Live Long and Well with Dr. Bobby

Heart disease is the number one cause of death in the US; we understand the risk factors for it, and there are 7 key steps you can take to reduce that risk. Here is a risk calculator that will give you your 10 year risk (and test how that might fall as key problems are addressed).
1. Treat the treatable causes like hypertension, high cholesterol, smoking, diabetes, and obesity.
2. Get exercise:  the most powerful way to reduce your cardiac risk based upon key studies. And more exercise leads to additional benefits.
3. Optimize your sleep.  Studies show benefit from getting 7-8 hours/night, and having sleep regularity (similar sleep times each night).
4. Think about your nutrition. weight control impacts risk of diabetes and risk of heart disease.  The story on type of fats is complex with no differences shown in studies of low vs. high fat diets. 
5. Add some mind-body work to your life.  Although there are no long term studies demonstrating that yoga/breath work/meditation lowers mortality, short term studies show that yoga reduces blood pressure (an important cardiac risk factor)
6. Consider taking a sauna:  studies are pretty clear that taking a sauna (perhaps 3x/week for 20' each time) is associated with lower cardiac risk of sudden death.
7. Build and maintain strong social relationships. Large differences in mortality between those with and without strong social relationships.

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It used to be when you got sick, you were advised to "take it easy".  But, does the evidence support this approach?  And, it isn't just an academic question since, on average, we get 2-4 colds/year and many of us will have an episode of low back pain.  And, how about COVID?  Rest or stay active?

1. Low back pain: a key randomized clinical trial showed that prolonged bed rest did not do better than usual activities.  Now we advise patients to continue activities.

2. Moderate exercise does not lessen (or worsen) cold symptoms.  But, exercise may reduce the number of colds you get.

3. Sauna use doesn't make the cold go away faster but may reduce the number of infections that you experience.

4. COVID-it appears that exercise may reduce the likelihood of fatigue, anxiety, brain fog if you do get long COVID.

5. Multiple Sclerosis-previously it was feared that exercise might worsen the disease.  Recent guidance is to be physically active.

Reach out to Dr. Bobby:  www.DrBobbyLiveLongandWell.com

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In this episode, we explore wearables and self-monitoring tools like step counters, sleep trackers, and continuous glucose monitors (CGMs). We'll dive into the science behind these devices and share how they can help you gain insights into your health, track progress, and personalize your wellness journey. We discuss the value of self-monitoring, backed by scientific studies, and how these tools can help motivate behavior change.

Key Topics:

1. Step counters (smart watches, FitBit)
   Studies have shown that this feedback helps increase amount walked, but only if you continue to use them.  
2. Home Blood Pressure Monitoring
   Using a home blood pressure monitor, I learned that my blood pressure is higher in the morning, helping me adjust my medication timing. A review of 52 studies found that home monitoring improves blood pressure management. However, it may only be effective if used consistently.
3. Sleep Trackers and Better Sleep
   Sleep trackers like the Oura Ring can help you monitor and improve sleep habits. Studies have shown that using devices like Fitbits, paired with sleep education, can improve sleep quality. Personally, I’ve found that tracking sleep has revealed important insights into how alcohol and consistent sleep schedules affect my sleep length/quality.
4. Continuous Glucose Monitors (CGMs)
   CGMs are not just for diabetics—many people use them to personalize diet and exercise. Studies show that CGMs improve glucose control when meal plans are personalized based on individual glucose responses. For example, I learned that pizza doesn’t spike my blood sugar much, but popcorn does.

N-of-1 Trials and Personalized Health
Wearables enable N-of-1 trials—personal experiments to find what works best for you. Whether it's testing the effects of sleep habits, exercise, or dietary changes, self-monitoring helps tailor interventions to your body’s needs, offering a personalized approach to health.

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Have you ever wondered why weight loss seems so elusive despite following strict diets and exercise routines? Obesity rates have skyrocketed, and we are eating more, likely due to 3 key factors:

• portion sizes are larger than ever before, often doubling what we ate 30 years ago
• the foods on our plate are more calorie dense than ever
• Foods we buy often have the perfect combination so that we crave them:  fats, carbohydrates/sugar, and salt (chips, pizza, ice cream)

My key thoughts on losing weight include:

• All diets can work, and ultimately no approach wins out over all of the others (e.g., keto, intermittent fasting, vegan, Mediterranean).  Ultimately, weight loss is about the number of calories consumed vs. burned.
• The new GLP-1 obesity drugs have taught us that eating too much is not just about will power--folks who struggled all their lives to lose weight, instantly feel more full and less hungry once starting them.  These drugs also help folks lose about 15% of their body weight

Evidence based strategies that might help you to lose weight

1. Be more aware of portion size and how many calorie dense and "craving" foods you eat (fat/carbs/salt).  For me, portion size has been the key.
2. Choose a diet that works for you.  And switch them up.
3. Give your brain time to adjust (20-30') before eating more.  That satiety lag is real and if you start with small portions and wait, you may feel full and satisfied.
4. Protein (and fat to a lesser extent) helps reduce our hunger.

Perhaps try an N of 1 study on yourself with some of the strategies above.

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Our bodies are 60% water and water  is really important.  But, It is not clear the origin of drinking  8 glasses of water per day. There were no studies that scientifically show that this number is the correct amount.  I vote that it is an "urban myth."  Good report summarizes important information about how our body uses water

But, water is crucial for us, just not that mythical amount.  Our body uses water in the following ways:

• urine to excrete byproducts of what we eat (perhaps 2-3 glasses of water per day needed)
• respiratory loss (perhaps 1 cup/day)
• "insensible loss"-sweating to maintain body temperature (wide range depending upon temperature--2 glasses of water/day up to 1 gallon or more)
• stool perhaps 1/2 cup of water per day

My take on the scientific evidence:

1.        The body is amazing at controlling our water balance.  Trust it!  There is no evidence based reason to focus on getting 8 glasses of water each day.  And, we get substantial fluids from our food/morning coffee/milk or sodas at meals...

2.        If you are thirsty, drink.  If your urine has gotten much darker, then perhaps drink.  Otherwise trust your body
3. these observations don't apply if you have kidney disease or are elderly.  Ask your doctor.

Tasty water "tidbits":  drinking extra water each day...

•  does not seem to make our skin look young and full (might hydrate it a little but not clear if it looks better)
• does not seem to affect our joints/cartilage (no evidence found here...)
• does not reduce dry eyes
• probably doesn't help us eat less 
• DOES reduce the risk of recurrent urinary tract infections

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• Approximately 40% of the risk for cognitive decline is preventable through lifestyle changes and proactive measures. 
• Nearly 7 million Americans are affected by Alzheimer's, with numbers expected to double in the coming decades. It's the sixth leading cause of death, costing the US around $800 billion annually.
• Not Inevitable: Cognitive decline is not an inevitable part of aging, as demonstrated by figures like Barbara Walters and Henry Kissinger, who remained mentally sharp well into their later years.

Part 2: Strategies That Work

1. Exercise: Regular physical activity is associated with a 28% reduction in the likelihood of Alzheimer's. Dancing, in particular, has shown benefits due to its combination of physical and mental engagement.
2. Sleep: Adequate sleep (around seven hours per night) is crucial, with poor sleep increasing the risk of Alzheimer's by 68%.
3. Smoking: Smoking cessation is critical, as smoking is linked to 5% of dementia cases.
4. Blood Pressure Control: Managing hypertension can greatly reduce the risk of cognitive decline
5. Obesity and Diabetes: Both conditions are associated with an increased risk of dementia.
6. Sauna Use: Regular sauna use correlates with a reduced risk of dementia, with benefits increasing with frequency of use and time/session.
7. Hearing Loss: Treating hearing loss may lower the risk of cognitive decline by maintaining cognitive stimulation.
8. Alcohol Consumption: Reducing alcohol intake can decrease the risk of cognitive impairment.
9. Social Engagement: Maintaining strong social connections is associated with a reduced risk of dementia.

Part 3: Strategies That Don't Work

• Omega-3 Supplements: No substantial evidence supports their role in preventing cognitive decline.
• Brain-Focused Diets: Diets like the MIND diet have not shown significant benefits in reducing cognitive decline in clinical trials.

Part 4: Unclear or Emerging Strategies

• Probiotics, Viagra, and Multivitamins may have benefits.
• Brain Training Games: While they may improve specific skills, there is limited evidence that they prevent general cognitive decline. Newer approaches have some promising results 

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We’re bombarded with advertisements for all sorts of tests these days: comprehensive blood panels for a few hundred dollars, total body MRI scans for cancer detection, heart calcium scans, and even tests to rule out multiple cancers. But are these tests worth it if you are asymptomatic and don’t have an important family history? 

A few years ago, I experienced fainting episodes while running. After a series of tests, including seeing a cardiologist, I was told that my blood pressure dropped upon standing—a condition that required no treatment, just caution. During these tests, they found that my heart was larger than usual. This discovery led to a lot of anxiety over the years, despite it likely being a false positive. This case illustrates how even with legitimate symptoms, testing can sometimes lead to more questions than answers.  And, large panels of tests compound the problem.

The Issues with Testing

It’s tempting to think that more testing is better, but the reality is that tests are imperfect. They’re often based on statistical averages, and results can be misleading. For example, if you undergo multiple tests, you’re likely to get some abnormal results just by chance. This can lead to further testing, expense, time, potential medical complications, and unnecessary worry.

Medical Expert Recommendations

Organizations like the US Preventive Services Task Force and the American College of Radiology provide guidance on screening tests. They recommend specific tests like pap smears, mammograms, and colonoscopies, but not routine total body MRIs or large blood panels. Even well-regarded screening tests can result in false positives, as shown by studies and practices in countries like South Korea.

Real-Life Examples

I’ve seen friends go through the stress of false positives from MRIs or calcium scores, leading to further tests and anxiety. It’s essential to weigh the potential impact of these findings on your life, including how they might affect insurance and your mental well-being.

Conclusion

To sum up, while early detection of health issues sounds appealing, the reality is that many screening tests can lead to false positives and unnecessary complications. If you’re asymptomatic and don’t have a concerning family history, it’s often best to save your money and avoid these tests. Always consult with your doctor to make informed decisions based on your specific health needs.

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Key Takeaways

1. Sit Less, Move More: The evidence is clear—reducing sitting time and increasing movement are crucial for health.
2. Exercise Isn't a Substitute for Moving: While exercise is beneficial, sitting has its own distinct risks that need addressing.
3. Practical Tips: Even small changes, like standing up regularly, can make a significant difference in your health.

Understanding Movement and Steps

Daily steps vary significantly by age, gender, and location. While the ideal number of steps isn't clear-cut, communities with higher step counts, like the Blue Zones, offer insights.

The Impact of Sitting

Ten years ago, Americans sat for perhaps 8 hours per day and that may be much higher post COVID.  Sitting time varies by country.  You can estimate your sitting time here.

Studies show that those who sit more have much higher mortality (34% higher in those who sit 10 hours/day vs. those sitting < 1 hour/day).  Although exercise has many benefits, it does not fully undue the harmful effects of prolonged sitting. Being sedentary also appears to raise cancer risk. 

Blood vessel changes have been shown after 2 hours of sitting.  We don't know the "safe" amount of sitting--my interpretation of the evidence suggests perhaps 10 hours raises the risk substantially, <3 may be ideal, and perhaps 6 hours/day may be a good target.  

Practical Strategies to Reduce Sitting

Studies have shown promising results with interventions like standing desks, fitness trackers, and gamified challenges to encourage movement. Even small changes in daily routines can lead to measurable health benefits.  And, exercise can reduce existing heart abnormalities.   Try to stand regularly (perhaps every 30'), have walking "meetings", or use a phone/watch app to remind you.

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Introduction

• Health Tips: Check out my Instagram for daily health tips (@DrBobbyLiveLongAndWell).
• If you can message me through my website, it allows me to respond to you.  The podcast comment function gets to me but I cannot respond to you.

Take-home Messages

• Enjoy the sun but protect your skin and eyes.
• The evidence on sun exposure's health effects is moderately clear, but leaves some questions unanswered.

Impact of Sun Exposure on Health

• Skin Aging:  Studies show that UV exposure accelerates skin aging, causing wrinkles and pigmentation changes.
• Skin Cancer: Types include basal cell carcinoma, squamous cell carcinoma, and melanoma (most severe).

Who's at Risk for Skin Cancer?

• Skin cancer is quite common 
• Fair-skinned individuals are most susceptible, as are Australians likely due to fair complexion and high UV exposure.

Evidence on Sun Exposure and Skin Cancer

• Studies show that childhood sunburns correlate with increased skin cancer risk later in life.
• The evidence is somewhat less clear about the risk of sun exposure later in life for the development of skin cancer.
• UV exposure from tanning beds also increases skin cancer risk significantly.

Challenges in Sun Protection

• Effectiveness of Sunscreens: Sunscreens reduce aging effects and reduce sun burns.  The evidence is not clearcut, but it appears that sun protection reduces the risk of melanoma, and likely other skin cancers as well.   
• The American Academy of Dermatology recommends the use of spf 30 or higher skin protection when outdoors.
• Behavioral Factors: People using sunscreen might stay longer in the sun, offsetting protective benefits and making the evidence less striking on reduction in skin cancer.  Men are less likely to use sunscreens.

Practical Sun Protection Tips

• Types of Sunscreen: SPF 30 or higher recommended; mineral and chemical options available. The best sunscreen is the one that you will use regularly.
• Application: Apply generously and reapply every couple of hours, especially in sunny and sweaty conditions.
• Clothing and Accessories: Long sleeves, hats, and UV-protective sunglasses are effective approaches.

Protecting Your Eyes

• UV exposure increases the risk of cataracts and macular degeneration.
• Wear UV protective sun glasses

Conclusion
I protect myself with sun screen, clothing, and sun glasses.  I also see the dermatologist yearly.

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Take-Home Messages

·      Lifelong use of supplements to prevent an illness is very different from taking a supplement to treat a known deficiency or a specific symptom

·      The evidence does not support the use of most all supplements to prevent illness (with multi-vitamins being the exception where there is some evidence)

·      Supplements to treat a particular problem can be very helpful, especially if we do our N of 1 study in ourselves

Part One: Understanding Nutritional Supplements

• Various types of supplements:   Vitamins, Minerals, Herbals, Probiotics
• Most commonly used Supplements: Multivitamins, Omega-3s, Probiotics, Vitamin D, Calcium, Protein Powder, Psyllium
• We want to live long and well—taking a supplement may help us feel “agency” or that we are proactive in improving our health---even when the evidence does not support it.  

Part Two: the Supplement Industry Differs From Pharmaceuticals

• Licensed and prescribed drugs go through extensive testing/FDA oversight to demonstrate that they work and that they are safe
• Nutritional supplements are viewed as “food” and don’t have similar regulatory scrutiny
• Challenges: traditional drugs receive patents and can afford extensive clinical studies.  Nutritional supplements generally don’t have patents and can’t afford to conduct extensive research.  For this reason, most supplements have very little scientific evidence to support their benefits, even though their claims may suggest otherwise
• Real-Life Example: Critical Evaluation of Broccoli Sprout extract Study

Part Three: Evidence (mostly lacking) for Common Supplements

• Omega-3s: studies don’t show a reduction in heart disease or cardiac death; they may have a role for high blood triglycerides or for patients with rheumatoid arthritis (pain control) 
• Vitamins and Minerals: Minimal Impact on Disease Prevention except for a daily multi-vitamin which has supportive evidence that they may reduce cancer and cognitive decline
• Cognitive function: omega 3s and the MIND diet aren’t effective at slowing decline.
• Supplements for specific deficiencies or specific symptoms can be very helpful.  You can do your own “N of 1 Study” to see if they help you. Step 1: identify the problem (bowel irregularity, sleep…);  Step 2: choose a supplement and begin taking it; Step 3: re-assess after a few weeks.  If it helps, great.  If not, then likely best to stop.

Dr. Bobby’s regimen: a daily multivitamin, colace (for bowel regularity), and recently started Creatine for muscle strength.  I don’t take omega 3s, vitamin D calcium, magnesium, or pro-biotics.

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