WEBVTT
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Number one, is this myth or a fact?
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Exercise is the single most powerful lifestyle intervention we have to improve longevity.
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Fact.
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Cardio versus strength training.
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Myth or fact?
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If someone wants to live longer, cardiovascular fitness is more important than muscle strength.
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I would say myth because we don't know.
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Both are important.
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Number three, this is about VO2 Max.
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VO2max is one of the strongest predictors of longevity and overall health.
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I'm gonna say myth, and we're gonna do a deep dive on what I mean by that.
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Number four, after the age of 40 or 50, it becomes significantly harder to improve fitness and cardiovascular capacity.
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Myth.
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Do you need to work out intensely to see meaningful improvements in metabolic health?
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Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health.
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I'm your host, Dr.
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Chaya Makija, or you can call me Dr.
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Chaya, a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.
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Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out.
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So let's get empowered.
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Hello and welcome, my friends.
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Welcome to another amazing episode on Hormones and Hope.
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This is your host, Dr.
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Chaya McHija.
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You're both certified endocrinologist and lifestyle medicine specialist.
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And guess what?
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I have the guest on today.
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It's a special, special guest.
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Yes, every guest on my podcast is special because they're coming in to educate me as well as you.
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And this one, why is it special, special?
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Because he's going to give us some tidbits, expertise, as well as recommendations on how you can live longer and healthier.
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Welcome, Dr.
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Ali.
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Dr.
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Ali is a longevity medicine specialist.
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And I've learned about him in the recent past, especially 2026, and I'm just marveled.
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Marveled by the fact that an ophthalmologist, a surgeon, is interested in longevity medicine and actually practicing what he preaches and also professionally involved in bringing about prevention and longevity medicine to his community.
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So welcome, Dr.
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Ali.
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Thank you, Dr.
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Shah, for that lovely intro.
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Good to meet you and good to be here.
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Yeah, thank you.
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Thank you for being here today with us.
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Before we learn more about fitness or certain ways of assessing our fitness, which can contribute to our longevity in terms of longevity medicine or science behind it, I really wanted to know why longevity medicine.
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Why switching your specialty, or is it combining your specialty being an eye surgeon and more of a preventive strategist or a lifestyle longevity physician?
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Great question.
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For me, it's in addition to its combination and so in my practice as a retina specialist, I see a lot of elderly patients.
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I see a lot of age-related eye diseases.
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And of course, I see a lot of age-related arthritis and a lot of people with mobility issues, a lot of people with heart disease, diabetes.
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And I'm catching them sort of when they're already at the end of their life and things are broken.
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And we in medicine, as you know, we're pretty decent at fixing broken things, but we're not so good at preventing.
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And so I've been frustrated with like how conventional medicine sort of waits till there's a problem and then tries to fix it.
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So I thought I'd have another project in which I try to catch people at a younger age where they can intervene in their lifestyle and exercise being one of them to prevent not only eye disease, but just many chronic diseases in general.
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It's been an interest of mine for a long time now.
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And now I'm helping others on the journey.
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It's very inspiring.
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You know, you remind me of uh another cardiothoracic surgeon who I'd met.
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I think I've shared about him with you.
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And uh, you know, after 20, 25 years of doing bypass surgeries, he was like, yes, there is a sense of fulfillment where I'm saving lives, but it's at the last stage of when the heart is literally collapsing, and that's where I can help them.
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But what can I do now?
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When I've realized that medicine or the way you're talking about that, we can offer treatment or try to fix things.
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So he's also, you know, now a lifestyle medicine specialist and practicing men's health, complete prevention, and you know, some tools and discussions that you're going to share with us.
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That's what he's practicing.
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So I really feel like many of us as physicians, no matter what specialty we are in, have really uh not necessarily changed our direction, but are actually re-emphasizing the fact that we need to focus on prevention and bring it back to medicine rather than someone else taking care of that specific aspect.
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Yeah, absolutely.
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I think real medicine, it's funny, people are saying is longevity medicine its own specialty.
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And I think every good doctor is a longevity doctor, right?
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Endocrinologist, you are helping prevent people from the complications of diabetes, right?
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Like thyroid disease.
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Your oncologist is a longevity doctor.
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They're trying to keep you alive from cancer, prevent cancer, screen, catch cancer early, treat the cancer.
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So good medicine is longevity medicine, right?
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The sad part is that most doctors don't work in an environment in which they can practice in that way because of the way the healthcare system is set up, the incentives.
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We have to see a high volume of patients in a short amount of time.
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And in that short amount of time, we're trying to fix broken things because that's where the acute issue is.
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We don't have the time and the resources to focus on the longer-term roadmap.
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Yeah, so true.
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That is one of the very important investments, other than you know, what our bank accounts or relationship investments are.
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It's also our health, and that starts with prevention.
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So I'm excited to learn from you and uh what uh you're gonna teach uh us as well as our audience.
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So, how about this, Dr.
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Zaidi?
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We're gonna start with rapid fire, which we usually do for all our episodes, one-liner or one-word answer, and then we get to learn more about uh these topics.
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Are you ready?
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Sure, let's do it.
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Number one, is this myth or a fact?
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Exercise is the single most powerful lifestyle intervention we have to improve longevity.
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Fact.
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All right.
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Cardio versus strength training.
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Myth or fact?
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If someone wants to live longer, cardiovascular fitness is more important than muscle strength.
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I would say myth because we don't know.
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Both are important.
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Number three, this is about VO2 Max.
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VO2max is one of the strongest predictors of longevity and overall health.
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I'm gonna say myth, and we're gonna do a deep dive on what I mean by that.
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Okay, thank you so much.
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Number four, after the age of 40 or 50, it becomes significantly harder to improve fitness and cardiovascular capacity.
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Ooh, people, midlife, and this is your time.
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Number five, exercise frequency.
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Do you need to work out intensely to see meaningful improvements in metabolic health?
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Number six, it's all about the muscle right now.
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Muscle is now considered as one of the most important organs for metabolic health and healthy aging.
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Myth or fact?
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Fact.
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Fact, fact, fact.
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Okay, thank you.
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Number seven, uh, this is also relevant to exercise.
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If someone has been sedentary for years, not moving, no physical activity, starting exercise in midlife can still significantly improve lifespan.
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Fact.
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Ooh, so we have two packs for midlife.
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All right.
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So that was a rapid fire.
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And one of them you actually mentioned that we should do a deep dive.
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Um, so how about this?
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We will start with if you can explain, which you actually explained it during your introduction about longevity medicine.
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We've been hearing this specific terminology, both in science as well as on social media, about the longevity movement or longevity medicine, longevity era.
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What does this longevity science mean?
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And can you just help us connect that how it is actually important in every field of medicine?
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Yeah.
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You know, I think I'll start with where this appetite is coming from.
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I think there's a growing number of people that are dissatisfied with their experience with conventional medicine because of the short visits that are again focused on what's the problem of today rather than keeping me healthy 20, 30 years down the road.
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And so there's a movement, it's sort of a trending buzzword to say longevity.
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And I think when you look at providers that are in this space, or you as a patient are in this space, I think there's a spectrum.
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And we'll say on one end of the spectrum is like really conservative, evidence-based lifestyle medicine.
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And that's totally appropriate.
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And there's people who are interested in that, people who are really focused on the pillars of lifestyle.
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And then there's patients in that space, there's providers in that space.
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And I think there's a lot of demand there.
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And then on the, let's say the other end of the spectrum, you have people that are willing to experimental things, peptides, put things into their body that haven't been vetted by randomized controlled trials because they're looking for that edge, whether it's hormones, whether it's supplements, red light therapy.
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There's stuff that there's evidence for, and there's stuff that's like the evidence is a bit gray or shaky, and it's extrapolating from animal data or some small human studies.
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I'm not saying that one end of the spectrum is right or wrong, but you decide where you are on that spectrum, and you also figure out where your provider is on that spectrum.
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So, like where I land on that spectrum as a practicing physician is more on the first side of it, which is what are the evidence-based, solid lifestyle pillars that we can tell people to do.
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And if you start with those and you optimize those, that's like gets you 80, 90% of the way there.
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Right.
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And if people are interested in then adding to try to get an edge, then we can talk about that or they can find providers that can fill that need.
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But I think that's a good sort of overall look at the landscape because there's a lot of providers in that area.
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There's a lot of stuff online.
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But the idea is people are dissatisfied with conventional medicine and they're looking for something a little bit different.
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Yeah, very well said.
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You really uh broke it down.
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So you're gonna share a lot more.
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And this is where I really love to connect with, you know, experts and specialists as yourself, is also that evidence-based science, which is personalized, which is applicable, but it's still individualized based on that patient-physician relationship and how you're uh connecting.
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With that being one of our core values, right?
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Why is prevention so important?
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Or what do you think about prevention?
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You know, you mentioned that again in your person story as to why you're talking about it.
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But what are those pillars that govern prevention?
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And I always think about this, also ask my patients that do you want to live longer versus do you want to still have a good, long, healthy life as much as it's going to be?
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But also the health span that we hear about or we talk about, and you know, how independent you could be, the freedom of you being independent and not needing, you know, that extra support that we've seen in our elderly patients and even many of our colleagues who have their parents suffering to that, being octogenarians like at the 80s, 90s, and how dependent that become.
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So, in the evidence-based world, longevity medicine, how do you curate or how do you bring health, prevention, aging as a concept and explain it to your patients?
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If I were to see you, right, how are you addressing or breaking down longevity medicine based on how you would approach the care?
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Yeah.
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That's a great question.
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I guess I'll start with the top three things that kill people in the United States are cardiovascular disease, cancer, and neurodegenerative disease.
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So the first thing when we look at people is how can we mitigate your risk of falling prey to one of these three things?
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We all have to go, obviously.
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We can't live forever.
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Longevity isn't about living forever.
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It is, like you said, about maximizing the time on this planet that you're healthy, that you're mobile, that you're independent.
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And by delaying or even eliminating the risk of these three things, we can sort of prolong the time that we're healthy.
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You know, one depressing statistic in the United States is the life span of the average American is around 78 years old.
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But the average health span is around 65 years old.
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So that means after 65 to 78, the time we die, we have more than a decade, that marginal decade of life we spend with illness or disability.
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And so the goal is how can we go from 65 to maybe go to 75, maybe even go to 77, right?
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Or and maybe even increase the ceiling and live till we're in our 80s.
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And so the first step is we have to look under the hood and figure out what's your risk for cardiovascular disease, what's your risk for cancer, what's your risk for these neurodegenerative diseases, and then how can we construct a plan to mitigate all those risks?
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The plan that starts first with lifestyle, the pillars being good food, exercise, sleep, social connection.
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Those are not in any particular order.
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I think all of them are super important.
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You had mentioned at the beginning, you know, exercise is one of the biggest factors to improve longevity.
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Yes, that's true.
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But I think social connection is super duper important.
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What we put in our mouth and what we eat and drink every day is super important, right?
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Um, how much we're sleeping, the quality of our sleep is super important.
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And it's hard to tease out which of these four is more important than the other.
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And ideally, we're we're working one at a time and optimizing all four of those.
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And then we can introduce medications and supplements and other things, right?
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Intervention surgeries, but we start with those four things.
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Um Yeah.
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The piece for the pillar is the stress management or the I I love to say how can I improve the stress response, or I can how can I help you with improving the stress response?
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And then, you know, avoidance of drugs, tobacco, alcohol, uh, which could be harmful.
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You know what you just mentioned?
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We released this podcast in June 2025.
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And since then, we've had all weekly episodes, not missed one week, and I've had lots of specialists.
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Every time when we have this specific question, which is a universal question for everyone, it's either sleep or it's you know, improving our stress management or stress response techniques as the most important one, either for lifestyle, either for you know, inflammation, cardiovascular.
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You talked about longevity and you emphasize the same thing right now as you were describing it.
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Thank you.
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So now I wanted to really get into the in-depth of uh the science, but also the practicality, what strategies, action steps that you would consider in patients or when you're educating or when you're speaking uh to the audience about, okay, we have the pillars we know we need to prevent.
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I, as a patient, am ready to make a change.
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Where do you have them start?
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So you're, I'm guessing, evaluating risk factors, assessing them.
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There could be biochemical evaluation.
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But what are certain tools that you might incorporate or use to assess their current level of fitness or their capacity physical and help them with a better or a curated plan?
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Yeah.
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So, you know, it's interesting when I go to my primary care doctor, let's say, and he asks me, are you physically active?
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Right.
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Oh, yeah.
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Um I bike or I play pickleball with my friends or whatever.
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I do 10,000 steps a day.
00:16:49.360 --> 00:16:59.039
Even though it sounds quantitative, like 10,000 steps, if you do, you know, 100 steps here and 100 steps there, and it adds up to 10,000 a day, it's not necessarily cardio exercise.
00:16:59.279 --> 00:17:02.799
And we don't have conventional medicine doesn't quantify.
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Like when somebody tells me they're gonna exercise, how do I know?
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Right.
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And so one way that's gotten popularized, what we're trying to assess, what we're trying to quantify is cardiorespiratory fitness.
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That's the term for how fit you are.
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And we can talk about all the research that's behind cardiorespiratory fitness and health and longevity.
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In 2016, which is now 10 years ago, the American Heart Association put out a guideline, a scientific statement, that said cardiorespiratory fitness should be evaluated in patients and as a risk factor for cardiovascular disease is as strong or stronger than diabetes, smoking, hypertension.
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That was 10 years ago.
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And I highly doubt that you and I have been to any doctor in the last 10 years who's asked, what is your cardiorespiratory fitness in any kind of numerical way?
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And so I think one thing that we should be considering is how do I quantify what my cardiorespiratory fitness is?
00:17:56.000 --> 00:18:00.240
One way that's gotten super popularized recently, is VO2max.
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And I'll talk about VO2 Max and I'll talk about why it's not exactly what you need to have, but it's it's a good metric.
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So VO2 max, a lot of influencers on social media gone on and said VO2max is the thing you need to check when it comes to cardiorespified fitness.
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And what it is, and I've had mine done too, is you go into a lab, you go into a center, a gym sometimes has this, you pay out of pocket, it's not covered by insurance, you might end up spending between$100 and$200, and you're gonna get onto a treadmill and they're gonna give you a mask that you're gonna wear a tight-fitting mask on your face, and it's gonna measure the CO2 coming out of your mouth, and it's gonna know what oxygen is going into your mouth.
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And you're gonna go on this treadmill and slowly they're gonna ratchet it up.
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And every few minutes, they're gonna increase the incline or they're gonna increase the velocity.
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And pretty soon you're gonna start huffing and puffing, and your heart rate is they're measuring your heart rate, your heart rate's going up higher and higher.
00:18:52.079 --> 00:18:56.079
And the goal of that test is you're gonna go until you can't go anymore.
00:18:56.400 --> 00:18:59.920
Which for most people falls somewhere between five and 10 minutes.
00:19:00.079 --> 00:19:01.680
So it's not like you're in there for an hour.
00:19:01.759 --> 00:19:07.599
Yeah, you after the warm-up period, usually five to 10 minutes, you're exhausted and you will tap out.
00:19:07.680 --> 00:19:11.920
You will tell the person there, I can't go any further, tap out, they'll stop the test.
00:19:12.079 --> 00:19:13.279
You'll be huffing and puffing.
00:19:13.359 --> 00:19:18.799
Your heart rate's probably gonna be 140s, 150s, 160s, and they're gonna measure your VO2 max.
00:19:18.960 --> 00:19:19.599
They're gonna give you a number.
00:19:19.680 --> 00:19:24.720
So the VO2 max is how much oxygen your body can take in and convert it to energy.
00:19:24.880 --> 00:19:31.920
And the reason it's appealing is because it's sort of a sum of air that your lungs are taking in, so how good your lungs are working.
00:19:32.160 --> 00:19:36.559
Then your heart, the oxygen goes into your bloodstream, it goes to your heart.
00:19:36.640 --> 00:19:40.799
Your heart's gonna pump it to your body, so it's a function of how good your heart is pumping.
00:19:40.960 --> 00:19:44.799
And then your muscles are gonna take that blood and that oxygen and they're gonna convert it into energy.
00:19:44.880 --> 00:19:46.880
So it's a function of your muscles and your mitochondria.
00:19:47.119 --> 00:19:54.400
So with one number, VO2max, you sort of got a sense of a person's lungs, heart, muscle, mitochondria, and blood, right?
00:19:54.480 --> 00:19:57.039
Because if they're anemic, they're not gonna deliver as much oxygen.
00:19:57.200 --> 00:20:02.559
So one number gives you a great sort of high-level zoomed-out overview of that person's health.
00:20:02.799 --> 00:20:08.400
Now, what's happened on social media is that VO2max has just gotten really the thing that's correlated.
00:20:08.480 --> 00:20:15.279
Now, when you go back to the studies that correlated what they looked at, they looked at cardiorespiratory fitness.
00:20:15.359 --> 00:20:16.640
They didn't actually look at VO2 Max.
00:20:16.799 --> 00:20:21.039
VO2max is one way to measure somebody's cardiorespiratory fitness.
00:20:21.200 --> 00:20:24.559
But turns out it's not the only way, and it turns out it's not even the easiest way.
00:20:24.640 --> 00:20:27.119
There's an easier way to do it, which is what they did in the studies.
00:20:27.279 --> 00:20:35.039
And I'll share with you this really cool study that I love, published in 2022 in the Journal of American Cardiology, College of American Cardiology.
00:20:35.200 --> 00:20:38.079
They took 750,000 veterans.
00:20:38.160 --> 00:20:39.519
I don't know how they did this study.
00:20:39.680 --> 00:20:46.559
750,000 veterans aged like 30s to 90s, but got them on a treadmill.
00:20:46.640 --> 00:20:48.160
Okay, did not do a VO2 max.
00:20:48.319 --> 00:20:48.960
This is way easier.
00:20:49.039 --> 00:20:50.000
This is a test now.
00:20:50.160 --> 00:20:57.359
What they did is they they did a test that evaluates their Mets, M-E-T, metabolic equivalent of task.
00:20:57.599 --> 00:20:59.599
I won't go into the details of what that means.
00:20:59.680 --> 00:21:04.240
It's just at a high level, it means how hard your body's working to do a certain task.
00:21:04.400 --> 00:21:06.640
Me and you sitting here talking is like one met.
00:21:06.880 --> 00:21:13.039
If we started getting up and started doing a walk, maybe two mets, a brisk walk, maybe three mets, jogging, four or five mets.
00:21:13.200 --> 00:21:15.200
And they measured their peak mets.
00:21:15.519 --> 00:21:19.279
And so some people got up to seven, eight, nine, 10, 11, 12 mets and above.
00:21:19.359 --> 00:21:21.920
If you're elite, you can get up to above 12 mets.
00:21:22.079 --> 00:21:26.400
And they followed these vets, 750,000 of them for 10 years.
00:21:26.720 --> 00:21:28.960
Incredible prospective giant study.
00:21:29.119 --> 00:21:30.319
Not a randomized trial.
00:21:30.480 --> 00:21:35.200
Mind you, this is not a randomized trial that they forced people to exercise and forced other people to be sedentary.
00:21:35.359 --> 00:21:40.160
They just took people where they came, followed them for 10 years, and see who died and who didn't die.
00:21:40.240 --> 00:21:43.279
And thousands of people passed away during this 10 year period.
00:21:43.440 --> 00:21:50.559
And they collected data about smoking and diabetes and end stage renal disease, and they also calculated their fitness based on their treadmill test.
00:21:50.720 --> 00:21:52.319
No oxygen mass required.
00:21:52.480 --> 00:21:58.160
This is something that you and I can go today after this call to the gym, walk on a treadmill, and we can figure out our own mets.
00:21:58.240 --> 00:21:59.759
There's charts that you can do this on.
00:22:00.480 --> 00:22:13.920
By the way, if your listeners go to Google and type in treadmill MET chart, the first image that comes up, it'll tell you if you're walking on a treadmill at this miles per hour, at this incline, this is how many mets it is.
00:22:14.160 --> 00:22:20.960
So you can today go and figure out your peak met just by how fast a treadmill you can get on and how the incline.
00:22:21.039 --> 00:22:25.039
And you can figure out, oh, my peak met is only six or seven or eight or ten or whatever.
00:22:25.200 --> 00:22:32.880
And in this amazing study of the veterans, they looked at, okay, if you're diabetic, your risk of dying was like 1.4.
00:22:33.039 --> 00:22:37.200
So that means 40% higher risk of death if you're diabetic, which makes sense.
00:22:37.359 --> 00:22:39.200
We know that diabetes increases your risk of death.
00:22:39.359 --> 00:22:43.359
If you had end stage renal disease, your hazard ratio for death was like 1.5.
00:22:43.440 --> 00:22:46.240
They had a 50% elevated risk compared to somebody who didn't.
00:22:46.400 --> 00:22:46.640
Makes sense.
00:22:46.720 --> 00:22:48.799
End stage renal disease is a terrible thing to have.
00:22:49.039 --> 00:22:50.240
Least fit.
00:22:50.559 --> 00:22:51.680
Least fit individual.
00:22:51.759 --> 00:22:55.920
So they took everybody on the treadmill and they categorized them into five groups, least fit up to elite.
00:22:56.079 --> 00:23:00.400
If you're least fit in this group, your risk of death was 400% higher.
00:23:00.559 --> 00:23:00.720
Four.
00:23:00.880 --> 00:23:02.000
Hazard ratio of four.
00:23:02.160 --> 00:23:05.759
So end stage renal disease and smoking were like 1.4, 1.5.
00:23:06.240 --> 00:23:10.720
Least fit was four, which is 400% higher risk of death.
00:23:10.880 --> 00:23:22.480
So that's why you hear this statement on social media is the strongest correlation with longevity, stronger than smoking, stronger than diabetes, stronger than end stage renal disease.
00:23:22.559 --> 00:23:23.680
Again, correlation.
00:23:23.839 --> 00:23:24.640
It's a correlation.
00:23:24.720 --> 00:23:29.200
It's not a randomized trial, but it's a huge study, prospective.
00:23:29.519 --> 00:23:40.079
And what they saw there for every increasing, when you went from least fit to slightly better, to slightly better, to slightly better to elite, at every level, your hazard ratio for death, your risk of death went down.
00:23:40.160 --> 00:23:46.240
So it was a dose response curve, which is something we like to see in medicine, right?
00:23:46.400 --> 00:23:50.480
That suggests that there's a causal role here, right?
00:23:50.640 --> 00:23:52.480
That that the correlation is meaningful.
00:23:53.039 --> 00:24:00.240
So this is where the whole VO2max craze comes from is these big studies that really showed a strong correlation.
00:24:00.640 --> 00:24:03.759
But you don't have to pay the money and get on this treadmill test.
00:24:03.839 --> 00:24:06.079
You can do it at your gym for free.
00:24:06.240 --> 00:24:13.920
You can just Google treadmill, met chart or graph, and you can figure that out yourself next time you're at the gym, you know.
00:24:14.079 --> 00:24:17.839
And there's equivalence for biking, there's equivalence for other forms of physical activity.
00:24:17.920 --> 00:24:20.240
So you don't have to do a VO2 max.
00:24:20.400 --> 00:24:23.839
Is a VO2 max a reasonable measure of cardiorespiratory fitness?
00:24:24.000 --> 00:24:25.839
Absolutely, but there's not, it's not the only one.
00:24:26.000 --> 00:24:27.279
So Yeah.
00:24:27.519 --> 00:24:38.000
You know, you actually gave this such an amazing descriptive answer for both why it's not necessarily a myth or a fact, and how you uh broke it down.
00:24:38.160 --> 00:24:43.920
I love that you told us about the internet search at the Google search so that everyone knows their meths.
00:24:44.160 --> 00:24:54.079
And you also made me uh remember that, you know, when I was studying for the lifestyle medicine boards, we have a long section on fitness and physical activity and the mets.
00:24:54.319 --> 00:25:04.400
And, you know, when this uh study was being published or when it was in progress of publication, these were uh certain important board questions relevant to the trial.
00:25:04.720 --> 00:25:10.319
And uh I I'm just uh so happy that you brought this up because this is so, so important.
00:25:10.480 --> 00:25:14.640
And it was, you know, the the study that the veterans, right?
00:25:14.799 --> 00:25:23.519
So it is that patient population who is getting care and access to care, medical care, and um how they were tracked.
00:25:23.680 --> 00:25:27.200
So I really appreciate you sharing and breaking it down.
00:25:27.440 --> 00:25:39.039
I wanted to follow this up with like really practical steps now because you really got us into solid conviction that exercise.
00:25:40.319 --> 00:25:41.440
No, because it matters.
00:25:41.519 --> 00:25:41.759
Yeah.
00:25:42.559 --> 00:25:42.960
Exactly.
00:25:43.119 --> 00:25:43.680
It matters.
00:25:43.839 --> 00:25:54.640
Exercise is the one great tool that is with us, we own it, to help us with that prime goal when we talk about longevity or really living.
00:25:54.799 --> 00:25:56.000
I would call it as happy.
00:25:56.079 --> 00:26:04.000
If I'm independent, you know, if I can take those decisions, choices, travel at that particular age, I would take that as goal for me.
00:26:04.240 --> 00:26:08.240
So tell us when you're assessing someone, right?
00:26:08.400 --> 00:26:15.440
They have this parameter available, they have this metric available versus they might not have it, but they're ready to start.
00:26:15.759 --> 00:26:25.200
The most common reason from patients that I get when we are working towards the other medical conditions or reducing their risk factors is the consistency.
00:26:25.839 --> 00:26:42.720
Or I am too busy, I don't have time, and they could have, you know, the highest profile jobs, or they have, you know, a mundane eight to five sedentary job, or they have, you know, of course, as adults, lots of responsibilities.
00:26:42.880 --> 00:26:48.960
But midlife, my medical students are young adults, so definitely I need some tidbits for them from you.
00:26:49.119 --> 00:27:08.640
But midlife age group, they're just bombarded, you know, it's also called as a sandwich generation, is where one of the most challenging aspects for me as their physician or lifestyle medicine coach is that consistency for exercise.
00:27:08.799 --> 00:27:10.000
They might initiate it.
00:27:10.160 --> 00:27:11.759
Nah, I don't have time.
00:27:11.839 --> 00:27:15.440
I'm traveling holidays, October, November, December.
00:27:15.599 --> 00:27:19.440
You know, I fell off the wagon and now I have to just get jumped back onto it.
00:27:19.519 --> 00:27:21.920
But that's delayed until I see them in March.
00:27:22.079 --> 00:27:25.680
So there's a six-month gap in the in the seasonal window.
00:27:25.920 --> 00:27:27.200
This is the most common pattern.
00:27:27.359 --> 00:27:33.279
And when I'm saying, uh, talking about my patient, this is, you know, almost, I've been in California since 2015.
00:27:33.519 --> 00:27:37.039
This practice has been four years where we've been able to coach them.
00:27:37.279 --> 00:27:41.039
But I would really love your feedback, your insights.
00:27:41.200 --> 00:27:52.880
How are you approaching that aspect of exercise, introducing it, the concept that you've described, but how do you make them implement it with consistency?
00:27:53.920 --> 00:27:56.240
Yeah, super hard, super important.
00:27:56.400 --> 00:28:00.880
I think the first step is there is no perfect workout.
00:28:01.119 --> 00:28:05.839
The best exercise routine is what you will actually do, whatever that is for you.
00:28:06.000 --> 00:28:07.119
So I start with that.
00:28:07.359 --> 00:28:12.960
If you wanted to ask me what's the optimal, I can give you that, but I'd rather say what works for you.
00:28:13.119 --> 00:28:13.839
Is it yoga?
00:28:14.000 --> 00:28:14.559
Is it walking?
00:28:14.799 --> 00:28:15.359
Is it swimming?
00:28:15.519 --> 00:28:16.640
Is it pickleball?
00:28:16.880 --> 00:28:20.319
We got to figure out what you enjoy and what you can do over time.
00:28:20.400 --> 00:28:26.160
Because if it's a chore for you, there's probably gonna be some aspects, let's be honest, that are gonna be chores and then you just have to do it.
00:28:26.319 --> 00:28:30.640
We need to have some aspect where it's enjoyable and you look forward to it and you want to do it, right?
00:28:30.720 --> 00:28:31.839
So we have to start with that.
00:28:32.000 --> 00:28:38.240
I think for a lot of people, if you're just starting out in your midlife and you're sedentary, is walking is a good place to start.
00:28:38.400 --> 00:28:41.680
I think walking is an underrated form of exercise.
00:28:41.920 --> 00:28:43.839
People think of it, oh, it's nothing, it's just a walk.
00:28:44.000 --> 00:28:51.039
But I think if you can do a 20-minute walk, 30-minute walk, ideally at a brisk pace, but if you're just starting out, it doesn't even have to be brisk.
00:28:51.279 --> 00:28:53.519
Just to get your joints moving, it's good for your back.
00:28:53.680 --> 00:28:55.759
It gets your heart rate up a little bit.
00:28:56.000 --> 00:28:58.720
I personally like to integrate it into my day.
00:28:58.960 --> 00:29:03.599
So I have time, I'm lucky I see patients in the morning and then I have a gap, and then I do afternoon.
00:29:03.759 --> 00:29:15.920
So I do a 30-minute walk at lunch, and I'm blessed to be in San Francisco where I have some parks nearby, I can just take a walk in the city, I can put my headphones in, I can listen to a book or music, make a phone call, and I can just walk.
00:29:16.079 --> 00:29:17.359
And it's built into my day.
00:29:17.440 --> 00:29:20.799
So I don't have to like do it after work, you know.
00:29:21.039 --> 00:29:27.839
If you can walk after meal, maybe you with your family, maybe with your spouse, you know, eat dinner and then say, let's go for a quick 15, 20 minute walk.
00:29:27.920 --> 00:29:29.599
It doesn't have to be some strenuous thing.
00:29:29.759 --> 00:29:31.599
That's a really, really good place to start.
00:29:31.839 --> 00:29:37.920
The other place where I start with people is to figure out this week might be different than next week or the week after.
00:29:38.079 --> 00:29:40.640
Let's say this week, what is your availability?
00:29:40.799 --> 00:29:42.960
What is your budget for exercise this week?
00:29:43.119 --> 00:29:44.160
What does your Monday look like?
00:29:44.319 --> 00:29:45.359
What does your Tuesday look like?
00:29:45.519 --> 00:29:46.640
What does your Wednesday look like?
00:29:46.799 --> 00:29:49.920
It doesn't have to be every single day, but okay, we got some time on Tuesday.
00:29:50.079 --> 00:29:53.599
You got 30 minutes before work, or you got an hour after work or whatever.
00:29:53.839 --> 00:29:56.000
Let's pencil that in in the calendar.
00:29:56.079 --> 00:29:59.200
I think for a lot of people, they're like, I'm gonna exercise tomorrow.
00:29:59.359 --> 00:30:04.000
And they don't put it on their calendar, whether it's their mental calendar, it's their actual Google calendar.
00:30:04.079 --> 00:30:09.519
I think you have to put it and say, at 7 a.m., I'm going to exercise.
00:30:09.759 --> 00:30:12.640
Not I will exercise at some vague time of the day.
00:30:12.799 --> 00:30:14.079
It has to be specific.
00:30:14.319 --> 00:30:16.880
And it might change from week to week, and that's okay.
00:30:17.039 --> 00:30:19.519
This week you might be traveling, so you're gonna do less, you know?
00:30:19.599 --> 00:30:20.240
So okay, great.
00:30:20.319 --> 00:30:21.359
We only have two hours this week.
00:30:21.519 --> 00:30:23.759
Let's figure out how we're gonna best use those two hours.
00:30:24.240 --> 00:30:26.960
Next week we might have three hours, and we'll figure out how we can do that.
00:30:27.200 --> 00:30:32.640
I would also say to people, now you're coming to me and you're saying, okay, fine, I have two hours, I have three hours.
00:30:32.880 --> 00:30:34.720
Now I enjoy a variety of things.
00:30:34.880 --> 00:30:37.839
Now you tell me what's the best way for me to spend those two hours?
00:30:38.000 --> 00:30:38.559
Let's just say.
00:30:38.720 --> 00:30:44.559
Now there's somebody who's maybe they're one of the medical students, maybe there's somebody who's already a little bit physically active.
00:30:44.720 --> 00:30:50.000
Then I would say half your time should be doing cardio, and half of your time should be strength training.
00:30:50.160 --> 00:30:50.720
That'd be the best.
00:30:50.880 --> 00:30:52.720
So if you have two hours, do one hour of cardio.
00:30:52.799 --> 00:30:55.119
Maybe you split that into two 30-minute sessions.
00:30:55.279 --> 00:30:56.880
This is, by the way, per week, let's say.
00:30:56.960 --> 00:30:58.079
So you have two hours this week.
00:30:58.160 --> 00:30:59.359
You're gonna give me two hours this week.
00:30:59.519 --> 00:30:59.680
Great.
00:30:59.759 --> 00:31:04.400
Well, do one hour of cardio, 30 and 30, and then give me one hour of strength training.
00:31:04.480 --> 00:31:06.240
Also, maybe split 30-30.
00:31:06.400 --> 00:31:07.039
So there we go.
00:31:07.119 --> 00:31:10.960
We've got now two workouts of strength, two workouts with cardio.
00:31:11.200 --> 00:31:12.720
That's our two hours for this week.
00:31:12.960 --> 00:31:14.400
If you want to do three hours, great.
00:31:14.480 --> 00:31:16.079
Let's talk about how to split the three hours.
00:31:16.160 --> 00:31:17.839
We can do more with that, obviously.
00:31:18.079 --> 00:31:26.880
I would say that then when we look at strength training, if you only have two sessions per week to do that, try to do something then as a full body workout.
00:31:27.119 --> 00:31:34.960
Because at that point, if you're just doing upper body one day and lower body the other day and you're only doing it two days a week, you're not gonna target that muscle group frequently enough.
00:31:35.119 --> 00:31:40.480
So if you're doing two workouts a week, you can do full body workout twice a week, 30 minutes, right?
00:31:40.559 --> 00:31:44.960
And that could be body weights, that could be resistance bands, that could be dumbbells.
00:31:45.119 --> 00:31:47.359
You have a whole spectrum of things you can do.
00:31:47.599 --> 00:31:55.759
Once you start getting into like three strength trainings a week or four strength trainings a week, then you can start doing things like splitting it up upper body, lower body, or deciding how you want to do.
00:31:56.000 --> 00:32:02.319
When it comes to cardio, there's a lot of talk about zone two and then high intensity.
00:32:02.400 --> 00:32:04.400
So I'll take a moment to talk about that.
00:32:04.720 --> 00:32:07.440
We talked about the hype around VO2 Max.
00:32:07.599 --> 00:32:10.400
And again, it is a metric of cardiorespiratory fitness.
00:32:10.480 --> 00:32:11.759
It is not the only one.
00:32:12.000 --> 00:32:15.279
Similarly, there's a lot of buzz about zone two.
00:32:15.759 --> 00:32:20.240
Zone two for the audience is low-intensity exercise.
00:32:20.480 --> 00:32:26.799
The simplest way to think about it is you can maintain a conversation with a person, but it takes a little bit of effort.
00:32:26.880 --> 00:32:33.920
The person on the phone, if you're talking to them on the phone while you're doing zone two, like my lunchtime walk, let's say, the person on the other end is like, oh, are you are you walking?
00:32:34.079 --> 00:32:34.960
Are you are you doing something?
00:32:35.039 --> 00:32:35.599
I can tell.
00:32:35.759 --> 00:32:35.920
Right?
00:32:36.079 --> 00:32:38.480
If it's if they can't tell, then you're probably in zone one.
00:32:38.559 --> 00:32:42.799
And if you're huffing and puffing and you can't complete your sentence, then you're higher than zone two.
00:32:42.960 --> 00:32:44.799
You're maybe zone three or zone four, right?
00:32:44.960 --> 00:32:49.839
So it's low intensity exercise, and there's a lot of buzz around do zone two, do zone two.
00:32:50.000 --> 00:32:53.039
It's very good for your mitochondria, it's very good for your VO2 max.
00:32:53.279 --> 00:32:58.559
There was a paper published last year titled Much Ado About Zone Two.
00:32:58.799 --> 00:33:01.680
And what they looked at is what is the evidence behind zone two?
00:33:01.920 --> 00:33:12.400
And it turns out, again, social media influencers, the hype comes from zone two, is where elite endurance athletes spend a lot of their time training.
00:33:12.559 --> 00:33:21.200
So if you look at cyclists like Tour de France cyclists who have some of the highest cardio fitness in the world because they're doing just hours and hours of biking.
00:33:21.440 --> 00:33:27.279
When you look at their coaches and you look at what they how they spend their time, they spend 80% of their time doing zone two.
00:33:27.519 --> 00:33:28.720
It's low intensity.
00:33:28.880 --> 00:33:29.680
It's impressive.
00:33:29.920 --> 00:33:30.799
You would not think that.
00:33:30.880 --> 00:33:34.799
You would not think that somebody like Lance Armstrong is doing most of his training in zone two.
00:33:35.039 --> 00:33:35.599
Here's why.
00:33:35.839 --> 00:33:38.960
A guy like that might train 30, 40 hours a week.
00:33:39.119 --> 00:33:39.440
Okay.
00:33:39.759 --> 00:33:41.759
You cannot train high intensity.
00:33:41.920 --> 00:33:45.920
Your body cannot train at that high intensity for 30 or 40 hours a week.
00:33:46.079 --> 00:33:48.240
So that's why they dial down the intensity.
00:33:48.319 --> 00:33:52.960
They do low intensity for 80% of the time, and then they do high intensity 20% of the time.
00:33:53.119 --> 00:33:57.680
And then we see their elite levels of cardio fitness, their VO2 max is just through the roof.
00:33:57.920 --> 00:34:04.640
You can't then extrapolate, is it the zone two that produced that, or is it the 20% of high intensity that they did?
00:34:04.799 --> 00:34:11.920
Because let's be honest, the 20% of their time that they're doing high intensity is probably more than you and I are doing total exercise for the whole week, right?
00:34:12.079 --> 00:34:16.320
They might do five hours of high intensity a week, 10 hours of high intensity a week.
00:34:16.480 --> 00:34:17.840
You and I are not doing that.
00:34:18.159 --> 00:34:31.280
So for those of us mortals, we're not elite cyclists, and you say, okay, now you've told me I need to spend 50% of my time doing strengths training and 50% of my time doing cardio, how do I spend that 50% of cardio?
00:34:31.440 --> 00:34:34.159
Do I do zone two or do I do high intensity?
00:34:34.320 --> 00:34:34.480
Right.
00:34:34.639 --> 00:34:53.920
And we don't fully know, but what we do have a lot of research showing is that high-intensity interval training has a lot of health benefits, does improve VO2 max or does improve cardiorespiratory fitness, and you get a lot of bang for your buck because you're spending less time.
00:34:54.159 --> 00:35:00.320
So if you only had 30 minutes to do a cardio workout, I would say spend it doing higher intensity.
00:35:00.480 --> 00:35:08.000
Again, these are now people who are coming to me saying, I'm already somewhat fit, I'm already active, I want to like optimize my time, right?
00:35:08.159 --> 00:35:12.320
So if you're in that category of like, look, I'm sedentary, I just want to walk, beautiful.
00:35:12.480 --> 00:35:13.519
That's what you should do.
00:35:13.679 --> 00:35:17.039
But now if you're in this sort of category of like, huh, I want to do more.
00:35:17.199 --> 00:35:21.440
I want to take it to the next level, but I'm still limited on time.
00:35:21.679 --> 00:35:24.960
I always spend that time doing high-intensity interval training.
00:35:25.119 --> 00:35:28.320
And you know, there's a simple thing that you can do when you do your walks.
00:35:28.639 --> 00:35:38.239
Simple way to a beginner's way to do it is in Japan, they have this method of Japanese, they call it Japanese walking, where you will walk fast for one minute and walk slow for one minute.
00:35:38.400 --> 00:35:39.840
Or walk normal for one minute.
00:35:40.400 --> 00:35:41.760
Do it do several rounds of that.
00:35:41.920 --> 00:35:46.719
Start with that, then walk fast for two minutes, then walk normal for two minutes.
00:35:47.039 --> 00:35:50.480
As weeks and months go by, you get more and more adjusted to that.
00:35:50.719 --> 00:35:54.480
Then you can start jogging for two minutes, walking for two minutes.
00:35:54.639 --> 00:35:58.480
Then you can start running for two minutes, walking for two minutes, you know.
00:35:58.719 --> 00:36:05.360
And ultimately you want to get yourself up to maybe three or four minutes of high intensity and three or four minutes of lower intensity.
00:36:05.440 --> 00:36:06.400
You know, that's that's your goal.
00:36:06.480 --> 00:36:09.039
Maybe it'll take you six months or a year to get there, you know.
00:36:09.199 --> 00:36:11.840
But you can do that once per week.
00:36:12.079 --> 00:36:23.360
High intensity for mortals like you and me, normal people who are busy, who have families, who have jobs, one workout per week of high intensity is enough to move the needle.
00:36:23.519 --> 00:36:37.599
So my sort of way of what I do is Friday mornings, I go to the high school near my house and there's a track, and I will do one lap, you know, relatively fast and one lap normal.
00:36:37.840 --> 00:36:42.239
One lap fast, one lap so, and then I've worked myself up to two laps fast, two laps.
00:36:42.800 --> 00:36:43.920
I do that once a week.
00:36:44.159 --> 00:36:45.920
I'm breathless at the end of it.
00:36:46.159 --> 00:36:50.559
I feel definitely like wow, that was unpleasant at times, but it's once a week.
00:36:50.639 --> 00:36:53.039
I feel pretty pumped up the rest of the day.
00:36:53.199 --> 00:36:56.239
And I know that I've checked it off and it's once a week, I'm happy with it.
00:36:56.480 --> 00:36:57.679
Yeah, amazing.
00:36:57.920 --> 00:37:00.480
This was phenomenal in terms of the breakdown.
00:37:00.639 --> 00:37:07.039
You know, you reminded me, it was a couple of weeks ago, we had a physician, a pediatrician who's a marathon coach.
00:37:07.280 --> 00:37:09.840
And um, she was uh interviewing on the podcast.
00:37:09.920 --> 00:37:11.519
It's already been released, Dr.
00:37:11.679 --> 00:37:12.320
Michelle.
00:37:13.039 --> 00:37:28.400
And uh, she gave us the mailbox technique, just the way you describe the Japanese technique, was um, I asked her that convinced me to run because I do not like to run, but I can power walk, or you know, walking is like one of my favorite ones other than strength training.
00:37:28.480 --> 00:37:29.760
So she said, How about this?
00:37:29.920 --> 00:37:32.480
I have a technique called mailbox technique.
00:37:32.719 --> 00:37:48.000
And she says, if you're living in a neighborhood where each house or each home has a mailbox, so just from mailbox to mailbox, jog, walk, jog, walk, or then you do two alternate or two mail mailboxes at the same time in terms of jogging and walking.
00:37:48.159 --> 00:37:56.480
Anything that could distract your mind, but knows that okay, I just have that endpoint to run or to jog, and then I will be walking.
00:37:56.800 --> 00:37:57.760
She's inspired me.
00:37:57.840 --> 00:37:59.440
I've been trying to do that.
00:37:59.920 --> 00:38:05.599
So every time, trust me, I I learned so much from our um from our physician experts.
00:38:05.760 --> 00:38:20.400
So thank you for sharing and breaking it down uh for someone who's starting versus someone really wants to up level their uh fitness game and you know, about the HIT training and how we could divide it into the number of hours in a week.
00:38:20.639 --> 00:38:21.840
Beautifully said.
00:38:22.159 --> 00:38:33.920
I really want you to cover this specific correlation also, because that's very commonly discussed in our exam rooms with our patients is insulin sensitivity.
00:38:34.239 --> 00:38:43.840
Like how transformative and how profound the changes in terms of improving insulin sensitivity or reducing insulin resistance.
00:38:44.000 --> 00:38:50.639
And this is again specifically geared towards either exercise or you know, strength training, but anything that's involving our muscles.
00:38:50.960 --> 00:39:01.679
So, can you share anything in regards to this specific metabolic aspect, insulin sensitivity, and how exercise is contributing towards improving it?
00:39:02.079 --> 00:39:08.559
Yeah, as you probably know, your listeners probably know, insulin resistance is one of your biggest enemies to longevity, right?
00:39:08.639 --> 00:39:12.000
So if there's one thing you want to avoid is insulin resistance.
00:39:12.320 --> 00:39:17.199
And there's a couple great things that happen with exercise that help you in the insulin department.
00:39:17.360 --> 00:39:22.320
First of all, when we eat carbohydrates, our body then has to process that, right?
00:39:22.400 --> 00:39:26.320
Like that glucose is gonna enter into our bloodstream, and then we're gonna have to do something about it.
00:39:26.559 --> 00:39:30.079
The body's the pancreas is naturally gonna respond by making insulin.
00:39:30.320 --> 00:39:38.960
But there's another way, it turns out, insulin-independent way to get the glucose out of your bloodstream, which is to get the glucose into your muscles.
00:39:39.199 --> 00:39:43.920
And you don't need insulin to do that because the muscles have something called a glute transporter.
00:39:44.320 --> 00:39:53.440
And when you activate your muscles, when you go for a walk after a meal, your muscles suck up the glucose without your pancreas having to make tons of insulin.
00:39:53.599 --> 00:40:00.960
So you're gonna lower your blood sugar, you're gonna give your pancreas a little bit of a rest by exercising after a meal.
00:40:01.199 --> 00:40:07.280
So, exercising after a meal, great way if you if you wear a CGM, then you can sort of see this happening in real time.
00:40:07.440 --> 00:40:13.280
And ideally, that walk is performed very quickly after you have the meal, not like an hour later.
00:40:13.599 --> 00:40:20.400
The second way that exercise is gonna help you handle your carbohydrates and manage your insulin is that when you build muscle.
00:40:20.559 --> 00:40:22.480
So this is where the strength training comes in, right?
00:40:22.639 --> 00:40:28.719
So it turns out that on the rapid fire, you had asked about is muscle like one of the most important organs for metabolic health?
00:40:28.960 --> 00:40:34.000
And that again, it goes back to the reason is if you have muscle is very metabolically active tissue.
00:40:34.159 --> 00:40:39.519
It's our most metabolically active tissue, and it's where we store a lot of our glucose, right?
00:40:40.000 --> 00:40:48.880
So building up muscle is gonna be a way for your body to handle the carbs that you're eating, and it's gonna be a way for you to store that glucose so you don't have to store it as fat.
00:40:49.360 --> 00:40:57.199
So both with resistance training and with sort of walking and light exercise, you're gonna help on the insulin sensitivity parameter.
00:40:57.599 --> 00:40:58.239
Beautiful.
00:40:58.480 --> 00:40:59.360
Thank you.
00:40:59.599 --> 00:41:07.039
You know, with uh being in the endocrinology world and the the type 2 and type 1 diabetes, it reminds me again.
00:41:07.280 --> 00:41:10.400
It feels like you're living in our office right now.
00:41:10.639 --> 00:41:11.599
The correlation.
00:41:11.760 --> 00:41:18.159
But my last patient yesterday was a young, 25-year-old guy with type 1 diabetes.
00:41:18.239 --> 00:41:22.239
And, you know, they wear uh the CGM along with their insulin pumps.
00:41:22.559 --> 00:41:28.159
Ben insulin pump is a continuous insulin delivery device where they have more control on it.
00:41:28.239 --> 00:41:35.039
It's it's a better way of correlating the physiological delivery of insulin as compared to just injections.
00:41:35.280 --> 00:41:44.559
So, anyways, he's been working out since he's you know structured his new work schedule and really built a lot of 10 pounds of muscle since the last time I saw him.
00:41:44.719 --> 00:41:47.599
So that was insane with the body composition.
00:41:47.760 --> 00:41:50.159
But and he's like, I'm doing perfectly fine.
00:41:50.239 --> 00:41:55.599
And you know, he came in for uh just a general body composition, which I have them do every six to eight weeks.
00:41:55.920 --> 00:41:57.920
Then I was like, you know, I'm looking at your CGM data.
00:41:58.000 --> 00:42:04.960
I know we were not supposed to, we were not planning to review it, but I'm seeing that every night there is a dip that the blood sugar is going low.
00:42:05.119 --> 00:42:06.559
Have you changed anything else?
00:42:06.800 --> 00:42:13.760
And he says, Well, I've been working out, but now my workouts are scheduled the latter half of the day because that's after work.
00:42:14.079 --> 00:42:16.800
And, you know, the insulin doses are the same.
00:42:16.880 --> 00:42:17.920
He hasn't adjusted.
00:42:18.000 --> 00:42:20.880
And even though insulin pump, they're more in the automated mode.
00:42:20.960 --> 00:42:25.199
They have algorithms where they're set to avoid a low blood sugar.
00:42:25.360 --> 00:42:35.840
His insulin sensitivity has improved uh dramatically because of the new exercises that he implemented in the last 10 days.
00:42:36.079 --> 00:42:37.760
In addition to what he was doing.
00:42:37.840 --> 00:42:45.920
So I had to back off on the insulin delivery, uh, the amount for all the days between like I think 10 p.m.
00:42:46.079 --> 00:42:47.599
to 6 a.m., right?
00:42:47.760 --> 00:42:54.400
And I was marveled and I said, let's take a look at you know what was happening a year ago with the the amount of insulin.
00:42:54.559 --> 00:42:59.679
So he's dropped his requirements by you know 15 or 17 units of insulin.
00:42:59.920 --> 00:43:14.159
They're the ones who need very limited insulin, they're leaner, type 1 diabetes, but with exercise, with building muscle over time, gradually, and you just mentioned that, you know, six months, one year, and then recent changes and what his workout plans were.
00:43:14.320 --> 00:43:15.920
But this these are real stories.
00:43:16.079 --> 00:43:22.159
So you're sharing your experience, you're sharing the education, you're giving us all these, you know, health bites.
00:43:22.480 --> 00:43:28.400
And they're actually when implementable, they bring about a change, they bring up bring about a transformation.
00:43:28.639 --> 00:43:39.119
So I wanted to tell the audience that maybe just tune in again, go back to the start of the episode and listen to it over and over again till you feel like you got it.
00:43:39.760 --> 00:43:40.000
Hmm.
00:43:40.239 --> 00:43:42.719
You know, I'll add to this is your world.
00:43:42.960 --> 00:43:58.960
I think that endocrinologists and primary care doctors are so focused on the glucose numbers being within the normal range and not focused on how much insulin somebody is injecting into their body or their pancreas is pr having to produce in order to keep that number.
00:43:59.199 --> 00:44:15.280
And so We don't fully appreciate in conventional medicine that pumping somebody with insulin, even though it drives the glucose down and prevents the complications of high blood sugars, there are downstream or adverse consequences of having too much insulin.
00:44:15.440 --> 00:44:28.320
So if you can reduce your insulin requirement, either a type 1 diabetic having to inject less as your patient, or your type 2 diabetic having to make less internally, anything you can do to lower your insulin requirements is going to be good for your body.
00:44:28.480 --> 00:44:30.480
It's good for your vascular system, right?
00:44:30.639 --> 00:44:36.480
And exercise is one of those ways to reduce your insulin requirements.
00:44:36.960 --> 00:44:38.400
Absolutely well said.
00:44:38.639 --> 00:44:39.119
Love it.
00:44:39.360 --> 00:44:47.679
So before we end the episode, would you be kind enough to give one more simple advice for our audience?
00:44:47.840 --> 00:44:59.840
Anyone in their 30s, 40s, 50s, 60s, whoever has decided that I want to improve my health, I am understanding what longevity or health span is now and how I could combine it.
00:45:00.000 --> 00:45:04.400
What would be that one simple piece of advice from you as uh Dr.
00:45:04.559 --> 00:45:07.280
Al-Rushaidi, the longevity specialist?
00:45:07.599 --> 00:45:08.159
Yeah.
00:45:08.480 --> 00:45:14.239
I would say know your fitness level, know your number and track it over time.
00:45:14.719 --> 00:45:17.360
And we, you know, you should know your blood pressure.
00:45:17.519 --> 00:45:25.360
You should know your fasting blood glucose, you should know your LDL cholesterol, and you and your doctor should know your fitness level.
00:45:25.519 --> 00:45:28.639
It's just, I think it's just, as we've established, it's just as important.
00:45:28.880 --> 00:45:31.920
And it turns out it's not super tricky to measure.
00:45:32.079 --> 00:45:37.679
So either you can go to the gym and do the Met treadmill chart and do it on your own.
00:45:37.840 --> 00:45:43.440
Or if you feel ambitious and you want to go into one of these specialized centers and wear the mask and get it, get the number.
00:45:43.519 --> 00:45:46.559
I'm a quantitative person, so I'd like to know what my number is.
00:45:46.639 --> 00:45:48.079
I'd like to know what your number is.
00:45:48.239 --> 00:45:59.440
And then do your exercise, whether it's you're walking between mailboxes to mailboxes, whether it's swimming, whether it's whatever it is, and then repeat that test so that you know, are you getting worse?
00:45:59.599 --> 00:46:00.320
Are you stable?
00:46:00.480 --> 00:46:01.360
Are you getting better?
00:46:01.519 --> 00:46:01.920
You know?
00:46:02.079 --> 00:46:07.119
And ideally, we're gonna try to be on that trajectory of improving ourselves and increasing our.
00:46:07.519 --> 00:46:19.280
We know that for every one increase in MET, so MET being a metric of cardio risk per fitness, for every increase in MET, we see a corresponding decrease in mortality, you know, a meaningful decrease in mortality.
00:46:19.360 --> 00:46:26.079
So even if you're at the lowest fitness level and you just go a little bit higher, you're gonna see a big drop in your risk of diseases.
00:46:26.239 --> 00:46:28.320
It's not like you don't need to go to elite.
00:46:28.559 --> 00:46:31.039
You just need to be a little better than where you are now.
00:46:31.440 --> 00:46:32.320
Absolutely.
00:46:32.559 --> 00:46:33.360
So true.
00:46:33.599 --> 00:46:41.440
I'm following your advice day in and day out with uh with the body composition, with the with the exercise.
00:46:41.679 --> 00:46:48.480
And uh it happened, I would say, at age 35, where I really got into okay, and now I'm 45.
00:46:48.800 --> 00:46:50.960
So the goal is to gain more muscle.
00:46:51.119 --> 00:46:57.360
And uh I appreciate you uh enlightening us even more in terms of uh breaking it down further.
00:46:57.519 --> 00:46:58.480
Thank you so much, Dr.
00:46:58.639 --> 00:46:58.800
Ali.
00:46:59.599 --> 00:47:00.239
Oh, thank you.
00:47:00.480 --> 00:47:01.679
Good to be with you.
00:47:02.480 --> 00:47:05.199
Thanks for hanging out with me on hormones and hope.
00:47:05.360 --> 00:47:13.360
If you've loved this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous.
00:47:13.599 --> 00:47:16.000
Want more tools to support your hormones and health?
00:47:16.159 --> 00:47:18.960
Head over to unified endocrine care.com.
00:47:19.119 --> 00:47:23.039
We've got free guides, resources, and more waiting for you.
00:47:23.280 --> 00:47:29.039
Until next time, stay curious, stay kind to your body, and keep your hormones happy.
00:00:00.160 --> 00:00:02.879
Number one, is this myth or a fact?
00:00:03.040 --> 00:00:08.400
Exercise is the single most powerful lifestyle intervention we have to improve longevity.
00:00:08.720 --> 00:00:09.119
Fact.
00:00:09.759 --> 00:00:12.160
Cardio versus strength training.
00:00:12.400 --> 00:00:13.359
Myth or fact?
00:00:13.519 --> 00:00:19.600
If someone wants to live longer, cardiovascular fitness is more important than muscle strength.
00:00:19.920 --> 00:00:22.879
I would say myth because we don't know.
00:00:23.120 --> 00:00:24.160
Both are important.
00:00:24.640 --> 00:00:27.359
Number three, this is about VO2 Max.
00:00:27.679 --> 00:00:32.960
VO2max is one of the strongest predictors of longevity and overall health.
00:00:33.280 --> 00:00:37.039
I'm gonna say myth, and we're gonna do a deep dive on what I mean by that.
00:00:37.359 --> 00:00:45.759
Number four, after the age of 40 or 50, it becomes significantly harder to improve fitness and cardiovascular capacity.
00:00:46.240 --> 00:00:46.719
Myth.
00:00:47.119 --> 00:00:53.520
Do you need to work out intensely to see meaningful improvements in metabolic health?
00:00:54.000 --> 00:01:01.200
Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health.
00:01:01.439 --> 00:01:02.399
I'm your host, Dr.
00:01:02.560 --> 00:01:04.959
Chaya Makija, or you can call me Dr.
00:01:05.120 --> 00:01:12.799
Chaya, a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.
00:01:12.959 --> 00:01:25.120
Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out.
00:01:25.359 --> 00:01:27.280
So let's get empowered.
00:01:28.079 --> 00:01:29.760
Hello and welcome, my friends.
00:01:30.000 --> 00:01:33.120
Welcome to another amazing episode on Hormones and Hope.
00:01:33.280 --> 00:01:34.079
This is your host, Dr.
00:01:34.159 --> 00:01:35.040
Chaya McHija.
00:01:35.280 --> 00:01:39.200
You're both certified endocrinologist and lifestyle medicine specialist.
00:01:39.439 --> 00:01:40.319
And guess what?
00:01:40.480 --> 00:01:42.640
I have the guest on today.
00:01:42.879 --> 00:01:44.879
It's a special, special guest.
00:01:45.040 --> 00:01:51.760
Yes, every guest on my podcast is special because they're coming in to educate me as well as you.
00:01:52.319 --> 00:01:54.959
And this one, why is it special, special?
00:01:55.280 --> 00:02:06.719
Because he's going to give us some tidbits, expertise, as well as recommendations on how you can live longer and healthier.
00:02:06.959 --> 00:02:07.599
Welcome, Dr.
00:02:07.760 --> 00:02:08.080
Ali.
00:02:08.479 --> 00:02:08.639
Dr.
00:02:08.800 --> 00:02:11.599
Ali is a longevity medicine specialist.
00:02:12.080 --> 00:02:19.039
And I've learned about him in the recent past, especially 2026, and I'm just marveled.
00:02:19.280 --> 00:02:35.039
Marveled by the fact that an ophthalmologist, a surgeon, is interested in longevity medicine and actually practicing what he preaches and also professionally involved in bringing about prevention and longevity medicine to his community.
00:02:35.280 --> 00:02:36.080
So welcome, Dr.
00:02:36.240 --> 00:02:36.479
Ali.
00:02:36.960 --> 00:02:37.439
Thank you, Dr.
00:02:37.520 --> 00:02:39.439
Shah, for that lovely intro.
00:02:39.680 --> 00:02:41.360
Good to meet you and good to be here.
00:02:41.759 --> 00:02:42.560
Yeah, thank you.
00:02:42.719 --> 00:02:44.960
Thank you for being here today with us.
00:02:45.199 --> 00:03:03.599
Before we learn more about fitness or certain ways of assessing our fitness, which can contribute to our longevity in terms of longevity medicine or science behind it, I really wanted to know why longevity medicine.
00:03:04.000 --> 00:03:15.680
Why switching your specialty, or is it combining your specialty being an eye surgeon and more of a preventive strategist or a lifestyle longevity physician?
00:03:16.080 --> 00:03:16.800
Great question.
00:03:17.039 --> 00:03:26.479
For me, it's in addition to its combination and so in my practice as a retina specialist, I see a lot of elderly patients.
00:03:26.719 --> 00:03:28.879
I see a lot of age-related eye diseases.
00:03:28.960 --> 00:03:36.080
And of course, I see a lot of age-related arthritis and a lot of people with mobility issues, a lot of people with heart disease, diabetes.
00:03:36.400 --> 00:03:42.960
And I'm catching them sort of when they're already at the end of their life and things are broken.
00:03:43.360 --> 00:03:50.240
And we in medicine, as you know, we're pretty decent at fixing broken things, but we're not so good at preventing.
00:03:50.400 --> 00:03:56.960
And so I've been frustrated with like how conventional medicine sort of waits till there's a problem and then tries to fix it.
00:03:57.120 --> 00:04:11.039
So I thought I'd have another project in which I try to catch people at a younger age where they can intervene in their lifestyle and exercise being one of them to prevent not only eye disease, but just many chronic diseases in general.
00:04:11.280 --> 00:04:13.680
It's been an interest of mine for a long time now.
00:04:13.759 --> 00:04:16.399
And now I'm helping others on the journey.
00:04:16.800 --> 00:04:18.000
It's very inspiring.
00:04:18.160 --> 00:04:23.439
You know, you remind me of uh another cardiothoracic surgeon who I'd met.
00:04:23.519 --> 00:04:25.920
I think I've shared about him with you.
00:04:26.240 --> 00:04:40.879
And uh, you know, after 20, 25 years of doing bypass surgeries, he was like, yes, there is a sense of fulfillment where I'm saving lives, but it's at the last stage of when the heart is literally collapsing, and that's where I can help them.
00:04:41.120 --> 00:04:43.120
But what can I do now?
00:04:43.680 --> 00:04:50.000
When I've realized that medicine or the way you're talking about that, we can offer treatment or try to fix things.
00:04:50.319 --> 00:05:02.560
So he's also, you know, now a lifestyle medicine specialist and practicing men's health, complete prevention, and you know, some tools and discussions that you're going to share with us.
00:05:02.720 --> 00:05:03.920
That's what he's practicing.
00:05:04.079 --> 00:05:24.639
So I really feel like many of us as physicians, no matter what specialty we are in, have really uh not necessarily changed our direction, but are actually re-emphasizing the fact that we need to focus on prevention and bring it back to medicine rather than someone else taking care of that specific aspect.
00:05:25.040 --> 00:05:26.160
Yeah, absolutely.
00:05:26.399 --> 00:05:30.560
I think real medicine, it's funny, people are saying is longevity medicine its own specialty.
00:05:30.639 --> 00:05:34.240
And I think every good doctor is a longevity doctor, right?
00:05:34.399 --> 00:05:38.879
Endocrinologist, you are helping prevent people from the complications of diabetes, right?
00:05:38.959 --> 00:05:40.319
Like thyroid disease.
00:05:40.480 --> 00:05:42.800
Your oncologist is a longevity doctor.
00:05:42.879 --> 00:05:48.160
They're trying to keep you alive from cancer, prevent cancer, screen, catch cancer early, treat the cancer.
00:05:48.399 --> 00:05:51.519
So good medicine is longevity medicine, right?
00:05:51.600 --> 00:06:01.759
The sad part is that most doctors don't work in an environment in which they can practice in that way because of the way the healthcare system is set up, the incentives.
00:06:02.000 --> 00:06:05.920
We have to see a high volume of patients in a short amount of time.
00:06:06.319 --> 00:06:11.199
And in that short amount of time, we're trying to fix broken things because that's where the acute issue is.
00:06:11.439 --> 00:06:16.879
We don't have the time and the resources to focus on the longer-term roadmap.
00:06:17.279 --> 00:06:18.240
Yeah, so true.
00:06:18.480 --> 00:06:25.920
That is one of the very important investments, other than you know, what our bank accounts or relationship investments are.
00:06:26.079 --> 00:06:28.879
It's also our health, and that starts with prevention.
00:06:29.120 --> 00:06:35.199
So I'm excited to learn from you and uh what uh you're gonna teach uh us as well as our audience.
00:06:35.439 --> 00:06:36.480
So, how about this, Dr.
00:06:36.879 --> 00:06:37.360
Zaidi?
00:06:37.519 --> 00:06:47.120
We're gonna start with rapid fire, which we usually do for all our episodes, one-liner or one-word answer, and then we get to learn more about uh these topics.
00:06:47.279 --> 00:06:48.079
Are you ready?
00:06:48.399 --> 00:06:49.839
Sure, let's do it.
00:06:50.079 --> 00:06:52.879
Number one, is this myth or a fact?
00:06:53.120 --> 00:06:58.480
Exercise is the single most powerful lifestyle intervention we have to improve longevity.
00:06:58.800 --> 00:06:59.360
Fact.
00:06:59.920 --> 00:07:00.560
All right.
00:07:01.120 --> 00:07:03.600
Cardio versus strength training.
00:07:03.839 --> 00:07:04.800
Myth or fact?
00:07:04.959 --> 00:07:10.879
If someone wants to live longer, cardiovascular fitness is more important than muscle strength.
00:07:11.279 --> 00:07:14.160
I would say myth because we don't know.
00:07:14.399 --> 00:07:15.439
Both are important.
00:07:16.000 --> 00:07:18.639
Number three, this is about VO2 Max.
00:07:19.040 --> 00:07:24.240
VO2max is one of the strongest predictors of longevity and overall health.
00:07:24.560 --> 00:07:28.319
I'm gonna say myth, and we're gonna do a deep dive on what I mean by that.
00:07:28.720 --> 00:07:30.000
Okay, thank you so much.
00:07:30.240 --> 00:07:38.639
Number four, after the age of 40 or 50, it becomes significantly harder to improve fitness and cardiovascular capacity.
00:07:40.240 --> 00:07:44.160
Ooh, people, midlife, and this is your time.
00:07:44.480 --> 00:07:46.879
Number five, exercise frequency.
00:07:47.120 --> 00:07:53.279
Do you need to work out intensely to see meaningful improvements in metabolic health?
00:07:54.639 --> 00:07:57.759
Number six, it's all about the muscle right now.
00:07:58.000 --> 00:08:04.399
Muscle is now considered as one of the most important organs for metabolic health and healthy aging.
00:08:04.639 --> 00:08:05.600
Myth or fact?
00:08:06.079 --> 00:08:06.480
Fact.
00:08:06.959 --> 00:08:08.000
Fact, fact, fact.
00:08:08.160 --> 00:08:09.199
Okay, thank you.
00:08:09.439 --> 00:08:12.480
Number seven, uh, this is also relevant to exercise.
00:08:12.639 --> 00:08:23.360
If someone has been sedentary for years, not moving, no physical activity, starting exercise in midlife can still significantly improve lifespan.
00:08:23.839 --> 00:08:24.319
Fact.
00:08:25.040 --> 00:08:28.079
Ooh, so we have two packs for midlife.
00:08:28.399 --> 00:08:28.879
All right.
00:08:29.040 --> 00:08:30.639
So that was a rapid fire.
00:08:30.800 --> 00:08:34.559
And one of them you actually mentioned that we should do a deep dive.
00:08:34.720 --> 00:08:35.919
Um, so how about this?
00:08:36.159 --> 00:08:42.720
We will start with if you can explain, which you actually explained it during your introduction about longevity medicine.
00:08:42.960 --> 00:08:53.440
We've been hearing this specific terminology, both in science as well as on social media, about the longevity movement or longevity medicine, longevity era.
00:08:53.919 --> 00:08:56.559
What does this longevity science mean?
00:08:56.879 --> 00:09:03.600
And can you just help us connect that how it is actually important in every field of medicine?
00:09:04.000 --> 00:09:04.559
Yeah.
00:09:04.799 --> 00:09:08.799
You know, I think I'll start with where this appetite is coming from.
00:09:09.039 --> 00:09:24.080
I think there's a growing number of people that are dissatisfied with their experience with conventional medicine because of the short visits that are again focused on what's the problem of today rather than keeping me healthy 20, 30 years down the road.
00:09:24.399 --> 00:09:29.440
And so there's a movement, it's sort of a trending buzzword to say longevity.
00:09:29.840 --> 00:09:38.159
And I think when you look at providers that are in this space, or you as a patient are in this space, I think there's a spectrum.
00:09:38.399 --> 00:09:45.120
And we'll say on one end of the spectrum is like really conservative, evidence-based lifestyle medicine.
00:09:45.279 --> 00:09:46.960
And that's totally appropriate.
00:09:47.120 --> 00:09:52.000
And there's people who are interested in that, people who are really focused on the pillars of lifestyle.
00:09:52.240 --> 00:09:55.279
And then there's patients in that space, there's providers in that space.
00:09:55.360 --> 00:09:56.799
And I think there's a lot of demand there.
00:09:56.960 --> 00:10:14.240
And then on the, let's say the other end of the spectrum, you have people that are willing to experimental things, peptides, put things into their body that haven't been vetted by randomized controlled trials because they're looking for that edge, whether it's hormones, whether it's supplements, red light therapy.
00:10:14.320 --> 00:10:22.720
There's stuff that there's evidence for, and there's stuff that's like the evidence is a bit gray or shaky, and it's extrapolating from animal data or some small human studies.
00:10:22.960 --> 00:10:31.519
I'm not saying that one end of the spectrum is right or wrong, but you decide where you are on that spectrum, and you also figure out where your provider is on that spectrum.
00:10:31.679 --> 00:10:43.759
So, like where I land on that spectrum as a practicing physician is more on the first side of it, which is what are the evidence-based, solid lifestyle pillars that we can tell people to do.
00:10:44.000 --> 00:10:48.720
And if you start with those and you optimize those, that's like gets you 80, 90% of the way there.
00:10:48.879 --> 00:10:49.039
Right.
00:10:49.200 --> 00:10:57.039
And if people are interested in then adding to try to get an edge, then we can talk about that or they can find providers that can fill that need.
00:10:57.279 --> 00:11:02.000
But I think that's a good sort of overall look at the landscape because there's a lot of providers in that area.
00:11:02.080 --> 00:11:03.120
There's a lot of stuff online.
00:11:03.440 --> 00:11:09.360
But the idea is people are dissatisfied with conventional medicine and they're looking for something a little bit different.
00:11:09.759 --> 00:11:11.039
Yeah, very well said.
00:11:11.279 --> 00:11:13.200
You really uh broke it down.
00:11:13.600 --> 00:11:16.480
So you're gonna share a lot more.
00:11:16.639 --> 00:11:34.080
And this is where I really love to connect with, you know, experts and specialists as yourself, is also that evidence-based science, which is personalized, which is applicable, but it's still individualized based on that patient-physician relationship and how you're uh connecting.
00:11:34.399 --> 00:11:38.879
With that being one of our core values, right?
00:11:39.440 --> 00:11:42.159
Why is prevention so important?
00:11:42.879 --> 00:11:44.799
Or what do you think about prevention?
00:11:44.960 --> 00:11:49.360
You know, you mentioned that again in your person story as to why you're talking about it.
00:11:49.600 --> 00:11:53.200
But what are those pillars that govern prevention?
00:11:53.440 --> 00:12:04.559
And I always think about this, also ask my patients that do you want to live longer versus do you want to still have a good, long, healthy life as much as it's going to be?
00:12:04.799 --> 00:12:28.240
But also the health span that we hear about or we talk about, and you know, how independent you could be, the freedom of you being independent and not needing, you know, that extra support that we've seen in our elderly patients and even many of our colleagues who have their parents suffering to that, being octogenarians like at the 80s, 90s, and how dependent that become.
00:12:28.480 --> 00:12:40.960
So, in the evidence-based world, longevity medicine, how do you curate or how do you bring health, prevention, aging as a concept and explain it to your patients?
00:12:41.120 --> 00:12:49.200
If I were to see you, right, how are you addressing or breaking down longevity medicine based on how you would approach the care?
00:12:49.840 --> 00:12:50.240
Yeah.
00:12:50.720 --> 00:12:51.759
That's a great question.
00:12:52.000 --> 00:13:01.360
I guess I'll start with the top three things that kill people in the United States are cardiovascular disease, cancer, and neurodegenerative disease.
00:13:01.600 --> 00:13:08.559
So the first thing when we look at people is how can we mitigate your risk of falling prey to one of these three things?
00:13:08.799 --> 00:13:09.919
We all have to go, obviously.
00:13:10.080 --> 00:13:10.960
We can't live forever.
00:13:11.120 --> 00:13:13.120
Longevity isn't about living forever.
00:13:13.279 --> 00:13:19.840
It is, like you said, about maximizing the time on this planet that you're healthy, that you're mobile, that you're independent.
00:13:20.159 --> 00:13:27.360
And by delaying or even eliminating the risk of these three things, we can sort of prolong the time that we're healthy.
00:13:27.519 --> 00:13:35.360
You know, one depressing statistic in the United States is the life span of the average American is around 78 years old.
00:13:35.679 --> 00:13:39.440
But the average health span is around 65 years old.
00:13:39.519 --> 00:13:47.679
So that means after 65 to 78, the time we die, we have more than a decade, that marginal decade of life we spend with illness or disability.
00:13:47.919 --> 00:13:54.320
And so the goal is how can we go from 65 to maybe go to 75, maybe even go to 77, right?
00:13:54.399 --> 00:13:58.159
Or and maybe even increase the ceiling and live till we're in our 80s.
00:13:58.320 --> 00:14:12.000
And so the first step is we have to look under the hood and figure out what's your risk for cardiovascular disease, what's your risk for cancer, what's your risk for these neurodegenerative diseases, and then how can we construct a plan to mitigate all those risks?
00:14:12.159 --> 00:14:20.320
The plan that starts first with lifestyle, the pillars being good food, exercise, sleep, social connection.
00:14:20.480 --> 00:14:21.840
Those are not in any particular order.
00:14:21.919 --> 00:14:23.279
I think all of them are super important.
00:14:23.519 --> 00:14:28.159
You had mentioned at the beginning, you know, exercise is one of the biggest factors to improve longevity.
00:14:28.559 --> 00:14:29.679
Yes, that's true.
00:14:29.759 --> 00:14:32.080
But I think social connection is super duper important.
00:14:32.320 --> 00:14:35.759
What we put in our mouth and what we eat and drink every day is super important, right?
00:14:35.840 --> 00:14:38.480
Um, how much we're sleeping, the quality of our sleep is super important.
00:14:38.639 --> 00:14:42.399
And it's hard to tease out which of these four is more important than the other.
00:14:42.559 --> 00:14:46.879
And ideally, we're we're working one at a time and optimizing all four of those.
00:14:47.039 --> 00:14:50.799
And then we can introduce medications and supplements and other things, right?
00:14:50.960 --> 00:14:54.320
Intervention surgeries, but we start with those four things.
00:14:54.480 --> 00:14:55.519
Um Yeah.
00:14:55.759 --> 00:15:06.159
The piece for the pillar is the stress management or the I I love to say how can I improve the stress response, or I can how can I help you with improving the stress response?
00:15:06.399 --> 00:15:11.759
And then, you know, avoidance of drugs, tobacco, alcohol, uh, which could be harmful.
00:15:12.080 --> 00:15:13.679
You know what you just mentioned?
00:15:13.919 --> 00:15:17.039
We released this podcast in June 2025.
00:15:17.360 --> 00:15:22.559
And since then, we've had all weekly episodes, not missed one week, and I've had lots of specialists.
00:15:22.879 --> 00:15:42.000
Every time when we have this specific question, which is a universal question for everyone, it's either sleep or it's you know, improving our stress management or stress response techniques as the most important one, either for lifestyle, either for you know, inflammation, cardiovascular.
00:15:42.080 --> 00:15:47.360
You talked about longevity and you emphasize the same thing right now as you were describing it.
00:15:47.600 --> 00:15:48.320
Thank you.
00:15:48.639 --> 00:16:07.600
So now I wanted to really get into the in-depth of uh the science, but also the practicality, what strategies, action steps that you would consider in patients or when you're educating or when you're speaking uh to the audience about, okay, we have the pillars we know we need to prevent.
00:16:07.840 --> 00:16:11.120
I, as a patient, am ready to make a change.
00:16:11.360 --> 00:16:12.720
Where do you have them start?
00:16:12.879 --> 00:16:16.240
So you're, I'm guessing, evaluating risk factors, assessing them.
00:16:16.320 --> 00:16:18.480
There could be biochemical evaluation.
00:16:18.720 --> 00:16:34.879
But what are certain tools that you might incorporate or use to assess their current level of fitness or their capacity physical and help them with a better or a curated plan?
00:16:35.279 --> 00:16:35.519
Yeah.
00:16:35.679 --> 00:16:42.799
So, you know, it's interesting when I go to my primary care doctor, let's say, and he asks me, are you physically active?
00:16:42.879 --> 00:16:43.039
Right.
00:16:43.279 --> 00:16:43.759
Oh, yeah.
00:16:43.919 --> 00:16:47.120
Um I bike or I play pickleball with my friends or whatever.
00:16:47.279 --> 00:16:49.200
I do 10,000 steps a day.
00:16:49.360 --> 00:16:59.039
Even though it sounds quantitative, like 10,000 steps, if you do, you know, 100 steps here and 100 steps there, and it adds up to 10,000 a day, it's not necessarily cardio exercise.
00:16:59.279 --> 00:17:02.799
And we don't have conventional medicine doesn't quantify.
00:17:02.879 --> 00:17:05.519
Like when somebody tells me they're gonna exercise, how do I know?
00:17:05.599 --> 00:17:05.839
Right.
00:17:06.000 --> 00:17:13.359
And so one way that's gotten popularized, what we're trying to assess, what we're trying to quantify is cardiorespiratory fitness.
00:17:13.519 --> 00:17:15.920
That's the term for how fit you are.
00:17:16.240 --> 00:17:23.119
And we can talk about all the research that's behind cardiorespiratory fitness and health and longevity.
00:17:23.359 --> 00:17:40.000
In 2016, which is now 10 years ago, the American Heart Association put out a guideline, a scientific statement, that said cardiorespiratory fitness should be evaluated in patients and as a risk factor for cardiovascular disease is as strong or stronger than diabetes, smoking, hypertension.
00:17:40.160 --> 00:17:41.519
That was 10 years ago.
00:17:41.759 --> 00:17:49.279
And I highly doubt that you and I have been to any doctor in the last 10 years who's asked, what is your cardiorespiratory fitness in any kind of numerical way?
00:17:49.440 --> 00:17:55.759
And so I think one thing that we should be considering is how do I quantify what my cardiorespiratory fitness is?
00:17:56.000 --> 00:18:00.240
One way that's gotten super popularized recently, is VO2max.
00:18:00.640 --> 00:18:06.480
And I'll talk about VO2 Max and I'll talk about why it's not exactly what you need to have, but it's it's a good metric.
00:18:06.640 --> 00:18:17.119
So VO2 max, a lot of influencers on social media gone on and said VO2max is the thing you need to check when it comes to cardiorespified fitness.
00:18:17.279 --> 00:18:39.200
And what it is, and I've had mine done too, is you go into a lab, you go into a center, a gym sometimes has this, you pay out of pocket, it's not covered by insurance, you might end up spending between$100 and$200, and you're gonna get onto a treadmill and they're gonna give you a mask that you're gonna wear a tight-fitting mask on your face, and it's gonna measure the CO2 coming out of your mouth, and it's gonna know what oxygen is going into your mouth.
00:18:39.279 --> 00:18:42.480
And you're gonna go on this treadmill and slowly they're gonna ratchet it up.
00:18:42.640 --> 00:18:46.400
And every few minutes, they're gonna increase the incline or they're gonna increase the velocity.
00:18:46.640 --> 00:18:51.920
And pretty soon you're gonna start huffing and puffing, and your heart rate is they're measuring your heart rate, your heart rate's going up higher and higher.
00:18:52.079 --> 00:18:56.079
And the goal of that test is you're gonna go until you can't go anymore.
00:18:56.400 --> 00:18:59.920
Which for most people falls somewhere between five and 10 minutes.
00:19:00.079 --> 00:19:01.680
So it's not like you're in there for an hour.
00:19:01.759 --> 00:19:07.599
Yeah, you after the warm-up period, usually five to 10 minutes, you're exhausted and you will tap out.
00:19:07.680 --> 00:19:11.920
You will tell the person there, I can't go any further, tap out, they'll stop the test.
00:19:12.079 --> 00:19:13.279
You'll be huffing and puffing.
00:19:13.359 --> 00:19:18.799
Your heart rate's probably gonna be 140s, 150s, 160s, and they're gonna measure your VO2 max.
00:19:18.960 --> 00:19:19.599
They're gonna give you a number.
00:19:19.680 --> 00:19:24.720
So the VO2 max is how much oxygen your body can take in and convert it to energy.
00:19:24.880 --> 00:19:31.920
And the reason it's appealing is because it's sort of a sum of air that your lungs are taking in, so how good your lungs are working.
00:19:32.160 --> 00:19:36.559
Then your heart, the oxygen goes into your bloodstream, it goes to your heart.
00:19:36.640 --> 00:19:40.799
Your heart's gonna pump it to your body, so it's a function of how good your heart is pumping.
00:19:40.960 --> 00:19:44.799
And then your muscles are gonna take that blood and that oxygen and they're gonna convert it into energy.
00:19:44.880 --> 00:19:46.880
So it's a function of your muscles and your mitochondria.
00:19:47.119 --> 00:19:54.400
So with one number, VO2max, you sort of got a sense of a person's lungs, heart, muscle, mitochondria, and blood, right?
00:19:54.480 --> 00:19:57.039
Because if they're anemic, they're not gonna deliver as much oxygen.
00:19:57.200 --> 00:20:02.559
So one number gives you a great sort of high-level zoomed-out overview of that person's health.
00:20:02.799 --> 00:20:08.400
Now, what's happened on social media is that VO2max has just gotten really the thing that's correlated.
00:20:08.480 --> 00:20:15.279
Now, when you go back to the studies that correlated what they looked at, they looked at cardiorespiratory fitness.
00:20:15.359 --> 00:20:16.640
They didn't actually look at VO2 Max.
00:20:16.799 --> 00:20:21.039
VO2max is one way to measure somebody's cardiorespiratory fitness.
00:20:21.200 --> 00:20:24.559
But turns out it's not the only way, and it turns out it's not even the easiest way.
00:20:24.640 --> 00:20:27.119
There's an easier way to do it, which is what they did in the studies.
00:20:27.279 --> 00:20:35.039
And I'll share with you this really cool study that I love, published in 2022 in the Journal of American Cardiology, College of American Cardiology.
00:20:35.200 --> 00:20:38.079
They took 750,000 veterans.
00:20:38.160 --> 00:20:39.519
I don't know how they did this study.
00:20:39.680 --> 00:20:46.559
750,000 veterans aged like 30s to 90s, but got them on a treadmill.
00:20:46.640 --> 00:20:48.160
Okay, did not do a VO2 max.
00:20:48.319 --> 00:20:48.960
This is way easier.
00:20:49.039 --> 00:20:50.000
This is a test now.
00:20:50.160 --> 00:20:57.359
What they did is they they did a test that evaluates their Mets, M-E-T, metabolic equivalent of task.
00:20:57.599 --> 00:20:59.599
I won't go into the details of what that means.
00:20:59.680 --> 00:21:04.240
It's just at a high level, it means how hard your body's working to do a certain task.
00:21:04.400 --> 00:21:06.640
Me and you sitting here talking is like one met.
00:21:06.880 --> 00:21:13.039
If we started getting up and started doing a walk, maybe two mets, a brisk walk, maybe three mets, jogging, four or five mets.
00:21:13.200 --> 00:21:15.200
And they measured their peak mets.
00:21:15.519 --> 00:21:19.279
And so some people got up to seven, eight, nine, 10, 11, 12 mets and above.
00:21:19.359 --> 00:21:21.920
If you're elite, you can get up to above 12 mets.
00:21:22.079 --> 00:21:26.400
And they followed these vets, 750,000 of them for 10 years.
00:21:26.720 --> 00:21:28.960
Incredible prospective giant study.
00:21:29.119 --> 00:21:30.319
Not a randomized trial.
00:21:30.480 --> 00:21:35.200
Mind you, this is not a randomized trial that they forced people to exercise and forced other people to be sedentary.
00:21:35.359 --> 00:21:40.160
They just took people where they came, followed them for 10 years, and see who died and who didn't die.
00:21:40.240 --> 00:21:43.279
And thousands of people passed away during this 10 year period.
00:21:43.440 --> 00:21:50.559
And they collected data about smoking and diabetes and end stage renal disease, and they also calculated their fitness based on their treadmill test.
00:21:50.720 --> 00:21:52.319
No oxygen mass required.
00:21:52.480 --> 00:21:58.160
This is something that you and I can go today after this call to the gym, walk on a treadmill, and we can figure out our own mets.
00:21:58.240 --> 00:21:59.759
There's charts that you can do this on.
00:22:00.480 --> 00:22:13.920
By the way, if your listeners go to Google and type in treadmill MET chart, the first image that comes up, it'll tell you if you're walking on a treadmill at this miles per hour, at this incline, this is how many mets it is.
00:22:14.160 --> 00:22:20.960
So you can today go and figure out your peak met just by how fast a treadmill you can get on and how the incline.
00:22:21.039 --> 00:22:25.039
And you can figure out, oh, my peak met is only six or seven or eight or ten or whatever.
00:22:25.200 --> 00:22:32.880
And in this amazing study of the veterans, they looked at, okay, if you're diabetic, your risk of dying was like 1.4.
00:22:33.039 --> 00:22:37.200
So that means 40% higher risk of death if you're diabetic, which makes sense.
00:22:37.359 --> 00:22:39.200
We know that diabetes increases your risk of death.
00:22:39.359 --> 00:22:43.359
If you had end stage renal disease, your hazard ratio for death was like 1.5.
00:22:43.440 --> 00:22:46.240
They had a 50% elevated risk compared to somebody who didn't.
00:22:46.400 --> 00:22:46.640
Makes sense.
00:22:46.720 --> 00:22:48.799
End stage renal disease is a terrible thing to have.
00:22:49.039 --> 00:22:50.240
Least fit.
00:22:50.559 --> 00:22:51.680
Least fit individual.
00:22:51.759 --> 00:22:55.920
So they took everybody on the treadmill and they categorized them into five groups, least fit up to elite.
00:22:56.079 --> 00:23:00.400
If you're least fit in this group, your risk of death was 400% higher.
00:23:00.559 --> 00:23:00.720
Four.
00:23:00.880 --> 00:23:02.000
Hazard ratio of four.
00:23:02.160 --> 00:23:05.759
So end stage renal disease and smoking were like 1.4, 1.5.
00:23:06.240 --> 00:23:10.720
Least fit was four, which is 400% higher risk of death.
00:23:10.880 --> 00:23:22.480
So that's why you hear this statement on social media is the strongest correlation with longevity, stronger than smoking, stronger than diabetes, stronger than end stage renal disease.
00:23:22.559 --> 00:23:23.680
Again, correlation.
00:23:23.839 --> 00:23:24.640
It's a correlation.
00:23:24.720 --> 00:23:29.200
It's not a randomized trial, but it's a huge study, prospective.
00:23:29.519 --> 00:23:40.079
And what they saw there for every increasing, when you went from least fit to slightly better, to slightly better, to slightly better to elite, at every level, your hazard ratio for death, your risk of death went down.
00:23:40.160 --> 00:23:46.240
So it was a dose response curve, which is something we like to see in medicine, right?
00:23:46.400 --> 00:23:50.480
That suggests that there's a causal role here, right?
00:23:50.640 --> 00:23:52.480
That that the correlation is meaningful.
00:23:53.039 --> 00:24:00.240
So this is where the whole VO2max craze comes from is these big studies that really showed a strong correlation.
00:24:00.640 --> 00:24:03.759
But you don't have to pay the money and get on this treadmill test.
00:24:03.839 --> 00:24:06.079
You can do it at your gym for free.
00:24:06.240 --> 00:24:13.920
You can just Google treadmill, met chart or graph, and you can figure that out yourself next time you're at the gym, you know.
00:24:14.079 --> 00:24:17.839
And there's equivalence for biking, there's equivalence for other forms of physical activity.
00:24:17.920 --> 00:24:20.240
So you don't have to do a VO2 max.
00:24:20.400 --> 00:24:23.839
Is a VO2 max a reasonable measure of cardiorespiratory fitness?
00:24:24.000 --> 00:24:25.839
Absolutely, but there's not, it's not the only one.
00:24:26.000 --> 00:24:27.279
So Yeah.
00:24:27.519 --> 00:24:38.000
You know, you actually gave this such an amazing descriptive answer for both why it's not necessarily a myth or a fact, and how you uh broke it down.
00:24:38.160 --> 00:24:43.920
I love that you told us about the internet search at the Google search so that everyone knows their meths.
00:24:44.160 --> 00:24:54.079
And you also made me uh remember that, you know, when I was studying for the lifestyle medicine boards, we have a long section on fitness and physical activity and the mets.
00:24:54.319 --> 00:25:04.400
And, you know, when this uh study was being published or when it was in progress of publication, these were uh certain important board questions relevant to the trial.
00:25:04.720 --> 00:25:10.319
And uh I I'm just uh so happy that you brought this up because this is so, so important.
00:25:10.480 --> 00:25:14.640
And it was, you know, the the study that the veterans, right?
00:25:14.799 --> 00:25:23.519
So it is that patient population who is getting care and access to care, medical care, and um how they were tracked.
00:25:23.680 --> 00:25:27.200
So I really appreciate you sharing and breaking it down.
00:25:27.440 --> 00:25:39.039
I wanted to follow this up with like really practical steps now because you really got us into solid conviction that exercise.
00:25:40.319 --> 00:25:41.440
No, because it matters.
00:25:41.519 --> 00:25:41.759
Yeah.
00:25:42.559 --> 00:25:42.960
Exactly.
00:25:43.119 --> 00:25:43.680
It matters.
00:25:43.839 --> 00:25:54.640
Exercise is the one great tool that is with us, we own it, to help us with that prime goal when we talk about longevity or really living.
00:25:54.799 --> 00:25:56.000
I would call it as happy.
00:25:56.079 --> 00:26:04.000
If I'm independent, you know, if I can take those decisions, choices, travel at that particular age, I would take that as goal for me.
00:26:04.240 --> 00:26:08.240
So tell us when you're assessing someone, right?
00:26:08.400 --> 00:26:15.440
They have this parameter available, they have this metric available versus they might not have it, but they're ready to start.
00:26:15.759 --> 00:26:25.200
The most common reason from patients that I get when we are working towards the other medical conditions or reducing their risk factors is the consistency.
00:26:25.839 --> 00:26:42.720
Or I am too busy, I don't have time, and they could have, you know, the highest profile jobs, or they have, you know, a mundane eight to five sedentary job, or they have, you know, of course, as adults, lots of responsibilities.
00:26:42.880 --> 00:26:48.960
But midlife, my medical students are young adults, so definitely I need some tidbits for them from you.
00:26:49.119 --> 00:27:08.640
But midlife age group, they're just bombarded, you know, it's also called as a sandwich generation, is where one of the most challenging aspects for me as their physician or lifestyle medicine coach is that consistency for exercise.
00:27:08.799 --> 00:27:10.000
They might initiate it.
00:27:10.160 --> 00:27:11.759
Nah, I don't have time.
00:27:11.839 --> 00:27:15.440
I'm traveling holidays, October, November, December.
00:27:15.599 --> 00:27:19.440
You know, I fell off the wagon and now I have to just get jumped back onto it.
00:27:19.519 --> 00:27:21.920
But that's delayed until I see them in March.
00:27:22.079 --> 00:27:25.680
So there's a six-month gap in the in the seasonal window.
00:27:25.920 --> 00:27:27.200
This is the most common pattern.
00:27:27.359 --> 00:27:33.279
And when I'm saying, uh, talking about my patient, this is, you know, almost, I've been in California since 2015.
00:27:33.519 --> 00:27:37.039
This practice has been four years where we've been able to coach them.
00:27:37.279 --> 00:27:41.039
But I would really love your feedback, your insights.
00:27:41.200 --> 00:27:52.880
How are you approaching that aspect of exercise, introducing it, the concept that you've described, but how do you make them implement it with consistency?
00:27:53.920 --> 00:27:56.240
Yeah, super hard, super important.
00:27:56.400 --> 00:28:00.880
I think the first step is there is no perfect workout.
00:28:01.119 --> 00:28:05.839
The best exercise routine is what you will actually do, whatever that is for you.
00:28:06.000 --> 00:28:07.119
So I start with that.
00:28:07.359 --> 00:28:12.960
If you wanted to ask me what's the optimal, I can give you that, but I'd rather say what works for you.
00:28:13.119 --> 00:28:13.839
Is it yoga?
00:28:14.000 --> 00:28:14.559
Is it walking?
00:28:14.799 --> 00:28:15.359
Is it swimming?
00:28:15.519 --> 00:28:16.640
Is it pickleball?
00:28:16.880 --> 00:28:20.319
We got to figure out what you enjoy and what you can do over time.
00:28:20.400 --> 00:28:26.160
Because if it's a chore for you, there's probably gonna be some aspects, let's be honest, that are gonna be chores and then you just have to do it.
00:28:26.319 --> 00:28:30.640
We need to have some aspect where it's enjoyable and you look forward to it and you want to do it, right?
00:28:30.720 --> 00:28:31.839
So we have to start with that.
00:28:32.000 --> 00:28:38.240
I think for a lot of people, if you're just starting out in your midlife and you're sedentary, is walking is a good place to start.
00:28:38.400 --> 00:28:41.680
I think walking is an underrated form of exercise.
00:28:41.920 --> 00:28:43.839
People think of it, oh, it's nothing, it's just a walk.
00:28:44.000 --> 00:28:51.039
But I think if you can do a 20-minute walk, 30-minute walk, ideally at a brisk pace, but if you're just starting out, it doesn't even have to be brisk.
00:28:51.279 --> 00:28:53.519
Just to get your joints moving, it's good for your back.
00:28:53.680 --> 00:28:55.759
It gets your heart rate up a little bit.
00:28:56.000 --> 00:28:58.720
I personally like to integrate it into my day.
00:28:58.960 --> 00:29:03.599
So I have time, I'm lucky I see patients in the morning and then I have a gap, and then I do afternoon.
00:29:03.759 --> 00:29:15.920
So I do a 30-minute walk at lunch, and I'm blessed to be in San Francisco where I have some parks nearby, I can just take a walk in the city, I can put my headphones in, I can listen to a book or music, make a phone call, and I can just walk.
00:29:16.079 --> 00:29:17.359
And it's built into my day.
00:29:17.440 --> 00:29:20.799
So I don't have to like do it after work, you know.
00:29:21.039 --> 00:29:27.839
If you can walk after meal, maybe you with your family, maybe with your spouse, you know, eat dinner and then say, let's go for a quick 15, 20 minute walk.
00:29:27.920 --> 00:29:29.599
It doesn't have to be some strenuous thing.
00:29:29.759 --> 00:29:31.599
That's a really, really good place to start.
00:29:31.839 --> 00:29:37.920
The other place where I start with people is to figure out this week might be different than next week or the week after.
00:29:38.079 --> 00:29:40.640
Let's say this week, what is your availability?
00:29:40.799 --> 00:29:42.960
What is your budget for exercise this week?
00:29:43.119 --> 00:29:44.160
What does your Monday look like?
00:29:44.319 --> 00:29:45.359
What does your Tuesday look like?
00:29:45.519 --> 00:29:46.640
What does your Wednesday look like?
00:29:46.799 --> 00:29:49.920
It doesn't have to be every single day, but okay, we got some time on Tuesday.
00:29:50.079 --> 00:29:53.599
You got 30 minutes before work, or you got an hour after work or whatever.
00:29:53.839 --> 00:29:56.000
Let's pencil that in in the calendar.
00:29:56.079 --> 00:29:59.200
I think for a lot of people, they're like, I'm gonna exercise tomorrow.
00:29:59.359 --> 00:30:04.000
And they don't put it on their calendar, whether it's their mental calendar, it's their actual Google calendar.
00:30:04.079 --> 00:30:09.519
I think you have to put it and say, at 7 a.m., I'm going to exercise.
00:30:09.759 --> 00:30:12.640
Not I will exercise at some vague time of the day.
00:30:12.799 --> 00:30:14.079
It has to be specific.
00:30:14.319 --> 00:30:16.880
And it might change from week to week, and that's okay.
00:30:17.039 --> 00:30:19.519
This week you might be traveling, so you're gonna do less, you know?
00:30:19.599 --> 00:30:20.240
So okay, great.
00:30:20.319 --> 00:30:21.359
We only have two hours this week.
00:30:21.519 --> 00:30:23.759
Let's figure out how we're gonna best use those two hours.
00:30:24.240 --> 00:30:26.960
Next week we might have three hours, and we'll figure out how we can do that.
00:30:27.200 --> 00:30:32.640
I would also say to people, now you're coming to me and you're saying, okay, fine, I have two hours, I have three hours.
00:30:32.880 --> 00:30:34.720
Now I enjoy a variety of things.
00:30:34.880 --> 00:30:37.839
Now you tell me what's the best way for me to spend those two hours?
00:30:38.000 --> 00:30:38.559
Let's just say.
00:30:38.720 --> 00:30:44.559
Now there's somebody who's maybe they're one of the medical students, maybe there's somebody who's already a little bit physically active.
00:30:44.720 --> 00:30:50.000
Then I would say half your time should be doing cardio, and half of your time should be strength training.
00:30:50.160 --> 00:30:50.720
That'd be the best.
00:30:50.880 --> 00:30:52.720
So if you have two hours, do one hour of cardio.
00:30:52.799 --> 00:30:55.119
Maybe you split that into two 30-minute sessions.
00:30:55.279 --> 00:30:56.880
This is, by the way, per week, let's say.
00:30:56.960 --> 00:30:58.079
So you have two hours this week.
00:30:58.160 --> 00:30:59.359
You're gonna give me two hours this week.
00:30:59.519 --> 00:30:59.680
Great.
00:30:59.759 --> 00:31:04.400
Well, do one hour of cardio, 30 and 30, and then give me one hour of strength training.
00:31:04.480 --> 00:31:06.240
Also, maybe split 30-30.
00:31:06.400 --> 00:31:07.039
So there we go.
00:31:07.119 --> 00:31:10.960
We've got now two workouts of strength, two workouts with cardio.
00:31:11.200 --> 00:31:12.720
That's our two hours for this week.
00:31:12.960 --> 00:31:14.400
If you want to do three hours, great.
00:31:14.480 --> 00:31:16.079
Let's talk about how to split the three hours.
00:31:16.160 --> 00:31:17.839
We can do more with that, obviously.
00:31:18.079 --> 00:31:26.880
I would say that then when we look at strength training, if you only have two sessions per week to do that, try to do something then as a full body workout.
00:31:27.119 --> 00:31:34.960
Because at that point, if you're just doing upper body one day and lower body the other day and you're only doing it two days a week, you're not gonna target that muscle group frequently enough.
00:31:35.119 --> 00:31:40.480
So if you're doing two workouts a week, you can do full body workout twice a week, 30 minutes, right?
00:31:40.559 --> 00:31:44.960
And that could be body weights, that could be resistance bands, that could be dumbbells.
00:31:45.119 --> 00:31:47.359
You have a whole spectrum of things you can do.
00:31:47.599 --> 00:31:55.759
Once you start getting into like three strength trainings a week or four strength trainings a week, then you can start doing things like splitting it up upper body, lower body, or deciding how you want to do.
00:31:56.000 --> 00:32:02.319
When it comes to cardio, there's a lot of talk about zone two and then high intensity.
00:32:02.400 --> 00:32:04.400
So I'll take a moment to talk about that.
00:32:04.720 --> 00:32:07.440
We talked about the hype around VO2 Max.
00:32:07.599 --> 00:32:10.400
And again, it is a metric of cardiorespiratory fitness.
00:32:10.480 --> 00:32:11.759
It is not the only one.
00:32:12.000 --> 00:32:15.279
Similarly, there's a lot of buzz about zone two.
00:32:15.759 --> 00:32:20.240
Zone two for the audience is low-intensity exercise.
00:32:20.480 --> 00:32:26.799
The simplest way to think about it is you can maintain a conversation with a person, but it takes a little bit of effort.
00:32:26.880 --> 00:32:33.920
The person on the phone, if you're talking to them on the phone while you're doing zone two, like my lunchtime walk, let's say, the person on the other end is like, oh, are you are you walking?
00:32:34.079 --> 00:32:34.960
Are you are you doing something?
00:32:35.039 --> 00:32:35.599
I can tell.
00:32:35.759 --> 00:32:35.920
Right?
00:32:36.079 --> 00:32:38.480
If it's if they can't tell, then you're probably in zone one.
00:32:38.559 --> 00:32:42.799
And if you're huffing and puffing and you can't complete your sentence, then you're higher than zone two.
00:32:42.960 --> 00:32:44.799
You're maybe zone three or zone four, right?
00:32:44.960 --> 00:32:49.839
So it's low intensity exercise, and there's a lot of buzz around do zone two, do zone two.
00:32:50.000 --> 00:32:53.039
It's very good for your mitochondria, it's very good for your VO2 max.
00:32:53.279 --> 00:32:58.559
There was a paper published last year titled Much Ado About Zone Two.
00:32:58.799 --> 00:33:01.680
And what they looked at is what is the evidence behind zone two?
00:33:01.920 --> 00:33:12.400
And it turns out, again, social media influencers, the hype comes from zone two, is where elite endurance athletes spend a lot of their time training.
00:33:12.559 --> 00:33:21.200
So if you look at cyclists like Tour de France cyclists who have some of the highest cardio fitness in the world because they're doing just hours and hours of biking.
00:33:21.440 --> 00:33:27.279
When you look at their coaches and you look at what they how they spend their time, they spend 80% of their time doing zone two.
00:33:27.519 --> 00:33:28.720
It's low intensity.
00:33:28.880 --> 00:33:29.680
It's impressive.
00:33:29.920 --> 00:33:30.799
You would not think that.
00:33:30.880 --> 00:33:34.799
You would not think that somebody like Lance Armstrong is doing most of his training in zone two.
00:33:35.039 --> 00:33:35.599
Here's why.
00:33:35.839 --> 00:33:38.960
A guy like that might train 30, 40 hours a week.
00:33:39.119 --> 00:33:39.440
Okay.
00:33:39.759 --> 00:33:41.759
You cannot train high intensity.
00:33:41.920 --> 00:33:45.920
Your body cannot train at that high intensity for 30 or 40 hours a week.
00:33:46.079 --> 00:33:48.240
So that's why they dial down the intensity.
00:33:48.319 --> 00:33:52.960
They do low intensity for 80% of the time, and then they do high intensity 20% of the time.
00:33:53.119 --> 00:33:57.680
And then we see their elite levels of cardio fitness, their VO2 max is just through the roof.
00:33:57.920 --> 00:34:04.640
You can't then extrapolate, is it the zone two that produced that, or is it the 20% of high intensity that they did?
00:34:04.799 --> 00:34:11.920
Because let's be honest, the 20% of their time that they're doing high intensity is probably more than you and I are doing total exercise for the whole week, right?
00:34:12.079 --> 00:34:16.320
They might do five hours of high intensity a week, 10 hours of high intensity a week.
00:34:16.480 --> 00:34:17.840
You and I are not doing that.
00:34:18.159 --> 00:34:31.280
So for those of us mortals, we're not elite cyclists, and you say, okay, now you've told me I need to spend 50% of my time doing strengths training and 50% of my time doing cardio, how do I spend that 50% of cardio?
00:34:31.440 --> 00:34:34.159
Do I do zone two or do I do high intensity?
00:34:34.320 --> 00:34:34.480
Right.
00:34:34.639 --> 00:34:53.920
And we don't fully know, but what we do have a lot of research showing is that high-intensity interval training has a lot of health benefits, does improve VO2 max or does improve cardiorespiratory fitness, and you get a lot of bang for your buck because you're spending less time.
00:34:54.159 --> 00:35:00.320
So if you only had 30 minutes to do a cardio workout, I would say spend it doing higher intensity.
00:35:00.480 --> 00:35:08.000
Again, these are now people who are coming to me saying, I'm already somewhat fit, I'm already active, I want to like optimize my time, right?
00:35:08.159 --> 00:35:12.320
So if you're in that category of like, look, I'm sedentary, I just want to walk, beautiful.
00:35:12.480 --> 00:35:13.519
That's what you should do.
00:35:13.679 --> 00:35:17.039
But now if you're in this sort of category of like, huh, I want to do more.
00:35:17.199 --> 00:35:21.440
I want to take it to the next level, but I'm still limited on time.
00:35:21.679 --> 00:35:24.960
I always spend that time doing high-intensity interval training.
00:35:25.119 --> 00:35:28.320
And you know, there's a simple thing that you can do when you do your walks.
00:35:28.639 --> 00:35:38.239
Simple way to a beginner's way to do it is in Japan, they have this method of Japanese, they call it Japanese walking, where you will walk fast for one minute and walk slow for one minute.
00:35:38.400 --> 00:35:39.840
Or walk normal for one minute.
00:35:40.400 --> 00:35:41.760
Do it do several rounds of that.
00:35:41.920 --> 00:35:46.719
Start with that, then walk fast for two minutes, then walk normal for two minutes.
00:35:47.039 --> 00:35:50.480
As weeks and months go by, you get more and more adjusted to that.
00:35:50.719 --> 00:35:54.480
Then you can start jogging for two minutes, walking for two minutes.
00:35:54.639 --> 00:35:58.480
Then you can start running for two minutes, walking for two minutes, you know.
00:35:58.719 --> 00:36:05.360
And ultimately you want to get yourself up to maybe three or four minutes of high intensity and three or four minutes of lower intensity.
00:36:05.440 --> 00:36:06.400
You know, that's that's your goal.
00:36:06.480 --> 00:36:09.039
Maybe it'll take you six months or a year to get there, you know.
00:36:09.199 --> 00:36:11.840
But you can do that once per week.
00:36:12.079 --> 00:36:23.360
High intensity for mortals like you and me, normal people who are busy, who have families, who have jobs, one workout per week of high intensity is enough to move the needle.
00:36:23.519 --> 00:36:37.599
So my sort of way of what I do is Friday mornings, I go to the high school near my house and there's a track, and I will do one lap, you know, relatively fast and one lap normal.
00:36:37.840 --> 00:36:42.239
One lap fast, one lap so, and then I've worked myself up to two laps fast, two laps.
00:36:42.800 --> 00:36:43.920
I do that once a week.
00:36:44.159 --> 00:36:45.920
I'm breathless at the end of it.
00:36:46.159 --> 00:36:50.559
I feel definitely like wow, that was unpleasant at times, but it's once a week.
00:36:50.639 --> 00:36:53.039
I feel pretty pumped up the rest of the day.
00:36:53.199 --> 00:36:56.239
And I know that I've checked it off and it's once a week, I'm happy with it.
00:36:56.480 --> 00:36:57.679
Yeah, amazing.
00:36:57.920 --> 00:37:00.480
This was phenomenal in terms of the breakdown.
00:37:00.639 --> 00:37:07.039
You know, you reminded me, it was a couple of weeks ago, we had a physician, a pediatrician who's a marathon coach.
00:37:07.280 --> 00:37:09.840
And um, she was uh interviewing on the podcast.
00:37:09.920 --> 00:37:11.519
It's already been released, Dr.
00:37:11.679 --> 00:37:12.320
Michelle.
00:37:13.039 --> 00:37:28.400
And uh, she gave us the mailbox technique, just the way you describe the Japanese technique, was um, I asked her that convinced me to run because I do not like to run, but I can power walk, or you know, walking is like one of my favorite ones other than strength training.
00:37:28.480 --> 00:37:29.760
So she said, How about this?
00:37:29.920 --> 00:37:32.480
I have a technique called mailbox technique.
00:37:32.719 --> 00:37:48.000
And she says, if you're living in a neighborhood where each house or each home has a mailbox, so just from mailbox to mailbox, jog, walk, jog, walk, or then you do two alternate or two mail mailboxes at the same time in terms of jogging and walking.
00:37:48.159 --> 00:37:56.480
Anything that could distract your mind, but knows that okay, I just have that endpoint to run or to jog, and then I will be walking.
00:37:56.800 --> 00:37:57.760
She's inspired me.
00:37:57.840 --> 00:37:59.440
I've been trying to do that.
00:37:59.920 --> 00:38:05.599
So every time, trust me, I I learned so much from our um from our physician experts.
00:38:05.760 --> 00:38:20.400
So thank you for sharing and breaking it down uh for someone who's starting versus someone really wants to up level their uh fitness game and you know, about the HIT training and how we could divide it into the number of hours in a week.
00:38:20.639 --> 00:38:21.840
Beautifully said.
00:38:22.159 --> 00:38:33.920
I really want you to cover this specific correlation also, because that's very commonly discussed in our exam rooms with our patients is insulin sensitivity.
00:38:34.239 --> 00:38:43.840
Like how transformative and how profound the changes in terms of improving insulin sensitivity or reducing insulin resistance.
00:38:44.000 --> 00:38:50.639
And this is again specifically geared towards either exercise or you know, strength training, but anything that's involving our muscles.
00:38:50.960 --> 00:39:01.679
So, can you share anything in regards to this specific metabolic aspect, insulin sensitivity, and how exercise is contributing towards improving it?
00:39:02.079 --> 00:39:08.559
Yeah, as you probably know, your listeners probably know, insulin resistance is one of your biggest enemies to longevity, right?
00:39:08.639 --> 00:39:12.000
So if there's one thing you want to avoid is insulin resistance.
00:39:12.320 --> 00:39:17.199
And there's a couple great things that happen with exercise that help you in the insulin department.
00:39:17.360 --> 00:39:22.320
First of all, when we eat carbohydrates, our body then has to process that, right?
00:39:22.400 --> 00:39:26.320
Like that glucose is gonna enter into our bloodstream, and then we're gonna have to do something about it.
00:39:26.559 --> 00:39:30.079
The body's the pancreas is naturally gonna respond by making insulin.
00:39:30.320 --> 00:39:38.960
But there's another way, it turns out, insulin-independent way to get the glucose out of your bloodstream, which is to get the glucose into your muscles.
00:39:39.199 --> 00:39:43.920
And you don't need insulin to do that because the muscles have something called a glute transporter.
00:39:44.320 --> 00:39:53.440
And when you activate your muscles, when you go for a walk after a meal, your muscles suck up the glucose without your pancreas having to make tons of insulin.
00:39:53.599 --> 00:40:00.960
So you're gonna lower your blood sugar, you're gonna give your pancreas a little bit of a rest by exercising after a meal.
00:40:01.199 --> 00:40:07.280
So, exercising after a meal, great way if you if you wear a CGM, then you can sort of see this happening in real time.
00:40:07.440 --> 00:40:13.280
And ideally, that walk is performed very quickly after you have the meal, not like an hour later.
00:40:13.599 --> 00:40:20.400
The second way that exercise is gonna help you handle your carbohydrates and manage your insulin is that when you build muscle.
00:40:20.559 --> 00:40:22.480
So this is where the strength training comes in, right?
00:40:22.639 --> 00:40:28.719
So it turns out that on the rapid fire, you had asked about is muscle like one of the most important organs for metabolic health?
00:40:28.960 --> 00:40:34.000
And that again, it goes back to the reason is if you have muscle is very metabolically active tissue.
00:40:34.159 --> 00:40:39.519
It's our most metabolically active tissue, and it's where we store a lot of our glucose, right?
00:40:40.000 --> 00:40:48.880
So building up muscle is gonna be a way for your body to handle the carbs that you're eating, and it's gonna be a way for you to store that glucose so you don't have to store it as fat.
00:40:49.360 --> 00:40:57.199
So both with resistance training and with sort of walking and light exercise, you're gonna help on the insulin sensitivity parameter.
00:40:57.599 --> 00:40:58.239
Beautiful.
00:40:58.480 --> 00:40:59.360
Thank you.
00:40:59.599 --> 00:41:07.039
You know, with uh being in the endocrinology world and the the type 2 and type 1 diabetes, it reminds me again.
00:41:07.280 --> 00:41:10.400
It feels like you're living in our office right now.
00:41:10.639 --> 00:41:11.599
The correlation.
00:41:11.760 --> 00:41:18.159
But my last patient yesterday was a young, 25-year-old guy with type 1 diabetes.
00:41:18.239 --> 00:41:22.239
And, you know, they wear uh the CGM along with their insulin pumps.
00:41:22.559 --> 00:41:28.159
Ben insulin pump is a continuous insulin delivery device where they have more control on it.
00:41:28.239 --> 00:41:35.039
It's it's a better way of correlating the physiological delivery of insulin as compared to just injections.
00:41:35.280 --> 00:41:44.559
So, anyways, he's been working out since he's you know structured his new work schedule and really built a lot of 10 pounds of muscle since the last time I saw him.
00:41:44.719 --> 00:41:47.599
So that was insane with the body composition.
00:41:47.760 --> 00:41:50.159
But and he's like, I'm doing perfectly fine.
00:41:50.239 --> 00:41:55.599
And you know, he came in for uh just a general body composition, which I have them do every six to eight weeks.
00:41:55.920 --> 00:41:57.920
Then I was like, you know, I'm looking at your CGM data.
00:41:58.000 --> 00:42:04.960
I know we were not supposed to, we were not planning to review it, but I'm seeing that every night there is a dip that the blood sugar is going low.
00:42:05.119 --> 00:42:06.559
Have you changed anything else?
00:42:06.800 --> 00:42:13.760
And he says, Well, I've been working out, but now my workouts are scheduled the latter half of the day because that's after work.
00:42:14.079 --> 00:42:16.800
And, you know, the insulin doses are the same.
00:42:16.880 --> 00:42:17.920
He hasn't adjusted.
00:42:18.000 --> 00:42:20.880
And even though insulin pump, they're more in the automated mode.
00:42:20.960 --> 00:42:25.199
They have algorithms where they're set to avoid a low blood sugar.
00:42:25.360 --> 00:42:35.840
His insulin sensitivity has improved uh dramatically because of the new exercises that he implemented in the last 10 days.
00:42:36.079 --> 00:42:37.760
In addition to what he was doing.
00:42:37.840 --> 00:42:45.920
So I had to back off on the insulin delivery, uh, the amount for all the days between like I think 10 p.m.
00:42:46.079 --> 00:42:47.599
to 6 a.m., right?
00:42:47.760 --> 00:42:54.400
And I was marveled and I said, let's take a look at you know what was happening a year ago with the the amount of insulin.
00:42:54.559 --> 00:42:59.679
So he's dropped his requirements by you know 15 or 17 units of insulin.
00:42:59.920 --> 00:43:14.159
They're the ones who need very limited insulin, they're leaner, type 1 diabetes, but with exercise, with building muscle over time, gradually, and you just mentioned that, you know, six months, one year, and then recent changes and what his workout plans were.
00:43:14.320 --> 00:43:15.920
But this these are real stories.
00:43:16.079 --> 00:43:22.159
So you're sharing your experience, you're sharing the education, you're giving us all these, you know, health bites.
00:43:22.480 --> 00:43:28.400
And they're actually when implementable, they bring about a change, they bring up bring about a transformation.
00:43:28.639 --> 00:43:39.119
So I wanted to tell the audience that maybe just tune in again, go back to the start of the episode and listen to it over and over again till you feel like you got it.
00:43:39.760 --> 00:43:40.000
Hmm.
00:43:40.239 --> 00:43:42.719
You know, I'll add to this is your world.
00:43:42.960 --> 00:43:58.960
I think that endocrinologists and primary care doctors are so focused on the glucose numbers being within the normal range and not focused on how much insulin somebody is injecting into their body or their pancreas is pr having to produce in order to keep that number.
00:43:59.199 --> 00:44:15.280
And so We don't fully appreciate in conventional medicine that pumping somebody with insulin, even though it drives the glucose down and prevents the complications of high blood sugars, there are downstream or adverse consequences of having too much insulin.
00:44:15.440 --> 00:44:28.320
So if you can reduce your insulin requirement, either a type 1 diabetic having to inject less as your patient, or your type 2 diabetic having to make less internally, anything you can do to lower your insulin requirements is going to be good for your body.
00:44:28.480 --> 00:44:30.480
It's good for your vascular system, right?
00:44:30.639 --> 00:44:36.480
And exercise is one of those ways to reduce your insulin requirements.
00:44:36.960 --> 00:44:38.400
Absolutely well said.
00:44:38.639 --> 00:44:39.119
Love it.
00:44:39.360 --> 00:44:47.679
So before we end the episode, would you be kind enough to give one more simple advice for our audience?
00:44:47.840 --> 00:44:59.840
Anyone in their 30s, 40s, 50s, 60s, whoever has decided that I want to improve my health, I am understanding what longevity or health span is now and how I could combine it.
00:45:00.000 --> 00:45:04.400
What would be that one simple piece of advice from you as uh Dr.
00:45:04.559 --> 00:45:07.280
Al-Rushaidi, the longevity specialist?
00:45:07.599 --> 00:45:08.159
Yeah.
00:45:08.480 --> 00:45:14.239
I would say know your fitness level, know your number and track it over time.
00:45:14.719 --> 00:45:17.360
And we, you know, you should know your blood pressure.
00:45:17.519 --> 00:45:25.360
You should know your fasting blood glucose, you should know your LDL cholesterol, and you and your doctor should know your fitness level.
00:45:25.519 --> 00:45:28.639
It's just, I think it's just, as we've established, it's just as important.
00:45:28.880 --> 00:45:31.920
And it turns out it's not super tricky to measure.
00:45:32.079 --> 00:45:37.679
So either you can go to the gym and do the Met treadmill chart and do it on your own.
00:45:37.840 --> 00:45:43.440
Or if you feel ambitious and you want to go into one of these specialized centers and wear the mask and get it, get the number.
00:45:43.519 --> 00:45:46.559
I'm a quantitative person, so I'd like to know what my number is.
00:45:46.639 --> 00:45:48.079
I'd like to know what your number is.
00:45:48.239 --> 00:45:59.440
And then do your exercise, whether it's you're walking between mailboxes to mailboxes, whether it's swimming, whether it's whatever it is, and then repeat that test so that you know, are you getting worse?
00:45:59.599 --> 00:46:00.320
Are you stable?
00:46:00.480 --> 00:46:01.360
Are you getting better?
00:46:01.519 --> 00:46:01.920
You know?
00:46:02.079 --> 00:46:07.119
And ideally, we're gonna try to be on that trajectory of improving ourselves and increasing our.
00:46:07.519 --> 00:46:19.280
We know that for every one increase in MET, so MET being a metric of cardio risk per fitness, for every increase in MET, we see a corresponding decrease in mortality, you know, a meaningful decrease in mortality.
00:46:19.360 --> 00:46:26.079
So even if you're at the lowest fitness level and you just go a little bit higher, you're gonna see a big drop in your risk of diseases.
00:46:26.239 --> 00:46:28.320
It's not like you don't need to go to elite.
00:46:28.559 --> 00:46:31.039
You just need to be a little better than where you are now.
00:46:31.440 --> 00:46:32.320
Absolutely.
00:46:32.559 --> 00:46:33.360
So true.
00:46:33.599 --> 00:46:41.440
I'm following your advice day in and day out with uh with the body composition, with the with the exercise.
00:46:41.679 --> 00:46:48.480
And uh it happened, I would say, at age 35, where I really got into okay, and now I'm 45.
00:46:48.800 --> 00:46:50.960
So the goal is to gain more muscle.
00:46:51.119 --> 00:46:57.360
And uh I appreciate you uh enlightening us even more in terms of uh breaking it down further.
00:46:57.519 --> 00:46:58.480
Thank you so much, Dr.
00:46:58.639 --> 00:46:58.800
Ali.
00:46:59.599 --> 00:47:00.239
Oh, thank you.
00:47:00.480 --> 00:47:01.679
Good to be with you.
00:47:02.480 --> 00:47:05.199
Thanks for hanging out with me on hormones and hope.
00:47:05.360 --> 00:47:13.360
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00:47:13.599 --> 00:47:16.000
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00:47:16.159 --> 00:47:18.960
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00:47:19.119 --> 00:47:23.039
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00:47:23.280 --> 00:47:29.039
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