Dhru Purohit Show - The Best and Worst Habits to Age Well, Avoid Frailty, and Keep a Healthy Weight with Dr. Mary Pardee

Episode Date: June 18, 2025

This episode is brought to you by Cozy Earth, Branch Basics, and Fatty15. Aging well isn’t just about looking young on the outside—it’s about building habits that keep our bones strong and our body composition healthy. Today’s guest ranks the top habits that support these goals and help enhance our healthspan. Today on The Dhru Purohit Show, Dhru sits down with Dr. Mary Pardee to rank the best and worst habits for aging well, avoiding frailty, and maintaining a healthy body composition. Dr. Pardee breaks down the staggering statistics on osteoporosis and highlights the importance of a DEXA scan, plus when you should consider getting one. She also shares her insights on longevity-specific testing, including a full lipid panel and coronary CT scan. Finally, Dr. Pardee ranks key lifestyle habits, such as achieving 10,000 steps a day, walking after meals, strength training, and following specific diets. Wondering where GLP-1 medications and hormone replacement therapy fall on the list? Dr. Pardee shares her nuanced take on those, too. Dr. Mary Pardee is a Naturopathic Medical Doctor specializing in preventative medicine and longevity in Los Angeles, California. She has an undergraduate degree in human nutrition and has worked in exercise physiology and performance research for the US government. She holds a doctorate in naturopathic medicine from Bastyr University. Dr. Mary is the founder of modrn med, a medical practice that provides medical and health services to patients via in-person consults as well as telemedicine. Her primary focus is on closing the healthspan-lifespan gap, extending lifespan, and enhancing healthspan.   In this episode, Dhru and Dr. Pardee dive into: The statistics on osteoporosis and other bone fractures (00:30) What the DEXA bone density scan is and why it matters (3:07) The importance of grip strength (5:02) VO₂ max: what it is, exercises to improve it, and how to get tested (9:10) Longevity-specific testing (24:05) A full lipid panel and everything you need to know about ApoB (28:41) The importance of getting a coronary CT angiogram (40:56) Why getting 10,000 steps a day matters (42:01) Strength training and why tracking your workout progress is essential (57:24) Diet: tracking macros and auditing your calorie intake (1:06:10) GLP-1s: what they are and their impact (1:10:44) Ranking the Mediterranean diet and why calories matter (1:13:31) Sauna, cold plunge, meditation, and mindfulness (1:21:15) Hormone replacement therapy nuances (1:31:36) Top screenings for aging well (1:35:05) Supplements: what’s worth it and what’s not (1:44:08) Where to find Dr. Pardee’s work (1:54:36) Also mentioned in this episode: Plaque Begets Plaque, Not ApoB, JACC Journals  Try This Newsletter Ginny McGonigal  Chris Kresser Article about Misguided Mercury Concerns  For more on Dr. Pardee, follow her on Facebook, Instagram - Modern Med, Instagram, TikTok, Apple Podcasts, LinkedIn, and her Website. This episode is brought to you by Cozy Earth, Branch Basics, and Fatty15. Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com/dhru and use code DHRUP. Right now, Branch Basics is offering 15% off the Premium Starter Kit; just go to branchbasics.com and use coupon code DHRU. Make 2025 your cleanest, healthiest year yet with Branch Basics! Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Mary Perdee, today we're ranking the best and worst habits to help you age well, avoid frailty, and maintain a healthy body composition, aka not get fat, especially as we get older. I'm honored to have you here. You're one of the top naturopathic doctors out there. You're deep into evidence space, so I'm excited to see your list. And for the first one, you have something that everybody, almost should be doing,

and you're going to talk a little bit about what it is, but more importantly, why? I love it. I love that intro, too. Everybody should be doing at some point in their life, I would preface it with. And I want to talk about first what

it's really important for, which is osteoporosis. And so we want to talk about prevention with osteoporosis. It's so important. Osteoporosis is more of a childhood disease, if we think about it in some ways, where you're building most of your bone density in childhood, teens, young adult years. It's not until you become older that we really worry about, like, frailty and breaking a bone, but all that foundation is happening way, way earlier.

Yeah. And so one of the tests that we like talking about is a Dexa scan, which is a bone density scan. And it's not for everybody at every point in their life. Like, you would not do this if you're a healthy 18-year-old woman. It wouldn't be appropriate. But when we talk about osteoporosis, I remember being in my 20s. hearing about osteoporosis being like, who cares? Yeah, that's something old people get.

Yeah, like, I'll worry about, I'm never going to worry about it. Like, it doesn't happen kind of thing when you're younger. And the stats behind osteoporosis are staggering. So if you're 70 years old and you're a woman and you get a hip fracture, within two years of that hip fracture, about 5% of women will be dead. And that's at 70 years old. So at 80 years old, if you get a hip fracture within two years, about 11. percent of women will be dead. And then at the age of 90, if you fracture a hip, it's about 26%

of women will be dead within two years. That's like one and four women will die within two years of a hip fracture at the age of 90. Wow. And it affects men as well. So it's both sexes. Women are at a higher risk. But it's really important to talk to your doctor, especially if you're over the age of 65 and you're a woman, then you should be getting a bone density scan. If you're post-men and you're less than 65 years old, but you have risk factors. Let's say you've been on glucocorticoidicords like prednisone long term. Maybe you have ulcerative colitis and you've used them. Or if you're underweight or have been underweight for a good portion of your life,

or if you have an eating disorder, a history of eating disorder, if you had a hip fracture or any sort of fracture yourself that feels like you're an increased risk, if you have a parent who fractured a hip or had a lot of, bones breaking. All of these things can indicate that you may want to get them under the age of 65 as well. Yeah. So what exactly is this scan?

Tell our audience. Yeah. So Dexa scan is a dual X-ray scan. Basically what happens is you walk in. There's like a bed that you lay on. And they scan your whole body and they're looking at your bone density. And they're looking at different parts of the body when they're doing that.

So they're looking at the lumbar spine. you're looking at the hip, and what they're giving you is they're giving you a score, which is how many standard deviations are you away from the mean of a healthy young individual? And it gives you an idea of if you are healthy bone density, if you're osteopenic or osteoporotic, which is what we're trying to avoid. Absolutely. So the reason we asked you about this is on today's episode, we are going to be tier ranking. If you're watching on YouTube, you can see it on the screen. if you're listening on audio, we have A, B, C, D, F, like a standard grade system.

And we also have a unique letter S. S means this is the best possible thing that you could do. So we're going to be giving you a list, and it started off with one of the best things that you could do, depending on your age and your background. If you want to avoid frailty and age well, you mentioned it was a Dexa bone density scan. So if you had to rank this on our list, where would you put it? For the right person, I would put it at an S. General Public I'd put it at an A.

And it really just depends on your risk factors there. So one of the ones that I add as a risk factor, which isn't on the guidelines, is undermuscled. We know that being underweight, having a low body weight, increases your risk for osteoporosis. But I also have concerns about people who are normal body weight, but undermuscled with an increased risk for fractures for a variety of reasons, including balance. issues with just being out of shape as well as the actual force that you're exerting on the bones when you're doing training to put muscle on. Amazing. All right.

Let's talk a little bit more about that because you hear that one of the best things that you could do to age well, protect yourself, avoid being frail is have a really good grip strength. So that's on our list. I want to hear your thoughts about that because I'm sure you have some nuanced thoughts. Yeah, so grip strength is something that I test on all my patients in the office. The reason we test grip strength is like I can't get a barbell in my office. So it's not that we think that having strong hands increases how long you're going to live, your lifespan.

It's that we think that grip strength is a proxy to total body strength, which is really what we care about. And so I also have my patients go through a full strength assessment with a strength and conditioning coach. And I think that's a better. measure of functional fitness and if you're actually strong than just grip strength. But again, most doctors are not going to be able to do a total body strength test. And so grip strength is a great proxy for it. Okay. Before I have you rank it, I want to read you a funny tweet that I just literally was looking at before you came in the studio.

So this is a guy named Brady Homer. We'll put on the screen for everybody as well. He wrote, grip strength is a useless biomarker of longevity as far as I'm concerned. He's a top marathon runner. He's an expert in V-O-2 max testing. he's been on a few podcasts. And it continues, especially put head to head with cardio respiratory fitness.

Why? Your fat, alcoholic 60-year-old uncle can have incredible grip strength, even if he has diabetes and cardiovascular disease. He's not living longer than a lean guy. Have you ever seen a sick person, he continues, record a VO2 max in the upper 50s or 60s, question mark. You can't game aerobic fitness, period.

What do you think about that tweet? It's edgy. I totally get where he's coming from. I really do. It kind of echoes what you were saying. It does. And so I think we're actually saying the same thing. And it's better than nothing.

It's a proxy usually for total body strength, not always. And I would not even, it's not an argument where I think VO2 Max is a better indicator of longevity than grip strength alone. I think being strong is one of the same. of the best indicators of longevity. Amazing. All right. So grip strength. We have a woman over here holding one of those hand things.

What do they call it again? Oh, yeah. Grippers or whatever. I got a comment. So if you, what we don't want is for people to work on their grip strength. Like that is not going to help you live longer with the exception of if you're doing dead lifts or you're doing like pull ups, right? Your grip strength is going to get better.

But your total body strength is going to get better. better because those are whole body exercises. So I would never say, hey, use this device and go strengthen your grip to live longer. It just can sometimes be an okay measurement to proxy total body strength. Can I ask a question inside of that? Of course. I've heard multiple things there and I have no idea what to believe. Some people say that independent of overall strength, if your grip strength is strong,

it is still correlated with people living longer because maybe it helps protect your fall, especially when you get older. So there could be something in that. What do you think? Maybe. Yeah. But overall, especially for a lot of people who are listening to this audience, you just want people to get strong overall, men, women, whoever.

Yeah. And we know strength is a better indicator of longevity than muscle is. And muscle is a great indicator of longevity. So how much muscle mass you have on your body is a great way to say, like, are you in a good place for longevity reasons? But the function of that muscle, your actual strength is an even better indicator. All right, so rank grip test on here, grip strength. Where would you put it?

This is a tough one. So are we saying it as just your grip strength or as a proxy of total body? People hear it. They're like, okay, great. I need to squeeze these balls. I'm going to put as a C. Yeah. Okay, now let's go to the other one that you mentioned, which is VO2 max, having a high VO2 max.

Give us the background and why you're so adamant that most of the patients that you with at a concierge level, you want them eventually to get to a place where they're tracking their V-O-2 max. This episode is brought to you by Cozy Earth because great sleep starts with how you wind down. Let's face it, we're all juggling a lot. Whether it's a pack schedule, constant deadlines, or just the chaos of everyday life, finding calm can sometimes feel a little difficult. That's why I've been leaning into small rituals that helped me and my wife feel grounded

and wind down in the evening and one of those favorite addition to the day. to my rituals is cozy earth. Their temperature regulating, bedding, and bamboo sleepwear have become a part of my nightly wind-down routine. They're unbelievably soft, breathable, and naturally cooling. And they're made without toxic chemicals like PFAs or plastics, just pure eco-friendly fiber from bamboo. Even Oprah is a huge fan.

Cozy Earth's sleepware has landed on her favorite five things at least five times. If you've been putting off investing in your own comfort, this is your sign. Whether it's for better sleep, more mindful mornings, or just treating yourself to something that actually feels good, Cozy Earth is worth it. Right now, Cozy Earth is offering my listeners 40% off site wide. Just go to CozyEarth.com slash Drew and use the code Drew P, D-D-H-R-U-P at checkout to grab the discount. That's Cozy Earth, C-O-Z-Y, Earth, E-R-T-H-H dot com slash D-H-R-U, and use the code D-H-R-U-P at checkout to grab the discount to grab the discount today. Trust me, this is self-care that pays off every single night.

Hi, everyone, quick break to share one of my favorite wellness upgrades and a huge supporter of this podcast, Branch Basics. Shout out to them for being an amazing company that also helps keep this podcast free for listeners. The reason I love Branch Basics is because I'm super careful about what I use in my home. In the U.S., cleaning companies aren't even required to list all their ingredients on the label. That means your everyday cleaners could be loaded with chemicals linked to hormone disruption, respiratory issues, skin irritation, and a lot of other things too. And you wouldn't even know it. That's why I personally switched to branch basics.

And it's been a total game changer. I started with their premium starter kit after hearing great things. And I was blown away by how effective and simple it was. Their plant and mineral base concentrate replaced almost every cleaner in my home. I use it as an all-purpose spray, a bathroom cleaner, laundry detergent. and yes, I even use it to clean produce. It's that safe. Branch Basics was founded by three women

on their own healing journeys who realized how powerful removing toxins from their homes could be. Their products are made safe certified and Leaping Bunny certified, meaning every single ingredient is human safe, biodegradable, and free from harmful chemicals

and dyes and synthetic fragrances. I don't know about you, but I want to clean my home in a way that supports my health, my family's health, and I don't have any pets, but if I had pets, my pets health too. Bonus, it's budget friendly. One bottle of concentrate makes up to 13 refills,

which brings the price per bottle down to just $2. If you've been thinking about making a clean swap, now is the time. Right now, my listeners can get 15% off the premium starter kit. That's where I started using the code D-H-R-U, Drew, that's me, at branch basics.com. Again, that's 15% off. Your new branch basics, premium starter, kit at Branch Basics, B-R-A-N-C-H-B-A-N-C-S-B-A-S-I-C-S.com with the promo code Drew, D-H-R-U. Make 20-25 your cleanest, healthiest year yet with Branch Basics.

Yeah, so it's one of the tests that I do. It's a fun test. Well, fun for me because I'm the one that's administering it. It's an intense test. I used to have to pay my friends an undergraduate to do this test on them. So if you guys are listening, I'm really sorry. and now people pay me to do it, which is a fun little switch. But VO2 Max is looking at how much oxygen your body can uptake and utilize at maximum levels of aerobic exercise.

And so practically what it looks like is we're either on a bike or a treadmill and you're starting at a really low intensity and we're doing a step test, which means that you start really low and we gradually increase either the incline or the speed or if you're on a bike, the wattage, the resistance. and you keep going until you literally max out. And there's a few ways to terminate the test. But you're basically stopping at the end of what you can do. And so why is it important? So if you go from a really low level of cardio-respatory fitness, which is what it's testing, your heart and lung fitness, if you go from a low level to below average, so you're still below the mean,

you get a 50% reduction in all. cause mortality. Now, that's really obvious when I tell you that people with a low level usually have chronic diseases, right? So we're looking at people with COBD are going to have low cardio-respatory fitness. But what we see is that even as you increase from below average to average to above average to elite, you see a continuous decline in risk for mortality. Even from a high to an elite level, you still get a reduction in mortality risk. Incredible. Incredible. Okay, so rank it on our list. Hey.

A. S. I forgot about S. Wow. I was going to ask you, you bumped it from an A to an S. Yeah. Okay, so it's S. It's right up there with one of the best things that you could do.

Yeah. And you don't want to just test it. So it's having a high level or training to get a high level. Okay, so talk more about that. Right. So I think a lot of these things where we're like, we're going to talk about lipid testing. Like the testing alone isn't going to get you outcomes. it's going to be testing, seeing where your baseline is,

and then trying to improve it. If you're already elite, then it's about maintenance of that. But really, making sure you're at a level that you feel like you have buffer because your VOT2 max is going to decline as you age. And we want to factor in. What if you get sick? What if you're hospitalized?

When those things happen, you get a real reduction in all of these things. And so we want to build a buffer in so that you can withstand going to, the hospital or you can withstand getting sick and you end up in a place that you're still happy with and can excel from there. Does that make sense? Yeah, absolutely. That's a great reminder. And you were mentioning that if that you want to have your lifestyle set up, especially if you're serious about aging, slowly working yourself up to a place. I mean, any activity that you're going

to be doing is going to be supportive of improving your VO2 max, even resistance training, right? Now there's specific ways to train to improve your VO2 max. What would those ways be? Yeah. So if somebody's not doing a lot of cardio exercise, then I would have them start at low-level cardio, so just steady state. And this could look like brisk walking. It could look like hiking.

It could look like walking on a treadmill at an incline or biking. But we're talking about at a pace that you can sustain for an hour or more. So it's low level. You should be able to still have a conversation, but the person on the other end of the phone knows you're working out. And that's going to build your foundation. So that's like the foundation of your house. And you really want a sturdy foundation before you build your house.

Your V-O-2 max is like the top of the house. So that's how high in terms of how much capacity that you actually have. And so when you're looking for VO2-Max specific training, we're looking at high-intensity interval sprinting. And so I'll have people start out with, it depends where they're at in terms of fitness level, but maybe 30 seconds all out, whether it's sprinting or on a bike, just 30 seconds as fast as you can, 30 seconds rest. And that high intensity is going to help build how tall your house is.

But if you are going from sedentary to active, just working on the foundation, the low intensity, longer duration cardio is where I start people. And there's all these great charts. You can go to Google or chat GPT and they give you averages for people. in your age group and even people who are younger. And it's nice that as you continue to spend more time on it, you try to see if you can get to a place where, you know,

you can score as high as somebody who's younger or in the top percentile of people who are younger. And that's generally when you're seeing these people who have elite levels, they're comparing themselves to like an 18-year-old or man or woman, if they're a woman, and seeing if they can score in the top bracket. Is that right? Yeah. So they're called normative data sets.

And we've got a few different normative data sets, which is just looking at, okay, what does the whole population look like? And then we break them up into, it's usually like quintiles, so like five categories. And to see, are you in the upper? Are you in the lower? Are you in the middle? Where do you compare to people who are your age and gender? And then, like you said, you can compare yourself to other ages or genders, but to see where you kind of fall within that normative data set can be really interesting. Amazing.

You've done this test before. I have done this test. Yeah. How does you feel about your results? I feel good about my results and I'm still very much working on them too. Okay. So there's another test that's coming up. Oh, for sure.

Yeah. I'm never going to stop testing. Man, I, the test is intense. I like sprinting. I hate running like for longer periods. And this test can be if you're, they give you options, you know, depending. You usually have it like a gym or sometimes a doctor will run this test if they're training this, some research facilities at hospitals.

So they'll often ask you, okay. do you want to do biking? Yes. Do you want to do rowing in some instances, maybe at a gym, or running? Yeah. It's usually running and biking are the main ones. So I was like, all right, I'll do running. And I wore the wrong shoes.

I have bad running mechanics, all these excuses, right? You can do all my excuses. I still scored somewhere between, I've talked about it in a previous episode, somewhere between 43 and 45. I got to go look back. That's great. And I ended up having to end the test early because I had knee pain. Okay.

So it wasn't even a true max then. I was a little bit upset because I felt like I had been doing so much hit training and other things like that in preparation. But I know I just got to go back and do a bike or do rowing, which a group of my friends, we're all going to try to do that sometimes soon. We have to do that. You would also do treadmill incline if you wanted to. So some people that, because you don't want to do a test where you're limiting factors something other than your VO2 capacity, like your actual capacity of the lungs and the heart. And so if people aren't used to running really fast, then we want to add an incline so that they're not limited by speed.

They're truly limited by their heart and lung function. So I'll put people at an really steep incline. And that way you're getting up to like four, maybe five miles per hour, but it's not a speed thing. That's your ending factor. Now, you put this as an S. And one of the things about having a high V-O-2 max is that you can find out

through a test. obviously you want your patience especially and the people that are listening to just be training in that direction whether they get a test or not but because the test is sometimes expensive for people and sometimes not always available because you have to have somebody facilitate it it's a little uncomfortable because you have to wear this whole sort of apparatus and you look like bane from Batman totally you now have watches and smart devices that are doing it what are your thoughts on them, especially whoop just came out with a brand new device, which they say is the closest that you have to a proxy for V-O-2.

Any thoughts? I think that those devices, I'm more familiar with like Garmin, and I've had patients who have used things like Garmin, and then we do the test on them. And sometimes they're accurate and sometimes they're not. And you'll never know if you're one of the ones that's going to be accurate for unless you actually test it. So it's really like a rolling of the dice where for some people, you're not. the watch will accurately predict

because the watches are mostly using your heart rate, right? So they're taking your heart rate and then I think they have a few other factors that they're putting in there. But they're not actually measuring oxygen consumption. So for some individuals, that line with heart rate and B02 max, you'll fall on the line. And for other individuals, they'll be way off the line.

And so without actually testing with both of them on at the same time to see if it's accurate for you, you're just not going to know. But that being said, you don't have to test your VOT2 max to improve it. So you can just train like you would after VOT2 max test in terms of those interval sprints and building the foundation. So if money is an issue,

then the actual test itself isn't necessary, but working to attain a higher V2 Max is accessible to almost everybody. That's great. All right. Again, we have you here today. We're ranking the best and worst habits to help us age well, avoid frailty, and maintain a healthy body composition,

aka not get fat. I know that's not PC, but it's the truth. That's what everybody's thinking about. On this list of aging well, one of the top things that you see everywhere today is there's an explosion of longevity-specific testing. Tests that literally will spit out to you and say, hey, Mary, you are X years of age biologically,

but you're, or chronologically, but your biological age is actually this, a little bit lower at this level. So talk to us about longevity testing, specifically tests that spit out this epigenetic age, and where would you rank it on the list? People aren't going to like this, but I'm giving them an F. Oh, F coming out strong.

Because I would never run them. So like I don't see any utility at this moment in time. Where are we? It's like 2025. I'm not sure about the month right now. It's been a wild year. But at this moment in time, I would never recommend somebody get one of those.

I just don't think that they have any utility to them. I think if you talk to me in a few years, that could change. We could actually have some useful, we call them clocks. So like epigenetic clocks or aging clocks. I think that we can definitely develop one that does have a utility. But right now, the ones that they're using, I think a complete waste of money. I think they're a marketing thing.

I don't think they're reproducible. I think if you did four from different companies, you're going to get four different results. They're pretty close to that. And then you don't know which one's accurate. Not impressed. I knew you were not impressed. You know how?

Because you crossed your arms immediately. That's like, I got something to say. Here we go. Buckle up. All right. So that's our first F. Longevity testing. You heard it here first from Mary.

Mary, if people have complaints, where do they email you? Just kidding. Drew. No, but save your money. Like, do, like get a gym membership for whatever, two weeks, but whatever it's going to cover. Yeah. And I've seen it.

I understand that there's some people that consider themselves longevity explorers and maybe the way that people spend extra money on trying different bottles of wine. They're like, okay, cool. I just want to try new things. I have extra money to spend. And they're just curious because they're curious about everything that's new. Yeah. Fine.

I think that what you want to avoid, if partly what I'm hearing you're saying is that you don't want to be doing that and deprioritizing other things that really, really matter. Many of the things that we're going to be ranking as an S and A, a B on this list. And then the second thing is I've had people do these tests and then they feel bad when the results come in that, hey, I'm exactly the same age in this epigenetic test as I am now as if they felt that they should be getting like some crazy younger score. And again, these aren't standardized.

There's a lot of really interesting things that are happening, but it's an emerging field. That's there. So buyer be where? Buyer be, buyer be no buyer. Be no buyer. Don't be a buyer. All right. So we are not on the longevity testing train, but there is another train that you are pretty excited

about. And that's the idea of making sure you have a full and complete. lipid panel. Can we talk about this for a second? Yeah, we can. What are your thoughts about it? And then we'll rank it. Here's the deal.

Healthy cells are the foundation of a healthy body. And most of us don't realize our cells are under constant stress from aging, inflammation, and environmental toxins. That's why I'm excited to share Fatty 15,

a science-backed award-winning supplement made with pure C-15, the first essential fatty acid discovered in 90 years. C-15, helps strengthen and protect your cells, improve mitochondrial function, and defend against oxidative stress,

so your body can run like it's meant to. This means more support for energy, deeper sleep, stronger metabolism, and overall resilience. Backed by 100 peer-reviewed studies, 40 patents, and 36 documented cellular health benefits, fatty 15 supports your brain, liver, immune, and metabolic health systems from the inside out. Plus, many users report,

smoother joints, improved mood, and a healthier skin, hair and nails. And there's no fillers, no flavors, no preservatives, just one clean, vegan-friendly ingredient, C-15. If you're looking to support your long-term health from the inside out, start with your cells. Just go to fatty15.com and use the code Drew to get 15% off their 90-day subscription starter kit. That's Fatty-F-A-T-T-Y-1-515.com slash D-H-R-U with the code D-H-R-U for 15% off. Give your wellness routine the cellular upgrade it deserves. Cardiovascular disease is the number one cause of death for men and women. A lot of women don't know that.

A lot of men don't know that. That it's still the number one. You know, breast cancer gets a lot of attention for women. All these other things get a lot of attention for women. And they should get attention, but it's still cardiovascular disease is number one. It's still the number one. and heart disease is silent until it's not. And so a lot of the times on social media,

you'll hear this. You know, I went carnivore and I feel better than ever. So I'm going to stay on it. You can't base how you feel as an indicator of longevity. And that might be triggering for some people because they're like, I'm intuitive. I know my body. You cannot base how you feel as an indicator of longevity

because then we could say, you feel great if you do this drug or if you drink alcohol. And we know that those aren't going to extend your lifespan. And so we have to have more objective measurements of how we can help prevent heart disease. And heart disease is preventable. So it's one of these ones that if you are young, you can cross heart disease off of your list as potential causes of death for the most part. And if we have that, we don't have that for cancer. We can't like fully prevent all cancers.

We don't have that for Alzheimer's disease at this point. But heart disease is one of those that we know so much about at this point that we really can cross it off the list for the most point. And so doing a lipid panel, which should be included on everybody's yearly blood work panel from their primary care, even like Kaiser and HMOs. And then there's a couple others, which we can talk about that I would add on to that. But if you just start with a standard lipid panel, that's a great place. to start. Yeah. And if you want to expand on it, you know, if you can find a provider that can do like a Boston heart, incredible information that you can get inside of that. But even a basic one can have a ton of information. You know, this has been a hot topic recently because there was a very

controversial study. I think you talked about on your podcast recently. You had on a cardiologist. Gentleman, I forgot his name. Dr. Allo. He's great. To talk about it. But there's a few citizen scientist, Dave Feldman, and Nick Horowitz, med student and a PhD from Oxford, them and a group of other people. I think the primary investigator was Adrian, got his last name, also cardiologist, researcher, and they did this study that was called the keto study. And a lot of controversy. We covered it very favorably in the beginning, and then we covered what we got wrong about

it and my nuanced thoughts. Bottom line, they tracked 100 people that were doing hardcore keto and in some cases like a carnivore diet that were metabolically healthy. And the theory always was for these guys that if you're metabolically healthy, if you low A1C, you have an optimal fasting insulin, et cetera, you have high HDL, could that be so protective that even if you have very high APOB, I think on average in the study, the particular their APOB was 180. Mm-hmm. Which is very high.

Which is very high. And if you have a very high LDL above like, I think 250. Very high. Very high. Which these participants did. They had a snapshot CCTV, which is in advance imaging, where you can look at both soft plaque and hard plaque in the heart. And they did a follow up a snapshot a year later on. I'm not going to get into the controversy, but basically a lot of what happened was there was a lot of plaque progress.

plaque progression. I do understand their point of view, which is that they were showing that just because people had high APOB didn't always mean that they had immediate plaque progression. The criticism was, hey, it was one year. But the vast majority of people did have plaque progression. So are you really willing to bet the farm that this type of diet? And there's a lot of ways to do keto that can be healthier, right? You can be a ketotarian and things like that. calling more the Mediterranean diet. But do you really want to take this diet to the bank and live another 10, 20, 50 years

with a super high APOB, which we know can be very problematic when it comes to cardiovascular disease? Yeah, and you can't do a study like that in one year. Like, do you want to live one year longer? It's just not, but anyways, they did find that. And the thing that I'll say is, even if everybody with a high APOB

doesn't see additional plaque building up or it doesn't have an adverse outcome, it doesn't mean it's not causative. And the most simple example of this that everybody will get is that, oh, not everybody who smokes will get and die from lung cancer.

But we're not going to say smoking is okay for you then, right? And that one sinks in with people a little bit more, but we know that APOB is causative for heart disease and we're not we can lower it. Yeah. I have a few genetic, I don't know what they're called. I have a few genes. I don't know if they're snips or genes or whatever, but I work with an incredible cardiologist, Michael Twyman. I've had him on the podcast before. And I said, I want both because I'm a hyper

reabsorber of cholesterol. So that means that doesn't even matter if I don't have a lot of added saturated fat. My APOB untreated, I'll talk about that in a second, is usually around like 120 to 150. Same. And if we, you know, ideally people talk about it, you know, depending on who you listen to, you wanted somewhere below 70, maybe around 60, etc. So Michael, you know, basically said, listen,

I want you to be both. I want you to have, I want you to be metabolically healthy. I want you to have high fitness levels because that nitric oxide production is going to protect your endothelium. Yep. And I want you to have also, a lower chance of shots on goal.

So if I were you and you have to make your own decision, I would consider taking a Zetamide. So I started on a Zetamite about two years ago, about a year and a half, two years ago. It's 10 milligrams, not medical advice, right? And within about three to four months, I saw my APOB and I just did another test recently, come down from probably like 150 to about 80.

in about three, four months, and I'll have to see what my latest one is. I just haven't done one in a little while, so I don't want to give an old number, but I've been about like 80 or so. And something like I said, I might have felt excited about it because from everything that I've learned, really low risk profile, like, you know, side effects are just super low, pretty much non-existent for a lot of people, although every drug and every intervention has side effects. And I just wasn't willing to roll the dice. Yeah.

I'm 43 years old. Why? I don't want to be 80. And there's always the factor that, okay, maybe cholesterol is doing some other positive things that are there, but I think I have plenty of it in my body to support all the functions and needs that are there. Yeah. And we talk about that with Dr. Allo on the podcast where you can function perfectly fine with

very low cholesterol that's circulating. So it's not going to impede your ability to make testosterone, which is one of the myths. It's not going to impede your ability to make other sex hormones. There's a lot of myths out there and they just don't pan out. And so I'm glad that you're on it. I'm on a statin myself because otherwise I'd be around like the 130 for APOB. But I think it's a no-brainer. It's an easy.

And we have so many other medications too at this point. We've got Zedia which you're on statins. We have many classes of statins and they're all idiosyncratic. Some people do really well with Crestor. Other people are on Lipitor and they're all. going to be different. We have PSK-9 inhibitors. We've got infusions that you can do. We have benpidioic acid. We have benedic acid mixed with other things. So we have just so many options at this point that usually you can find something that works for somebody. Yeah. And if you can find a smart,

open-minded cardiologist, like recently I had my dad start seeing this Dr. Twyman. And one of the things that he'd been having for the last few years, because he's been on a statin since he was like 30, is that he was having some joint pain, some, you know, muscle cramping and other things. And just having him go to open-minded, you know, functional cardiologists, there's not a lot of them out there, right, who are both equally sort of versed in how the body works, but also understand the evidence base. He just tweaked a few things. He put my dad on Zedia, lowered the medication on one side, optimized this, told him to double down on some dietary nitrates, get his, you know, VO2 max. up a little bit, support the nitric oxide production. And my dad's been doing that and we'll see how it all, you know, fairs out.

I do want to say I'm undereducated. I'm obviously not a medical doctor, but I'm educated on the whole layers of all the controversies around statins that I know that are out there. And I'd be interested to having, you know, somebody on here to talk about that, maybe even like a little bit of like a debate type thing. But the thing that I did is I also got a clearly scan done, a CCTA. and I had I had, you know,

one of the cleanest scans that my cardiologist has ever saw. I had on the vegan cardiologist, Dr. Joel Kahn. He said I was the second cleanest to him. He's older than me. He's like 60 something. So who knows all the different things

that play into that, but I'm still not willing to bet and roll the dice with something like cardiovascular disease because the highest rate of cardiovascular disease, disease in America for any ethnic population is South Asians. They tend to be under-muscled, sedentary life, they eat a lot of sugar, they drink a lot. Higher metabolic disease.

Right? Higher metabolic disease. So I already know that I have those genetics sort of, you know, as a ball and chain. I'm not going to, I'm not going to, you know, risk it. But I'm going to do everything else, right? Good. Okay. All right. So we don't have this on here, but where would you rank getting a CT scan? Right.

A CCTA, you mean? Not even a CCTA, just a CT scan. Like a total body CT? No, like a hard CT scan. Like calcium, calcium square. CTA, yes. That's a tough one. And you can say it for the right person.

So in general, I would say like a D, and that might be surprising to people. If this, the right person in my mind would be somebody who we think there's a very good chance actually has plaque that's accumulated and they are unwilling or unwanting to treat it and they need some evidence to push them in the direction of treating it. And so I've had instances of that before where, you know, you have a guy who's 70, who's had a high APOB LDLC his whole life, doesn't want to treat it. And then they actually see their CT angiogram and they're like, oh, wow, I'm willing to treat it now. And the reason why,

because I've done clearly on people and I've kind of turned in terms of my recommendation is that if we do them on 30-year-olds, 40-year-olds, most likely you're going to get a zero. And we don't want people to get a score of a zero, meaning there was no soft plaque, no calcified Plaxine and say, great, I'm fine. Like, I don't need to treat anything. Same with, you know, if you don't have lung cancer at the age of 30, like, do you think it's okay to continue smoking? We all know that the answer to that is no, but sometimes doing these heart scans on people that we don't expect them to actually have plaque can give them the wrong impression of what is a potential. That's great. Yeah. I appreciate the perspective. I see, and again, I'm not a medical doctor,

I see a little bit of the opposite. I see a lot of people in my community, especially, you know, 40, 50-year-old men, because they're in this higher-risk population, South Asians, they are already on lipid-lowering medications. And so you look at their lipids, which sometimes a friend will send it to me and say, hey, which doctor should I go see? What do you think about this? And I'll point them in the right direction.

Often their lipids are like, they're perfect, right? I just had a friend's dad sent me some the other day. And it's like, perfect. You look at it. And the most evidence-based cardiologist would say, I wish every patient of mine would be on this. And then when they actually, let's say they were more curious and they went and did a clearly scan, which is expensive.

It's like $2,000, right? A CTA scan is cheaper. It's like $100.99. That's out there. You don't get the soft plaque information. They go and do that. They actually see that because of their lifestyle could be, drinking, could be eating a lot of processed foods, could be not enough working out, that they

thought actually they were okay because their lipids have been low, maybe now for 10 years, right? But they're in their 50s and they only got put on a statin when they were in their 40s, but they actually have so much hard and soft plaque that's inside the body that that sort of gets to be like, oh shit, I actually have to like put in the work for all these other lifestyle things. I can't just have a pill and think that that alone is going to protect me moving from here. I've seen this as young as people, one of my best friends, he did it. And he had the plaque of what, you know, a 50 or 60 year old should have. And he wasn't even 40 years old yet. Yeah. And it was a huge motivator for him to say, holy shit, I really got to get my act in a way. Yeah. Yeah. And I think we're

actually saying something similar where it's like if somebody is unwilling to make changes, then I can see a utility for them at that point. We just want to make sure that we're screening the right people because if that same friend did it and got a clear score, the last thing we want is for him to keep drinking and thinking everything is fine. And there's a chance that he could have a clear score if his APOB and LDLC had been low enough for a long enough period of time. My guess is that person had really high levels at some point and was accumulating then went on therapy. So I think a history is really important. And I also think it just depends on like your financial place, right, in terms of what we're going to spend our money on.

Totally. One last caveat about the clearly that I want to share because I'm always learning different stuff. So my dad did clearly last year. And one of the things that showed up for him is that there was some blockage. And then clearly was estimating that the blockage in one part of the heart was around 60%. And then he ended up going in for what's called an NGO? Cath. Cath, sorry.

Yeah. He went in for a Cath exam. And when they actually looked, they found out that it was, it was more like 30 or 40%. So if anybody's gotten a clearly scan done, which is this advanced CCTA, I talked to Dr. Twyman about this.

He was the first person to tell me. He said sometimes these scans can also overestimate to just to make sure that people understand. Yeah. Yeah. And that's actually a great, that's part of the reason I gave it such a low grade is there is a chance, and I've seen this multiple times where people get these scans, something scary comes up, but they're not a candidate to say get a stint. They're not a candidate for an intervention. And sometimes these people are left with kind of this looming thing. They're already doing everything. So there's no additional interventions, let's say. And it can create. anxiety in some people too. So I think it's just important to like see like who are you? What's your history? What's everything been like? Do you need a push? Like are you not willing to do

interventions? But this is something like just to have an educated informed discussion with your doctor. Awesome. Amazing. All right. Let's move on. Okay. One of the number one things you hear people talk about when it comes to aging well is get your 10,000 steps in. Where would you rank 10,000, steps, but first, why would you rank it there? Okay, so any exercise in my mind is so important. And that can be walking, it can be dancing, it can be resistance training. People just need to move more. And if people move more, you're going to improve your health span for sure, like your quality

of life and very likely your lifespan as well. So it depends how we want to grade these, but I would put virtually every exercise as an A because I'm just like, yes, move. Most people just need to move more. So movement is an A. But specifically, since this is your scoreboard, within the movement category.

10,000 steps specifically. Okay. 10,000 steps specifically, God, this is hard. It's really tough just because, you know, low to moderate intensity exercise, majority people are not getting the recommended amount, which is like 300 minutes a week. And so if it gets you to that,

then I think great win for you. I'll give it a B because you're going to make me do it. Okay, you're going to put it as a B. I'm going to put it as a B. It's really hard. There was this clip of Rhonda Patrick on my friend's show, Lewis House, School of Greatness, great show, recorded here in L.A.,

and she had some super controversial thoughts, which actually were really good. And it made me think, oh, man, this is interesting. I think I agree with this. Let me hear it. She said, all right, I love movement, just like you said. But the challenge for 10,000 steps is it takes a lot of time. And a lot of people don't have always that time, depending on their schedule,

could be a young mother, could be this, could be that. Yes, we want a lot of movement throughout the day. But how many times have you and I both looked at our step counter on our phone and said, oh, shit, it's like 6 p.m. and I've only gotten 4,000 steps. You're sitting with patience. I'm in front of the computer. You're in front of the computer.

Whatever it might be. So she said, not that it has to be either or, but if you're going to put me in this position, because Lewis was asking, if I would rather say, give me 10 minutes of vigorous activity. And that actually might be more impactful. And she referenced a few studies.

I don't have those receipts in front of me. She said that could be more impactful, like 10 minutes of all out, you know, activity in some capacity, which, you know, a few little breaks in between, that could be more impactful to the body than 10,000 steps overall. Thoughts on that?

You know, high intensity exercise is invaluable in my mind. So you're going to get different benefits, especially with like mitochondrial density. There's a lot of benefits from high intensity specifically. I don't like to live in the world of like either or. It's like, why can't we do this and? Well, I think a lot of people are in this position where they regularly feel shit, like to hit 10,000 steps every single day based on where I'm at right now. Like the people that I see that regularly hit it, no problem is usually people that are like my parents age.

They have time. They're walking, getting 10,000. Like if I walk at a very chill pace, not fast, in one hour with my men's group, that's usually 6,000 steps. Yeah. That's one hour of dedicated walking in a day at like a chill pace. most of my friends that are young, they're just not getting that in. Now, you're not supposed to get it in in one hour or like supposed to, quote unquote. You want to get it out sprinkled throughout the day.

So I think the component that just brought me a little bit of a sense of it was, okay, I empathize for so many people, especially young people who are still going to the gym, who are still working out hard, who are like, shit, it's very tough for me to get those last three to four thousand steps. I'm not going to answer this question. Instead, I'm going to give you some more information. Please, please, go for it. Okay, so there was a study that was done.

It was a prospective cohort study. And they saw that people who performed two to four times above the recommended amount of long-term vigorous physical activity, which is between 150 and 300 minutes per week, had an observed 30% lower risk for cardiovascular disease and mortality. And that's a really big number. but this study then goes in and they talk about, okay, well, what about more moderate activity or vigorous activity, which is kind of what we're talking about, more moderate, low intensity, or vigorous. And what they found is that it can be a combination of it or it can be all of one or all of the other and it doesn't really matter that much as long as you're meeting one of the requirements. So I would say base it on your lifestyle, whereas like, okay, if you can't do the 10,000 steps,

per day. You can't do like longer duration cardio, then do shorter duration but higher intensity. And if you have, if you want to really excel, then it's going to be a combination of those. But I think it's important that people know because some people walking 10,000 steps, maybe they're a gardener or they're a housekeeper, you know, they're doing stuff that they're moving all day. That's actually going to be easier for them versus getting a gym membership or figuring out how to do the interval training. So I think we need to be a little bit more lenient on it because I think that you can get really great results. And what they found is that a combination of medium to high levels of physical activity

provide nearly the maximum mortality reduction, which was 35 to 42% reduction in mortality. Amazing. I love it. Okay. On that same note, I have another one for you to rank. Okay. Walking after meals. So walking for like 10, 15 minutes after meal.

What are your thoughts on it, and where would you rank it? I think it's overrated. So I would probably put it like around a C. Again, all the caveats of any walking is better than no walking. Walking after a meal can help. So if you're pre-diabetic or diabetic, then maybe it's going to get a higher ranking, just because it's going to help with post-pranial glucose levels. But for the general population who is insulin sensitive and they're healthy,

I don't like don't stress about walking after a meal. Just get your movement in whenever. Yeah. It's more about you feel the total movement. Yes. Than necessarily just walking after a meal. Yeah. When we make things too specific and we feel like we've failed a goal,

it can set people back. So I don't think there's enough of a benefit to make sure you walk right after a meal, again, for healthy individuals versus just get your movement in. Yeah. I know for somebody like my mom, it's a great reminder. It's a great reminder that, hey, listen, just you eat and then you walk.

Yeah, wonderful. If you're trying to get her total volume up and shout out to my mom who's going to the gym and strength training especially because my sisters who are awesome who I work with, Herschel and Kea have been really supporting her. My brother-in-law, Neil, Dr. Neil Patel

have been supporting her as well. So it's been really inspiring to see her at the gym, bench pressing and doing things like that. That's incredible. I got my mom a gym membership. Seven years old. Awesome. Yeah, your mom is amazing.

I got her gym membership for Mother's Day this year. And is she been going? I think so. You know, a lot of people, you and I around the same age. Yeah. And once you get to like your later 30s and I'm in my early 40s, you care about your parents. You always care about your parents, but you have, you want to nudge them. They grew up in the sort of world that they grew up in.

Nobody was doing podcasts back then. Nobody was really discussing a lot of this stuff. And a lot of their habits just came from the world that they grew up in. Yeah. What have been one of the top one or two or three things that you've seen, even as, doctor of naturopathic to get your mom to move in the healthy direction, whether it's through movement, diet, whatever. Like what's been helpful, more from a psychology, from a supportive, from a, you know,

you're her daughter, you're not her doctor. Yeah, yeah. So what's been helpful for that? Because I know there's a lot of my friends, we have this conversation on a regular basis. Yeah. Well, I have to give my mom props. Mom, I love you. She is so open-minded and she wants to do all of the things.

So she doesn't really have to be convinced, I think, that logistically, I know she'd be okay with me sharing this, but it can be intimidating going to a gym if you've never been to a gym and don't really know, like, how to use all the equipment. So I think that was one of the barriers that she got over and I'm so proud of her. She, like, goes to the gym now. She knows, like, how to use the equipment. Or she just knows that you can ask people how to use the equipment, the trainers that are there. And so I think, I think it's really just like leading by example and just being healthy yourself. and talking about it, but never telling somebody,

hey, you should do X, Y, and Z because that's never worked for me. Yeah, we can all remember being a kid and so telling us we had to do this thing and how icky it felt. We've got to make sure we don't return that favor back to our parents. I do still sometimes in their years. I'm sorry.

Yeah. That's great. Shout out to your mom and my mom and my dad as well. Okay, here's another one that's there that I've heard you talk about, but I don't know where you're going to rank it. Okay? And that's the idea of,

of a rocking vest. Okay? We have a photo of a woman walking with almost military-style vest on. It doesn't have to look like that. Yeah. But explain what a rocking vest is, why somebody would wear it, and then where would you rank it on this list? I don't like this exercise portion.

It's really, really hard because I want to give everything an A because movement is just good. So I'm going to do these within movement. Okay. Okay, that's how I'm ranking them. Yeah. Do it ever you want to. People are smart.

They can understand the layers around this. So a weighted vest is going to add weight to your body. It's going to add resistance. And so I have patients that will use them, let's say, on a treadmill because, like you, they don't want to run on the treadmill. But they want to get a really good workout in. They want to get their heart rate up. And it's a way to add resistance to whatever you're doing.

So if you're walking around your house is a way to add resistance. If you're doing an actual workout, it's going to add resistance. If you're going for a hike, it's going to add resistance. So all often where you're going to add resistance. So all often where you're going to add resistance. than when I'm hiking so that I don't have to be running to get my heart rate to the level that I want it to be at. So it's just a tool. It's not a necessity.

You don't need one. It doesn't have like life changing benefits in my mind. But it does have the ability to get you to a resistance level that pushes you. So in terms of within movement, it's really just personal preference at that point. So let's give it like a B. I don't know. It's kind of arbitrary. That makes sense.

It's a B. It's a nice to have. Yeah. It's not something that everybody needs to do. No. You have a little bit of extra money. Yeah. And you want to turn up the intensity on some of your workouts. Yes.

Without having to put in a lot more like running effort. Yeah. For example, you can add on one of these best. Yes. Okay, great. All right. So these two are going to go hand in hand. You've already talked a little about strength training.

I'm going to give you an opportunity to rank it. Okay. And maybe even put in there a little bit of the footnote for UCBub, both men and women in your concierge practice, but especially for women, what you want to say about strength training. And then more importantly, we have a separate one here, which is the idea of tracking your progress in workouts. So they go hand in hand, but they're two different things.

Yep. Okay. So let's start off with strength training and then let's go into tracking your progress. Strength training S, easiest one we've done so far. Ideally, every human, if you can, should be doing this. it's low-hanging fruit when it comes to longevity. It's one of the biggest levers in longevity that we have in terms of how do you increase how long you live, but more importantly, how well you live in your quality of life.

Strength training is one of the number one things that we have. So that's an easy, easy answer. In terms of tracking your workouts, this depends on where you're at. And explain what we mean by that. Okay. So what you mean? Yeah. What I mean by that is you've got, so if somebody is sedentary, they're not working out at all, anything you do movement-wise is going to be beneficial for you, right? Like just moving,

moving after meals, wearing a rucking vest, going for a walk, 10,000 steps, any of that is a huge win and great checkmark. When you get to a certain level of fitness, though, so you've been working out for a while, maybe your strengths training now, then it becomes more important that you start to dial in if you want to keep improving because the simple things that you first started with aren't going to get you to the next place. So I think tracking your workouts, I would give it an A. And this is, again, for those people that have been working out and want to keep progressing. And what does it look like? Yeah. And why are you even emphasizing it? Because partly what I'm hearing you saying is that a lot of people don't track their workouts. And you see this with your

patients and what's the sort of story that they end up telling you because they're not tracking their workouts. Yeah, and I'll give you like an archetype where a woman comes in, she's like, yes, I'm resistance training and I'm asking her, okay, tell me more. What did you do? I always ask, what did you do in the last seven days? Tell me everything you did for exercise. And she may say, okay, well, on Monday, I went to this high intensity class that's like a treadmill class. And then on Wednesday I did Pilates and then on Friday I did yoga but we use weights so I did resistance training there and then on Saturday I'm going to go do like one of those circuit resistance training workouts as a class and my usual response to that is like phenomenal like you are moving your body

and if you want to get to the next level we need to have more trackable measures to actually see what load, what volume are you lifting on a weekly basis. And so for resistance training, I'll always have my patients create a log. And it can be on your phone. It can be just like a quick notepad thing. It doesn't have to be super complex. But you want to say, how much are you lifting today?

So let's just say Monday you're doing squats. You're doing three sets and you're doing this amount of weight. And have a record of that because the next week on Monday, you want to be lifting at least that amount of weight at either a higher repetition or a higher weight level to make sure that you're progressively overloading those muscles. Otherwise, people usually get to a place where they plateau and they kind of are just on a hamster wheel of repeating workouts,

and it's still great for their cardiorespiratory fitness. They're keeping their level of fitness most of the time, but they're not able to progress in a linear fashion or what they could be able to do. That's great. Awesome. So a quick little recap, of what we have so far because we've been going for almost an hour, an hour flew by. How?

How? Right? So the first one that we have on our list that you talked about on S. And S, for everybody who forgot, S is supreme. This is literally one of the best things that most people can do within the nuances that Mary shared. So it was the first item you shared was getting a Dexap bone density scan for the people who especially have some history of frailty in their, in their, in their, in their, you know,

sort of medical history. Indicated, yeah. Right? To make sure that you don't end up getting to 50, 60, 70, and you're so frail you end up with a hip fracture or something worse, which is very hard to recover from. Catching osteoporosis early. Yeah.

Maybe at the osteopino level. We had an incredible newsletter that will link in the show notes where you talked about Jeannie McConnell. Do you know her? No. She's the oldest female American Ninja Warrior. She was a ballet dancer in her entire life. She's incredible.

And then she went in for a regular checkup. And her doctor recommended that she get a Dexas scan done. She went in and it came back and it completely surprised her because her entire life, she was skinny, fit. Everything was fine as a ballet dancer who would largely be eating chicken salads and things like that. So her weight was always good. But the scan came back and it showed that she had osteosophiles. Pena. She was on her way to getting osteoporosis. And her doctor said, this is, you know, you have to monitor it and pay attention. She said, can I do anything? And he was undereducated about stuff. And he said,

well, just try to live a healthy lifestyle, be a little bit more active, nothing strong. Her daughter was a crossfitter who had started training in some of these competitions. And she said, mom, I'm seeing a lot of information that strain training can start to turn things around. And let's see. Let's start small. She couldn't even do one pull-up, which is very common, not just for women of that age, but even sometimes men of that age. She went on the journey, started training, getting her protein up as well, and she got the bug. And that turned into her becoming part of the community and realizing that there's these competitions called American Ninja Warrior that are televised. Maybe she could try to compete. A year and a half later, she qualified for one, and she became the oldest

female Ninja America Warrior. And on top of that, she went back for her bone density scan and her osteopenia was no longer gone. Yeah. That's wonderful. It's wonderful. And I see it all the time. I've had a patient last week ago from osteoporotic to now just osteopenia.

And resistance training is such a great way to prevent, but also you can use it in treatment too. So it's a no-brainer. Amazing. So on that note, we have resistance strength training on there, tracking your workouts. So we also have on there. Should that be an A? Maybe tracking your workouts should be an A.

Tracking workouts in A? Okay, great. Let's move it. So we have three Supremes, which we covered. High V-O-2 Max strength training, Dex of Bone Density Scan for those that needed. We have an A, which is tracking your workouts. We have two Bs getting 10,000 steps, you know, wearing a rucking vest.

Nice to have things with the caveats that are there. Go back and listen if you need a reminder. Inside of that, we also have grip strength is a C, a little overrated. Overrated. But something that we have. We want to improve overall just from working out, walking after meals. Again, maybe a little overrated, but has benefits. But walking is great, right?

Walking is great. This is stressful. And then we have no D's and we have one F, which is longevity and epigenetic testing. The clock test. Get them out of here. All right. We got a few more on our list over here. You game to continue?

I'm so ready. It is stressful. On the topic of tracking. These two are going to go hand in hand. You could talk about them together, differently. however you want to do it, but we're going to switch to the topic of diet. Okay. And we're going to go into first tracking macros and the counterpart to that, which is auditing your calories,

having a two-week window where you track calories to get a sense of how much you're consuming. What are your thoughts about those as a whole or individually? And where would you rank them? Okay. If you're tracking calories, are you overweight? Because that's going to be two different. If you're normal body weight, I don't see a need to track your calories virtually ever. Let's say you're the average person who's listening here who probably has somewhere between five and 20 pounds to lose.

That they feel like they want to lose. Yeah. Okay. If you are overweight, tracking your calories is an A. Okay. S. It's an S. It's an S.

Yeah. If you're overweight. Forever? No, no, no. Period of time? Usually you don't have to do it for a long period of time. Some people need a little bit more structure. But for a period of time tracking your calories to get a baseline of where you're at,

which will give you a really, a way better targeted approach to lose that 20 pounds that you have. It's a no-brainer in my mind. And it's not fun. Tracking your calories is tedious. And it's not for everybody. See, a history of eating disorder, disordered eating, body dysmorphia. You'd want to talk to your doctor and see if it's right for you. But if you are overweight, tracking your calories is a go-to.

Okay. Great. So that's going to be an S. Yes. Okay. Awesome. what about the idea of tracking your macros how do you feel about that and where would you rank it this one so what what i would look for here is are you getting enough protein in your diet which is

really important um i i usually say between like 1.2 to 1.6 grams per kilogram of body weight is ideal protein intake so doing an audit of that sometimes can be helpful just to see where you fall because I've had women that do an audit and they're eating 25 grams of protein per day. Or they're eating 30 grams of protein per day. They have no idea that they're that low. They have no idea that they're that low. And especially like if you're doing like a GLP1 where you're on Zepbound or Manjaro, you know, OZempec, making sure you're getting enough protein to maintain your muscle mass with weight loss can be really helpful as well.

So if it's indicated, I think tracking your macros, just doing an audit, like you said, doesn't have to be every day, but just to get an idea of it and you don't have any contraindications to. I put that at A. Add an A. Yeah, perfect. And the other thing we're tracking your macros talking about protein. I'll have people look at saturated fat sometimes, keeping it low, especially if you have high ApoB levels. The other thing that I would say is it's not technically a macro fiber is under the carbohydrate

macro. Most people, when I do a diet log with them, they're under-eating fiber. So that is a really common thing. And I think that's a nice one to track once in a while to see, like, how many grams of fiber are you getting? Women, ideally more than 25 grams of fiber, men, closer to 35 or above for fiber intake. I had a friend text me last year and he said, dude, I had the biggest revelation. And I was like, yeah, tell me what it is. He's like these GI issues that I've been dealing with for five, 10 years now that I thought, oh, it's because of this or because of that thing or I have that

component or this. And some of those items might have some truth to them. He's like, I solved in one week just by adding basically he was adding cillium husk. Yeah, great. And some acacia fiber to his diet in the form of a smoothie or a drink. And just by having better and more complete bowel movements, he saw that all of his GI issues that he was dealing with. I'm not saying that's everybody. Totally. But, you know,

I'm sure you see improvements just from people upping their fiber. Yeah. Especially a fiber that they can tolerate. There's some fibers I do not do well with. Yeah. Even though I've done all this different. work on my gut over the years. But other fibers I do great with, and I focus on those. Yeah, focusing on the ones that work for you, but also just start low and go slow with fiber.

Don't start with two tablespoons of cillium husk right off the bat. So cillium husk is one of my favorites, insoluble fiber. You can use it for diarrhea or constipation or other GI issues. And you start with a teaspoon in eight ounces of water and gradually increase from there. And two tablespoons per day is like the dose that we usually work up to. Okay, just because you mentioned it, let's bring it up. GLPs. Okay.

Where are you going to put on this list and then put whatever context you want? There's so much context here. It's a whole episode of context. GLP ones for people who are overweight with comorbidities or obese is an S or A. And what does overweight mean? Overweight means above a BMI of 25. Mm-hmm. And then, yeah, with comorbidities, like they have sleep apnea or they have other things going on.

Okay. So for them, it's an A, maybe even an S. Yep. Yeah, and we don't always start with those either because if somebody's never tracked their food and, you know, isn't exercising, sometimes we don't need GLP1. So you don't always need them. They're a tool in the toolbox and they're really helpful, especially for people who have tried things and they can't lose the weight and they've got a ton of food. noise and they've been stuck like this for a little bit of time, then they're a really powerful tool.

For somebody who's normal body weight, I don't use them. Yeah. You don't use them, but where would you rank it? For normal body weight? Yeah. Not you not prescribing to them, but if they chose to do it, or let's forget about normal body weight because normal means a lot of different things to people. Let's talk about the person who feels like, wow, this feels like a great way to lose

10 pounds. Where would you rank it? Oh, that's really hard. In terms of its efficacy, it would work. In terms of my recommendation, I would rank it at a D. And it's going to be so person dependent, though. So I can see, yeah, it's a really tough one. But we don't really use it for normal weight people that want to lose like the,

like the vanity weight kind of thing. May that change totally? And I think GLP once we're going to, we're uncovering, okay, like they have protection to your kidneys, like heart. Like there's all these things. And so I think that there's a utility potentially for them beyond weight. And I'm really excited for that. But right now we just don't know it.

So we haven't researched them in terms of like the longevity lens of if somebody is a normal body weight and just wants to live longer. We just don't know if that that's actually going to pan out yet, but potentially. Because there would be concerns about potential downside? Yeah, absolutely. Osteoporosis, malnutrition, malabsorption. Yeah. Okay. Great. Amazing.

We'll have you back on the future to continue to share your thoughts on that. Yeah, we're still learning about them. And I think we're going to uncover way more in the next year or two years. There's going to be new, you know, agonists that are coming out besides the dual agonists that we have. So it's exciting. So one of the ones that you added to the list was this idea of an adequate diet. Right. And I'm going to bring it up in the context of since we're talking about sort of macro,

diet, other things. You know, you called it sort of like a Mediterranean diet. Yeah. And where would you rank that? And you're ranking that in contrast to some of the things that we talked about earlier. I think there could be a lot of reasons that somebody might want to do a ketogenic diet for mental health. In fact, we've had a lot of people on this podcast that have come on and talked about

their stories of recovering from bipolar disorders, schizophrenia. And again, there's a lot of different ways to do ketogenic diet that might be there or a therapeutic diet. But where would you rank the Mediterranean diet, especially in context of a lot of specialty diets that might be trending on social media? Yeah. Like a low lectin diet, a diet that is like an elimination diet that somebody might be doing or a detox diet. Where would you rank it and why would you rank it there? Yeah. For general health, wellness, longevity, Mediterranean diet gets an S for me. It's one of the top ones. We have a ton of research. on the Mediterranean diet and its ability to reduce the risk for cardiovascular disease,

people who are on the Mediterranean diet that are eating adequate calories and protein have a 55% reduction in their risk of frailty, which is incredible. Can you get that by doing something other than the Mediterranean diet? Absolutely. You probably could. But it's just one of the ones that we have the most research on and incorporate so much of the good stuff in terms of like fruits and vegetables, nuts and seeds, clean proteins. So it's an easy one to recommend, and we have the most robust data on it. Do a quick little one to two minutes on how your thoughts about diet have changed over the years, if they have.

Yeah, for sure. Anything you can share with the audience? I'm one of those people that I've done every diet that you can pretty much imagine. I've done full keto. I've done high protein. I've done vegetarian. and I've done vegan. I know that you've done those as well.

And what was the motivation of doing all these different things? Ooh, well, to be transparent, it was probably an eating disorder. For real, for real? For real, for real. Yeah. So when I was younger, I had anorexia, I had bulimia. And I think I masked it by saying I wanted to try all these different diets. And subconsciously or consciously, I was just trying to lose weight.

And then it transformed into like I just got really geeky about nutritional sciences and experimenting, and I worked in a research lab, and I had access to all this equipment to, like, test my blood whenever I wanted. And so I just love the scientific method. So at some point, it transformed from being really unhealthy to just a huge curiosity around nutrition. And so I've tried pretty much everything,

and it's been really fun. And so how is your belief system shifted and brought you to where you are today? Give us a little bit of a compare and contrast. Yeah, so there's been fake. phases where, you know, I've gone through, okay, we should all be vegan. And some of it was ethics. And I think that there's, you know, that's just a personal decision as well. And then I went through a phase of gluten is the devil and nobody should eat gluten. I was gluten free for probably

five years. I was dairy free because I thought that that was inflammatory at one point when I was younger. I'm talking about my teens and 20s. And then I got to this point where I had tried everything. Like I had been through the whole gamut. And I came back out. And I came back out. on the other side with moderation. Crazy. Because I had done all the extremes. And so I came out and at this point in my life, I really believe that moderation is key.

Fruits and vegetables, like the things that we just know are tried and true have the most research. Very likely you're going to be the biggest game changers in terms of longevity. You don't have to overcomplicate nutrition, which I was the biggest overcomplicator of nutrition. I was tracking.

I was changing. I was tweaking. I was eliminating. And I've learned some from all of it, right? And there can be utilities for a lot of these different diets for different people in different circumstances. But for the person who is healthy and just wants to stay healthy and doesn't have anything that we're actually trying to treat with diet specifically,

a well-rounded diet, rich in fruits and vegetables and clean proteins is what I landed at. Yeah. With also all the lifestyle stuff that you do. Totally. I think a lot of people in a well-intention, way and I have gone through a similar journey, although I didn't have an eating disorder. Yeah. I think if I really think about why was I trying all these different things, even like an extreme

raw food diet, it was this sort of thing that a lot of people get into where they think that they found like the Holy Grail. The Holy Grail. Totally. This diet is going to be the fix for a lot of things. And I got a lot of stuff at a lot of different aspects of those. But looking back, I forgot who I heard say this, but it was almost like the thing that I was looking for that would come from, and I'm in a place in my life where I don't eat gluten,

I don't eat dairy, I don't eat a lot of these things just because I don't feel good. And a couple other reasons too, which I can get to in a little bit. But the things that I was looking for, like I was putting too much pressure on just diet to be the fix for all the things that I was looking for in my life instead of putting, you know, doubling down on strength training, you know, getting my V-O-2 math. up, getting all these other things that actually your diet doesn't need to be perfect from this viewpoint of some other person, like you means that you eat no ultra processed foods ever, right? Or you eat no sort of heavily processed foods like protein powders or whatever, ever.

It doesn't need to be that perfect. And it's often just relying on diet alone is not going to get you the results that you're looking for. Totally. It's going to be those lifestyle components, many of them. them that you've already ranked that will give us the biggest movers along with a generally healthy whole food diet with a little bit of indulgence here and there absolutely yeah i couldn't have said it better and with diet like one of the things that social media gets wrong some of the times is that calories don't matter calories i would put at an s where you have to have adequate

calories i think that's one of the ones we're doing right yeah where adequate calories whether And that goes both ends of the spectrum. When you keep saying the title of this episode, I keep wanting to interrupt you and say, you don't want to be overweight, but you don't want to be underweight either. And it's equally as important as being overweight. And we don't put that much weight on it,

well, pun not intended in our society because of stereotypes and all of this stuff. But being underweight is one of the biggest risk factors for frailty. And increasing the risk for osteoporosis and poor outcomes if you get hospitalized or if you get cancer or all of these things. And so you don't want to underconsume calories and you don't want to over consume calories. But calories are king when it comes to body composition.

And then food quality is super important in terms of it reduces your risk for a multitude of diseases if you have enough fiber, fruits, and vegetables in your diet. Great. Awesome. Okay. We are going to be moving from the diet section to some things that are sort of trending on social media. to get your thoughts because again, you're ranking the top things, the best and worst habits to help us age well, avoid frailty, and maintain a healthy body composition, aka not get fat and not get too thin.

There you. Thank you. Happy. Let's talk about a few things that are trending that are out there. One of the top ones that comes to mind is sauna. What do you think about it and where would you rank it on this list? SANA. I'm like, what did I put that one as? I'll think live right now. Sana has like a little bit of research in terms of cardiovascular disease. It's not great. I put it at a, oh, I put it at a sea, but walking after meals I'd put before Sana. So I don't know if we can order them. Okay, so you're bumping walking after meals to a B? Yeah, I'll put that out of B then because they're not the same. Like walking after meals, I would definitely put before sauna. Okay, so we got saunas a sea.

Yeah, sonnas of a sea. But I love it. I do it. So talk to me about this because I might be undereducated. I regularly hear that these finished trials that have been done showing the reduction to all-cause mortality from regular sauna use is like one of the most powerful interventions. If, no, not that doing a sauna is easy. And often people are underdosing. It's a dose dependent is what a lot of.

of experts have talked about. They're underdosing because it looks like the benefits start at making sure, you know, these are traditional saunas. Yeah. So they're not infrared. So they get hotter. It's usually like 180 degrees Fahrenheit for 20 minutes and at least three times a week because even the control group in some of these larger studies of thousands of people, these people are doing sauna like minimum two to three days a week. So I've heard from a lot of people just in my interpretation of their interpretation that Sana's a huge needle mover, especially for people who are older who generally may not be doing as much resistance

training as we'd like to see. I'd still put it below walking after meals for sure. Like any movement. This is my board. Any movement is going to be above sauna. Like easy. The research is not even close. Like some of the finished studies we're looking at. I think that there's some issues with how to have done. We want to look at like the size of the studies as well. But from everything that I've seen, exercise is exponentially more important. Any form of exercise versus sauna. Okay. Yeah. Got it. Easy. All right. It's a C.

It's a C. I'm not moving it. I'm going to toss you a new one. Okay. Cold plunging. Oh, cold plunging, D. I give cold plunging D, but people like cold plunging because it changes their mental health. So, like, they feel more energized, they feel more motivated. So if for you, it, like, makes you go out and exercise after.

It makes you have a better day. You just feel better after. Then great. Then for you, it's not a D. But if you don't, like, I'm one of the ones like, I don't love it. And in terms of longevity, I would saunit. I would sauna over cold plunge for sure and exercise above all of them easy. All right. Finally, we have our first D.

Yes. Cold plunging. You're right, though. I love cold plunging as a fun added bonus. It's not something that I have to do every week, but it's a fun little challenge. And I use it as a social thing between me and a couple of my friends, you know, my buddy Mark May You House. Yes. and my buddy me here, a couple of other buddies in my men's group.

It's sort of our weekly thing to just get a chance to do together. And I definitely feel like I drank a cup of, not a cup. I drank like a little espresso right after. Like there's a big dopamine hit. If I'm feeling low energy or a little tired and I've already done my workout for the day and I need a little bit of a boost, I'll just do a quick cold plunge. Now, caveat's being there's like a cryout therapy place next. to me. Right. So it's easy to go to. My buddy has a cold plunge at his place. We'll go there.

But it's not something that I'm bending over backwards to do every single week. But it's a fun little challenge for me and my friends that we enjoy. And that's wonderful. Because if we're talking about socialization and being around friends, A. So then that is one of our items, community. Right. We don't have an image for it. But talk about that in the context of everything you were just sharing. Community is an A for sure. We know it. improves your lifespan and your health span, which everybody knows intuitively, you're happier when you're around people who you love. But it's really important to have a good sense of community. We don't talk about it as much as we should in medicine in my mind. It should be

talked about it every primary care's office because it has such an influence on how long you live and how well you live. Just having people that you can call on that you feel supported by a huge effect on mental health, but also physical health. And our habits are so contagious. If we're hanging out with the right people, we're going to want to be healthier. If we're hanging out with people who don't have as healthy of habits, those are also going to be contagious too. So if you want to solidify a lot of these things, weight training, you know, tracking your macros, other stuff, this is literally what my friend's group talks about on a regular basis in our text message thread. And it's not just because we live in Los Angeles, although I'm sure

that's a big part of it too. Yeah. And we send funny memes that are like stupid. And I think that's so important for your mental health is just to have a laughter and joy and like it's it's crucial where would you rank again we don't have an image for this one meditation oh meditation both as a concept but also to where it shows up if it shows up if it doesn't show up in your own life and what you recommend to patience yeah um so individual here but stress reduction which i would put it under that umbrella of stress reduction mindfulness, that I would put that at A or a B. Let's give it a B plus.

Okay, stress reduction as a whole. A, you got to give an A. Stress reduction is huge. A, final answer. When you talk to patients and you say, look, you know you're stressed, I know your stress, what are like three or four rotating interventions

that people could pick and choose from to actually have a regular way to support, you know, stress reduction in their life. So if you were my patient, I would say, what outlets do you currently use when you're stressed to feel less stressed or to cope with stress? Because everybody's different. For me, I go and work out and it makes a night and day difference between my level of

stress and my mood. And then I know people who reading a book or meditating or taking a nap or hanging out with friends, being social. So I think it's really about getting to know yourself and how you, cope with stress in healthy ways because we all have healthy and unhealthy coping mechanisms for stress. Yeah. So we're not going to put that as the A.

But yeah, what way do you respond really healthy to stress that helps you personally? Within that meditation, you know, some people feel like I want to try meditation. I feel like it's really great. I just haven't gotten around to it. I've had periods of my life where I've been very serious about meditation. and I look at myself now and it's not something that I regularly do in a classic practice of, let's say like a transcendental meditation or Vedic meditation, which I've gone to class for where you do 20 minutes twice a day, mad respect to everybody who does that.

And I'm like, dude, I'm one of the happiest people I know. And people generally think of me as pretty happy. Yeah. And it seems like other things that I'm doing are working too. I would never knock meditation, but I'm not going to lie and make it sound like I do it on a regular basis. I'm more of a crisis meditation person. If I feel like really overstimulated, I'm like, all right, let me just take a step back. And I do this practice called falling still, where I'll just close my eyes and I'll watch my

breath and I'll tune in. And I'll just take like five or 10 minutes to get a chance to do that. Beautiful. Beautiful. And that's knowing yourself and what you really, so what's your go-to stress relievers that are non-meditation based? Stress relievers. Probably typically, I have so much of this built in. It would be going for a walk. Yeah, same. Yeah, just going for a walk. Whether it's myself or whether it's a friend or with my wife, Yasmin, going for a walk is probably one of my top ones. Yeah.

I love. Have you seen like some of the stuff around Francie and Shapiro and EMDR and other things like that? She was the one that created this whole. With the eye movement. Eye movement thing. She found that when she went walking, it would create this de-stressing sort of thing for her and a lot of her students that she was teaching at the time. and the whole theory around it was is that when we're moving forward in a,

we're moving in a forward plane and our eyes are scanning the horizon left to right, it's a sense to our body that we're making progress. And that sort of lets our vagus nerve, our nervous system, everything, know, like, hey, no matter how bad things are, no matter how much things are worrying for you right now, like you're heading in some direction. Yeah. And it's a calming thing. And then they turn that into, you know, an eye movement sort of process that people can use to work through traumatic events in their life.

EMDR, right? Yeah, EMDR. Yeah, EMDR. I don't know any personally that's done it, although it seems really interesting. But it makes sense that you walk and you start to feel better. You get ideas around stuff. You step away from the problem. All of a sudden, you let your subconscious work on something for you and you just feel like you're in a better mood.

100%. Movement is my number one for me personally. Okay, great. So those were some of those habits, both trending and soft habits that people talk about. I want to go into this category here, which that we want to drill into a little bit further. And it's this whole topic of women's self. Not that everything we haven't covered hasn't been part of women's self, but more specifically, because this is an area that you work with a lot of women on.

I want to start off with the first one, which is hormone repulmone. placement therapy, specifically in the context of, you know, ranking the best and worst habits to help us age well, frailty, et cetera, et cetera. Thoughts on that. We don't have an image. Where would you rank it? So dependent on the woman. So there's some women where I'd rank it around like a C, where I don't know how much it's going to do for them. And then there's some women that I would rank it at, you know, an S or an A. And it's really dependent on the person. And so, you know, indications for hormone replacement therapy, hot flashes, night sweats. And if you're having issues sleeping because of your hot flashes, night sweats,

it's going to affect the rest of your life, right, if we're not sleeping. Quality of life changes. We can use hormone replacement therapy to help for the prevention of osteoporosis. And so if you're at a higher risk for osteoporosis, you would be in that higher category that you're going to get benefit from as well. But I think that sometimes we're touting hormones as like the fountain of youth, And like you said, like the golden ticket, like this like answer to everything. And I don't think that we have enough data to say that that's the case at this point.

Yeah. And there's a lot of women that I've heard that have gone on it and they feel like it's a game change for them. Totally. And those are the people that I would say it's an A. And sometimes you have to try it and see. But there's also going to be a group of women that don't notice much change, aren't getting much benefit from it.

And then to be on it just because you think that it's going to improve your longevity, or any of these other claims that you're hearing, you know, I think that you want to proceed with caution with. You know, there's this trend as part of this whole mental revolution that's going on right now. And I've had a lot of the leaders on my podcast for almost five years talking about this, including people like Sarah Godfried and many others. There's this trend where a lot of women who are going through perimenopause, menopause, are talking to their moms about like, hey, what do you remember about this time period? And one of the interesting things that have happened, I've seen this even in my own

family members. I'm not going to name any family members specifically. But you see this trend amongst a lot of women that are in the perimenopause, about to go into perimenopause, or are thinking about the subject or, you know, are just paying attention to this. They'll interview their moms and I'll regularly hear things like my mom like literally doesn't remember how hard it was for her during that time period. She's like, what are you talking about? I never went through menopause or other stuff. I was fine. Everybody's making a big deal about it. And then the daughters often, who are leading this conversation, are like, mom, are you kidding? Like, it was so intense. You're, how would move swings? Or you would mention, like, you'd have to turn up the air because

you'd get so hot. Have you seen this before? Um, I'm trying to think in terms of my family, I don't, I don't know if there's, yeah, I don't know if I've seen it as much, but I have heard people in terms of what you're saying where they're like, yeah, there's this disconnect. between what they experienced versus what other people saw. I don't have kids yet, but I think it's kind of similar to when people look back and they, oh, when we had kids, we didn't even do, we didn't talk about it. We didn't even feed them. They just took care of themselves.

And it's like, what? There was a lot that went into it. Anyways, it's an interesting discussion that I'm tracking because I see a lot of women having this conversation with their moms or their aunts or other things like that. I'm sure that's a whole other episode that we can get a chance to do. Continue on the topic of women's health. What are some of the top and most important? important screenings, right, that are related to aging.

We've already talked about one of the main ones. You're talking about bone density, especially if people have a history of any of the things that you mentioned earlier. What other things are super, super important for especially women? We talked about cardiovascular health, which is both for men and women, of course. It's a number one killer for women as well. Anything that is unique for women that you want to double down on that is a huge part of the process of aging well and being strong into your later years.

Well, the most obvious ones that come to mind are saying up to date on your mammogram pap smear for women, specifically colonoscopy for both sexes there. So staying up to date with your screening exams is so important. And then in terms of other ones, I'm trying to think about women specifically. I have to think more. I'm probably missing some. How do you feel about on the topic of one thing that's very popular? these days. I've done it myself. I've discussed my results on this podcast, full body MRIs.

Give us your nuanced thoughts about that. But in particular, since we're talking about women's health, it seems to be, and I could be undereducated on this, it seems to be that one of the most popular reasons that they've become popular is that they might be able to catch certain cancers in some instances a lot earlier than they would be picked up in a self-examination or potentially in an x-ray. Thoughts on that? Well, so you're talking about whole-body MRIs, and I could be wrong on this, so don't quote me, but whole-body MRIs, they're trying, each body part requires different settings for an MRI,

which is why a whole-body MRI would never be used if you need just like an MRI of your knee, for instance. It's not going to be, the knee part isn't going to be as accurate as if you got just a knee MRI. Does that make sense? And so MRIs are used for breast screening in certain individuals, but I'd want somebody to get a specific breast MRI if we're doing that, or we have phenyl ultrasounds that you can do on top of a mammogram if a woman has dense breasts. And so we would never want to replace the actual screening exam that's just the local look at the

breast for a whole body MRI. My big caveats with the whole body MRIs are number one, I see them having more and more utility as they get more and more accurate. The biggest setback that we have with them in my mind right now is that there's almost a guarantee if the person's over the age of what, like 30, you're going to have incidental findings in them. So for me, for instance, I've gotten one done and I probably had like three things that popped up more than that, but like three things that I was like, oh, I have to look into these. And so you want to weigh your risks and benefits with everything and catching cancer early is a real benefit.

Like we want to catch it as early as possible. And if you're somebody with extreme anxiety and if you, you know, see like a cyst on your ovary and you're going to have to get an ultrasound every single year and that's going to send you into a tailspin of anxiety. or panic attacks, then that's really something to weigh. Was it worth it or not for you? And so I'm not pro. I'm not against them. I think they have a utility. I think we just have to know that, okay, are you somebody that's going to be okay if we find an incidental finding? And then we have to really look at how many incidental findings are we finding and are they leading to biopsies that

are unnecessary that could increase the risk for infection and things like that. But I think that we're going to get to a place where they're more dialed in and we're going to get less noise within them. Then you have the blood tests for cancer like gallery and things like that. And you don't have the issue of incidental findings with those because it's either positive or negative. You do have the issue of false positives that come back. And it's about one in, I think, every 200 test you can have a false positive that's there. So super interested in them.

We need more things for cancer prevention because it's still one of the leading. causes of death and risk-benefit ratio for each person. Great. Anything else on women's health? If not, I have another category that I want to go into. Another category. Let's go. Okay.

Gut testing. Oh, love it. This is one that you know a lot about. Yes. You know, people have a lot of GI issues, bloating. They eat a meal. They don't know why their gut is a little rumbly. They don't feel good.

Maybe they're constipated. It could be a whole plethora of things. light things, all the way to heavier things. And they see a lot of tests that are out there that are marketed to them. Do this gut test. We'll tell you either what to eat, what not to eat, or what the exact issue to fix. If you have SIBO, if you don't have SIBO, what's your thought about this category? And do you want to add any context about your knowledge in this space?

Yeah. So I want to differentiate because like a lactulose breath test for small intestinal bacterial overgrowth, I think, has a utility for sure. And I use them with my patients. I think they can be helpful for those people. But let's talk about comprehensive stool analysis that look at the gut microbiome. Those go along with the clocks. F.

F for them. Don't run them. Don't like them. These are the ones that you can buy on Instagram or from companies that just ship you the kit and they tell you what kind of bacteria are in your gut or protozoa or fungi or whatever, they're analyzing your gut microbiome. And this answer, I believe, is going to change over the next five, 10 years where we're going to maybe have something that does have utility. But for this point in time right now, as I'm speaking, they don't have utility. They're not going to be helpful.

I don't recommend them. I think they're a complete waste of money. You used to run a lot of these early on. And so you know from first-hand experience. Absolutely. And what did you find? Well, they're fascinating and people like to see them, first of all. People like want, people request these for me every single week. They're like, should we do a stool test? Should we do a poop test? And there's the gut microbiome is so complex that we currently don't know what the ideal gut microbiome is. And so if you go to one of these companies, they're testing like 20, 30.

Some of them test more of what's in your gut. But they're really cherry picking most of the time which bugs they're. they're looking for. And then they're not looking at a detailed enough level even. They're looking at like the species or genus level, which, you know, if we're talking about like E. coli, we need to know what strain of E. coli we're talking about. Because you have E. coli Nissel 1917. And that's a beneficial bug in the gut. And then you have Ecoli 0157H7, which causes diarrhea and is pathogenic. And so the test are just not designed to have a utility for them. And they create more confusion and they don't lead to clinical outcomes, meaning that if you get a comprehensive

stool analysis, you look at who's in your microbiome, we don't yet have the information to say what should be there. So if you don't know who should be there, there's no way to use it effectively to get you to a place that you want to go. But I think at some point we'll have that information, and I'm super excited for that time, but the time is not right now. I guess some other concerns is also are the test reproducible? No. One stool sample shows one thing. Another stool sample shows something completely different.

Yeah, I have an hour-long podcast on all the issues with these stool tests, so I can go on and on. But that's one of them is they're not reproducible. Most of the bacteria in your intestines are anaerobic, and once they're exposed to air, when we sample them, they die. There's so many issues with these, and people are selling them because they sell. because people want to know, but they don't have utility.

And if you're telling me, but I saw this doctor and they said, I had high provitella and then we took this thing and I got better, there's a very good chance that one of two things happens where you had regression to the mean where this is something that was going to get better by itself, or you were treating SIBO and you didn't know it. And the best test for you in that case would have been a SIBO lactualist breath test, which could have been covered by insurance or much more affordable. And you would have gotten the same or better outcomes with the right.

treatment. I love it. The unfiltered truth from Dr. Mary Perdey. I was surprised you didn't cross your arms on that one. Yeah, that's the arm crossed her for sure. I mean business. As we wind down here, Mary, let's end on a fun one. Not that these other ones haven't been fun. Okay. Talk to us about supplements. What's worth it and what's not worth it. When you talk to your patients, obviously there are very specific things that people might need very specific supplementation for, but because you're talking to an average population here, in the context of everything else that we've seen, again, another thing where people are marketed the world and are told that this supplement will do this or that or whatever, but there's also some pretty strong evidence base around

some standard supplements that are there. So what are in your top list that, generally speaking, most patients can benefit from? Yeah, and even with my top list, I'm going to put all of these around a C. And I want to caveat, like, all of the grades where I do some of the Ds. It doesn't mean that you can't do them and you can't enjoy them and get a little bit of something. But if we have to grade them, obviously, some have to be lower than others. And Cs, you know, are just all it means to me is that is not as good as a B. So all the ones that are in the C category, which actually,

have research are going to be creatine monohydrate can help with power strength muscle gains also can have some cognitive benefits for people weigh protein to hit your protein goals you don't have to but if you're having a hard time getting enough protein in then weigh protein is a great option i put cillium husk in there especially for people with some chronic GI issues or if you're just trying to hit your fiber goals i think cillium husk is a great one um what am i missing in terms of vitamin D if you're vitamin D deficient. If you're in the normal levels for vitamin D taking extra, I don't think it's going to do anything.

I like people between a 40 and 70-ish for vitamin D. Fish oil? Fish oil is one that I'm like really digging in on more. I used to say it was up there and now I have a question mark about it because some of the research that it's like, is this actually doing anything? Where I'm at right now, if you're my patient and you say should be on a fish oil supplement, I would tell you that if you're eating fish,

two or more times per week, then you likely aren't going to benefit from a fish oil supplement for healthy people. If you're not eating fish two or more times per week, then I put people on a high quality fish oil supplement. I had a really, can I share a little caveat? I had a really weird thing happen. I was going in for some routine blood work. And I had Dr. Bill Harris on the podcast. He's one of the leading researchers in the space of Omega 3. And he's also the co-developer of the a mega quant test and a lot of the strong observational data of that having low levels of omega-3 observational studies I believe this was extracted from the Framingham data having low levels of omega-3 was worse than being a smoker from the observation so that was one finding that they talked

about from there and thousands of data points that are that are on that that's how damaging having low levels in their in their ranking of their sort of omega-3 fatty acid profile But he was the one that really sort of like got me into like, hey, cool. Like are you in the optimal ranking? Right. And you can look at this on like labs like Boston Heart. And then also you can do this prick test called a mega quant, which is I think like $69 or something like that.

And I was just a little bit below optimal. So I got really motivated like, okay, I'm going to up my fish intake. But guys, my preferences, I'm going to fish. Yeah. And we're lucky here. We have a lot of places like Air One, they wild caught fish, you know, on top of that. you know, I'm sure regular fish would have been fine as well too. So I was having fish and I was also trying to lower my APOB a little bit. So I was cutting back on some saturated fats and ground beef

and other things. So I was having fish like five days a week. Oh wow. Yeah, it's a lot. Right? For dinner usually. And I went in for some routine testing and a standard blood mercury test. It came back very elevated. And the practitioner who I was working with was like, hey, we got to treat you for this. And I was like, I think it's just because I I've been eating a lot of fish, even though it's wild caught, even though it's like good. And my omega three is, you know, in the optimal optimal ranking, I think it was higher than 8%, which is fantastic. I was like, why don't I just try?

And I started working with a different practitioner for other reasons. I said, let me just cut back on the amount of fish that I have right now because I'm just curious. So I stopped eating all fish, but I continued having fish oil. Mm-hmm. And my blood mercury, which I think was tested through Quest, which was 18 on their reference range, which was very high for blood mercury levels. After six weeks of not having fish, dropped down to zero. So like no blood mercury.

But my fatty acid profile was still in the optimum category. So it was just an interesting end of one little experiment. Totally. Now there's different thoughts about that. Somebody like a Chris Cressor, he has a whole article, which is. you know, this transient mercury that comes from organic matter like a fish, it's not the type of mercury that is inorganic, that would be something that you'd have to worry about as much like from

amalgam fillings. And it just kind of goes through your bloodstream. And as long as you have high levels of selenium, it kind of goes through and it kind of passes out. It's not something that you have to worry about too much. I'll link to his article on that. And other people are like, hey, if you're going to eat that much amount of fish on a regular basis and you're going to be walking around,

with blood mercury that high for the rest of your life, I don't know. Is it an issue? Is it not an issue? So that was an interesting experience that I had. Yeah, I have one thought on. Please. Well, first, everybody's different, right? So, like, this is why we do individualized medicine, because you could also put another person eating fish five days a week that has totally normal mercury levels. So everyone's going to react differently and depends on what type of fish, like all these caveats. But one thing that I think is pretty clear in the research is that eating fish, like the actual food, is more beneficial than a fish oil supplement. Yeah, 100%. And so I think it's a

no-brainer that if you can eat fish more than twice a week, and you can test your mercury levels and see what they're at, eat low mercury fish. I would definitely recommend the whole food because there's other things in that fish that we don't even know about that are likely playing a part in why omega-3s have great research behind them that are reducing the risk for cardiovascular disease. So I'm food first. I'm food first. Yeah. But I still will use fish oil if somebody's like, I hate fish. I'm not going to eat it at all. And their omega-3 index is really low. Then I think that's the case where, okay, fish oil, I think is better than no fish. Creatine, way protein, um, vitamin D at the levels that you want. You don't want to be under, you don't want to be

over, that's problematic as well too. Yeah. Fish oil if somebody doesn't eat fish on a regular basis. Anything else on that list? For supplementation? Most people are deficient in magnesium or just have lower intakes of magnesium, I should say. They don't meet the recommended intake of magnesium. So that's like one that is a question mark, but it's not for everybody.

Like a lot of people won't have to take magnesium. So I'll put that in like the question mark category. Do I miss any other big ones? Um, multivitamin? No, I don't put it on the list. I don't think if you, for, it would be on the list for somebody who has a malabsorption issue. Let's say they have like ulcerative colitis or Crohn's disease or anorexia, bulimia. Like there's people that I would definitely suggest a multivitamin for, but for a healthy person,

the research for multivitamins is like pretty shitty. Excuse my French, but like it doesn't make, it doesn't make you live longer. Like you just don't get outcomes from it. And I'm really outcome driven. So yeah, it's not a recommendation I have unless you're trying to get pregnant. Then we do a prenatal, of course. But we're a healthy individual that's not having issues with malabsorption. I don't recommend a multi.

You know, we're in Los Angeles. We are. We just had these crazy fires. You were one of the people that lost your home. Yeah. In the fire. And very sad to have that happen to you. and a lot of our friends.

Obviously, we have a lot of friends that are in that mix. And knock on wood, you know, everybody's, nobody's lives were laws directly that, you know, we know. I'm thinking, in Altadena, there were some people that didn't end up dying, which is very sad. There was a lot of concern afterwards that the level of toxicity that came from all the plastics, electric cars,

everything that was burning. Yeah. Massive plume of smoke. 10,000 plus homes that are there, I think, in the palisades that were destroyed. Anything, you know, there was this whole conversation that was there. Like, people were like, okay, I'm going to just take a little bit of extra sulfurophane, be a little bit more mindful about going out on windy days, making sure I have an air filter at home.

Were you worried about any of that stuff? I mean, air quality was a concern of mine for sure. and I purposely tried to stay away from the areas, like to just have distance between where I was. We got air filters, thanks to you in our house. And I wore a mask when I was outside. I mean, there was one point where it was like raining ash in Venice. Yeah, it was pretty crazy.

It was crazy. So absolutely it was a concern of mine. We actually went up to Santa Barbara for a little bit just to get out. That was for other reasons too. It was very strange losing your house overnight. So just had to like get out of the energy more so. But yeah, it was definitely a concern of mine. And I wasn't going to let it run my life where we had to deal with losing a house and insurance and all this stuff. So it was lower on the list. And I think that I know me personally, I can get really obsessive about things. So I have to be cautious with my brain. And it wasn't one of the things

that I was going to let myself be obsessive over. I feel like you have to live your life. You have to do what's best for you and make the best steps that you can. And I live in L.A. and I'm not going to move just because of the fires too. Yeah. Mary, this has been fantastic. Let's talk a little about your clinic.

The people that have stuck with us for almost two hours now, they're curiously about you. Tell us about your clinic. Talk about your podcast. Talk a little bit about your world. Cool. Yeah.

I have a practice called Modern. Med. I see patients personally through a concierge model, which we do a deep dive into your health with a focus on preventative medicine and longevity and help people with weight loss, with hormone replacement therapy for perimenopause, testosterone for men. And I love just forming relationships with my patients and doing a deep dive on their health. And then I have another doctor who works with me and she also sees people in our practice for a different model, but also a membership based for preventive medicine. And I have a podcast now called the Modern Wellness Podcast and it's a hobby, I would say, and I love it. And I just created it for myself

where I wanted to interview people that I was inspired by and just had questions for. So it's a very selfish project of mine. And that's on Apple Podcast. So you can take a listen in terms of We talk about heart disease. We've talked about health anxiety. We've talked about comprehensive stool testing as well. And I'm on social media on Instagram at d.r.com, Mary Party, just health content. Well, some of the episodes you have will link to because you kind of go deeper into some of the things that we brought up.

Yeah, yeah, we do. We do some deep dives into each one. Cardiovascular disease was one of those, yeah. Yeah, amazing. Mary, I've been a big fan of yours for a long time. I've been lucky to call you a friend for a long time. It's been so fun to have you on the podcast again to try out this new format. I hope you enjoyed it.

It was really fun. It was really fun. The time just like flew by. And I think it gave us an opportunity, too, to give a lot of your updated thoughts and views on a very nuanced world where, you know, you do a really good job of explaining this. Most people, as we all know, just only have a few so many hours in the day. There's only so many things that they can prioritize. So how do we make sure that they're majoring in the majors and not the minors? And that it's fine to play around a little bit, but we shouldn't assume that something that might be a softer intervention with not as much research, at least right now, should return some astrological benefit.

Yeah. And that happens in this world where it's easy to be convinced about a lot of things that people are very excited about. And they can be excited about it, but you still have to make the right choices for you. And I think by ranking some of these things, which were hard, you help people understand the pros and cons of why you put it, where you put it. I can see myself trying to fall asleep tonight being like, it should have been a C, not a D. Why didn't I put coal plunging as an S?

I put it as a D. I shouldn't put it as an S. Just kidding. Mary, you've been awesome. Thank you again. Your website one more time for the audience. It's modernmed.com, no E and Modern. Amazing.

we'll link to in the show notes. Dr. Mary Perdie, thank you for coming back on the podcast. Thank you for having me, Drew. Hi, one, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me.

And it's the number one thing that you can do to support this podcast is share it with a friend. Share it with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.