesity.

Interviewer: So we talked a little bit about kind of how you have to have the mindset of eating healthy, watch what you eat but don't watch what you eat. But then you know at the same time how does that affect your body and your physical sense.

Dr. Nick Galli: Anytime you cut anything completely out of your diet yeah that's not usually very good for your body. We could go into all the physiological stuff but I mean we saw these diets that they were supposed to be miracle diets and they usually involve cutting something significant, completely out of your diet.

Interviewer: Right

Dr. Nick Galli: The first one was the Atkins diet.

Interviewer: Okay yeah. That's right.

Dr. Nick Galli: Completely cutting out or almost completely cutting out carbohydrates, which are our main source of energy. Carbohydrates but you find them in a lot of snacky foods so and the doctor who created this said well if you just cut carbohydrates pretty much out of your diet you will lose weight. And people were losing weight but they were having health concerns because they're eating a lot of saturated fat in meat, they were missing out on carbohydrates, they weren't feeling very good. So they were cutting weight but it was having all these unintended consequences and you really when you looking at carbohydrates there's not very much.

Interviewer: Any final thoughts, maybe alternative ways to eat healthy without eating too healthy.

Dr. Nick Galli: Try different foods, be open to different foods, you may not think that you like fruit or vegetables- try different ones. Learn how to cook.

Interviewer: I'm already failing on that point.

Dr. Nick Galli: Make it something that you can do with a friend or a partner. I don't know, just don't restrict yourself. There's so many foods out there that people don't even want to try and you need to expand your personal menu a little bit.

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

Interviewer: Thirty million Americans suffer from eating disorders at some time in their life, and those are only the reported cases. But what identifies an eating disorder and why do people suffer from them to begin with? Could you have an eating disorder and not be aware of it? Ask today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.
We're with Dr. Nick Galli, Assistant Professor of Department of Health Promotions and Education. There are so many types of eating disorders; you hear it all the time, but what is it?

Dr. Nick Galli: There are actually four major types of eating disorders identified in the DSM, the Diagnostic Statistical Manual, which a new version just came out, so the standards are changing.
The two classic eating disorders that most people know about and think of are anorexia nervosa and bulimia nervosa. In either case the underlying theme is being dissatisfied with one's body weight, and making an attempt to in some way or another control the diet. Anorexia without going into every single diagnostic criteria, one of the big indicators is extremely low body weight, and intense fear of gaining weight. Those are kind of the two hallmarks, and the person may look to restrict their food intake.
Bulimia nervosa is characterized by binging, so eating a high quantity of calories and purging those calories in one way or another. So that's the characteristic of bulimia. Individuals with bulimia may be a normal weight. And then binging disorder is the binging without the purging.

Interviewer: Okay.

Dr. Nick Galli: And then there are criteria regarding the amount of time the person has been exhibiting certain symptoms.

Interviewer: So with all these different signs and symptoms of these eating disorders, it almost sounds like it's just I don't like food. And so in a way could some people have eating disorders and not know that they have an eating disorder? Or is it just an illness that you just know you have?

Dr. Nick Galli: I don't know that it's that simple. I'm sure there are people who might be diagnosed as having an eating disorder who don't know; maybe they don't have very great self awareness; or maybe they've just been living like this for awhile. There may be people who know there's something not quite right going on with the way they feel; it's possible. That's why we rely on people to help us recognize that there's something going on, because sometimes you get into a habit of how you live your life.

Interviewer: Exactly.

Dr. Nick Galli: And maybe if you're surrounding yourself with people who also have these dysfunctional eating patterns I would say it is quite possible that someone could at least be eating dysfunctionally and having disordered eating and maybe not a full blown clinical eating disorder.

Interviewer: What factors into someone developing an eating disorder? Does age play into all this, physical form?

Dr. Nick Galli: Yes, we've sort of identified different clusters of factors that contribute to an eating disorder. You mentioned age; I wouldn't say that age is a contributing factor, but we do tend to see the age of onset as around that adolescent period.

Interviewer: Someone who needs to find myself age?

Dr. Nick Galli: Exactly, but we're also seeing eating disorders linger into adulthood, and even in adults developing eating disorders it's less about age and more about sort of this inner play of the person and their environment. So personality does play into it; also who you are surrounded with. Did you have parents who modeled dysfunctional eating? Was your mom or dad always on a diet? That plays into it. Biological factors; they are still trying, and they think there might be something there, in a level of the brain.

Interviewer: So it's not just somebody just looking at a cover magazine and saying I want to look like that, the cover of the magazine?

Dr. Nick Galli: Well it's probably an interaction of where we see people who might be predisposed because of their personality and their genetics and what not. If they're exposed to these images of men and women in the media, it might be more likely to feel the urge to have to look like that. As any psychological issue it's usually not just one thing.

Interviewer: So how do you prevent then that bad eating habit into becoming an eating disorder? Is there that line, is there a gray line or is there kind of like I know this is...

Dr. Nick Galli: I'd say there's a gray line. If someone who's a typical college student is a good example, as they tend to maybe be not eat as many meals as they should, or they pack them all into one meal. We consider that disordered eating.

Interviewer: Okay. So I could have an eating disorder and wouldn't even know it.

Dr. Nick Galli: Maybe not an eating disorder but maybe you have a disordered eating pattern.

Interviewer: Bad eating habits.

Dr. Nick Galli: Yes. Maybe not developing into a full blown eating disorder, because maybe you've got some other good things going on in your life. Maybe you don't necessarily feel bad about your body, you just don't have the greatest eating patterns; the same with a lot of us are like that. We don't eat when we should, and the different nutrients that we should.

Interviewer: Do you see many cases where, like you said the typical college student, do you see that transitioning into an eating disorder?

Dr. Nick Galli: It could.

Interviewer: It could, okay.

Dr. Nick Galli: It could with some people, but not with all people.

Interviewer: Okay.

Dr. Nick Galli: They'll have multiple identities, you know, don't define yourself by how you look. So I think it's important for parents, and of course you want your parents to be on the lookout for signs, but even in the younger children you want to set the stage. You want to be proactive in helping your kids have a healthy self esteem and not define themselves based on how they look.

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

Interviewer: You've just recovered from an eating disorder. Life is good and you're getting healthier. The question is can relapse happen? And what might trigger it? We're talking about the steps to take after you've recovered from an eating disorder today on The Scope.

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

Interviewer: We're talking to Dr. Nick Galli, assistant professor of the Department of Health Promotion and Education about the steps you take after recovering from an eating disorder. Dr Galli what are the steps? Can relapse happen?

Dr. Nick Galli: Relapse can certainly happen and I think if you talk to most people who have fully recovered from an eating disorder they would probably say that they had lapses certainly. You know I think a couple of things to keep in mind almost always there's a lapse. And I think the first rule is be ready for that to happen. And know that it's going to happen. And don't judge yourself based on that happening. Have a support system in place, going back to the support systems. Someone that you can call when it happens. And know that just because you have a lapse that doesn't mean that you have to fully relapse back into an eating disorder.
We call that the abstinence violation effect. When somebody is on a course of behavior and then has a slip up. Maybe if it's someone with an eating disorder they binge one time. And using that as an excuse to, "Well I can't do this. I give up." The best thing you can do for yourself is have a plan going in. Okay I know what are the situations that trigger me. Is it being around my mom when she makes comments about dieting and weight and size? Is it watching a certain program on TV? Is it looking at a certain magazine? Is it a certain website?

Host: Avoid those triggers.

Dr. Nick Galli: Plan one is avoid it. But maybe it's the holidays; you've got to be around Mom. What's my coping plan? When I feel a certain way, what am I going to do?

Interviewer: When you are aware of the problem and you want to treat it because you treated it already, you've been through this already, do you think it's harder the second time to go through the treatments?

Dr. Nick Galli: I have not had an eating disorder myself so I can't specifically speak to that. I know that there are people that are in and out of treatment their whole lives. I don't think it's ever easy. Whether it's the first time or the second time. And then there are people who went through treatment once and they never had to go back.

Interviewer: Are there different maybe levels of seriousness that are involved in these treatments to maybe help the patient not relapse again? Or is it just kind of each patient is different?

Dr. Nick Galli: I would say each person is different. There are different levels of severity. What you also have to think about is most of the time eating disorders co-occur with other psychological disorders, depression, anxiety. So making sure that the persons getting the treatment they need for those as well. And often times that will involved a combination of medication and therapy. I've known several people with an eating disorder and I mean an eating disorder is an eating disorder to an extent. But it's so personal so that makes treatment somewhat personally. We have guidelines and things we know work well but in the end it has to be personalized. But sure, there are people who are for whatever reason the level of severity is much higher. And it's going to be much more difficult.

Interviewer: So on the road to recovering from an eating disorder are there certain things to look out for? Maybe certain things to do more of that will help you in successfully recovering 100%? Or can you recover 100% from an eating disorder?

Dr. Nick Galli: Yes. I believe that you can recover 100% because I know people who believe that they are. So I take it right from the source. Have a plan. Recognize your triggers, so that you can hopefully avoid those. But if you can't what is your functional response to those triggers going to be? Stick with your course of treatment. Your therapy. If there are medications involved. Adhere to what's prescribed. I would say that if there's anything to begin doing more of it's more being physically active. Playing sports. Expanding yourself. Learning to appreciate the beauty of your body not just for how it looks but for its' functionality. I mean we use exercise and physical activity in treatment as a way of, yeah it's great for health and fitness. But also as a way to get in better touch with your body and gain a greater sense of appreciation for your body. Or for other people it could be music therapy. Or it could be art. Or different ways of expressing yourself. And that's all going to be part, hopefully, of the therapeutic process.
Who are you surrounding yourself with? Are there people that really do tend to trigger you who are just so aesthetic focused? Maybe you need to not be around those people. Are there certain health clubs that have posters up that just really trigger you? Maybe you need to not go to that health club. Certainly paying attention to what bothers you. And doing more of what makes you feel good.

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

Interviewer: How do you identify an eating disorder in someone else and what help can you offer if any at all? That's coming up next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for happier, healthier life. You're listening to The Scope.

Interviewer: You might not have an eating disorder but chances are you probably know someone who does. Everyone knows somebody who has an eating disorder. Here is Dr. Nick Galli, Assistant Professor of the Department of Health Promotion and Education. The question is how do you identify someone with an eating disorder?

Dr. Nick Galli: There are some signs that you can recognize somebody who has an eating disorder. I think one of the most important signs is how they talk about food and what their relationship is with food, if they seem to be orally preoccupied with food and eating at a certain time or eating a certain thing, or constantly seem to be trying a different diet. That could be an indication there's something going on.
Physically you might recognize someone as being severely underweight, somebody is having very dry hair, dry nails, and dry skin. In some cases people who are severely underweight might grow a fine layer of hair on their body called lanugo as a way to keep themselves warm since their body weight is so low. So there are some physical symptoms that you can recognize.
But to me it's more the behaviors. Food is a centerpiece often times for people with eating disorders, and so they might sort of put on a pedestal and make it more important than someone else might. It might affect their relationships and their social interactions. It's just something that people with eating disorders think a lot about, is food.

Interviewer: Is it more that food is bad or food is good? Or is it kind of it just depends on the person?

Dr. Nick Galli: Yes, it's definitely not food is good. It's not food doesn't tend to be something enjoyable. It's tied to the way the person feels they want to look and how do I need to eat in order to look a certain way. And here are the bad foods that I can't eat; maybe foods that have a lot of fat they might classify as bad and have very rigid rules about what food they can't eat. So I definitely wouldn't say that food is thought of as a good thing. There may be safe foods that, hey, I can eat carrot sticks and that's all I'm going to eat because it's low calorie and there's no fat.

Interviewer: So they don't really have a healthy relationship with food?

Dr. Nick Galli: No.

Interviewer: So when you see somebody like a close friend, a family, a relative, and you kind of see these signs and symptoms, how to you help them?

Dr. Nick Galli: It's a difficult thing to watch, absolutely. You can't help them. Like anything else they have to want to be helped. You can't be the police. You can't try and want to try to fix them. You approach them from a place of concern. You share your observations and what you're seeing. You ask them, how are you feeling? Are you okay? Can I help you? I'm concerned; I'm seeing you, you're not eating. You've lost a lot of weight. Your mood is fluctuating; what's going on? And if they want to engage with you in that conversation, then it's how can we get you connected with a professional, a doctor, or a dietician or somebody who specializes in this area. And how can I help you do that, because that can be a scary thing.
On the other hand if someone is defensive and isn't ready to have the conversation and then it's just, okay, well you can't force the person to have the conversation. It's I'm here if you need me, but I want you to know I am concerned and we should talk more about this, and maybe we should consider talking to a professional. But ultimately nothing gets better unless they want it to.

Interviewer: Okay.

Dr. Nick Galli: But the most important thing is presenting yourself as someone who's there, who cares and who wants to help.

Interviewer: What I'm hearing is just a lot of this just take charge, get some help for yourself. Does it really matter if someone tells you, hey, I see what's going on. Let's get you some help. Does it really matter in the final end, or is it just more of a self reflection thing?

Dr. Nick Galli: I do think that the person needs to decide for themselves, that they want to get better. But I don't think it's something that you do on your own, and that doesn't just mean you have your support of your medical team, but the friends and family are equally important in terms of just you're going to have some tough days, and having that person to talk to, to call, or that person to talk to.
It's about getting the right type of support from the right people. Friends and family aren't there to diagnose and to prescribe, but they are there to provide emotional support, whereas the doctors and the dieticians are there to give you the tools to actually work through. So I think someone would have a really hard time recovering if they didn't have any support. No matter how good their medical team is, if they didn't have support from their friends and family it's just going to make it a lot more difficult. You need somebody there.

Interviewer: A support system.

Dr. Nick Galli: Yes.

Interviewer: Any final thoughts?

Dr. Nick Galli: I would caution you from going in there with an attitude of what's wrong with you. Like I said before, don't be the police, resist that urge. Because I think that we come to that at some point where we're just like, oh, my gosh, why don't they just get it? Look at it as a complex problem and know that it's not your place to be the police. It's your place to be a supporter.

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