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Breathing is a necessity for all living creatures, but when the air we breathe isn't clean, the damage goes beyond the health of our lungs. And it's not just pollution from cars, our BBQs…
Whether it’s a pap smear, a mammogram, or even a colonoscopy, medical screenings are vital to staying healthy as we age. But is there a point when you no longer need them? Dr. Kirtly Jones…
August 20th, 2021
So you just had your Pap smear or your mammogram and it wasn't that bad was it? Or your colonoscopy. Okay, it really was that bad, but you didn't remember it. Are you wondering when you can stop doing these tests?
I asked a woman I know, who is in the health and fitness business, when she thought she could stop doing her cancer screening, you know, Paps, mammos, colonoscopy. She said, "Never," with a smile. She never wanted to stop her cancer screening, "It isn't all that bad, and it makes me feel safe," she said. I replied that cancer screening decisions about when and how often is a cost, risk, benefit analysis, and there are some data to inform that decision. She said, "You go with your brain, I go with my heart."
Well, let's go with the brain for a little while, okay? Let's start with Pap smears. The recommendations about Pap smears have been changing as we know more about what mostly causes cervical cancer -- the HPV virus -- and how fast it grows, usually not too fast. Cervical cancer does not increase with age for a lot of reasons. Sexual activity and the number of partners doesn't increase with age. Well, usually. And the cervix in postmenopausal women may not be as receptive to the virus. So there are good reasons to say that when you get to 65, if you've had normal Pap smears for the past 10 years, that means you actually have been having Pap smears in the past 10 years, and you haven't had an abnormal Pap in 20 years, you can stop testing. There's some pretty solid numbers to back this up, and the U.S. Preventive Services Task Force makes that recommendation.
Okay. How about colonoscopy? Well, colon cancer does not decrease with age. But if you don't have any family history of colon cancer and if your previous colonoscopies, that assumes that you've had some, have not shown any polyps or precancerous lesions, you can stop at 75. That's the recommendation of the U.S. Preventive Services Task Force and the American College of Physicians.
Lastly, mammography. Breast cancer does not decrease with age. It increases with age. The aggressiveness of breast cancer is less in older women than it is in younger women. But women still will get treated, which can be aggressive in and of itself. The U.S. Preventive Services Task Force said there's not enough evidence to recommend for or against mammograms at age 75 and older. But about a quarter of deaths from breast cancer each year are attributed to a diagnosis made in women after the age of 74. Women as they get older are less likely to get mammograms. About three-quarters of women 50 to 74 have had a mammogram in the past two years, but only 40% of women over 85. Of course, many women over 85 are in poor health, and mammography is just not on the list of things to do. And clinicians are less likely to recommend mammography if a woman is in poor health. The American Cancer Society suggests women should continue mammograms as long as their overall health is good and they have a life expectancy of at least 10 more years.
Well, how long am I going to live? I went online and Googled, "How long will I live?" There are lots of calculators because insurance companies and pension plans really want to know. Well, I tried a life expectancy calculator that was developed by the University of Pennsylvania and has been mentioned in the mainstream media. It asks sex not gender, age, height, weight, alcohol, smoking, diabetes, marriage status, whether I exercised, ate my veggies. I didn't fudge my weight or height. This calculator said I was going to live till 93 and I had a 75% chance of living to 85.
Another life expectancy calculator from confused.com asked me just a few questions, not my height or weight,or smoking, or alcohol, or diabetes. It did ask my relationship status, and options included happy relationship and married, but these were mutually exclusive. You could only pick one. Well, this one had my life expectancy of 97. And the calculator from Northwest Mutual, a well-respected life insurance company, cranked me out at 98.
Well, I really don't want to hang around the planet all that long. But I really hope that my savings will take me up there, and I'm going to have to have mammograms for a while yet.
Thanks for joining us for the "Seven Domains of Women's Health" on The Scope.
Whether it’s a pap smear, a mammogram, or even a colonoscopy, medical screenings are vital to staying healthy as we age. But is there a point when you no longer need them? Learn about the research behind common preventive screenings and under what circumstances you may no longer need to be tested.
The guys review their experience with cooking Stuffed Spaghetti Squash and homemade No-bake Chewy Granola Bars. Troy is victorious, hunting down a gourd and Scot learns to not always expect…
August 17th, 2021
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Scot: Tasty and easy-to-make man meals you can eat all week. Today, it's a very manly review of last week's recipes, stuffed spaghetti squash and the other optional recipe, the no-bake chewy granola bars. Then we'll also have a recipe for next week as well.
And by the way, hit the kitchen with us and share your story and photos at facebook.com/whocaresmenshealth. These recipes are there. You can find links to them. Get in the kitchen, see what you think, see if you like them, see what we can do to improve them. That would be awesome.
I'm Scot Singpiel from thescoperadio.com. I'm learning I enjoy making food, so that's cool. Here's today's crew. We've got co-host, Dr. Troy Madsen. He's the MD to my BS.
Troy: That's right.
Scot: And the guy my wife told me that he should talk more on the podcast, it's Producer Mitch in the mix.
Mitch: I'm here.
Troy: Just keep talking, Mitch. Just keep talking.
Mitch: All right.
Scot: And both of our guests today are from the Department of Nutrition and Integrative Physiology at University of Utah's College of Health. We've got kitchen daredevil Thunder Jalili.
Thunder: Hi, everyone.
Scot: And the person who has the hardest job on the show teaching the rest of us how to cook, it's registered dietician and culinary coach Theresa D.
Theresa: Hello, hello.
Scot: You have just a cool last name. Now, it's just an initial. It's not even your whole name. That's how you know you've made it.
Theresa: I just read an article too about cooking therapists, and I think I should be a cooking therapist. I think that would work with this group.
Troy: Does this mean you are therapy for those who do not know how to cook, or use cooking to provide therapy for other things?
Theresa: I think it could go both ways, but mostly anxiety in the kitchen.
Troy: Oh, sign me up. Since you brought that up, Theresa.
Theresa: I'll call you later.
Troy: I hope you don't mind me starting this out with an analogy. My wife once invited me to a Zumba class, and I went to the Zumba class.
Thunder: I can just picture it now.
Troy: I had never been to a Zumba class before. We were on the back row, but there was a mirror on the front so people could see other people. At the end of the class when it was over, my wife asked me, "Were you making fun of the class, or were you actually trying?"
And I will say that is how I felt last week talking about my experience in the kitchen. Everyone here knows what they're doing. I am clueless. And that's how I felt in the Zumba class. I did not go back to Zumba after that. I have come back here.
Troy: So I'm still with you.
Troy: I came for my second Zumba class. I'm still here.
Scot: All right. I think you're going to find though, Troy, the more you do this, the better it's going to feel. I think you are.
Troy: I will say that's the case already. Yeah.
Thunder: It couldn't get worse.
Troy: It could not get worse. You're right. Technically, it could. This whole parchment paper thing, as I'm putting this in the oven, I'm like, "Is this going to catch on fire? Is this going to be the next episode about my oven fire?" It could get worse, but it didn't.
Theresa: That's great.
Scot: Thunder is always there for some support.
Scot: Back-handed support in a way.
Thunder: I'm here for you.
Troy: Thanks, man.
Scot: All right. So let's go ahead and we'll start with a review of the stuffed spaghetti squash. We'll go ahead and start with Mitch. Any thoughts on that? Did you like it?
Mitch: I did. And I think the thing that I was the most surprised about was just how much food it actually made. The spaghetti squash looks small, but when you start to scoop things up and fill it up, I think we ended up getting almost six meals out of the recipe.
Scot: Wow. It's cool too because the spaghetti squash, you can scrape that thing to the shell. You can use every little bit in there. That's pretty awesome.
Troy, how'd it go for you?
Troy: It was great. I am now a fan of spaghetti squash. And this, again, pushed me a little bit. I had to find someone in the store and ask them, "What is a spaghetti squash?"
Theresa: Yes. I love it.
Troy: I did. I had to.
Thunder: Is it in the pasta section?
Troy: "Is it next to the pasta?" So this nice lady in the store then, who works there, of course, she had a couple of smaller ones. She's like, "Oh, let me go get you a good one." So she went to the back room and brought a nice big spaghetti squash out for me. And it's cool. This is cool. It's fun to eat.
Scot: Wow. Special treatment there. I like that.
Theresa: Troy, did you find the olive bar?
Troy: I did. Our olive bar, though, it's still not an open olive bar. They have an olive bar with everything packaged so they don't have it all exposed, but I did find the olive bar.
I'll tell you the way this happened if you're interested. I went to the store for something else and then I said to myself, "I am really overthinking this cooking stuff. Why am I doing this?" And so I tried to pull up the recipe on my phone and I couldn't get a connection in the store, and I'm like, "I remember what to get." I remember Thunder talking about the olive bar. So I went there. I found olives. They did not have sun-dried tomatoes, but I remembered that. I found that. I remembered the spaghetti squash, so I'm like, "Hey, I can do this."
And so I found most of the stuff. Just remembered what we talked about. I tried not to overthink it and got everything together, and it was much less stressful. It was like, "I can do this." I got the nice spaghetti squash. It was not the cheap stuff. It was in a glass bottle, and so . . .
Scot: The spaghetti squash was in a glass bottle?
Theresa: The sauce.
Troy: I wish the spaghetti squash was in a glass bottle. I just gave it away. No, the spaghetti sauce was in a glass bottle.
Scot: Got it. Sorry.
Troy: Yeah. I think in multiple levels I was just like, "I'm just going to do this. I'm overthinking it." And overall, it was a good experience in that sense. Just not stressing about it, just like, "Hey, I can do this. I remember what I need. I can make this happen." And found the stuff and it all worked out.
Theresa: That's great.
Scot: Hey, Theresa, you teach a lot of cooking classes to people probably at all levels. I think what Troy is discovering is it's really hard to screw things up in the kitchen.
Theresa: Yeah. We can try and take a step back, and a lot of this is this analysis paralysis. We're trying to overthink it. We're trying to be that Food Network chef, that Instagram influencer, or what have you. And we really just need to . . . especially when we're starting out, you need to take that step back and remember those basics.
And if we think about some of the basics that these recipes have introduced us to, sautéeing, chopping things, roasting, buying pre-prepared and then adding a bunch of fresh stuff to it, it can be a lot easier than what we're holding ourselves to these unrealistic expectations.
Scot: Yeah. And even if it doesn't turn out, it's still good. I had a little botch story I'll tell here today, but it still turned out good.
Theresa: That's right. And at least you know that, "Most of the time, well, I know that it may not be amazing, it may not be a Michelin restaurant caliber, but all of the ingredients are good. I followed food safety. It's cooked through. I don't have raw beef in here or something of the sort, and it's probably going to taste better the next time I make it." So learning experience.
Scot: The spaghetti squash. So I've got just a few questions here, and then if anybody else has any questions or comments that they want to dive a little more deeply into.
Theresa, these are just rapid fire. Okay? So how does spaghetti squash freeze? It seems like it's really full of a lot of water. Is it going to not be good if I freeze this?
Theresa: No. Don't freeze it. Awful.
Scot: Okay. So this is one of those ones you've got to . . .
Theresa: Do it fresh. You can save the squash. You could save it and not prepare it until earlier or think about your different steps, but don't make this dish and then put it in the freezer.
Scot: Okay. And when a recipe says two cups of spinach, chopped, does that mean I take two cups of pre-chopped spinach and then chop that, or am I supposed to chop up the spinach until I get two chopped cups?
Theresa: I love this. This is so what I was going to talk about during this episode. In the recipe that we're going to make, it has some of this recipe jargon that is helpful to know. It's not the end of the world. Again, it's still going to taste really good if you mix it up, but it makes a little bit of a difference in the taste and quality.
So, for example, the recipe today will call for "one cup parsley, chopped," or if the recipe were to say one cup chopped parsley. So it's a matter of when you measure it. If it says "one cup of parsley, chopped," then you start with one cup of loose leaves and chop that up. But if it's saying one cup of chopped parsley, then you want to chop until you fill up a cup.
Scot: Got it.
Theresa: A full cup of parsley.
Mitch: When do you learn that in your life? Is it just right now or is it . . .
Theresa: Right now is when you learn it, Mitch.
Mitch: Because I've cooked for a long time in my life and I'm just like, "Wait, what?"
Theresa: It's just like algebra. What do you do first?
Troy: It's the order it's in.
Theresa: Is it parentheses? Is it addition or multiplication? That's all. There you go.
Scot: All right. Yes. So, in the squash recipe, it's "two cups baby spinach, chopped." So I take two cups of whole leaves and then chop those up.
Scot: All right. Yeah. We're rocking and rolling.
Theresa: You would just have a little extra spinach. It probably wouldn't equate to all that much extra, but in some things like parsley or herbs that really chop down fine, it would make a strong difference.
Scot: Yeah, it would make a flavor difference. With spinach, it's just kind of . . . It was a really tasty recipe. I got a ton of leftovers. I looked up how many calories and carbs spaghetti squash has. Literally none. I think one cup is nine grams of carbohydrate and one and one-half of that is fiber. The beans in there have more carbohydrates than the spaghetti squash.
So it was really, really filling and really, really good. I ate it cold today from my leftover and it was great cold.
Theresa: I was just going to ask how did you guys think about repurposing it? Or did you just eat it as was for leftovers?
Troy: I ate it for leftovers. I heated it up in the microwave last night. And it's funny, I just left the whole . . . I didn't scrape it all out. I just left the quarter spaghetti squash there. So I've got a couple of those in the fridge. But I heated it up. The outside of the spaghetti squash really heated up. When I touched it, it was really hot, and the inside of it wasn't super warm, but it was still good though. I enjoyed it.
I will ask something that Mitch wanted me to ask but was too embarrassed to ask. Does spaghetti squash give you gas?
Mitch: It's a legitimate question.
Troy: This was on our group text. Mitch brought it up, if anyone else might have experienced a little bit of upset.
Theresa: I would say no, but it's always possible because there's lots of . . . Do you have issues with other carbohydrates?
Mitch: Not typically. No.
Thunder: Maybe it was just a bigger fiber load than you're used to eating at one time, Mitch.
Mitch: That could have been it. Sure.
Scot: Because those beans . . . the spaghetti squash has fiber, but those beans also have a lot of fiber in them.
Thunder: Yes, they do.
Theresa: It's true.
Troy: I'll admit too . . . I kind of put Mitch on the spot, but I did feel a little bit of stomach unsettling maybe two or three hours afterwards as well. So I wondered if maybe there's just a lot of fiber content in there, but it sounds like there probably is.
Theresa: That would be my guess, is the fiber piece. If you think about . . . the sun-dried tomatoes are really condensed from a fresh tomato.
Troy: That's probably what did it.
Theresa: The olives, similar thing. The beans, the spaghetti squash, certainly. The greens, depending on how much spinach you put in. It's certainly high on the fiber content from your typical roller food.
Troy: Higher than the taquitos.
Theresa: I have to. Every week, I've got to bring it in, Mitch.
Mitch: That's fine.
Troy: That makes sense.
Mitch: So it's not like anything is wrong. It's just fiber is good for you.
Theresa: Yep. And as you get used to higher fiber content in your meals, that should decrease.
Theresa: You're training your gut.
Mitch: I guess one of the things that I was wondering was . . . it seemed like I had a bit of sticker shock as I was scanning one jar after another. It just seemed like it was a bit pricier than I was used to.
Theresa: Very valid. And this is where looking at where and how we buy our items and then reusing them . . . So this is sometimes challenging when we're trying a recipe for the first time and we don't know if we're going to like it. So if you're buying jars of these items, it's quite possible that you had some left in that jar. You didn't use the entire jar.
And this is where maybe some of those grocery stores that have an olive bar where you can just purchase the amount that you need for the recipe . . . So if you only needed a half a cup, that's all you have to buy instead of needing to buy the one to two cups' worth that's in the jar.
Look at other store options as well. Trader Joe's does some of these items less expensive. Those kinds of things are a great way to look at some of these alternatives.
So certainly, it's a valid question, valid concern with this particular recipe. I would also argue, though, at the same time when you think about the quantity that it made . . . It gave Troy six meals' worth for one or two. That's a significant amount of food that it made. So pricing it out per meal, hopefully, would be considerably less. Yes, the initial purchase can sometimes be a bit of a shock.
Troy: And I will say I priced mine out, because I'm curious about this too. I priced mine at about $20 for everything. And admittedly, I did forget to get the artichoke hearts. I would have liked to have had those and I didn't remember until I got home. I was like, "Ugh, artichoke hearts." So that probably would have added on another $5.
But you're right. I think if you look at $20 and you spread it over four or five meals, it's not crazy high. But it seems like there are variations you could do on that. Maybe you don't do the sun-dried tomatoes and maybe you just do the olives or something. Because I found . . .
Thunder: Oh, sun-dried tomatoes are the best part.
Theresa: Or if you didn't like the olives . . .
Troy: You're right. They are the best part. Maybe you don't do the olives.
Theresa: Or doing canned olives. You could do canned olives. Artichokes, there are frozen artichokes and those are fantastic as well.
Troy is exactly right. You could certainly modify this and make it a little bit less expensive of an initial punch.
Troy: You're right, Thunder. That was my mistake. I would not remove the sun-dried tomatoes. Those were amazing. So maybe the olives . . .
Thunder: I'm glad you're a convert to the tomatoes now.
Troy: Yeah. Big fan.
Scot: All right. Let's move on to the granola bars. The official title . . . what was this?
Theresa: No-bake chewy granola bars.
Scot: All right. Yeah. How did that go for you guys? Let's start with Troy.
Troy: I did not make it to recipe number two, unfortunately.
Scot: I've got to tell you, it was pretty easy. So if you want to try it at some point, it doesn't take that long and it was pretty simple.
Troy: I would like to, yeah.
Scot: How about you, Thunder? Did you do the granola bars?
Thunder: Yeah. So, actually, like the good parent I am, I delegated and had my daughter do it.
Scot: That's not the point. The point is us make them.
Thunder: Well, I was in the kitchen at the time in a supervisory capacity.
Theresa: And what were you drinking, Thunder?
Troy: Love it.
Thunder: We had one modification. We didn't do the brown sugar. I think it actually turned out really, really good. And we used a special kind of chocolate chip that my wife found that I guess are some sort of baking chocolate chip, but that ended up being one of the good parts of the recipe.
So bottom line is I think it was a bit more crumbly because we didn't add the brown sugar, but I thought they tasted great. And as long as we ate them chilled, they were fantastic.
Scot: I've got to say Mitch's picture of his look like it was straight out of a food magazine compared to how mine turned out. Mitch, talk to us about the granola bars.
Mitch: I find these suspiciously delicious. The question I have, because I don't have it readily available . . . We ended up swapping . . . we did some Kashi Go rather than puffed rice to make it a little more protein-rich. What is the caloric density of these things? I've had to run up to the hospital a time or two. I've been grabbing them just as a quick lunch.
Thunder: It's high.
Mitch: They are so tasty, though. I'm just concerned. I'm very concerned.
Theresa: And especially with putting in the Kashi Go, it's certainly upped it from what it was. So if you just made one batch and cut it into the, I believe, nine servings that it was allotted for, which would be a fairly good size bar, they're about 300 calories.
Mitch: Okay. That's like a meal replacement.
Theresa: So then with the Kashi Go, I'd probably add another . . . probably if you did that fully instead of the puffed rice, it's probably another 25 to 50 calories. So it's a very dense snack, yes.
Thunder: Mitch, did you cut them into . . . did you actually make nine bars or did you cut them into smaller bars?
Mitch: I cut them into nine, and I just . . .
Theresa: Portion control on this one.
Thunder: So you didn't have just one big bar.
Mitch: So one of the things I think I run into a lot with my own nutrition is I get into that health food blindness where I'm like, "These are healthy. Theresa told me I could eat as many carbs as I wanted." And then I have two of these and then it's like, "Oh, no."
Scot: I don't think she said you could eat as many carbs as you wanted. I think she said you could eat the rice, but I don't believe she . . .
Mitch: Yes. All right.
Thunder: Well, one thing to think about is we actually made them into smaller pieces when we did them. They're like bite-sized pieces, so maybe about an inch or inch and a half or something.
Theresa: And also, if you're thinking about having it as a snack, but realizing that you're eating a lot of them, certainly think about how many you portion and take with you. Another thing to think about is that I have something else alongside it. So maybe I have a low-fat plain yogurt.
Thunder: Like an exercise bike?
Theresa: An exercise bike. Hopefully, you're walking around work. Or an apple. Something fresh along with it.
Mitch: I have been having an apple with a full-size bar, so I need to re-evaluate my life. Okay. Cool.
Scot: Well, I don't know if . . .
Mitch: Good to know.
Thunder: Nothing wrong with a full-size bar in the right circumstance. But I think if you're just popping them as a snack, it's probably a bit much as a snack. So maybe half a bar, a third of a bar, or something.
Scot: I'm treating it as a dessert, really. Just a little something afterwards. And mine didn't come out in bar form. I think where I made the mistake was I put the liquid part in the microwave. It came out bubbly and hot. And then I think I waited a little too long and it hardened up, so it didn't mix very well. So I need to work on my kitchen technique, but they were good. This is one of those cases, Troy, where it didn't come out like . . . it wouldn't be something I'd want to take to a party because they look terrible, but they taste great.
Troy: They tasted good.
Scot: So even though it was a little bit of a failure, it was not a failure because they are absolutely delicious. And I could even see maybe taking these and putting these in the bottom of a bowl, just a few of the crumbles, because mine really crumbled up, and put a little ice cream on top of them. That would be a good little dessert.
Theresa: I was thinking yogurt, but yeah, ice cream works too.
Scot: Yogurt is even better because then you get the protein in the yogurt and the fat in yogurt to help slow down the sweetness in the granola bars. That's brilliant.
All right. On to next week's recipe. It looks really, really good. It looks light and summery. I can't wait to learn more about it. Theresa, what are we making next week?
Theresa: Zesty lentil salad.
Scot: What do you think, guys? Zesty lentil salad.
Troy: I'm already intrigued.
Thunder: It sounds great.
Troy: I like all three of those words.
Theresa: Nothing from Mitch.
Mitch: You like lentils?
Theresa: Mitch, hold on to me. Hold on, Mitch.
Mitch: I'm here.
Theresa: Because it's a salad. However, I don't want you to cringe too much because it's not a salad in the sense that lettuce and iceberg is your base.
Mitch: Yeah. Okay.
Theresa: So hold with me. It's a warm salad. And I use salad a bit loosely because we're essentially just mixing things together like you would, say, a fruit salad. Well, there's no lettuce in there, but we still call it a salad. So we're mixing things together in a giant bowl.
So we had talked I believe the first week about wants or goals or desires of this class and something of this conversation was talking about lentils. And so here is an awesome lentil recipe for you guys to try. And talk about having leftovers. This one is going to give you leftovers. So this is going to be a great combination of lentils and bulgur and some nice fresh veggies as well as a homemade dressing that you'll put on the top.
Troy: So you just said a word there I've never heard before. What was that?
Scot: Yeah. It sounds like somebody that was in "He-Man and the Masters of the Universe."
Troy: Exactly. Who's Bulgur and where do I find him?
Scot: Bulgur. Bulgur smash.
Troy: Exactly. What is that? I have no idea.
Theresa: So it's wheat. It comes from wheat.
Theresa: And it is considered a whole grain, less processed than if you were to, say, have wheat pasta, or wheat bread, or something of that sort. But you can find quick-cooking bulgur and it'll cook up in about 10 minutes. It's a two-to-one ratio similar to rice, two cups of water to one cup of bulgur. And it's a really great addition to your grain repertoire. A lot of people think about quinoa or rice or couscous. I put pull bulgur in there as well. It has a nice nutty, roast-y flavor to it without adding a whole lot.
Troy: Where does one find bulgur?
Theresa: You'll find it with the other grains. So Bob's Red Mill makes a really great one. So if you're in either the baking aisle or in sometimes the Italian pasta aisle where maybe they have cornmeal or polenta or packaged quinoa, things of that sort, it should be there. It can sometimes be in the cereals, though, too.
Thunder: I was going to mention, don't give Troy any hints. It'd be more entertaining to watch him try to find it.
Troy: I know. I have learned my lesson.
Thunder: All the places you mentioned I don't think he could find anyway.
Troy: Yeah. Well, number one . . .
Theresa: This could be one that you find that produce lady and say, "Hey . . ."
Troy: Yeah, I need to find that nice lady again.
Theresa: Or look at your store app. If you're at a store that does have an app function, this would be a great thing because you can put in bulgur and it'll tell you exactly where in the grocery store it's located.
Scot: I bought the ingredients for this while I was buying the ingredients for the spaghetti squash thing and I had a hard time finding the bulgur. One store I went to, I couldn't find it anywhere. The other store, I found it in their . . . not the health food aisle, but the natural foods aisle is where I ended up finding it.
Troy, like Theresa said, look for the Bob's Mill brand and you're going to look around quinoa and that sort of thing. So it could be in two or three different places just depending on your grocery store.
Troy: Sounds like an adventure. We'll see.
Troy: We'll see how this . . . Are there any alternatives? Let me ask you that first. Are there any alternatives to bulgur? Rice?
Theresa: Sure. You could do rice. I would more so suggest something like quinoa or couscous.
Thunder: I was thinking couscous would be a good alternative.
Theresa: Or if you really want to go out, millet would be a . . . But that'd be probably just as hard for you to find as bulgur.
Troy: So get wheat and . . .
Scot: No, you're not milling anything, Troy. Millet is a thing you buy. You're not going to go down to the creek where the mill is with the big mill wheel.
Troy: I swear you said, "Mill it." But now I understand what you said. I get it. I thought you were just seeing how far I was going to go with this, but I get it.
Scot: So is this going to be a main course then, or is this a side, or what's your recommendation on that, Theresa?
Theresa: It's both. You'll see on the recipe I have that it makes 6 main courses or entrees and 10 sides. So this is a really great one that you can really multipurpose. So it's great the first night that you make it. Maybe eat it warm if that works with your timing, because it's really yummy warm. But then for lunch the next day, it's awesome cold as well, or putting it into a pita and having more of a sandwich-type or a wrap or something like that would be really great too.
Scot: And if you're using it as a side, what would be a good type of food to eat with this then?
Theresa: Oh, I would do grilled chicken. I could do some sockeye salmon. It's summertime, so throw something out on the grill. That would be really awesome with it for sure. Thunder's sautéed tofu would be a good topper. It's nice and zesty and kind of Mediterranean, Eastern, Middle Eastern, and so you could think about any of those poultries. A lighter poultry or fish would be really great.
Scot: Let's go around the room here. Troy, let's start with you because you have the most questions normally, so maybe we'll get everybody else's questions. Do you have any questions? Any concerns? You got the recipe there?
Troy: I think I'm ready to try it.
Scot: Do you know what an English cucumber is?
Troy: I will probably find an American cucumber, but . . .
Scot: Do you know how to tell the difference between English cucumbers and American cucumbers?
Thunder: Is it the accent?
Scot: Well, yeah. You go, "Hello, governor," and if it goes, "Hello, how are you?"
Troy: Yes. That will be me talking to the cucumbers.
Scot: "Mighty cheeky today, aren't you, Dr. Madsen?" Then it's an English cucumber.
Troy: If it's wearing a top hat, I'll purchase it. What am I supposed to look for?
Theresa: If it's wrapped in plastic, long and wrapped in plastic, it's an English cucumber most of the time.
Scot: All right.
Theresa: They tend to have fewer seeds, they have a lower water content, and so they work really well for something like this. If you were using a traditional cucumber, say, that you were harvesting out of your garden maybe, or your typical American cucumber from the grocery store, they tend to be really waxy. So I would suggest peeling it as well as scraping out a lot of the seeds in the middle, or it's going to make the salad really watery. Find that produce lady.
Troy: I will find the lady. I've got to find her.
Theresa. Or gentleman. There are plenty of good produce men as well.
Troy: I'm sure there are.
Thunder: So my question about this recipe . . . when I was looking at it, it looks like it's going to create a massive volume of food, and I'm pretty sure I can't freeze it. Would it be okay to cut everything in half, and could I still mix everything?
Theresa: Yes, certainly. This one fairly easily could go in half, yes.
Thunder: Okay. Good.
Mitch: We'll see. I have suspicions also about lentils, but we'll see how this comes together. Troy, the thing that I've been doing lately is that I've just been doing the pickup, the grocery pickup. So I don't even need to hunt in the store to find things.
Troy: Oh, you just put everything on there and someone finds it for you.
Thunder: That's like cheating.
Troy: It is cheating.
Mitch: Yes, her name is Mary. It's been every Wednesday for the last month. I know her. We chitchat. It's great. So she's like, "Oh, getting something different this week." And I'm like, "Yes, I am." So I will . . .
Theresa: You should share the recipes with her.
Mitch: I might have to, but that's just it. So that's how I've been skipping the "Where on earth is this item in the store?" So that's my tip.
Troy: That's a really good strategy. I didn't even think about that. That's actually a good idea. I may do that. I think I can find most of the stuff.
Thunder: Troy, it's part of the adventure.
Troy: I know. It is part of the adventure. I have to say it is, and I have found some new things I hadn't really found before. So this looks pretty straightforward though. The bulgur, that really threw me off, but everything else on here . . . The English cucumber, now that you've described it, I think I can find that. Everything else looks pretty straightforward.
Scot: All right. Can't wait to try zesty lentil salad. We'll talk about it next week along with another brand new recipe from Theresa. And we would love it if you'd join us in the kitchen. Try these recipes out. You can find them at facebook.com/whocaresmenshealth. We're posting the recipes there. You can post your comments and pictures there. We'd love to have you just be a part of this and let us know what you think in the kitchen along with us with "Who Cares About Men's Health."Relevant Links:
Culinary Medicine at University of Utah Department of Nutrition & Integrative Physiology Contact: email@example.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Spend enough time outside during the summer months and you may feel tired, thirsty, or a little nauseous. These are relatively common symptoms of heat exhaustion. But if your body temperature gets…
July 23rd, 2021
Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.
We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?
Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.
In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.
Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?
Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.
But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.
Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?
Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.
The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.
Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?
Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.
Spend enough time outside during the summer months and you may feel tired, thirsty, or a little nauseous. These are relatively common symptoms of heat exhaustion. But if your body temperature gets too high, you may experience potentially life-threatening heatstroke. Learn how to protect yourself and your loved ones from severe heat exposure.
During the summer months, heat exposure can be common. But could it be life-threatening? According to emergency physician Dr. Troy Madsen, heatstroke is an extremely dangerous condition that can lead…
June 30th, 2021
Interviewer: It is time for "ER or Not," the game where we come up with a scenario and give it to emergency room physician, Dr. Troy Madsen, and you get to play along at home and decide whether or not that scenario is something you'd go to the ER or not and Dr. Madsen will tell us the definitive answer. Dr. Madsen, are you ready to play?
Dr. Madsen: I am ready.
Interviewer: So the weather has been getting quite hot lately, especially for us here in the Southwest, and we've been getting a lot of questions coming from people that are really concerned about overheating, so everything from heat exhaustion to heatstroke. So the question is, heatstroke, we know it's pretty serious, but is it serious enough for the emergency room? Troy Madsen, ER or not?
Dr. Madsen: It is, Mitch. Yeah, heatstroke, you need to go to the ER. And that's an important distinction. You mentioned there, heat exhaustion and heatstroke. So heat exhaustion is just when you start to get very overheated. So this is when you start to feel very hot, maybe you feel lightheaded, a little bit nauseous, maybe a headache. This is when your body is overheating, your body temperature is rising.
But then heatstroke is the next step beyond that. And heatstroke, we're talking about people who are really experiencing severe effects, very high body temperatures, and then they start to even experience some damage to the organs in their body, maybe their kidneys, even their brain. It can affect the brain. It can affect the heart. These are cases where people become confused. They're just not responding as well, maybe passing out. These are very serious cases. So if someone is truly experiencing severe symptoms, where they have been in an environment, say in a house without air conditioning or they've been outside exposed to the heat for a long period and they seem confused, they're passing out, they're just not responding to you well, absolutely get them to the ER. And I would say even in these cases, don't hesitate to call 911 to get them to the ER, just because it's essential that we get them in a situation where we can make sure everything is okay and then get their body cooled down rapidly.
Interviewer: Wow. So what are like the top signs, I guess? Because it sounds like heatstroke could be a real problem for your organs, for your brain, like almost as serious as maybe even a stroke.
Dr. Madsen: The biggest signs I would say to look out for are people who are not responding, who seemed confused, or just not responding altogether. You try to get them to respond, they're not answering questions. People who are passing out. Those would be the biggest things I see in people who have moved just beyond heat exhaustion to heatstroke, where you're seeing very serious effects on their body from this.
Interviewer: Is there anything that people can do at home while they're, say, waiting for help to arrive or to get to the ER?
Dr. Madsen: Absolutely. If you can get a fan going on the person, get a spray bottle with cool water in it, spray that on the person, that evaporative cooling can really help, especially in a dry environment like Utah, where evaporative cooling can decrease your body temperature. So spraying down with a cool mist, getting a fan going, circulating air, that can definitely help get that cooling process started. And if someone is in a situation where they're not to heatstroke, but they just say, "Hey, I just don't feel great. I feel a little bit nauseous. I'm just feeling hot." Those are things you can do at home as well to avoid having to go to the ER.
Interviewer: So heatstroke, it's serious. Time is of the essence. Get help as soon as possible?
Dr. Madsen: That's exactly right. If someone is hot, they're confused, they're not responding well, get help, get to the ER.
During the summer months, heat exposure can be common. But could it be life-threatening? Heatstroke is an extremely dangerous condition that can lead to organ and brain damage. Learn how to identify the symptoms of heatstroke, prevent overheating, and determine when it’s time to call 911.
Time-restricted eating may seem like an easy way to lose weight and feel great, but it may not be right for everyone. Dr. Susan Pohl explains how our digestive and metabolic systems are more…
June 22nd, 2021
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.
Dr. Pohl: Are we recording right now?
Dr. Pohl: Okay.
Troy: We didn't really intro the episode though, Scot, did we?
Scot: I know. But sometimes with new people, Troy, I like to sneak into it, so they feel more comfortable.
Troy: Sorry, Scot.
Scot: Maybe not call attention to the fact that we're actually doing the show.
Troy: Don't let me mess with your technique. Please continue.
Scot: I think it might be too late. I think Dr. Pohl is wise to me at this point.
Troy: I think now she knows what you're doing. So go ahead. Now, I do too.
Scot: You've probably heard of this concept of time-restricted eating. That's where say you eat for 8 hours out of the day and then you don't eat for 16 hours. And it's a way that a lot of people are talking about being able to lose a little extra weight. We've talked to Thunder Jalili, our nutritionist. We have a couple of episodes about it you can listen to. Today, we want to bring in a physician, Dr. Susan Pohl and find out what her take on time-restricted eating is. And if it's right for everybody or if there's some people that it is not going to work out for and what are the impacts it can have on your health. My name is Scot Singpiel. I am the manager of thescoperadio.com. With me, my co-host, Dr. Troy Madsen and Dr. Dr. Susan Pohl. So time-restricted eating, tell me your definition of that.
Dr. Pohl: The concept of it is that the digestive system is more than just a food tube and that one of the key factors in health is digesting your food and getting your nutrients into cells. And that happens with a chemical primarily called insulin. And that insulin is one of the key drivers that helps us use the nutrition from our gut.
So insulin is very important. Obviously, if you know anybody who has diabetes, especially Type 1 diabetes, Type 1 diabetes is the kind that children get. They don't have insulin and they can get very sick. For the more common type of diabetes, which is Type 2, you actually have too much insulin and your body starts to get insulin resistance. And so one theory that has been popularized is that not only do we need the right nutrition, but by timing it with insulin and giving our body a rest from food and a rest from the insulin, we actually can boost health and boost vitality.
Scot: Yeah. That's a little bit of a different take on it that Thunder has. So, when we talk to Thunder, it's primarily more about I think weight management, losing some weight or maintaining your weight. So that's fascinating. It can actually impact your health as well. So is time-restricted eating something that everybody should be doing?
Dr. Pohl: No. The idea behind time-restricted eating from my point of view is primarily around insulin and storing and getting into that storage mode. And when we eat foods that are high in carbohydrates, we tend to secrete insulin and then we go into the storage mode for our nutrition. And the theory behind that, back in high school biology, we learned that the brain was the computer that helped drive the body, we had this nutrition tube to helped us digest food, and that we had fat and fat was a storage vehicle.
What we know now from research is that although those ideas are correct, it's a very simplified model and that there actually are hormones that talk to each other between the brain, the gut, and the fat in our body. So, by doing time-restricted eating, you are decreasing the amount of insulin that your body is being exposed to. But you also are triggering some other hormones like the balance of leptin and adiponectin, which are two other hormones that are secreted by fat. And so for some people, as you start to drive weight down, you actually start to get a decrease in leptin. And you can actually drive the brain to cause some binge eating behaviors.
So the balance between the gut and the brain can become a little bit off. And so I have patients that come to me and say, "I did time-restricted eating and I'm fasting several days a week, but I'm not losing weight," or "I'm not successful in this," or "I do 16/8. So I'll go 16 hours of fasting and 8 hours of eating and I'm not losing weight and I'm not getting more vitality." And I keep reading about this and what may be happening with a lot of those people is that they actually are triggering some bingeing because of the brain's reaction to the fasting.
So it's a tool that works for lots of people, but some people will start to trigger bingeing. And there are certain people who should not be doing time-restricted eating, specifically those that have a history of binge eating disorder or any eating disorder. We don't recommend it for children under 18, which just hasn't been studied. And we know that nutrition is vital for functioning and growth, so children should not be doing time-restricted eating or intermittent fasting and pregnant women because again, nutrition is very important for pregnancy.
Troy: And do you find that there's a certain cutoff in this time-restricted eating where it starts to become more problematic? You mentioned the 8-hour eating, 16-hour fast? That seems like a very long fast. Is that just too much or do you just tell people, "Hey, do what works for you and adjust it to your schedule"?
Dr. Pohl: Yeah. I don't think we understand. As we peel the onion, like I said, if we think about the onion and insulin is one of the big layers in there and then we get down into some of the more detailed hormones around leptin and adiponectin and the way that signals and triggers the brain to crave more food. And so everybody has a different reactivity to that. So, again, I think I recommend exactly what you said. You can try those things like 16 and 8.
I have seen some studies that the balance of leptin, adiponectin are not as put into as much imbalance if you do every other day fasting as opposed to everyday fasting. So using it as a tool that maybe you don't do all the time for some people who are being triggered to binge eat or consume more calories during their non-fasting times. And I think it's unconscious. I do think that patients don't . . . People don't quite realize what 100 or 200 calories looks like. And so they'll be recording their food log and say, "I'm only recording 1,500 calories," or, "I'm only recording 1,800 calories." But this trigger for the brain I think gets out of balance.
Troy: That's interesting. Yeah.
Scot: Yeah. It is.
Troy: We've really been on the time-restricted eating bandwagon here. And I worry sometimes this happens with a lot of health things that you see something that has some benefit and we think, "Well, if it's good, if I just do more of it, it's better." We've talked about doing 12 and 12 and maybe increasing that to 14, but then maybe people think, "Well, let's go to 16 and 8." And then potentially as you mentioned, then maybe that just starts to throw things off and you just want to binge eat during that eight hours and it's counterproductive.
Dr. Pohl: Yeah. I see a lot of patients that will do alternate day fasts, eat a norm, regular timing for foods one day and then alternate day, a lower calorie, 16 and 8 or 12 and 12 on alternate days. And I think a lot of people can manage that a little bit more. And some people find that that's a technique that makes it more sustainable.
Scot: I did the 8/16 and I had a lot of success with it. But as I'm listening to you talk, I think I was set up for a little bit more success. First of all, perhaps my body is not having the same chemical reactions that some people do, because bingeing wasn't an issue for me. Second of all, my whole life I've been very aware of what 200 calories looks like. I understand my macros pretty well. So I was eating essentially what I would eat, except for I was just compressing it. And I know how many calories I eat. So I was finding success, but if somebody is not quite sure, it can be really easy. I imagine if that chemical reaction kicks in to just go, "Oh, I need a bag of Reese's Peanut Butter Cups" and you're down that and there's four or 500 calories, now you're eating more than you normally would. The other thing that fasting the reason it worked for me is because I can only eat so much in that period.
So what were you finding when people binge? Are they bingeing on good stuff or bad stuff? Or usually, how does that play out?
Dr, Pohl: So the interesting thing is that if you look at the brain's trigger, we actually think that we have this hedonic pathway. And so during times of stress, we tend to gravitate toward foods that are highly palatable. So speaking in English, you're going to crave . . . If you're given a chocolate cake or a salad, if you are in that craving mode, you're definitely going to go more for the chocolate cake. So I think the other piece of it is when you do break a fast, think about breaking it . . . When your first food that you're eating, I would concentrate on a balanced nutrition profile, so some protein and some fat that'll keep the gut from going into a real fast metabolic rate. So, if you make sure that you have some protein and some fat as you start to break your fast, I think you won't get triggered as much to crave the high sugar, high carbohydrates.
Troy: And you mentioned also you don't recommend this for people who have had a history of eating disorders. Have you seen any cases of people who maybe didn't have a previous diagnosis of anorexia or bulimia or anything like that, but where going to this time-restricted eating maybe triggered some eating disorder tendencies?
Dr. Pohl: I haven't seen it in my practice, but that is a concern. There's another condition called orthorexia. And I don't know if you guys have talked about that at all. So people can go into anorexia where you just don't eat, you never break your fast or adequately break your fast to get enough nutrition. It can trigger bulimia where you're bingeing and then purging. And then orthorexia is, again, a newer diagnosis where patients with anxiety can start to become really obsessed about their food content and it can interfere with other parts of their life so that they can never go off of their food schedule. And so that is a disorder that we're starting to see, some in our practice where I've seen more orthorexia where patients are actually starting to obsess. And it's under the realm of obsessive compulsive disorder where patients will start to spend all their time and energy looking at the food and their food content.
Troy: And I have seen some things as well. Looking at intermittent fasting and time-restricted eating of even some health effects like an increased rate of gall stones, I guess the idea being that the gallbladder isn't working as much because there's no food in there, you don't need that bile secreted. And that bile sitting there increases the rate of gall stones. Are you seeing anything along those lines or any other health effects similar to that?
Dr. Pohl: Yeah. I think if you're weight neutral, I think that the rate of gallstones are less. But with anything that promotes weight loss, you're at risk for gall stones, especially if the weight loss is rapid.
Troy: So a lot of what I'm hearing here is that Scot and I have certainly been on the bandwagon here. With time-restricted eating, we're like, "Hey, this is great." But it sounds like you're telling us yeah, there's maybe a place for it, but there's a whole lot else you should be addressing maybe before even thinking about it. How do you talk to patients when they first come in, in terms of just their general health, weight loss? And when does this come into that conversation?
Dr. Pohl: So most people are very comfortable talking about exercise and nutrition when they're talking about weight and really health. We start to talk more on a global level about things like sleep and mood when patients are having more difficulty and we'll start to talk a little deeper about other issues around health. And if we feel like they're addressing things in a good way around mood and sleep, I might bring up, have they heard of intermittent fasting and what is their experience with it. And we'll talk about time-restricted eating and I'll give them some resources to read about it. I've actually recommended "The Obesity Code" as a book for someone to read and then have them follow up with me and really talk about what that would look like and then support them as long as I know that they're otherwise in a healthy place and have the support that they need to start time-restricted eating.
Troy: So this is not a first-time treatment for obesity, this isn't something you're talking about in your first time, it's like, "Hey, if you've got everything else in place, this is an option as well."
Dr. Pohl: Yeah. I definitely add it after we've maximized nutrition and especially looking at things like carbohydrate content and total exercise, both vigorous exercise and more moderate exercise and making sure they have a balance of all those things.
Scot: So it sounds like if somebody is getting some exercise, they're watching their nutrition, their caloric intake, they're getting good sleep, they've got some good mental health, there's nothing in their life that's causing stress. That tends to work for the most part for people feeling healthy losing a little bit of weight. If somebody hits a plateau, that's when maybe you might pull this one out of the toolbox of intermittent fasting.
Dr. Pohl: Yes. And I make sure that they're following up with me and making sure that we have a good plan for follow-up and just making sure that all their . . . none of those other issues become triggered.
Troy: So here's the next question for you. Do you practice intermittent fasting?
Dr. Pohl: Yes, I do. Actually, I have found that I maximized exercise and nutrition and felt like I had hit a wall. During the pandemic, actually, I started doing 16 and 8 and I found that it helped break through some issues for me and I was able to have some success that I hadn't previously been able to achieve.
Troy: Wow. And were you doing 16 and 8 every day or every other day like you mentioned?
Dr. Pohl: For me, the issue and it was a little bit, maybe a little bit of that what I talked about earlier, that hedonic drive, but what I found was that I was able to look at my nutrition five days a week. And then on the weekend, I love a piece of chocolate cake or a glass of wine or something like that. And so it was very hard for me, and discouraging for me to do seven days of really good monitoring your nutrition and exercise and then have a weekend of maybe some celebration or something and then lose ground. And so what I found for me was that if I did interment, if I did 16 and 8, during the weekdays, I was able to then let off steam on the weekends a little bit and participate in those fun activities that included some nutrition that maybe I didn't have during the week. And that for me made it sustainable.
Troy: And it seems that if you do 16 and 8, you're essentially skipping a meal during the day, and I've heard breakfast is the easiest. That seems to work for me. Did you do that or did you approach it a little differently?
Dr. Pohl: No. That's exactly what I did. Again, because I do have a family, I just moved my lunch to about 1:00 and then made sure that I was finished up with dinner before 6 or 7. And then that was a really easy transition because I was able to have dinner with my family.
Troy: Yeah. That makes sense. Yeah. That's what works for me. For me, the balance seems to be 12 and 12, and then sometimes that 12 stretches to 14 where I don't eat after 8, then I may not eat until 10 a.m. the next morning. But 16 and 8 sure sounds tough. I have not tried that. That seems tough to sustain, but it seems like you had some pretty good balance there.
Dr. Pohl: Yeah.
Scot: Shockingly, so I flip flop it. Breakfast is too important to me. So I usually have my breakfast, and then I'd wrap up at about 3:00 or 4:00 in the afternoon. And my concern was, I think what Dr. Pohl speaks to a little bit is then that time between 4 and bedtime, right? You get into that no man's land where maybe you're going to start making some bad decisions. I just upped my water intake, and a lot of times that took care of the problem. So that worked for me. I don't know if it would work for everybody or not, but . . .
Troy: I guess it depends how many times you want to get up to pee at night, Scot. I don't know if that was an issue for you.
Scot: Well, this is the shocking thing. No. This is a shocking thing. I didn't.
Troy: You didn't?
Scot: It didn't have to get up and go anymore.
Troy: You just like chugging water and . . .
Scot: Which is bizarre because I used to have to. So I don't know if it's related to this or what it was, but . . .
Troy: Huh, interesting.
Scot: Dr. Pohl, what about intermittent fasting for somebody that's trying to manage their blood sugar levels if that's been a challenge? Is that a good strategy? Are there other better strategies, much like we talked about with weight loss?
Dr. Pohl: So, again, if you do have diabetes, I would definitely make sure that you're working with your doctor about this and that you are monitoring your blood sugar. And if you're on medications for diabetes, you need to be adjusting those based on fasting. So, for patients that have pre-diabetes, which is a condition where your blood sugar tends to run high after eating, I think that this is a tool that you can use to help control that. If you already are on medications for blood sugar and diabetes, then you definitely only want to do this under a doctor's supervision.
Troy: So definitely not a first line. But Scot, I know you've had this question. You've asked and maybe you can ask it. I don't want to necessarily reveal your health information, but you've talked about it on the podcast that you said you were borderline on your blood sugar, on your fasting glucose. And I don't know, maybe you can tell us a little bit more about that.
Scot: Yeah. So I come in around 97 to 99 and that pre-diabetes is 100. So I'm right underneath there. And I don't know if that's been just the way I've been my whole life because I don't have enough history of those numbers to be able to tell you if that's always where I've been. I used to subscribe to the Zone diet, which one of their tenants is that you have a little snack before bedtime. So, really, my time eating would be from 6 a.m. until 10 p.m. because it would be like cottage cheese and nuts and fruit. It would be healthy. I don't know. Troy, what question did you want me to ask? What question are you asking for me?
Troy: The question I'm asking on your behalf, Scot. For someone like Scot, is time-restricted fasting . . . because he tried everything. Is this some way to then maybe help a little bit more to move someone out of that pre-diabetes range? Is there any benefit there?
Dr. Pohl: Yeah. So the theory behind pre-diabetes is that you're constantly bombarding your body with insulin. And so by constantly having carbohydrates throughout the day, you're constantly having insulin in your body throughout the day. So, with time-restricted eating, what you're doing is giving your body a break from that insulin and you're saying, "Okay. I'm not going to expose the body to carbohydrates and insulin during a certain time period of the day." And that's a way that in the pre-diabetes when you have this tendency toward that borderline, you can actually pull that back a little bit. And so, Scot, were you successful or did that change your . . . What's your fasting glucose now? Do you actually monitor that?
Scot: I have not been doing it long enough to really check.
Dr. Pohl: Yeah.
Scot: So I started doing it right before the pandemic hit. And since then, all bets for me. Troy's doubled down on everything in his life, meaning he runs further and he eats healthier. And I've gone it completely the opposite way.
Troy: I don't know about that, but . . .
Scot: I do. So I haven't tried it yet. Is there any research on that, Dr. Pohl? Is there any expectation I could have? Because I did exercise. I was eating healthy. I was just eating throughout the day. So I wonder if my eating throughout the day and never giving me my break is what started developing that pre-diabetes. There again, I don't know, maybe I've always had high blood sugar resting. I don't know.
Dr. Pohl: Yeah. Well, it's interesting to see what your weight was before and what your weight is now. But the balance between your fat and your sugar and that trigger of the insulin, I would expect your fasting blood sugars to now be a little bit lower, more like 90 or 85. But it'd be interesting to see how your body responded. Again, it's a really complex system and that insulin is that big part of the onion. But as we drill down into the other hormones in your body, those could be affected as well. So we would only know by checking.
Troy: I think we got to check, Scot.
Troy: I think you are our case study because you've talked about it and I know you were struggling just to get that number down and definitely concerned. So I'd love to see where it is after doing some intermittent fasting.
Scot: So I'll do a 12 on, 12 off and I'll see how that works. How long would I need to maintain that, Dr. Pohl, before I'd want to get my blood sugar tested again, which I haven't done in two years, by the way?
Dr. Pohl: Yeah. What's your eating style right now? Are you not doing any time-restricted eating?
Scot: I do try to do 12 on, 12 off. I do try to wrap up. I start at 6 and I try to wrap up at 6.
Dr. Pohl: Yeah. So I would test it now and see where you're at. If that's what you're doing.
Scot: Oh, really doing?
Dr. Pohl: Yeah.
Scot: So that soon?
Dr. Pohl: Uh-hmm.
Troy: Let's do it. Yeah. Let's do it.
Scot: All right.
Troy: This will be our next episode, Scot. We're going to do the reveal with you. You get your blood sugar drawn, we'll do the reveal and find out what it is, if you're willing to share it.
Scot: That'll be a lot of fun for our listeners . . .
Scot: I'm sure. Yeah. I'm sure there's nothing more . . .
Troy: Radio drama.
Scot: . . . intriguing to podcast listeners than hearing a guy's blood sugar revealed live on the air. That seems solid.
Troy: Here is the number.
Scot: Now, I know why you're the doctor and I'm the professional broadcaster.
Troy: Exactly. That's right. Not my area of expertise, but I'm intrigued.
Dr. Pohl: I want to know too.
Scot: All right. Well, the doctors in the room want to know. That's fine.
Troy: Yeah. We want to know. We'll listen to that episode.
Scot: All right. Dr. Pohl, so it sounds like just to summarize. Time-restricted eating is something that somebody could try, but there are some caveats. It can cause overeating, some bingeing, you might end up going the opposite direction. Better to check in with some of those basics first like, how does your nutrition look, what you're eating, how does your activity look, your stress, your sleep. This could be a tool that maybe if somebody has hit a plateau they want to try. And then there are some medical conditions, you might want to talk to your doctor first before thinking about time-restricted eating. Did I sum that up fairly well?
Dr. Pohl: That's a great summary.
Scot: Okay. Great. This was a great conversation because I think I get excited about something like this and I forget that everybody is going to react to something like this differently. I was blown away when you said that some people would binge because I didn't experience that. So, of course, that's the way everybody would experience it. That's what we think, but that's not necessarily the truth. So great conversation. Thank you for being on the podcast and thanks for caring about men's health.
Awesome. You made it to the end. I hope that you enjoyed this. "Who Cares About Men's Health?" We have three shows in one podcast. We have our core four episodes, which is just what you listen to here where we concentrate on nutrition, activity, sleep, and also your emotional health. We have our sideshow episodes, which are a little bit more loose, we do still talk about health topics. So maybe not directly related to men's health. And then we have the men's health essentials that's talking about issues that are specific to men that you should know about.
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Headaches are very common, with many treatment options available. Yet, many people suffer with headache pain without ever speaking to a doctor. Don’t suffer in silence. Headache specialist Dr.…
June 18th, 2021
Interviewer: Today, we're going to talk about how you can go into your primary care physician and talk to them about headaches, so you can finally get that relief.
Dr. Karly Pippitt is a primary care physician, but she's also a headache specialist at University of Utah Health, so she understands both the perspective of a primary care physician and a headache expert. So, hopefully, we'll be able to bring those perspectives together to find out how to talk, how to prepare, and other things like that. So the first question is, what kind of barriers do people run into when they're trying to talk to their doctor about headaches?
Dr. Pippitt: I think probably one of the biggest barriers, when talking to primary care, is time, right? I mean, if I go to my primary care doctor, I probably have four or five things that I want sort of checked off my list to get taken care of, and this is just one in a list of a number of things. And what I have learned is that what's really important is you need to make a visit that is dedicated to your headaches. This is a problem that deserves the appropriate amount of time. So you need to go into it with that perspective if your provider doesn't guide you to that already.
Interviewer: I've been fortunate. I know people that have had severe headaches. And when we talk about headaches, are we talking just about headaches in general, or are we talking about migraines? I mean, what type of headache is it generally that people seek help for?
Dr. Pippitt: So most people I would say probably seek care for migraines, but I think one thing I've been very impressed by is how much people don't talk about headaches. And in my role at the Headache Clinic, I'll sometimes ask people questions about their headaches and they'll say, "No one ever asked me that before."
Dr. Pippitt: And it doesn't seem like a particularly earth-shattering question that I've asked them. So I think that's a pretty important thing is that if your headaches, migraines or not, are impacting something in your life, right, like it's keeping you from work, it's keeping you from school, it's keeping you from anything like that, that means you should talk about it.
Interviewer: Yeah. If you kind of take an inventory and you're like, "Yeah, that is kind of an issue." Because we all get just kind of one-off headaches, a lot of people do. And that's not what we're necessarily talking about here, or is it?
Dr. Pippitt: I think it can be. I think if it's not a one-off as much anymore, but like, "Hey, wait a minute, I think that's kind of been every day. And yeah, maybe I can get done what I need to do, but maybe I can't quite focus as well, or maybe I'm a little more irritable at home with my partner, with my family, and I don't really like that." Those are things you should talk to someone about.
Interviewer: All right. So make that appointment with your primary care provider and just make it just about headaches if that's what you want to tackle with your primary care provider. Then what would you recommend that a patient do to start moving towards maybe managing them a little bit better?
Dr. Pippitt: Yeah. So when you go in for that appointment, be ready. So most people who have headaches have more than one type of headache. This is sometimes I think if you don't have headaches or don't have frequent headaches, you don't think about this very much, but go in ready to talk about that. Maybe I have this sort of low-level headache if I don't eat enough that day or if I go a little bit late on a meal or don't stay super well hydrated, but maybe I get a really bad headache if a storm comes in or if I haven't slept very well for a couple of nights in a row. So be ready with sort of all of those different types of headaches and especially coming in with a diary. So I've seen all sorts of different diaries. There are apps for your phone that you can use. You can write these down on a calendar or just on a notepad. But you want to keep track of the frequency. So how frequent are you having headaches? How bad are they? So did you have to go home from work, or were you able to keep doing what you wanted to do that day? How did you sleep the night before? How active had you been? And then what did you take, and did it help or not? These are all important things to just sort of get a bigger picture, because we all think we remember. "Oh, I think I had a couple of headaches last month." But sometimes when you write it down, it can be pretty striking how frequent you might be having headaches.
Interviewer: Yeah. So go in prepared. It's going to take a little time beforehand. How long would you recommend somebody do the diary before then they actually go and talk to their doctor?
Dr. Pippitt: I'd probably say somewhere around six to eight weeks. Some of it depends on how bad your headaches are. So I think if your headaches are really pretty debilitating and you're having to miss work, then you might not want to go for quite that long. But at least a good couple of weeks of volume of extra information so that then you and your provider can look at that together to determine what might be the next appropriate step.
Interviewer: Okay. And you had mentioned that there are some apps out there and they tend to ask the questions that are going to be the most useful in that appointment. Most of them are pretty good, or do you have a recommendation?
Dr. Pippitt: The one that I've used the most is called My Migraine Buddy. It seems to be the most user-friendly. It actually prints out some nice, pretty charts that talk about how frequent, how intense was the pain, and things like that. That's the one I've heard the best reviews from patients.
Interviewer: Yeah. And when a patient comes in with that information to you because, as you mentioned at the top, you're a primary care physician, but you have also taken extreme interest in headaches and have educated yourself to the extent that maybe the common primary care physician has not. Are you kind of struck by when they come in with that information? Does that truly make it easier for the regular primary care physician?
Dr. Pippitt: Oh, absolutely. I mean I think anytime you come to me as a primary care doc and have information about when your last labs were, about your family's medical history that's really detailed, I'm never going to be upset about that. That is like a gift when you walk in the door.
Interviewer: Okay. So the person brings that in, they bring you some great information, and then at that point, you would review it, and you would likely come up with a treatment plan. Are we at that point yet?
Dr. Pippitt: Yeah. Absolutely. And treatment, we usually break down into two big categories. So one is rescue or acute treatment. So if you're having such intense headaches or migraines and whatever you're trying over the counter isn't working, that's sort of step number one, one thing we could treat. And then I think the second aspect of that is prevention. So if you're having really terrible migraines every week, that lasts for two or three days, well, then we should do something to try to reduce that frequency. So talking to them about what the options are, what might make the most sense based on their particular set of circumstances.
Interviewer: So if I'm a person with a headache and I've gone to my primary care physician and I know maybe they've had like a day or two of training, right, and maybe they have educated themselves off and on throughout their practice, how often can a primary care physician that's kind of got that base level of headache knowledge really solve a problem?
Dr. Pippitt: I think we are well equipped to solve the problem. There are a lot of good migraine medicines that have been out there for a while. And I would say before you escalate to a specialty level of care, unless there's something unusual or concerning about your headache in particular, but you should be able to try at least a couple of rescue medications with your primary care provider and at least a couple of prevention medications. I think it's important to always keep in mind there is no magic cure for any of this. There is no snap of my fingers that is going to make this go away. So patience is really important. If you come in with a migraine a week for a year, it's going to take some time to get at that. So being patient and having reasonable expectations about the outcome, I think is important going in.
Interviewer: Yeah. That can be important. I know some people personally that they have headache issues and they've gone to their doctor and then they felt like they weren't able to solve it so then they just gave up. So I think kind of realizing that it sounds like it's a process, where maybe a few treatments might need to be tried would be useful. At what point then would you want to consider going to more of a specialized headache care center?
Dr. Pippitt: I think if you've tried a couple of things with your primary care and you're not making any headway, if you'll pardon the pun, I think that's the time to think about talking to someone else. It's an okay thing to ask your primary care provider. Just be forthright and say, "At what point do you usually refer patients to a specialist?" I think most of us have a level of comfort with different medical conditions, like I'm clearly going to take care of a lot of things in my primary care practice that are headaches that some of my partners will not, but they'll take care of some things that I would probably send to a specialist as well. So I think asking your provider when. I think it's important that you've tried something, though. I occasionally will see patients in our Headache Clinic who've never tried anything before. They've never tried a prescription rescue medicine. They've never tried a prescription preventive medication. And while that's particularly lovely for me in the Headache Clinic, I would say it's not a good use of a pretty limited resource, because we're there to really take care of patients who've tried quite a few things and are not making any progress.
Interviewer: So we talked about how to talk to your doctor, your primary care physician about headaches, make that diary. It sounds like have a little bit of patience with them as they work through a few treatment options. Are there some other keys to getting that correct diagnosis and treatment from a primary care provider?
Dr. Pippitt: I think you as the patient are the one who knows your history best. So I think we worry that maybe the right questions aren't being asked. So if there's some symptom or something you're experiencing that you don't know if my hand tingling, before I get a migraine, has anything to do with it, bring it up, pay attention to those things. Really ask the questions when you go in so that you're well informed about your own condition, because that helps your provider make the correct diagnosis.
Headaches are very common, with many treatment options available. Yet, many people suffer with headache pain without ever speaking to a doctor. Don’t suffer in silence. Learn the best strategies to prepare for a discussion with your doctor about your headaches so you can get the best treatment for you.
Mindfulness practices can help with stress, depression, and anxiety—but research has shown that they can also help with physical conditions. Trinh Mai with University of Utah Health's…
May 18th, 2021
Interviewer: I think many of us have already heard or know that mindfulness can help with stress and depression and anxiety, but did you know mindfulness can also help with a lot of physical conditions as well, such as pain management, high blood pressure, diabetes, heart disease, AIDS, cancer? It can help improve your sleep, stomach issues, and even eating disorders.
Trinh Mai is a mindfulness educator at The Resiliency Center at University of Utah Health. And mindfulness can help all these physical ailments as well, huh?
Trinh: Yeah. Isn't that wild?
Interviewer: It is wild. Tell me more about that. I mean, how does that work exactly?
Trinh: What all of those conditions share in common is that chronic stress can contribute to all of those conditions — hypertension, diabetes, heart disease, digestive conditions. Often stress is at the root of it, and stress is also the outcome of a lot of health conditions. So if there's a practice like mindfulness that can help you to better manage stress, then it's going to help you to better manage those symptoms.
Interviewer: This isn't something right now that I think a lot of physicians necessarily do. I bet you I could go to my doctor and say, "Hey, tell me about mindfulness and how that could manage my diabetes." You might get a blank stare. So are more and more physicians kind of adopting it, or how is this manifesting itself in traditional healthcare?
Trinh: Actually, how I came to mindfulness was my neurologist. I don't just teach this, I practice it and I'm a believer because I went to my neurologist about 10 years ago and said, you know, "I'm having all these neurological issues, pain, numbness." And we did a workup, and luckily I didn't meet any particular diagnoses, but she said, you know, stress often contributes to pain.
So she actually recommended that I take mindfulness-based stress reduction, and that's a course that I currently teach now so I feel really lucky. But that course changed a lot for me. It helped me to become more aware of what triggered my pain, and then it helped me to be aware of, you know, how I react to my pain can actually reduce it or exacerbate it. Sometimes the reactions actually make things a lot worse than the initial problem.
And then I, through the practice, actually became more aware and then I hopefully have been able to reduce my pain in other aspects. Hopefully, I'm less of a pain as a parent and as a partner. But yeah, it's awareness. That's what mindfulness is. And when you're aware, then you have more choices of what course to take.
Interviewer: I know a lot of people personally, and probably even me a few years back, if a physician in medicine would have told me what your neurologist told you, I'd be like, "Oh, they just can't figure out what it is. This is ridiculous." I can almost hear somebody going home and go, "Yeah, they told me I need to be more mindful. How's that going to help? Give me a pill, give me a diagnosis, tell me what's wrong."
And I think a lot of us have a hard time believing that stress can cause some of these other health conditions. So that story was great because I think it just really illustrated, you know, it did, it made a difference in your life and it can make a difference for a lot of people.
So let's get to the question now. So somebody is listening to this podcast, maybe they're suffering from one of the things we mentioned, maybe it's something else. How do they do it? Let's give somebody a first primer and then we'll give some resources.
Trinh: Yeah. So let me start with, first of all, I think that a lot of people that I've taught they'll tell me, "Oh, yeah, it's not for me because my mind races and I just can't make it stop," or "I can't sit still, that makes me too nervous." Well, you know what? I totally get that. I come from generations of people, particularly women, that cannot sit still. Like my mom, she's 70 something, she's retired, but she does not sit still. So I totally get that.
And it's like anything, the more we do, the stronger our muscles are to be able to do it, and the better we get. The other thing I think it's important to know is that you don't have to make your mind stop. So I'm going to just repeat that. You do not have to make your mind stop. We can't necessarily control that, but what we do have control over is if we pay attention to it or not, and we can bring attention to our bodies.
So for example, if I were to ask you now, can you bring attention to your feet on the ground and feel the surfaces of the ground? And if you can do that, you're practicing mindfulness.
Interviewer: That's it?
Trinh: Yes. And, you know, your mind's going to wander off to, "Oh, well, I got better things to think about." And that's cool. But when you notice that, you can bring it back.
So now I'd like to invite you to bring your attention to your breath and maybe see if you can pay attention to three breaths, the inhale, the exhale, feeling the air enter the nostrils, and opening up your body. Exhaling completely, feeling the body contract.
The mind wanders off. You notice. That means you're aware and you bring it back to your breath. And then at the end of the next exhale, maybe just check in and notice how you feel. See if there's any shifts.
Interviewer: I feel more relaxed already, and we did that for like, what, 18 seconds. That was amazing.
Trinh: Thanks for practicing along, Scot.
Interviewer: That was fantastic. So it doesn't seem like it's hard. You just kind of have to be paying attention. I'd imagine there's a lot of resources that you can get to it. There's apps I hear advertised or probably YouTube videos. Is there any place, in particular, you'd like to go for somebody who just wants to start?
Trinh: So, you know, I'm biased. I work for Wellness and Integrative Health here at the University of Utah, so I am going to invite you there first. You might want to check out the University of Utah Wellness and Integrative Health YouTube channel, and it's under Be Well Utah. So that's the series that you can check out.
And then, you know, taking courses, trying a class is a lovely way to get support and structure and a community to start a habit. So we have two courses. We actually have three. We have Everyday Mindfulness, which is an introductory course, and it's four weeks. And then we have the gold standard, which is Mindfulness-Based Stress Reduction. And that's the one that John Kabat-Zinn started and has decades of research behind it. And that one is nine weeks.
And then I just started a self-compassion course during lunch, and that's only an hour long for four weeks. So a few options for you to just, you know, try it out and see what it's like for you.
Mindfulness practices can help with stress, depression, and anxiety—but research has shown that they can also help with physical conditions. Explore the treatment of chronic stress through mindfulness practices and how it can help manage health conditions like chronic pain, blood pressure, and heart disease.
If you’ve tried diet and exercise and still can’t seem to lose the excess fat, you’re not alone. Obesity is a complicated condition that involves more factors than just activity and…
April 9th, 2021
Diet and Nutrition
Interviewer: You've tried diet and exercise, and you're still not losing weight. What's next?
Dr. Jennwood Chen is from the Comprehensive Weight Management Program at University of Utah Health. And Dr. Chen, how often do you see patients that struggle to get to a healthy weight?
Dr. Chen: It's not uncommon when patients come to see me that they have a history of failed weight loss attempts, even though they are fairly religious with diet and exercise. That's likely because obesity is a multifactorial disease. There are many things that cause obesity and continue to or make it hard for people to lose and keep the weight off.
Interviewer: What are some of those other factors that keeps that weight on us?
Dr. Chen: Genetics plays a big role, medical comorbidities, obesity-related medical comorbidities, long-standing diabetes also makes losing and keeping the weight off difficult as well, how long you've been obese, we know this is a temporal relationship between how long you've carried this excess weight and/or diabetes, and how easily it is to take that and keep it off as well. Chronic stress, we know that shift workers, disrupting your sleep and therefore disrupting your glucose regulation will contribute to weight gain and diabetes. So there are many factors, and many factors that we're still learning about.
Interviewer: I think that could be kind of rough for somebody who's just heard over and over again, "It's diet and nutrition, diet and nutrition." And if you're not losing weight, it could be really frustrating, and you could start feeling like, "Well, what's wrong with me? There must be something wrong with me."
Dr. Chen: That's correct.
Interviewer: But what I'm hearing is there are other considerations, other than just what we hear all the time, diet and nutrition. You covered some of those. So when a patient has some other considerations like that, what are some of the tools that you have to help them then, beyond diet and nutrition?
Dr. Chen: I'm a bariatric surgeon, and certainly there are surgical options, but I work at a comprehensive weight management, and there are a plethora of new pharmaceutical modalities. We have a wonderful medical bariatrician there that prescribes and manages these medications as well.
Interviewer: And then, you had mentioned bariatric surgery as a way to do this as well. But I've heard of it in terms of metabolic surgery and not bariatric surgery. To kind of reframe that in people's minds, help me understand what that means.
Dr. Chen: I'm so glad you mentioned that. I think we've done ourselves a disservice by framing it as weight loss surgery. The weight loss comes for sure, but it's not the primary goal. It's really to restore your metabolic health and put you on a healthier trajectory. It's not a cosmetic surgery.
Interviewer: And then what is the hope, as far as you're concerned, if somebody comes in and they do get bariatric surgery, they start losing that fat, how does that then make them healthier?
Dr. Chen: So with the fat loss, we also see resolution or at least remission of a lot of the metabolic diseases, being diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, PCOS, I mean, so many. It's quite amazing actually. I remember a time where I learned that diabetes was a chronic disease with no cure, and now we are curing it.
Interviewer: Well, Dr. Chen, it's reassuring to know that, you know, sometimes diet and nutrition just isn't enough when you're trying to lose weight. And the benefits of losing weight, just are so many that it's really worth trying some of these other pathways, if at all possible. Tell me a little bit about the University of Utah Health Weight Management Program and how you approach weight loss, you know, in addition to diet and nutrition.
Dr. Chen: So the University of Utah Comprehensive Weight Management Program is what I like to think of as a multi-disciplinary, holistic approach to treat obesity. And we tailor our approach to the needs of the patient. So whether it's, "I need to lose a few pounds, and I think I could do it through diet and exercise, that I just need some help implementing and sticking with healthy lifestyle choices," to, "I've tried this, I need some medical help via pharmaceuticals," to, "I've really thought about this, and I want to investigate surgical interventions." I mean, we cover it all, and we are open minded to all of it.
Interviewer: It's easy to forget, again, coming back to this theme, that diet and nutrition, that's kind of what we get hammered into our head over and over, that that's the only thing you have to focus on. Well, that's great. But if you don't quite understand nutrition, which, you know, is totally normal, you've got a nutritionist that can help you. If you need help with exercise, you've got exercise people that are part of the program. Cardiology, sleep, dieticians. I mean, just like all these things we talked about, you have somebody that can help somebody, regardless of what their situation is.
Dr. Chen: Yeah, it's in the name. That's why we call it comprehensive, you know? But you're absolutely right. Our traditional advice, "Eat less, exercise more," it just doesn't work for everyone. And that's really because obesity is a complex, multifactorial disease. And that's why, you know, we're proud of our comprehensive weight management. The bottom line is we're here to help in any way that we can, in a very team-oriented, tailored approach.
If you’ve tried diet and exercise and still can’t seem to lose the excess fat, you’re not alone. Obesity is a complicated condition that involves more factors than just activity and nutrition. How genetics and other health conditions may impact your weight as well as what options are available to help improve your health.
Resistance bands are a great exercise and physical therapy tool—but can sometimes be dangerous. Emergency physician Dr. Troy Madsen talks about the types of eye injuries caused by exercise…
April 6th, 2021
Interviewer: Are you working out from home with exercise bands? Well, you might want to watch out for this injury.
Dr. Troy Madsen is an Emergency Room physician at University of Utah Health. And a lot of us are trying to get in some exercise at home, and we might reach for those exercise bands. But, Dr. Madsen, I understand that there could be some risk working out with those exercise bands. Tell me more about that.
Dr. Madsen: You know, Scot, I have used exercise bands, and this is a risk I've never really considered, but apparently there is an increase in risk and injury to the eye that has been something that's been noted since the pandemic started. So what we're seeing, I think, more and more people are not going to the gym, they're working out from home, and a great tool is a resistance band. If you've ever used this, it's like a giant elastic band. You know, these things are huge. You put it around your foot, and then maybe you're leaning back or doing something with your leg, all kinds of different things, stretching, strengthening.
Well, at the University of Miami, they actually published their experience with seeing multiple patients come to the Emergency Department with injuries to their eyes from these resistance bands. So the title of this article is "Ocular Trauma Secondary to Exercise Resistance Bands During the COVID-19 Pandemic," published in the "American Journal of Emergency Medicine."
And you can imagine how this can happen. I don't know if this has ever happened to you, but let's say you wrap it around your foot, and you're stretching your leg out, and that thing is really tight. And then, maybe you've got socks on or something, and it slips off your foot and flips back and hits you in the eye.
Interviewer: Oh. Ow. Oh.
Dr. Madsen: Yeah, sounds miserable. Sounds absolutely miserable.
So they reported their experience in the "American Journal of Emergency Medicine," and they talked about 11 patients they had seen, and these were not minor injuries to the eye. So they said 11 patients, 14 eyes, so that means several of these patients had both eyes injured. Eighty-two percent of these patients had a hyphema.
So a hyphema is a pretty big deal. That's where you get blood behind the cornea. And, you know, if you ever look in the mirror, you see the cornea, you see your iris, the colored part of your eye. The cornea is the clear part over the top of that. And if you ever see blood there, it just looks like just this red line that's filling up behind there, that's a pretty big deal. That's a serious injury.
And then, vitreous hemorrhage in 36% of these patients. That's blood back behind the iris, back in kind of the main part of the eye. That can really affect your vision. Potentially, if it causes enough damage, potentially have long-term effects. Same thing with a hyphema if it's not treated.
So these are not minor injuries, but they saw a number of these, and just given the number they've seen, they reported on it in the "American Journal of Emergency Medicine" to make people aware that things are happening with resistance bands.
Interviewer: All right. So not happening to, necessarily, a large number of people that we know of, but is in the realm of possibility of happening apparently.
Dr. Madsen: Exactly. And I think the reason they published this and their conclusion was, if you're using a resistance band, wear glasses or consider wearing goggles. I mean, it may seem like overkill. It is something that emergency departments are seeing. This is one emergency department's experience. I'm sure it's happening elsewhere. I have to be honest. I have not seen this in the ER yet, but if we talk to some of our ophthalmologists, my guess is that they probably have. So it's out there, it's happening. You know, takeaway, be aware of it and consider wearing some glasses or goggles if you're using a resistance band.
Interviewer: Yeah, or consider just making sure that you're looking at how you're using it, and "If it was to slip right now, would it slip back and snap me in the eye?" And is there an adjustment you can do in your form that would, you know, prevent that from happening?
Dr. Madsen: Yeah, exactly.
Types of eye injuries caused by exercise bands and how to protect yourself.
Whether you’re trying to lose weight to improve appearance or your health, getting started can be quite the challenge. Dr. Jennwood Chen from the University of Utah Health Weight Management…
March 26th, 2021
Diet and Nutrition
Interviewer: Today, you're going to learn about four research-supported steps to begin your weight loss journey.
Dr. Jennwood Chen is a member of the University of Utah Health Weight Management Program, and he helps patients that want to lose excess weight, not only for appearance but more importantly for better health. So let's talk about those four steps. What are those four steps to help somebody create some new eating habits to help them lose weight?
Dr. Chen: Yeah, yeah, absolutely. So, you know, changing what you eat or starting any new habit is notoriously difficult, right? I mean, we all are familiar with the New Year's resolutions that are broken and abandoned by, you know, January 5th. And so really in looking at how people actually implement, start and retain healthy habits, I think science has really identified four steps, and those four steps are inspiration, intention, action, and repetition.
So really, so, for instance, if someone is wanting to make a healthy change in their diet, really you need an inspiration. So many of my patients, when I talk to them, "Why do you want to lose this? Why do you want to lose this weight?" And they'll tell me that, you know, "I have young children and I know that my excess weight is affecting my health and I want to be around for them and I want to be able to play with them and be active with them." And that's inspiration, and that inspiration is it's what you draw on in those times where you know it's going to get hard just to stay with it.
However, we know research tells us that that inspiration is fleeting. So you may be inspired today to make a change, and tomorrow you can't rely on that inspiration because you just can't feel inspired all the time. And so that's where the next step intention. Once you're inspired, you need to set an intention. Okay, tomorrow, I'm going to cut this out of my diet.
Interviewer: And when you talk about intention and you have a patient, what are some of the first suggestions you have? I've heard like eliminate sugary drinks. If that's something you do, maybe start to eliminate those. That's like a really low-hanging fruit, high-impact sort of a thing. Are there some other things?
Dr. Chen: Well, that is absolutely. If someone tells me that they, you know, drink a couple of cans of soda a day, I immediately jump on that one. And, you know, people will get pretty addicted to soda. I have patients that tell me, you know, they drink up to a liter of pop a day. And so that intention to make a change needs to be a realistic. For some people, you know, cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.
Interviewer: All right. What is the next step? We've had inspiration and intention.
Dr. Chen: Action. So really, you know, once you've set an intention, the action, and by action I mean immediate action. If you have inspiration, your intention is to start cutting out the soda, don't start next week. Start with the next time you are going to have a soda, that next time and just take action right then. It could be a small thing. Yeah, I'm not going to drink the whole liter. I'm just going to, you know, cut out half a liter, but, you know, take action now.
Interviewer: All right. When the inspiration is there and you're ready to go . . .
Dr. Chen: That's right.
Interviewer: You got to cash in on those deals, right.
Dr. Chen: That's absolutely right.
Interviewer: So inspiration, intention, action, and now rinse and repeat with repetition.
Dr. Chen: Rinse and repeat. Absolutely, yeah. And so we know, on average, it takes about three weeks to really develop a "habit," you know, and it just doesn't happen unless you could repeat these steps.
Interviewer: After three or four weeks of somebody doing this, you know, they come back to your office. What do you find that are some of the other things they can do to succeed on these four steps or some of the things that maybe, you know, cause people not to succeed?
Dr. Chen: I really think that, through all of this, you have to have self-compassion. And that really means that when you slip and it's inevitable, we all do. We all miss going to the gym. Even though I say, hey, I'm going to go, you know, five days a week at 7: 30, there's just, you know, life happens and you just miss a day. You can't beat yourself up about it. You can't torpedo the whole idea just because you slipped up once.
And on the flip side, at the end of the week, when you have, you know, cut out a liter of soda a day for five days, you got to pat yourself on the back, and you should tell your family, you should tell your friends, and you should be proud of yourself really. And that's how we stay on the path.
Four research supported strategies to help you find the inspiration, motivation, and knowledge to help achieve your weight loss goals.
It doesn't make sense that these five "common sense" medical beliefs aren't actually true. Troy dispels myths such as using rubbing alcohol to clean wounds, the importance of…
February 23rd, 2021
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: Great. Yeah, Mitch is our producer, and he doesn't even listen to the podcast. What hope . . .
Mitch: I'm listening to the podcast right now.
Troy: What hope do we have?
Scot: What hope do we have beyond the walls of these microphones?
Mitch: I'm sorry I didn't remember what you were . . . okay.
Scot: I love how frustrated you get, Mitch. That cracks me up every single time. "Okay, fine. Yeah. Right. We're doing this now. Okay."
Helping provide the inspiration and the information to care about your health, this is "Who Cares About Men's Health." My name is Scot Singpiel, I am the manager of thescoperadio.com, and I care about men's health.
Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Scot: All right. Today, we're going to talk to Troy about five things that you figure are common-sense medical things, but they really aren't true. So, Troy, how long have you been an emergency room physician?
Troy: Scot, I graduated from medical school in 2003, so I started residency in emergency medicine 17 years ago. Man, I say that and it makes me feel really old, but it's been 17 years of emergency medicine. Fourteen years since I finished my emergency medicine residency training, so it's been a little while.
Scot: What's the average career expectancy of somebody in emergency medicine? Because I'd imagine it's not like just being a family physician. I'd imagine that burnout is higher, or maybe not.
Troy: It is a bit higher. Yeah. Studies have been done and it used to be they'd look at burnout in emergency medicine and say, "Well, it's because it's a lot of people who didn't train in emergency medicine," but I think since then we've seen that yes, there is, unfortunately, a higher rate of burnout in the ER.
So you don't see a lot of really old ER doctors. That's why I think I'm starting to feel old. You don't see a lot of white-haired guys going around talking about the old days 40 years ago. It's not something you see in the ER.
Scot: Yeah. And all the ER docs talking about the old days 14 years ago, so . . .
Troy: That's right. I feel like the old guy now. There are guys older than me, trust me, but I'm starting to feel the years.
Scot: So point being you've been doing medicine for a long time and emergency doctors sometimes see a lot and hear a lot and experience a lot, some that might make most of us shake our heads, probably make you shake your head as well.
And today, Troy came up with a topic that I just absolutely love, and I would love it if you'd share this with us. So "Common Sense That Doesn't Make Sense." So in your experience as an ER doc, these are five things that you have seen and heard from people and patients that think are common sense medical things, but aren't really true.
Troy: That's right. These are things that I grew up believing. And maybe even in medical school, I still thought, "Yeah, this makes sense to me. It's common sense." These are things maybe your mom told you as a kid, like you need to do this if this happens, or it's just stuff your friends have told you. Maybe even a doctor told you at some point.
But from my perspective as an emergency physician who deals with certain things and sees these things, it's just, from my practice, it doesn't make sense. These are things I've heard, and then I've heard them again after years of experience. I'm like, "Wait a sec. I believed that at one point, but it doesn't make any sense." It's not something you really need to know or you really need to pay a lot of attention to.
Scot: All right. So we're going to run down through this list right here. And some of them, I'm like, "Really, that's not true?" Number one here, for example. Number one, putting rubbing alcohol to clean wounds is on Troy's Madsen's . . .
Troy: Yeah. It's something you always hear.
Scot: Yeah, common sense that don't make sense. So that's not true? That's what I did all the time. That's what my mom did all the time.
Troy: Oh, I know. Me too. Do you put rubbing alcohol on your wounds now still? I mean, is that something you do?
Scot: I don't live a life that I end up with a lot of wounds.
Troy: You don't have a lot of wounds on your regular wounds?
Scot: But if I was to get one, I would come home, I'd get a cotton swab or a cotton pad, I'd probably put rubbing alcohol on it, and I'd try to clean it up.
Troy: Yeah. I mean, it makes sense. You've got to get that wound clean and that's what you're thinking. Like, what better thing to do than pour some rubbing alcohol on it and just scrub that thing out? You think back as a kid, just the pain and agony from that. Your mom grabbing some rubbing alcohol and rubbing it on your wound or that sort of thing. It's like, "Well, you've got to get it clean." Or even soap, just getting a bar of soap and rubbing it on a cut or just scrubbing it in there. It's not something we do.
And it's not only not something we do in the ER. It's something I tell people not to do. Let's say you get a wound on your hand. And there have been a lot of great studies done on this. All you have to do is run that wound under some kind of lukewarm tap water for five minutes. That does a great job. It washes it out. It gets it clean.
If you do have a lot of debris and dirt and rock stuck in the skin, maybe you do have to get a little scrubbing brush or something really that's not going to tear the tissue apart, but something to kind of rub that stuff out. But you don't want to use rubbing alcohol.
And the reason I say that is because rubbing alcohol or a lot of these things kills a lot of that healthy tissue in there. So that can actually affect the wound healing and even make things worse than if you just did nothing.
Just putting that rubbing alcohol in there can do some damage, so I tell people don't put rubbing alcohol on. Just run it under some nice lukewarm water for five minutes. Just get things irrigated really well with that. It doesn't have to be sterile water. You don't have to boil the water on the stove for five minutes. Just tap water is perfectly fine. It's going to clean the wound out great and keep that healthy tissue there.
Scot: All right. And cleaning out the debris, you just want to be gentle, it sounds to me. You don't want to get in there and really make sure . . . better to have a little debris. I mean, is that damaging the tissue as well if you get in there and, even without rubbing alcohol, just really scrub?
Troy: Yeah. It's a tough balance because you've got debris in there and you've got maybe some chewed-up tissue that's just going to die off anyway. But you don't want to just get in there and really scrub it super hard. I mean, that sometimes is just going to tear things apart and damage the healthy tissue you've got there.
Scot: All right. "Common Sense That Doesn't Make Sense." This is five things you figure are common sense from a medical standpoint, but they aren't true. Troy has encountered people that still believe that they are true. He even believes some of this stuff. I even believe of this stuff.
Number two, know your blood type. I have a memory that back in the day didn't they have blood type bracelets?
Troy: Yeah. You can have cards you carry in your wallet. Because you know your blood type, right?
Scot: Yeah. I'm A-positive.
Troy: I know you know that because you say you have special baby blood or something like that.
Scot: Yeah. Well, first of all, I know my blood type because I donate blood, but I also have baby-saving blood because apparently. I don't have some virus or something that most adults have. I don't know what it is. I'm pure.
Troy: You're pure.
Scot: Yeah, I'm pure apparently.
Troy: You don't have the coronavirus. You are pure.
Scot: Yeah. But the average person doesn't need to know their blood type. That's not something I'm going to be asked if I'm in an accident. "Hey, what's your blood type?"
Troy: The reality is if you come to the ER and you need a blood transfusion, there is absolutely no way I would ever trust you to tell me your blood type, and then I would give you the blood. Scot comes in and he's like, "A-plus." "Okay, let's order up some A-positive blood for Scot." Because if I gave you the wrong blood and you told me, "I'm A-positive," and you're not A-positive, you're B-positive or AB-positive or AB-negative, and I gave you the wrong blood, I could kill you. That would be a really, really bad thing.
So the reality is you don't need to know your blood type. You're never going to get a blood transfusion based on what you say your blood type is. We're either going to give you blood that's what we call universal donor blood that's essentially the blood type that is okay for anyone to receive, or if it's not an emergent thing and we've got time, we'll do cross-matched blood. What that means is we just test your blood, tell what type it is, and then we get you that type right then.
So, again, like I said, it just always kept . . . I can't say it kept me up at night, but it worried me as a young boy to know I didn't know my blood type. "What's going to happen?"
Scot: Well, that's interesting. All right. And it makes total sense too. "Common Sense That Doesn't Make Sense." Number three, speaking of the ER, this was a favorite one of moms everywhere, including my mom. "You better wear clean underwear in case you end up in the ER." I always thought this was just a vanity thing. Did other people have the impression it's a health thing, or was it always just a vanity thing?
Troy: It's a vanity thing, but it's one of . . . yeah, you always hear it too. "You better wear clean underwear because if you end up in the ER and you've got dirty underwear on, it's like . . ."
Scot: "Sorry. Can't help you."
Troy: Sorry. But it's this idea that you're just going to be absolutely humiliated going in the ER and like, "Oh, I haven't changed my underwear in three days," and you're going to have nurses pointing their finger at you, like, "Look at this dirty little kid," or something. But no one cares. I mean, honestly, no one cares.
Number one, no one is going to look at your underwear. But the only time we ever see anyone's underwear is if they come in as a critical patient or a trauma patient, and there, I'm not looking at their underwear. If they're a trauma patient, we've got these scissors, trauma shears, and we're just cutting their clothes off all in one fell swoop, and everything just gets bundled up and tossed in a bag. I don't care. Like I said, it all gets bundled up.
Scot: Not on your list of concerns.
Troy: It's not. No one is going to look at your underwear or judge you for your underwear, whether it's clean or not.
Scot: All right. That was a fun one. Number four, getting a little bit back more to the seriousness. "You should go to the ER if you have high blood pressure so you don't have a stroke." Now, I can't say that I believe this. So I'm hard-pressed to believe what situation this arises in. So maybe you could shed some light on that.
Troy: Well, have you ever checked your blood pressure? Like, just gone to the grocery store or at a pharmacy and sat down on one of those machines and it squeezes on your arm and tells you your blood pressure? Is that something you ever do?
Scot: Yeah. Usually screwing around, but . . .
Troy: Yeah, like, "Hey, what's my blood pressure today?" It is not at all uncommon for us to have people come into the ER who have done that exact thing, and they checked their blood pressure and they got a high reading.
The reality is, number one, we don't base a whole lot off a single blood pressure reading. People's blood pressures fluctuate when you're exercising. If you've been kind of worked up, like you walked in from outside and it was hot outside, maybe that raised your blood pressure.
But the other reality is that you're not going to have a stroke from just high blood pressure like that. It's not going to just somehow cause you to rupture an aneurysm necessarily or do something like that. It's one of those things where the body tends to respond pretty well to fluctuations in blood pressure.
And unless you're having other symptoms with high blood pressure, like chest pain or stroke-like symptoms, like numbness, weakness, difficulty speaking, anything like that, just a single blood pressure reading at a grocery store or a pharmacy or home blood pressure cuff, it's not a reason you have to rush to the ER.
You could call your doctor. You could see them in a week or two. They may check your blood pressure there. And even then, they're probably going to say, "Well, let's see what your blood pressure does over the next three months. We're not going to start you on medication. Let's just keep an eye on it, and then we'll see what it does over the next few months and then kind of make some decisions from there."
Scot: So without the symptoms, if your blood pressure comes back a little high, don't worry about it too much. Maybe check it again a little bit later if it's a home cuff.
Scot: Okay. That's good advice.
Troy: And you know what happens 90% of the time? When people come in with high blood pressure and maybe they're in the waiting room, as they're getting triaged, they do have a high blood pressure. We get them back to the room, turn the lights down, let them relax, check their blood pressure 30 minutes to an hour later, and it's come down. And it's kind of like, "Well, we don't need to start medication. Don't need to rush to do anything. Sometimes just different things make our blood pressure fluctuate."
So, like I said, it's one of those things where we see it often enough that it's . . . certainly, I think people worry about that, but no reason to rush right in to get things checked out.
Scot: Is there a number that I should be concerned about?
Troy: No. I'm not going to say any number.
Scot: All right. Fair enough. The no other symptoms part, that's the key there.
Troy: That's the important piece, yes. As long as no other symptoms.
Scot: Five things you figure are common medical sense, but they aren't really true. This is "Common Sense That Doesn't Make Sense." And we are up to number five on Troy's list. "Get an annual physical to get a clean bill of health."
Yeah, I've heard this before, but that's not true. That's going to make a lot of guys feel good because we don't necessarily want to go in every year, do we? I mean, does that mean we don't have to go in every year?
Troy: Well, I think the "common sense that doesn't make sense" piece of this is this whole idea of a clean bill of health. Occasionally, I'll see people in the ER who are coming in with chest pain and they say, "Well, I just saw my doctor last month and he gave me a clean bill of health."
Scot: "So this couldn't be a heart attack."
Troy: So it's kind of this idea of I saw my doctor, he listened to my lungs and my heart, maybe did a little bit of blood work. You've got a clean bill of health. It's a funny term because you think about that and you're like, "Wow, that sounds really reassuring. It means everything is good. It means I must be healthy. There are no impending heart attacks or strokes." But there's no way of predicting those things.
You could go to your doctor and get your annual physical and get whatever you might consider a clean bill of health. They say everything checked out, and your blood work looked okay. You could still walk out the door and have a heart attack. Nothing about their testing is going to be enough to predict whether or not you could have a heart attack within the next hour or two hours or week or month or whatever it is.
So I guess kind of the point of that isn't to say don't get an annual physical. It's more to say this whole idea of a clean bill of health really doesn't hold a lot of weight.
Scot: Got you.
Troy: Basically, what it's telling you is during the visit things looked okay, your vital signs look good, everything checked out. Stuff can still go wrong. You could still have strokes, heart attacks, etc. So still a reason to take those symptoms seriously if you do have those, even if you just saw your doctor a week ago.
Scot: Got you. So the danger for the average person is "I was with my doctor a month ago. He said I had a clean bill of health." Now, somebody has these symptoms and they're like, "Well, it can't be anything. I have a clean bill of health. It's written right here. It says on this piece of paper."
Troy: "It says I have a clean bill of health, so I must be fine."
Scot: So then people will ignore those symptoms to their detriment.
Troy: Yeah. They ignore those. It may create a false sense of reassurance.
Scot: And get that annual physical. Sure, it might not predict that you could become sick a week or two from now, but a lot of times those numbers that they get can actually start to recognize a trend that you can turn around, as in Troy's case with cholesterol, and my case with my higher blood sugar.
Troy: Yeah. And I want to be careful there in saying, "The common sense that doesn't make sense." The annual physical makes sense. I think you want to do that to predict stuff and prevent stuff down the road and potentially uncover issues. But if it doesn't uncover an issue, stuff can still go wrong.
Scot: All right. There you go. Five things that you figure are common medical sense, but really aren't true. "Common Sense That Doesn't Make Sense" according to emergency room physician Dr. Troy Madsen.
Any final thoughts as we wrap up this segment of the show on "Who Cares About Men's Health"?
Troy: Like I said, these are all things that are just funny thoughts I've had over the years of stuff that I've just thought, "This used to be a really big deal for me. I used to think a lot about this and now I realize it's not worth worrying about it. It doesn't make any sense."
So maybe you've had some other ideas, other questions that you've wondered about, like, "Is this really something I should worry about? Is this sort of a medical myth?" Feel free always to contact us at firstname.lastname@example.org or reach out to us on Facebook. I'd love to get your questions and explore some more of these things as well.
I would sing it, but I . . .
Scot: Na-na-na-na-na. Thunder. Thunder. Troy, do the honors of singing, "You've been Thunder debunked."
Troy: I can't do that, Scot. Come on.
Scot: Thunder debunked.
Troy: I have to maintain some sense of dignity.
Scot: Thunder debunked.
Troy: I'm sorry. I can't . . . I think you already did it.
Scot: All right, Troy. Excited again to have Thunder. Thunder is back. We love it when Thunder comes on the show. He's our resident nutritionist here at "Who Cares About Men's Health." Thunder Jalili on the show.
Troy: Yeah, Thunder.
Thunder: Thank you.
Troy: Thanks for being here.
Scot: Where else do you go in life that people applaud you like that when you show up?
Thunder: I'm pretty sure you two are the only ones.
Scot: Yeah. Well, me. I mean, Troy, he never claps for anybody.
Thunder: He didn't even applaud? Okay, it's only you, Scot.
Troy: It was just Scot, but I was clapping in my heart for you, Thunder.
Scot: All right. We have a listener question. That's why he brought Thunder on the episode today. So how can you gradually improve your eating habits? That is one of the questions that we got. There are a lot of ways to contact us, which we'll give you at the end of the podcast, but this individual is interested in improving their eating habits, just doesn't quite know where to start. Where do you start? Do you just the next day decide, "Oh, I'm eating healthy. Let's go"? Is that what you do?
Thunder: No. I think it's really hard to do anything cold turkey like that. We are kind of creatures of habit, so really, what we have to look at is how do we build new habits? And that requires maybe making some smaller changes and going from there.
So what would I tell someone who wants to try to improve their eating habits? First, I would say take a look at how much natural versus processed foods you consume, and how many beverages that may contain sugar you consume, and pick a couple of the low-hanging fruit, easy things to modify, and go with that. And then build on that over time a little bit.
Because it is really hard, especially if you're not sure how to eat well, to just wake up one day and say, "It's all over. I'm going to the store and all I'm buying is quinoa and green beans." You have to build up into it. So that would be my advice.
I find that when people start doing that, and they get kind of used to maybe a different way of shopping, a different way of preparing food, then they can . . . it's like a snowball rolling effect. They can kind of build on it and it increases over time. But it is daunting if you just try to go all-in in one day, because you don't even know what to buy, how to cook, when to eat, everything.
Troy: Yeah, cold turkey never seems to work well, that 0-to-60 thing. Same thing of someone going out like, "I'm going to run a marathon," so they go and run 10 miles and they're injured and then they're just done. It seems like the same thing happens with diet. You're just like, "I'm just going to go cold turkey and eat great." It seems like people are miserable. It just doesn't go well.
Scot: Interesting take. At first, it's just getting rid of some of the stuff that's not optimal. Just one or two of the things. You don't have to all of a sudden get rid of all of it, but maybe you just decide, "All right. A couple of meals this week, I'm going to try to get rid of some of this suboptimal stuff and replace it with something that's a little bit better."
I'm going to also say, Thunder, at least from my experience, you've got to be kind to yourself. Because at first, you're not going to get it right. You're going to have setbacks. You're going to have moments of weaknesses. So don't beat yourself up. Just go, "All right. Well, try again next time."
Thunder: Yeah. If I could give a quick concrete example too, because this is something I've talked to people about. There's a bigger push, I guess, in society that maybe we should eat less meat, some of the health effects associated with meat intake.
I've had people say, "Well, I'm not really sure. If I don't eat meat, what do I eat? I don't know what kind of foods to eat." And I tell them, "Well, why don't you try to pick one meal in one day and make that a vegetarian meal? And if that works out, then try to pick one day and make that your vegetarian day. And this just gives you time to think about it and practice a little bit and buy some different foods and build into it, and you can just keep adding days."
So I think that is a good way to go, because if you tell somebody, using the meat example, "You're going to go vegetarian starting in an hour," you're like, "Okay, the only thing I can figure out is I'm going to have cereal for every meal of the day."
Troy: Right. When I went vegetarian, I just tried to replace everything that was meat with non-meat. So I used to eat turkey sandwiches every day, grilled turkey sandwiches. So I bought about all this Tofurky, this soy turkey, and that was disgusting. It often doesn't go well. You're right.
Scot: Time for "Just Going To Leave This Here." It might have something to do with health or it could be something completely random.
Just going to leave this here. I've been kind of into sayings lately, Troy, so I'm going to throw another saying down for "Just Going To Leave This Here." It might be a new paradigm to look at something if you've recently found yourself kind of at square one again on a project. For a lot of people, COVID has kind of put them back.
I like this. It says, "Don't be afraid to start over again. This time, you're not starting from scratch. You're starting from experience." So I like that. Just try to think about you're in a different place when you start something over again, and that different place is actually going to help you make the next part better. So I like that and wanted to share it. Hopefully, it helps somebody out that's listening.
Troy: Scot, I'm just going to leave this here. I mentioned recently on our podcast that we have a pull-up bar outside the ER. It sits outside the ER right there in the ambulance bay. I have been very intimidated to go out there and try and do pull-ups on it, but I've taken a couple of steps in my life recently, Scot.
Step 1 was during shifts, if I just kind of hit that lull halfway through the shift, I go out there and I do a few pull-ups. Fortunately, none of the EMTs have been out there who are generally pretty big guys.
Scot: They make it look easy, right?
Troy: Yeah, exactly. So, fortunately, none of them have been out there to laugh at me and no ambulances have pulled up while I'm doing it. But the other thing I've done, Scot, is I actually got a pull-up bar. So I'm now doing pull-ups at home too.
Scot: I want to know more about that. Is that one of those indoor pull-up bars, or where is it?
Troy: It's indoors. It goes over the doorframe. It's got a wide pull-up . . . kind of your arms wide and then a handle for closer arms. And you definitely find doing this, when you do the wide arms, those are tough. When your hands are in closer together, it's a little bit easier doing the pull-up. But I've been doing it now for a couple of weeks. I like it.
Scot: Does the pull-up bar feel safe and secure, the one that you put in between the doorway?
Troy: It does. Yeah, it does feel safe and secure. I was a little concerned about that, but the way it's set up, it loops up over the doorframe and it's got these pads. So as long as you have it set up correctly and it shows you the diagram to make sure it's safe and it's not going to flip off the doorframe or something, it's been fine for me. And I've been using it for a couple of weeks. I haven't had any issues.
Scot: I've been thinking about getting one of those pull-up bars, because you talk to just about anybody that knows stuff about exercise and doing resistance training, that is kind of one of the big exercises, the king of back exercises, because you're using so many of those back muscles.
Troy: Yeah, it's great. I'm enjoying it. I would be embarrassed to tell you the number of pull-ups I can do, but I'm enjoying it. You definitely feel like you've had a workout in a very short time. So I kind of like that.
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 601-55SCOPE. That's 601-55SCOPE. 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, email@example.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.
Thunder Jalili tells us why you should be concerned about those extra pounds around the midsection and how to get rid of them. Plus, what should you do if you get Frostbite? Troy shares his…
January 12th, 2021
Scot: All right, Troy, this is your show. Go ahead. I'm just kidding.
Troy: Don't put me on the spot like that, man. You know I don't know what to say.
Scot: All right. Here we go. "Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future.
Got some guys here that care about our health. We're proud to say it too. My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.
Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I care about men's health.
Thunder: I'm Thunder Jalili. I'm a professor in the Department of Nutrition and Integrative physiology, and I care about men's health.
Scot: All right. Today on the show, what's wrong with a few extra pounds? Is that a bad thing or not? We're going to talk about your diet, your nutrition, that extra weight you may be carrying around, and how that could impact your health today and in the future as well.
So, right after the holidays, and you tune in to your favorite podcast, "Who Cares About Men's Health," and boom, this is the topic we choose. I'm sure you're like, "Thanks, guys. I just got done gluttonizing from Halloween through New Year's and this is when we're going to talk about a few extra pounds?"
So, Thunder, from a nutrition standpoint . . . we talk about proper nutrition and exercise in the core for health now and later. And one of those reasons is to keep your weight within a healthy range. But why does that matter? We've learned that knowing why we do things is important for us to actually follow through on those things, so what's wrong with extra pounds?
Thunder: Well, there are several health risks associated with extra pounds. I think the one that most people know about is the fact that it increases your risk for diabetes. And it's actually the weight gain that happens around the middle, so around the belly. That's kind of the worst kind in terms of increasing diabetes risk.
And that happens to affect men more than women. So as a guy, when you see the belly start to get bigger, which happens after the holidays, that's not always a good thing.
With women, the risk is a little less, they tend to gain weight in different places, more around the extremities and the legs and the rear end. And that's not as bad as far as diabetes risk. So that's the main one.
And then the other one that has been getting more attention lately is actually the fact that obesity is related to cancer risk. So it turns out that that's another risk factor for cancer, is obesity.
And there's now some work that's actually being done in our department trying to also establish a link between metabolic syndrome, which is what happens when people gain weight, and having that be the link to increased cancer risk.
Troy: So, when we talk about a few extra pounds, Thunder, are we talking like, "I just did not do super well eating over the holidays. I put on five pounds"? Are we talking 10 pounds, 20 pounds, or we're talking BMI, looking at that? Anything that you can put there in terms of a cutoff where you really see that risk?
Thunder: Yeah, so if you want to just take the straight clinical approach, BMI, the cutoff where you start to see increased health risks is a BMI of 25. Twenty-five to like 29.9, that is the range that is called overweight. That's where you see these health risks go up. Obviously, the greater the BMI, the more those health risks go up.
To translate that into pounds, what does that mean? Because most people are not quite sure how to make a connection between, say, a BMI of 27 and extra pounds. It's an easy calculation to do. There are lots of online calculators that can help you do that if you want to go in and type in your body weight and your height and it can spit out your BMI. But in general, if somebody is probably 15 to 20 pounds over their ideal body weight, their BMI is going to be in a range that's going to be around that kind of mid-27 or so. And that's where the health risks are going to increase.
But I encourage everyone to go online, find one of those BMI calculators, and try it out. It's good to know where you're at.
Scot: So I'm standing in front of the mirror right now looking . . .
Thunder: Always a bad idea.
Scot: Well . . . I'm looking at my stomach. Is it just the front part of my stomach or the love handles/muffin top? Does that count? What are we talking here?
Thunder: Yeah. It's all there. It's everything.
Scot: Okay. Allow me to put my shirt back on and back away from the mirror slowly now at this point.
Thunder: And mostly the abdominal obesity that is the subject of concern, that is kind of the front, like as your belly protrudes out. Love handles are a bit more subcutaneous, and that's not quite as bad. If you think about like the anatomy of the body, the fat that's packed in around the intestines and the organs, that's the kind that is more associated with diabetes risk.
Scot: So you talked about metabolic . . . what did you call it? Metabolic disease?
Thunder: Metabolic syndrome. Metabolic syndrome is three out of the following five conditions. Either somebody has kind of high blood pressure. Maybe not the blood pressure that we would classify as classic high blood pressure, but that borderline high blood pressure. They may have slightly elevated cholesterol. Again, on its own, maybe it wouldn't be the first thing of concern, but it's elevated more than normal. They may have slightly higher blood glucose levels, which is indicative of pre-diabetes. And they probably have extra weight around the middle, around the belly that we were talking about. And they may have more fat, which we call triglycerides, in their bloodstream.
So, if somebody has three out of those conditions I described, or more, then we would say they have metabolic syndrome.
If somebody has this undiagnosed hypertension, maybe they're running around with a blood pressure that's 5 or 10 points above what we would classify as normal and that would maybe fly under the radar when they would go get a health screening or whatever, but over time, that can increase risk.
Scot: Is the fat the cause of these things starting to happen, or is the fat the indication these things are going to happen? Does that make sense? Because the fat is an indication of a lifestyle that somebody has maybe been doing that is not the healthiest.
Thunder: Yeah. I would say the fat is an indication of the lifestyle that can affect some of those factors, because we know lifestyle is involved with cholesterol or hypertension or, obviously, blood sugar. So, if somebody is gaining weight, for me, and Troy can chime in on this, that's the first kind of warning sign, "Let's take a closer look and see what else happens to be there."
Troy: Yeah, exactly. And I think you're right, Scot, and obviously, Thunder. Yeah, it's one of those things where is it a chicken and egg thing? Is it because these other things are going on? But my understanding is they're all interrelated. Yeah, one may cause the other, but then the other is there, and then it feeds into the other thing.
So I do think that putting on that extra weight, and obesity is going to make you more likely to have that blood sugar that's going to be a little bit too high. And then often, once you get into more of the diabetic issues, then you're going to see more high blood pressure with it and heart disease and all that as well.
So, yeah, it's hard to say if one is definitely the thing that precipitates everything else. But I think definitely the obesity is something that really gets that ball rolling, especially if you've got any sort of genetic tendency toward these things or any sort of just mild underlying issue. It's really going to push that forward to where it gets much more severe.
Scot: It sounds like those video games where you have to string together moves, and you get times two, times three, times four, times five. It sounds kind of like that's what this is, except for not in a good way.
Troy: Yeah. Exactly. If you're already struggling with your genetics, and then you have a tendency toward high cholesterol or toward high blood pressure or diabetes, and then you throw in obesity, you're right. It just makes that snowball and take off.
Scot: What is the turnaround for somebody that has found themselves in a range that's concerning? They've gone online, they did the calculator, they figured out their BMI. How do you start to turn that around? Is it just exercise? Is that what it is?
Thunder: Oh, it's the whole package. It's exercise, and it's what you eat. It's really difficult to use only exercise to control your weight. Unless you're young and you exercise like crazy, then you can probably do it. But if you're a middle-aged guy and you're looking to control your weight or lose weight, you're going to have to bring nutrition into it as well.
Troy: Thunder, what about long-term risk? I've got this BMI calculator up on my computer, and I'm putting in the weight I was five years ago when I was living in California, just living the life of convenience. And every day, there were snacks in the break room, and I was eating snacks, and my BMI was in the 25 to 29 range. How does that compute to longer-term risk? Is my risk dropping immediately as I lose that weight? Or does that time at that range put me at risk of a heart attack in 10 years? Or any idea in terms of what that means longer term?
Thunder: Yeah, I would guess that your risk does drop fairly quickly after you assume a normal body weight or healthy body weight, I should say. So there shouldn't be any reason to say, "Oh, I've already been overweight, so what's the point? The damage is done." I would always try to go towards healthy weight because your risk can always be reduced.
Troy: Again, I was actually a little surprised to put that in. I think at the time, I didn't really realize exactly where I was in terms of BMI, or maybe I justified it or something and I was telling myself it was muscle mass, which it wasn't.
But I'm hoping it's kind of like some of these ads and some of these graphs you see about quitting smoking, about how you may not think that it's making a big difference, but one month after you quit smoking, your risk is dropping. Then you look at that risk drop a year, and then two years out, and it's a pretty dramatic drop in your risk, just with that change. And I imagine the same thing would apply to weight loss as well.
Thunder: Yeah. There have been human studies and animal studies that have found that, where you take an obese animal or human and weight loss occurs, and then you find that their bodily function improved, like their endothelial function in their blood vessels is better, and their insulin sensitivity gets better, and things like that. Yeah, we do have a fair amount of evidence that shows weight loss always results in some sort of improvement.
Scot: I'd like to jump in and say, Troy, at no point have I ever thought that you would have been pushing a BMI that was unhealthy. I need to also confess I had at point . . . maybe now again. Who knows? I had been pushing a BMI that is not healthy, because I would not have considered you overweight. So I think it's good, even if you don't realize, I think your story is really great to maybe check that number out just to make sure, because it can make a big difference.
Troy: It's eye opening. Like I said, I'd never really thought about it until we were just talking now and I thought, "Wow, I wonder . . . well, where am I now? Okay, good." I thought, "Well, where was I five years ago?" And I put it in there and was like, "Wow, I would definitely was in the overweight range."
And it wasn't one of those things where anyone ever necessarily told me, "Hey, you're overweight." People aren't really going to tell you that anyway, hopefully. But I certainly did not think of myself as overweight. So it's a little bit eye opening when you actually plug those numbers in there and see what the results say.
Thunder: Hey, can I add two quick things, as long as we're on the topic of BMI? The thing is, there are so many people in our society who are overweight. Now, I'm making a distinction between overweight and obese. Being overweight is almost normal, really. So the thing is people will say, "Oh, he looks pretty good. Maybe his belly is a little big," but it doesn't register because that's what you see all the time. So that kind of desensitizes us to what overweight actually is.
And then the second point I'll make about BMI is it is just considering your overall body weight. It doesn't discriminate whether that weight is from fat mass or muscle mass. And in the classes I teach, we always do BMI and I come across a fair number of young men who will have kind of a higher . . . like a BMI of 26 or 27, which is in that overweight range, but they're not overweight at all. They're just more muscular than the average person. So you have to keep that in mind, that that can affect BMI, but not in a negative way.
Troy: And like I said, that's how I justified it in my mind, but it was not the case.
Scot: I think you know.
Thunder: Yeah, you know. You can borrow Scot's mirror.
Scot: Yeah, it might be 28 and you can tell yourself it's muscle, but I think if it's muscle, you know.
All right. Hey, Troy, since you've got the BMI thing up, why don't you walk us through what that looks like so we all have a better idea of what we'd be getting into?
Troy: I just Googled "calculate BMI" and it took me to the NHLBI, National Heart, Lung, and Blood Institute, to their BMI calculator. I just put my numbers in here. There's a standard and there's metric. We're going to use standard just because we're using feet, inches, and pounds. My height is five feet, and I'm going to put 9.5 inches. Sometimes I will say 5'10", but it's 5 feet, 9.5.
Thunder: Come on. Go for it.
Scot: COVID has gotten Troy down a half an inch.
Troy: I'll be honest here and type 5 feet, 9.5 inches. My current weight it's about 153 pounds. So that puts my BMI at 22.3. The normal range it gives me on here as a normal weight is 18.5 to 24.9. So I'm within that range.
But then I thought back, "Okay, where was I five years ago?" And I peaked out there at 175 pounds. My height was the same. It hadn't changed. Still, 5 feet, 9.5 inches. That's a 22-pound difference. And at that point, my BMI was 25.5. Overweight is 25 to 20 29.9. Although I did not realize it at that time, I was at that time in that overweight range. Surprising for me to think about that because I certainly didn't think of myself as overweight.
Scot: Thunder, let's go ahead and wrap this up. So we've discussed that this is not a healthy thing, that you should try to get back to more of a healthy weight. Exercise is definitely a part of that equation or activity. You should be getting that 30 minutes every day. But unless you're young and exercising a lot, that's not the only thing. So you're going to have to take control of some of the things you're eating.
I think a lot of us realize we're not probably eating the healthiest, and we can make some adjustments. But what are some of the things that you think could make the biggest impact right off the bat? What are some changes that could be made right away that can make a difference?
Thunder: So what I recommend to people, the first thing they should look at is their sugar intake. The reason why I pick on that is because there's a lot of hidden sugar in foods that we don't really suspect. Between drinks, like iced teas and obviously sodas and juices and snacks and things like that, it's just easy to have a lot of that in there.
Scot: All right. So sugars would be one of the first things, the obvious sugars in the sodas, and then the hidden sugars and stuff like sweetened yogurt. Any sort of flavored yogurt that's not a plain Greek yogurt is going to have hidden sugars. Get rid of those. What would be a good Step 2 then?
Thunder: A good Step 2, I would say, is look at the timing of your eating. When do you eat? When do you snack? Things like that. Sometimes people are grazers. They'll tend to kind of nibble and munch the whole day, and that basically puts them in a position where their insulin levels are always high. Insulin is the hormone that's needed to make fat and to store nutrients. So looking at your food habits, your behavioral habits is another way. Maybe instead of eating 18 hours out of a 24-hour cycle, try to eat 8 or 10 hours. That's a great tool to use.
Scot: If you find yourself overweight and you're trying to lose that weight, is that something that you should go to a health professional and should be done under the supervision of a health professional? Or is this something that a person can do on their own safely? What is both of your guys' take on that? Thunder first.
Thunder: I would say if you're just trying to lose 10, 20 pounds, something like that, then just do it on your own. If someone is very obese, with a BMI of over 40, and they're in a position where they have life-threatening conditions, they need to lose 100 pounds or 200 pounds, at that point I would recommend those people get involved with the physician because they need a more drastic weight loss program.
Troy: And it's also worth thinking . . . Scot, you mentioned working with a healthcare professional. If you have just struggled and you can't get the weight off and you're morbidly obese, consider gastric bypass. Consider bariatric surgery. It's been proven it works. It's successful. Most of the time, people are able to lose weight. They're able to keep the weight off long term. Obviously, we want to talk about diet and exercise and everything there. But if this is about really trying to reduce your long-term risk of heart disease, and diabetes, and everything else, and just nothing has worked for you, talk to your doctor. That's something to consider. And for some people, that's what they need and it does the job.
Thunder: Yeah, and I think it's important to make a distinction between someone that's trying to lose 15, 20 pounds versus someone who is 75, 80, 90 pounds overweight, and they have pre-diabetes and maybe they have high blood pressure. So they have documented medical reasons that they need to lose weight to improve those conditions. What we're talking about in contrast is someone who is slightly somewhat overweight, 20 pounds, and they know if they can stay on that road, in 10 years, you're going to have an increased risk of various ailments.
Thunder: I think that's important for listeners to keep that in mind.
Troy: Yeah, we're not talking about getting in swimsuit shape and getting gastric bypass for that. This is about taking a surgical step to reduce your long-term, very real risk of heart disease and stroke and everything else and serious medical issues, and someone who's been struggling with long-term morbid obesity.
Yeah, this is not really what we're talking about, but, again, getting back to that question of when do you talk to your doctor, when do you think about medically supervised things, I think that's probably more where you may want to look into that.
Scot: Some good lessons. Fat is an indicator that you might have some other health issues down the road. So even if it's just a little bit more than you'd like, perhaps start turning that thing around sooner than later before it becomes much more difficult, because as we've learned today, that extra fat can impact your health in a lot of different ways, including diabetes, and heart disease, and cancer.
Thanks, Thunder, for that great information today, and thank you for caring about men's health.
Troy, are you ready for a new segment idea we're going just kind of float out there and see how it works?
Troy: Yeah, let's do it. Let's start something new.
Scot: All right. As guys, I think . . . at least I can only speak for myself, but I like this feeling of being prepared to handle situations that come up. So, if a situation comes up and I'm out in the world, I'm like, "I know how to help with that."
This is "Who Cares About Men's Health." You are an emergency room physician. So these are going to be a little bit more serious things, but I think I want to call the segment "How Do You Handle It?"
Troy: "How Do You Handle It?" I like it.
Scot: "How Do You Handle It?" We're going to talk about some things that might happen out in the world, and hopefully, you are going to be able to give us some advice on if this happens, how we could be helpful and useful in that moment so we know how to handle it.
Today, I thought it might be fun to do frostbite. Not fun to get frostbite, fun to do frostbite. You think you've had frostbite at one point in your life.
Troy: Oh, yeah.
Scot: Didn't you tell that story?
Troy: It was awful. Yeah. I was nervous. It was bad. It was one of those things. I was out on a long snowshoe run in the middle of winter, and it's like eight degrees out and my feet are covered in snow the whole time, just in powder. And I get up to the point where I'm turning around to come back down, and I think, "Wow, I can't feel my feet, but my feeling will come back as I get closer to home in lower elevation and as things warm up a little bit."
I get home, and I take my shoes off, and I still can't feel my feet. Right now, as I'm talking about it, I still have that sensation. Just thinking to myself, "From the ankle down, I can't feel my feet. This is the weirdest thing."
I peeled my socks off and my socks were pretty much stuck to my feet because they were frozen on my feet. I looked at my feet and it looked like textbook pictures of frostbite. My feet were just white. And I touched my feet and I could not feel anything. I started to feel very nervous. It was scary.
Yeah, I did experience at least some mild frostbite. Fortunately, I recovered from it. But we can talk a little bit more about that process of what I did to treat that and how you do that. But it was a scary experience.
Scot: When you saw that, was there a little bit of a denial? You're like, "I know I'm a doctor. I know I've studied this. I know what it looks like. I'm seeing it on myself. No, that can't be frostbite."
Troy: I usually go one of the two extremes. I'm usually in complete denial, or I go all in and I'm like, "Wow, I have frostbite, I'm going to die, and I'm going to lose my feet." And that's kind of extreme I went to. It was more like, "Wow, should I call 911?"
Yeah, I was nervous. It was one of those things where it was a combination both of being like, "Okay," and then there was a lot of pain following that time. So it was both that pain and then also definitely a high sense of anxiety associated with that.
Scot: Painful. Your feet are white. Those are some of the things to look for. You said there are different degrees of frostbite. So how do you handle it? Cover some of that for us.
Troy: I think one of the important things about handling frostbite is, first of all, if you're in a situation . . . let's say I were up there at the top of my run, and I'm at 9,000 feet, and my feet are in the snow, and I think to myself, "I think I have frostbite." I should not make a fire there and boil water and try and get water hot and try and rewarm my feet because my feet are going to get cold again. You don't want to thaw it out and then have it freeze again. That's the number one goal.
Scot: That's the worst thing?
Troy: Yeah. Don't thaw it out. Do not treat frostbite unless you're in a situation where your feet can stay thawed out. So, if you're up there in that scenario, and you're like, "Wow, I have frostbite," just deal with it and get to a point where you can then be in a safe place and treat the frostbite and not have it refreeze, because that's when really bad damage can happen. That's probably the number one take-home of it.
Scot: All right.
Troy: But then once you get to a point where you can thaw your feet out, or your hands or whatever it is . . . feet, fingertips, toes, those are the most common sites where we see frostbite. The way you want to do it is get a warm bath, about 100 degrees. Something that feels warm to you. You put your hand in the water, and it's like, "Okay, this is warm. It's not crazy hot where it's burning my hand, but it definitely feels warm." And you want to re-warm your feet in that.
Basically, what I did was I took our bathtub, I filled it up, just started running some warm water in there, and I put my feet in there and it hurt like crazy. So as that blood started coming back into my feet and the tissue started to re-warm, it hurt like crazy and it itched. I just wanted to scratch at my feet. It was very uncomfortable.
And that's the biggest thing with re-warming frostbite, is it does hurt. If we see it in the emergency department, sometimes we have to give pain medications with it to help people tolerate that. But you want to just have warm water where you're circulating that water through there. Maybe get the bath full to a certain point and then just keep running some more water in there and go through that process. For me, I did that for about 15 minutes.
Then I looked at my feet after I had re-warmed it, and I actually sent a picture to Laura, my wife, at that point. I said, "I'm a little bit nervous," because it just had this funky, weird appearance like my feet were all bruised as that tissue was re-warming and blood was trying to work its way back in. It was kind of scary looking.
That's often where the damage happens in frostbite. It's not the freezing piece. Usually, the freezing doesn't cause the tissue damage. It's during that re-warming process that it can get damaged.
But I tried just to do what I would normally do with any sort of patient and just say, "Okay, we're going to go through a re-warming process now." I took some pain medication with it too. I took a Tylenol to help with some of the pain I was experiencing.
And after I'd done that first 15 minutes, I kind of took 10 minutes off and said, "Okay, we're getting there. I'm still nervous about this, but let's do another re-warming trial in the bath and see how things go." And then I went through that, and after that second 15 minutes of re-warming my feet, things weren't back completely to normal, but I was getting some feeling back in my feet. At that point, the tissue was looking a little more normal, not really that crazy, weird bruise look to it. It's the same process I'd recommend someone go through if this happens to them.
Scot: If you're in a situation where you are at the top or wherever of the 9,000-foot peak, or wherever you might happen to be, is there a point where you just make it your priority that I'm going to stay here until somebody can come get me and I'm going to start re-warming stuff right now?
Troy: No, I wouldn't. Because then you've got hypothermia and everything else you've got to deal with.
Scot: Oh, right.
Troy: If I'd stayed up there . . . like I said, the high that day was in the single digits. And if I'd stayed up there and I'd stopped moving altogether, then I'm risking hypothermia. Then you're risking not only loss of limb, but loss of life. You want to just keep moving. This is going to happen probably when you're somewhere in the backcountry on a hike or snowshoeing or . . .
Troy: Yes, snowmobiling or something like that. Yeah, don't stay put. Just work your way back and work your way back calmly and recognize that, yeah, you've got some frostbite, but you can deal with it and you can work through it and get things back to normal.
Scot: So the protocol that you would follow in the ER is literally what you described that you did at home You don't have any secret weapon?
Troy: No secret weapon. The treatment for frostbite is re-warming. And it really just comes down to trying to get it re-warmed as soon as you can. You just want to keep re-warming until that tissue no longer feels like a block of ice, that crazy feeling that I felt as I touched my feet where it felt like ice. You want to get it re-warmed to where it feels like normal tissue.
Scot: All right. "How Would You Handle It?" Our very first one on frostbite. How are you feeling about that?
Troy: Feeling good. It's something I think that's very relevant right now. We're going to see, I think, a lot more of these things this winter. Frostbite, potentially avalanche injuries, things like this, stuff that happens in the backcountry because my guess is we're going to see a whole lot more people getting out in the backcountry this winter, just with COVID and everything else. So this is one thing to keep in mind. Know what frostbite is, know how to deal with it, be prepared for it, know what to do if it happens.
Scot: Time for "Just Going To Leave This Here." It might have something to do with health or it could be a random thought that we have.
Just going to leave this here. Troy, do you ever run on the treadmill?
Troy: I do.
Scot: You ever get on that thing and think, "Oh, man, this is a form of punishment"?
Troy: Oh, absolutely. That's why I run outside.
Scot: So I found an article in "The New York Times." The treadmill was once a criminal sentence.
Troy: That doesn't surprise me.
Scot: And there's a picture that shows prisoners on a treadmill in London around 1850. Yeah, the treadmill used to be . . .
Troy: Is a form of punishment.
Scot: It was a form of punishment.
Troy: Probably would be considered cruel and unusual punishment. That's why it doesn't exist anymore. You can't do that to prisoners now.
Scot: You're right, and you shouldn't. If you throw golf on the TV while you have them on the treadmill, that's cruel and unusual. That's like the worst.
Troy: That's awful. Well, Scot, I'm just going to leave this here. I ran across an interesting website recently. It opened my eyes to some very fascinating pedestrian laws. I am very attuned to pedestrian laws because I am often a pedestrian. And when you're a pedestrian, you really feel like your kind of putting yourself out there. I've been in some places as a pedestrian on the road where it's downright scary.
But let me ask you about this, Scot. You've got kind of the crosswalks that are just the two lines going across the road. And then you've got the crosswalks that are like those thick things that look like railroad ties going across the road. Do you know what the difference is in the law with those things?
Scot: I didn't know there was a legal difference. No.
Troy: There is a legal difference. If someone is in a crosswalk when there's just the two stripes going across the road, you just have to wait until they're not on your side of the road and then you can go. If you're at a crosswalk with those big railroad tie looking things, and those are usually school zones, you have to wait until the person is completely off the crosswalk before you can go. Interesting.
Scot: I didn't know that difference. At one point in my life, I had heard that here in Salt Lake, if the pedestrian was in the crosswalk, but they were on the other side of traffic, not my area, even then you were supposed to let them completely clear the crosswalk. But there are actually visual indicators. That's interesting. That's good to know.
Troy: Scot, this came up on a website. Actually, the state of Utah put it together. Some of this may be different state to state, but the website is drivermyths.utah.gov. It kind of goes through some of these things. And some of these are a little tricky. It was a little bit surprising to see what laws are specific to pedestrians in crosswalks and what we really need to be aware of.
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 601-55SCOPE. That's 601-55SCOPE, 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, firstname.lastname@example.org. 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.
Well-child visits are still happening, even during a global health pandemic. The good news is your doctor's office is probably one of the safest places to be during COVID-19 outside of your…
December 21st, 2020
Well-child visits are still happening during COVID. What can you expect during your child's visit?
When COVID first hit hard, the American Academy of Pediatrics had a big concern that came true for a lot of pediatric providers -- well-child visits would come to a screeching halt. We also became concerned that there would be outbreaks of diseases again due to kids, especially babies, not coming into the office to get their vaccines.
Well, the good news is, in most cases, your doctor's office is probably one of the safest places to be outside of your house. Every office is different, but most of us are trying to divide the waiting room into sick and healthy sides. At check-in, every person is asked screening questions to see what area they need to wait in and also to make sure if someone is sick, that our staff takes appropriate precautions.
Only one parent is allowed in a visit per child. Parents are informed of this when they schedule the appointments, and I know we welcome the parent who couldn't be in the clinic to be involved in the visits through FaceTime. I've actually done two visits today where the parent who couldn't be in the visit was involved via FaceTime, and we were able to have a great conversation. Everyone is wearing eye protection and surgical masks also, and if there are concerns about COVID, we have complete PPE gowns and respirators that we wear.
We disinfect chairs, table, and toys in between each patient, and I have several rooms, so we are able to let the room sit for about 15 minutes to let the disinfectant dry by rotating which rooms we have patients in. We have separate exits for the patients who do not need to go back to the front of the clinic, and there is abundant hand sanitizer. We also have strict precautions for when we think somebody has COVID in terms of letting the room settle with the droplets, cleaning everything including the floors, and using special filters to cycle the air through.
What about virtual well-child visits? Some providers are doing them that way if there are no vaccinations needed. Others are doing only in-person. It's best to check with your pediatrician's office to see what they're doing.
So the next question is, how do you know if your child is due for a well-visit? Well, at our office, we do what is called outreach, meaning that our computer people can generate a list of all the kids that are coming due for well-visits or shots. We call and send letters reaching out to those families to have them schedule appointments. Not all offices have this ability though. If you're not sure if your child is due, please call your pediatrician's office, and they can let you know if an appointment is due and help you schedule at the same time. Your child's health is very important to your pediatrician. Please be sure to keep up with all of their necessary visits during this crazy time.
What to expect during your child's visit, how doctors' offices are adjusting to COVID-19, and whether or not virtual well-child visits are a good alternative.
As the holidays approach during the COVID-19 pandemic, many people find themselves trying to navigate how to celebrate with family safely—if they feel safe to meet up at all. Some family…
November 20th, 2020
Family Health and Wellness
Interviewer: This Thanksgiving and Christmas, it's going to be very different than Thanksgivings and Christmases in the past. It used to be you would get together with family and friends, and now health officials are saying that perhaps you should reconsider that because of the spread of COVID-19, that you should maintain that family bubble.
However, even within families there are a lot of different opinions on how dangerous the virus is and what kind of safety precautions could be taken. So having those conversations with family members about whether or not to come to Thanksgiving or get the whole family together could be very, very challenging.
Dr. Benjamin Chan is a psychiatrist at University of Utah Health and in communication, communicating your thoughts and feelings is referred to as assertive communication, and it can be a very challenging thing to do. And I wanted to find out how somebody could be an assertive communicator, not aggressive, but an assertive communicator in talking about plans for Thanksgiving and Christmas. So is that what you call it? Is that what you call it, is assertive communication in your field?
Dr. Chan: Yes, Scot. And again, we're all in the middle of a pandemic. This is historic, unprecedented, and incredibly challenging. And in years past, Thanksgiving dinner would be a time that we get together, see and talk to long-lost cousins, aunts, uncles, grandmas, grandpas, maybe some neighbors, family friends. That is not safe this year.
And there's a lot of disagreement in the community about how to get together for Thanksgiving. A lot of people have different thoughts and feelings about COVID, and what social distancing is, and what masks are. And this time more than any other is the time for you to be assertive because you have to protect your own health. You have to protect your family and your loved ones. And COVID is silently transmitted. This is not the podcast that goes into it, but you can listen to many others. But there's a lot of different research and data out there that shows how pernicious and silent COVID can spread.
So assertiveness means behaving and communicating in a manner that equally values your rights and opinions on par with other people's rights and opinions. And the opposite of assertiveness is passiveness. And passiveness is when you put someone else's rights and opinions above your own. So now is the time to be assertive.
Interviewer: Have those assertive conversations beforehand. What does that look like? Because I mean, some people, myself included, we don't like conflict, right? So it's really difficult for us to know . . . I'm going to be talking to somebody in my family who thinks that COVID maybe isn't a big deal, that we should still get together, and it's going to be tough for me to express, "No, I disagree." How do you do that in an assertive way?
Dr. Chan: You do that in an assertive way by first recognizing that the other person has a different opinion and feeling than yourself. And then you segue into statements that start with, "I feel." So, "I feel scared for my own health because when I hear that you're going to host a Thanksgiving get-together and not everyone there is going to be wearing a mask or socially distancing, I feel scared that I might get COVID." And you frame things where you recognize the other person's belief or values, and then you maintain your own beliefs and values.
And people want to be heard, they want to be listened to. So my experience has been if you immediately start talking about what you believe and do not give the other person the recognition for what they believe, that's where conflict really starts escalating because the two parties don't feel like they're being listened to or heard. But if you can restate perhaps in their own words or maybe a summation of what you understand what their belief is and then give your belief, that gives an opportunity for that person to feel that you actually listened to them, an acknowledgement, and then you can present your belief.
Interviewer: I tell you what, I can see the spiraling for me pretty quickly, because I think people that do believe that COVID is a serious threat to the health, when they hear somebody that does not necessarily have that same belief, we just want to go, "Well, I understand you don't think this is a big of a threat impact as I do." Would that be the restating? Is that fair enough? Is that all I need to say? I mean, it's so hard not to do that judgmentally.
Dr. Chan: I agree, Scot. And it's credibly difficult. It might take practice. And I think when you, like, your example you just gave is a very quick response and people's responses tend to be much longer. So if you say, you know, "When I hear you, it sounds like you do not feel that the COVID pandemic is as serious as some of the public health officials have said or as serious as some of the hospital officials have said. I do believe those individuals, and this is why I believe them." I agree, it could start spiraling, but to me the key is to reframe it through core values. Just go back to values.
So people want to feel safe. They want to feel heard. They want to feel that they're being listened to. So if the core value is health, you can talk about like, "What is your value about the health," and they'll talk about the memories and the mental health of getting together for Thanksgiving. And you can use that as a springboard of, "Okay, this is my conceptualization of health. I'm worried about COVID. I'm worried about the fevers and the respiratory problems and everything else associated with COVID." If you have a discussion about values, the vast majority of people have core similar values, and then you can just explore those basic values together.
It's hard, Scot. It's incredibly difficult because people are drawing upon information from a wide variety of sources. Some of these sources might not have the same beliefs that you believe or might have different versions of facts. But you need to be assertive during this moment because if not, you will open yourself up to potentially being exposed to COVID and then a lot of hurt feelings will stem from that.
Interviewer: You know, being assertive doesn't necessarily mean the other person is going to react in a positive way. And if they don't, I guess you just have to go away with, you know, "I tried my best, but I have to make this decision for myself, or for grandma, or for grandpa, or for whoever." How do you deal with that? So again, I don't like conflict. I don't like it when somebody, you know, doesn't like me anymore. How do you deal with that? Is there a closing phrase you would use? Like, "I'm sorry we couldn't come together on this, but I still love you and care about you very much."
Dr. Chan: Yeah. Again, Scot, you did a great job. I think it's like you want to normalize this as best as you can during a pandemic. So this is an important holiday coming up. It's very important to a lot of people, but it's simply one day out of the year. And we have talked about previously, we're in a marathon. This is not a sprint. There's a lot of things happening in the country as we're trying to address this. So in my attempt to normalize, it's like, if everyone got together for Thanksgiving there's going to be disagreements. We've always had disagreements over the Thanksgiving table. Sometimes it's about the Dallas Cowboys and the Detroit Lions football teams. Sometimes it's about someone's political beliefs. Sometimes it's about someone not doing well at school or their job. It's normal to have conflict during Thanksgiving time.
This is a time when it might be normal to have a disagreement if we should really get together, or if we get together, it needs to be socially distant and safe with masks, or maybe we don't get together this year, or maybe we do a Zoom Thanksgiving and a virtual Thanksgiving. And that's okay because the most important thing is safety and health. And we want to stay together as a family in the coming months, and there's a light at the end of the tunnel. We all feel that. We all believe that. We want that to happen. That's still very much many months away.
So I try to end all these difficult conversations kind of like you gave with positivity. Let's say something nice. Let's say something that we can all agree on. I always like in these tough discussions kind of like a U shape. You start off high, you kind of go low, you go really deep, you kind of talk about feelings, emotions, values, and then you rise back up. You never want to end these discussions at the bottom of the pit. You want to rise to the top and say some nice things to each other, and agree to, you know, let's talk about something that's not as emotionally taxing, like the Dallas Cowboys or the Detroit Lions. Let's talk about something that we can agree on because these are difficult conversations. It's really hard to be assertive, but now more than ever it's really required.
How to be assertive about your health concerns with your family during COVID-19.
Some patients, unfortunately, don't get better after the first doctor's appointment, and an estimated 30 percent of patients don't even fill their prescriptions. If your condition…
November 20th, 2020
Family Health and Wellness
So you went to the doctor for a problem, doctor made a plan, and you may have followed the plan or maybe you didn't, but you never told the doctor that it didn't get better. This is why follow-up is so important.
So it turns out that often people come to their physician, and in this case, for me, it's a gynecologist, and they have a problem. Let's just pick hot flashes. They come in, they have hot flashes, I talk about hot flashes, and I say, "I think you're a good candidate for some estrogen." And I write them a prescription, and I send them home. And I think I'm the best, smartest doctor that ever was because I didn't see them again. Now, what possibly happened?
Statistically, 50% of those patients, they get a prescription for hormones, and this is just this particular kind of problem, but get a prescription for hormones, don't ever fill it. Do I know that? No, I don't know. My system doesn't tell me with a little alert on their electronic health record that she didn't ever fill it. So I don't know she didn't fill it. What happened if she filled it and took it and it didn't help, but she thinks I'm a bad doctor because I gave her something and she didn't come back? I have lots of other tools in my toolkit, but if I don't know from her that she isn't better, then I can't do anything.
So follow-up is a difficult thing, because it has to do with failure. It has to do with communication. So in the case of the thing that I know best, which is hot flashes, I may have not really gotten to the bottom of what this patient's primary concern is. Maybe her primary concern is that she's not a woman anymore, or maybe her primary concern is that these hot flashes make her cranky and she's angry at her family, and this is really not about hot flashes, but that's what brought her in. I heard hot flashes. She's a woman of the right age. I prescribed a medication that usually works, and I sent her home happily according to me, but she's not happy. And this is where follow-up is important.
Now, the question is, whose responsibility is it to follow up? I personally think it's my electronic health record, because the electronic health record should give me a ping if my patient didn't follow up the prescription. I think my electronic health record should send out a little reminder to my patient, "Dr. Jones gave you a prescription three days ago for the problem that you saw her for. Did you get better? If you got better, keep taking it. If you didn't get better, please call. If you got better but you're having side effects, make a follow-up appointment so we can talk about alternatives." This is something that would be so easy for an electronic health record to do, and we get all these telephone calls anyway about what we thought about our doctor and what we thought about the clinic. So why not have a little reminder, "Your doctor gave you a prescription. Did you fill it? If you filled it and it didn't work, push 1. If you filled it and it did work, push 2. If you filled it and you had side effects, push 3, which it will get you right to my nurse."
So if your electronic health record doesn't do this, and the vast majority don't, what should you do if it doesn't work? You should let us know. So if you didn't fill it but you're still symptomatic because you had questions that weren't answered, call my nurse, ask those questions on our private email, or come back and see me. If you took it and did fill it and it worked, well, just keep taking it, and I'll see you in a year. If you took it and you had a side effect, I want to hear about that, because it turns out I have a whole bunch of other things in my tool case that we could try.
So I used the paradigm for hot flashes. I could have used it for any one of a number of common problems. But follow-up is important on my part, and follow-up is important on your part. And don't just give up because you tried once, because we have a lot of Plan B's. So keep thinking about it, learn more, come back and see me, and thanks for joining us on The Scope.
The importance of following up with your doctor after an initial visit.