73: Healthier Living Starts with the Core Four

Scot: The podcast is called "Who Cares About Men's Health," giving you information and inspiration to better understand and engage in your health so you feel better today and in the future.

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

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

Mitch: And I'm Mitch, and I care about men's health.

Scot: What I want to do is do a Core Four Plus One More revisited. The concept is we started this thing about two years ago, 70-some episodes deep into it, and we started with this premise that we were trying to make health as simple as possible. So that's why we came up with the Core Four. If you watch these four things, then you're going to have a pretty good chance of being healthy now and in the future.

So activity, nutrition, sleep, and your emotional health, and then we also had the one more, which was genetics. And initially, I don't know if you guys remember this far back, but we also had nagging issues in there. And then we also talked about smoking, drinking, and other addictive habits. Of course, then it's no longer the Core Four, so those kind of things.

Troy: It'd become the Core 10.

Scot: I think initially when we were coming up with this, it was the Core Seven, but that didn't rhyme, so that's no good to anybody.

Troy: Core Four Plus Six More.

Scot: And it goes against the whole premise of we're going to make health and wellness . . .

Troy: Simple.

Scot: . . . simple. Right?

Troy: We're going to give you a really long list.

Scot: Here comes 28 things that you need to watch out for. We're going to just revisit the Core Four Plus One More. I thought it would be cool to talk about what we've learned over the past couple of years in almost 70-plus episodes, how we've integrated them in our lives, little tips that have been useful for us based on all the guests we've had on the show. And just talk about that a little bit in hopes that maybe we may have redefined this a little bit more. Hopefully we have. Hopefully we've matured.

Troy: Hopefully.

Scot: Hopefully our Core Four is starting to grow up and be a Core Four teenager.

Troy: Yeah, let's hope so.

Scot: So Troy and Mitch. Producer Mitch is here, and Dr. Troy Madsen is here, and I'm Scot. I'm just the guy that's not the doctor. I own the microphones and I'm just struggling like everybody else with my health. We have said before that this podcast focuses on the basic things, that Core Four that helps you now, and it's also an investment in your future. If you concentrate on these things, then you can prevent a lot of the illnesses and diseases that we know affect people as they get older.

We've also talked about the concept of health isn't an end to a means. It's a means to an end. It's what allows us to do the things we want, have energy throughout our day, be able to focus and concentrate, be able to move pain-free, have a good head space to engage with those that we love, and those sorts of things.

Troy, what is this podcast about for you? Those were some of the ideas that come to mind for me, but what is this podcast about for you?

Troy: I think the biggest thing this podcast is about for me, Scot, is just moving away from the idea of men's health being all about bulking up and sex drive and everything you read in "Men's Health" magazine, and more just getting to the essentials and recognizing . . . again, going back to the Core Four, just what a difference sleep can make, what a difference diet can make, exercise, mental health.

And for me, the biggest thing I think has been focusing on that simplicity, and not trying to complicate things with diet, not trying to complicate things with exercise, looking at consistency. And honestly, that seems to be a recurring theme with what we talk about and I think what our guests talk about as well.

Scot: Consistency over complicated. I like that.

Mitch, how about you? Do you want to jump in?

Mitch: Sure. The thing that this podcast was very much kind of a wake-up call for me . . . being I'm in my 30s now and things aren't quite working the way they used to and starting to care about things now. And not only that, really trying to figure out that . . . echoing what Troy says, it doesn't have to be all bulking and super complicated. It's finding out what health means to me, and what health means to me right now, and why it should be something that I value in my 30s, not when I'm in my 60s or 70s and dealing with some real complications and being able to really continue to live my life the way I want to.

Scot: I think over the past 70-plus episodes in two years, Troy, I like your notion and that Mitch echoed about it's not about being bulked up. It's not about being able to perform in extreme sports. It's not being able to be on the cover of "Men's Health" magazine or any men's health magazine. They were smart when they named that, didn't they?

Troy: They were.

Scot: I didn't even mean to call them out, but I just said what it was. That's not what it's about. It's about doing these things so you feel good. One of the things you've said before, Troy, is you run marathons, and you look out at the starting line and it's . . . one would think that everybody that's running a marathon looks like a runner, but they don't. Health is going to look different for everybody, right?

Troy: That's exactly it. And that's the great point. I think that's the point, is that you're healthy and you're in the best health you can be as a person while being yourself. You're not trying to fit some sort of image or some other model that someone has set up in terms of how they should do things or how they think you should do things.

It's more about, "This is what works for me, and this is how I feel good. This is what I enjoy doing." That's my image of health. It's not something that is trying to, again, like you said, be on the cover of "Men's Health" magazine or something like that.

Scot: Or even chasing this ideal that let's face it . . . we talked to a bodybuilder. I think we think that as men, we need to exercise and that's what we need to look like, but that takes a tremendous investment of time that then takes away from other things we want to do.

Part of the simplicity and the consistency is just realizing number one on the Core Four for activity is . . . it's just get out and sweat for 30 minutes a day. Get out and do something for 30 minutes a day. It doesn't have to be go and lift weights at the gym. It could be go outside and chase your dog, which is what I've been doing a lot lately. If you do like going to the gym, that's a cool thing, too. It could be going for a run.

Any thoughts on activity, how you're incorporating activity into your life? Mitch, let's go to you.

Mitch: It was last year finding out that . . . trying to do the 5K. Just little bits of activity, doing it slow and finding what I enjoy doing, because a lot of the times I've tried to run or workout or anything really . . . before, I tried to push myself so hard. I try to model it off of what "fit guys" were doing. It wasn't a personal thing, but now I go out running and I put on a murder podcast. I just love to run to murder podcasts for reasons I cannot explain, but it's . . .

Troy: I love it.

Mitch: I'm working with my physical therapist and everything. They're like, "Oh, yeah, do a metronome, and whatever music pumps you up." And I'm like, "I don't listen to music. I just listen to these podcasts and run." It's a nice break.

Finding out that activity is for me, what my activity is. It's not what other people say I need to be doing. Just what gets my heart rate up and what gives me a break and something I really enjoy in the day. It's a completely different paradigm than what I was doing before.

Scot: Yeah. It's because it's activity. It's moving. I think of now when I go out in the fall and I rake the leaves, I could build up a little bit of sweat, right? If you go after it, that's activity.

Troy: Listen to you just living the Matthew McConaughey role.

Scot: Well, you've got to remember, Troy, you're the one that brought that saying to us, that you had heard Matthew McConaughey say, "Just get out and sweat a few times."

Troy: "Just work up a sweat every day." That's right.

Scot: "Just work up a sweat every day. That's what I try to do." I don't know if that's Matthew McConaughey or not.

Troy: That is.

Scot: Troy, what's activity to you? Of course, we know that you take it a step further. But what I love is I don't think Mitch is trying to live up to your standard. You can admire Troy's standard. I don't want to speak for you, Mitch. Maybe you are. Maybe you do want to run marathons, but . . . Troy, activity, what does it mean to you?

Troy: The biggest thing I think is consistency. Scot, it's interesting. I actually tracked down . . . we've talked about our health journeys before and the point I'm going to try and make by saying this is that even small, consistent effort makes a difference. I tracked down my numbers because we've always talked like, "Oh, my LDL was bad. My HDL was bad."

Scot: Your cholesterol rating.

Troy: Exactly.

Scot: It was stressful. It was a source of stress for you.

Troy: Oh, it definitely was. I finally tracked down some numbers. I can't find my original numbers way back in 2007, but I found them from 2014. And at this point they had improved a bit. In 2014, my LDL was 121. Ideally, it should be less than 100. Definitely less than 120, so I was definitely on the high side. HDL, the good cholesterol, was 36. It should be higher than 40, somewhere between 40 and 60. It was at 36, so neither of those was very good.

And at this point, I considered myself active. I was eating a vegetarian diet, granted not an ideal diet. And that's when I said, "I'm just going to start to run two miles a day." That was it. Two miles a day, every day. That's all I did. Four months later after I started doing that, my LDL had gone from 121 down to 103.

Scot: Wow.

Troy: And the HDL had improved from 36 to 41. That was just doing two miles a day, just every day. I said, "I'm just going to do this. See what happens."

I think that's the bigger point we're trying to make. It's not like some Herculean effort. It's just consistency, and when you'd have that consistency, you see the difference. And that's really what activity is for me, just finding what you like, just do it consistently, do it because you enjoy it, not because, if you're running, you're trying to qualify for the Boston marathon or something like that. Just do it because you enjoy the process, you enjoy how you feel when you're doing it, and just stay consistent with it.

And definitely pick something you can be consistent with. If you don't like it, you can't continue to do it. If it's running, if it's biking, working in the yard, walking your dog, whatever it is, just do it, stick with it, and you'll see results.

Scot: All right. Number two on the Core Four . . . and by the way, I feel that activity for me is the cornerstone. If I can get my activity in line, then my nutrition will fall into line. If I'm not necessarily eating the healthiest, if I'm making poor choices, that will start to self-correct if I'm consistent with my activity. That helps my sleep, and I definitely know that that helps my mental health as well.

How about you? What's your order on these, Troy? What would your priority be? This is just our own personal experience. There's no science behind what we're talking about in this particular aspect of it.

Troy: I agree with you. I think for me so much flows from activity. I find when I'm active, I sleep better at night, my mental health improves, I eat better, and I just feel more motivated in general. I agree. I think that's the cornerstone.

Scot: How about you, Mitch? What order would you put those in?

Mitch: Well, I'm turning over a new leaf here actually. Last year, I started to work with a mental health specialist to deal with some of these little nagging things. And to be honest, after working with them for a little bit, it was . . . similar to some of the interviews that we've had with mental health specialists before, it unclogged the drain of my brain. All of a sudden, I'm able to run in the mornings. All of a sudden, I'm sleeping better.

And for me, at least it started . . . I was pushing it really hard last year, but with how stressful the year had gotten and stuff, it was the mental health. As soon as I'd gotten back working on it . . . it's a process, etc., but once that got out of the way, the other three seem like they're coming easier.

Scot: Yeah, and if you go back through some of our older episodes, our library, a catalog, I don't know what we call it, but we've had a couple our experts talk about that aspect of it. Sometimes you've got to get the emotional health thing straightened out so you even feel like engaging in activity or caring about your nutrition or whatever. I love that you had a little bit of a different take on that.

Number three is sleep. I've been pretty good about sleep, so I didn't really have a lot to improve there. I think my hardest thing is activity sometimes, just getting that in. It's easy to sit at the desk and do whatever, but luckily I've been pretty good with sleep. Of course, you want to try to get seven to nine hours they say. There's a number that works for each individual. Try to have a consistent bedtime, try to have a consistent rise time if you're having a hard time falling asleep, which Troy ran into. How has sleep changed for you?

Troy: It's something I still struggle with and it's in large part just due to my schedule, where I have to work evenings and nights, and that just throws everything off. I come off a night shift and it's just . . . those are rough.

But the biggest thing I tried to do . . . I often think about Kelly Baron and talking with her and her recommendations for just routines prior to bedtime, trying to have that same routine. So now I just do it consistently. Every time I'm not working an evening shift, I don't have to stay up late, I'm not working a night shift, I try and have that same routine and that makes a difference. Again, it's a battle, but it's definitely a lot better than it was three years ago.

Scot: And what's that routine look like?

Troy: My routine at this point is at about 9:30 I start to wind down. I try to avoid any screen time then. Brush my teeth, get ready for bed, get the dogs ready, make sure they all go outside, everyone's ready, which is often a project at this house.

Ten o'clock, I will sit in bed and I will read a book. I don't look at my phone. I'm not reading on my phone, not reading news, nothing like that. I just have a book. I'm just sitting there reading a book. And then I try to have lights out by 10:30.

I just try and follow that same routine. Again, it's not always possible just based on my shift schedule, but when I'm not worried about work and I'm not at work, I'm trying to do that consistently and it seems to help.

Scot: And then get up at the same time consistently every day?

Troy: I try to, yeah. Again, sometimes if I'm coming off a night shift, I just need that little extra sleep, so I'm like, "I'll get up at 8:00."

She talked about having that consistent time block. So that time block for me is 10:30 p.m. until 7:00 a.m. That's an 8.5-hour block. Often, I'm awake before then at 6:30 a.m., but typically 10:30 p.m. to 7:00 a.m.

Scot: How about you, Mitch? Has sleep changed for you since the beginning of the podcast?

Mitch: I'm still working on it. I think of the Core Four, it's the one that I'm actually having the most . . . I think of the Core Four, it's the thing that I've been working the most at. I don't know. It's been one that hasn't really been fitting in quite yet.

Scot: Gotcha. Was there any advice that you've found useful? Or what challenges are you running into there?

Mitch: I don't necessarily wake up particularly rested and I guess that's really it. So I'm sleeping when I'm supposed to, I'm getting a deep sleep according to my Fitbit, which I know we're not supposed to trust or whatever, but I'm trying to keep . . . I'm having pretty good habits I feel. I feel my sleep hygiene is good, but I'm still not feeling great. I think I need to see someone, but . . .

Scot: I wonder if you're just one of those people that's a . . . you're just a night owl.

Mitch: I might actually be. I've been staying up later recently and feeling a lot better about it.

Troy: You do what you've got to do.

Scot: That's a challenging one, right? The sleep. Our whole society and culture is built around to work at 8:00 or 9:00, you quit at 5:00. Of course, Troy does weird shifts in the ER. But there's evidence out there . . . and maybe we should talk about this and have a guest on about it. There's evidence out there that shows that some people just naturally are more night people than day people.

Mitch: I think of our producer Chloe.

Scot: Yeah, sure.

Mitch: She works in the middle of the night.

Troy: Oh, wow.

Scot: Yeah, one of our co-workers, she works late at night and just seems to function better that way. There's also a lot of good evidence for younger students, if you shift their start time just by an hour, hour and a half for school, how it can just really change their school performance. So sleep, that's an interesting one. We should focus on that a little bit more, I guess.

Finally, emotional health or mental health, has anybody's opinion on that changed? Troy?

Troy: Talk about a year when you've really had to just struggle with emotional health. It's been a hard year for me. I'll be honest. This was a hard year. It was interesting to reach March 13th because I remember that date so clearly. It was Friday the 13th. I had a night shift. This was a day after everything just hit the fan, and everything shut down and all sports shut down, which was devastating for me personally. I had a night shift that night, Friday the 13th, and I was just like, "I don't know how I'm going to do this." We've got this pandemic here. This is real now. We had all these changes coming about.

Yeah, it's been a challenging year in terms of mental health. It's been a great year to have a lot of wonderful guests on who have talked to us about mental health and about reaching out and talking to others about issues you're facing, and about trying to incorporate different things into your routine to certainly help your mental health.

I guess the biggest takeaway for me from so many of these things was being present, focusing on the moment, not worrying so much about tomorrow or a week from now or a month from now, which again was very challenging in the middle of the pandemic and continues to be a bit of a challenge, but being more present.

I think mindfulness certainly . . . I worry that term is becoming a little bit more cliché. Mindfulness and everything else incorporated with it, and grit, and whatever else you want to talk about. But I do try and incorporate that more when I'm running and being more present and I guess focusing more on mindfulness and really appreciating the moment. That's probably been my biggest take, but talk about a challenging year for mental health.

Scot: I also find a lot of joy, too, when I run of trying to just be in the moment instead of my head and just experience what my body's doing at that particular time. I like that. I like feeling the breathing pattern or I like feeling how my feet are hitting the ground, or I like personally . . . Mitch, you said you didn't like to do this. I like to run to music that . . . there's an app out there that will do a certain beats per minute. I like that rhythmic part of running personally. That's one way to be mindful, I guess.

I think consistency and structure was the thing that I took away, and I believe it was Dr. Chan talked about this when we first came into this whole pandemic. All of our structures and the way we did things radically changed. That can be really emotionally and mentally draining because now you've got to think about everything you do.

And I struggle. I still struggle getting that consistency and structure. I think going into work at a physical place, which I'm still not doing, I think having the routine of eating lunch, talking to some coworkers around noon, having those break times is important to me and I haven't been able to figure that out. But I do know I do better with consistency and structure.

How about you, Mitch? You had mentioned emotional health was what got you back on the path. Did you want to expand on that for the Core Four?

Mitch: Absolutely. The thing that this podcast and listening to our guests and just talking with other guys about health, as dumb as that sounds, just talking about it. For a long, long time, I've held this very toxic, typically masculine thought towards mental health, where it's like, "Well, if you go to a therapist, it means you weren't able to be strong."

Scot: "Pull yourself up by your bootstraps. What's your problem?"

Mitch: "You failed. You're weak," whatever. And I think just by talking to some of these people, some of the guests that we've had on and just to be like, "That's a dumb idea." You're not weak to go and talk to a professional about what you're struggling with. You're not weak if you are having trouble, to go and seek help for it. We always talk about if you broke your arm, you're not going to be like, "I can do this on my own." You go to a doctor. You don't try to pop it in yourself.

Troy: What are you talking about, Mitch?

Mitch: That was a big revelation for me. And so when last year got really tough, I reached out and I found some help, and I'm not ashamed to do that. The same sort of thing too is that your health, your treatment, your therapy is your own way. I've gone through a couple of different specialists. I haven't found my forever therapist as they call it.

Scot: I didn't know there was such a thing.

Mitch: It's like dating, really. You have this awkward . . . and it's all over Zoom too. You have these awkward one-on-ones and then you find out you don't really mesh, blah, blah, blah.

But the moral of the story is that when I first started doing mental health, I was so sure that it was going to be me on a couch, over Zoom, talking about my mom or something. Something like that. But no, the guys that they paired me with so far, the men that I've spoken with, the professionals I've spoken with, they're like, "Here's the research. You seem like a guy who needs research. You need backed whatever." And that's true. I need to know this is backed by stats. I need to know this is backed by whatever. I need to know this isn't woo-woo. That's for me. I need to know this isn't strict buzzword after buzzword.

And so getting rid of that idea of mental health being a weakness, seeking help being a weakness, and then number two, finding out I don't have to do it like every other person or every other thing I've seen on TV, I can do it my own way with my own person that I find, that's very empowering and it's really led to an entire difference in my approach to my mental health.

Scot: I agree with you about the stats thing. I think for me I like to know why things are happening. I like to know that there's a real legitimate reason why things are happening, so I love it when it's explained to me, "Well, this is going on in your brain and this is why that's happening. It is what it is." Once you can name it and once you understand why it's happening and what it's doing, it's like fixing anything else, for me anyway. If I can understand it, then I can usually beat it.

Mitch: It's funny you mention that, because when I was first doing the intake process, and they were doing a quick, brief questionnaire, the guy they first paired me with who gave me all this stuff and was a great help, he works with police officers. They decided that the person I needed to start with was someone who dealt with that kind of population, male police officers who have all the walls up against woo-woo stuff.

So the guy came in with like, "You're going to do a gratitude journal, and here's three Stanford studies as to why it's important. You're going to do this, and here's why this is important." It was very eye-opening.

Scot: Interesting. Troy, did you know Mitch was so hard as nails that he needed a therapist?

Troy: They know he loves true crime and they're like, "We're giving this guy." That's why. He's a police officer at heart.

Scot: All right. Let's wrap this up. I think a good discussion about the Core Four. I think we've agreed after this 70-some episode, two-year experiment that the Core Four is still a solid concept to base what we're talking about on, because you can just pick one of those four things if you're struggling with your health, or you're struggling with you don't feel that you are healthy, and just make one small change in one of those things. Just maybe increase your activity. Go for a 15-minute walk every day. Maybe that's the one thing.

Nutrition, maybe tell yourself, "I'm going to have one serving of vegetables a day more than I have." And if you have zero, then that's one. Do that for a few weeks and then make another change.

Don't expect that you're going to go from somebody you weren't to somebody else completely different in a short amount of time. And then just be consistent with that. I think that's what I've come away with.

We should probably hit briefly that, of course, you need to know your genetics because that can derail everything. Troy, explain how that works. You're the doctor.

Troy: Well, certainly you can be higher risk for certain types of cancers. The biggest thing for me has been cholesterol. We already talked a little bit about that, but that's been a genetic issue for me that my family members have dealt with as well. There may be other issues with blood pressure, heart disease, diabetes. I think it's just worth talking to your parents, to other family members, recognize what they're potentially dealing with. And you may realize that that's an area you just have to focus on more. I think that's where that plays in.

And often then that comes back to the Core Four, but I think it just helps us just to recognize, "Hey, this is an area . . . I'm going to have to work a little harder in this area."

Scot: Smoking, drinking, and other addictive habits, that was one of our initial things we don't talk about much anymore, but definitely if those were issues, that's the easy . . . well, it's not the easy fruit because Mitch quit smoking and that was not easy.

Mitch: It is not easy.

Scot: But it pays big dividends, right? The return on that investment is pretty huge.

I think with genetics, Troy, you made me think even alcoholism that there could be a genetic component to that, and depression. Those sorts of things, you should really know what you're dealing with, because it might be beyond your control. Like you said, you just pay a little closer attention to it.

And the one thing that really resonated with Mitch that we of dropped were these nagging health issues, which was a big thing for me because through years of, I think, misuse or hurting myself and then making accommodations, I've been using my body in strange ways, then muscles start to become compromised, weak, tight, whatever. And then that starts causing other problems. So unwinding some of those nagging issues. It's not going to go away on its own. But we don't talk about that much anymore. Is that a mistake, Mitch?

Mitch: I'd like to hear more about it.

Troy: Yeah, nagging health issues. We come back to it now and then, but yeah that's something that we definitely need to focus on.

Scot: Do you have a final thought, Troy?

Troy: Well, my final thought would be something that Dr. Chan said, talking about mental health, that has really stuck with me and I think gets to everything you just said, Scot. The point he made in talking about mental health and some of the challenges we're facing right now, he said just be patient with yourself. Recognize that everything is more difficult now. Be patient with yourself. Be patient with others as well.

I think that applies to making these changes too. Everything is more difficult. Yeah, we're coming out of this pandemic, but still be patient with yourself. Like you said, Scot, don't expect dramatic changes. Start small and then congratulate yourself for your success. I think that's very important. Recognize what you're doing and then just build on that.

Scot: Mitch?

Mitch: I'm going to say it again. Make your health your own way. You don't have to be like everyone else. Be independent, stand up for yourself, find out what makes you happy, and go do it. Don't judge yourself compared to others and just take control. Just do it your own way.

Scot: My final thought on this ties a little bit back in with what Troy said, and that's be kind to yourself. Make these changes gradually and be kind yourself. I do what I call daily pages, and I've written for, I don't know, five, six, or seven years now. And I can go back and read three or four entries and it's constantly, "Oh, I need to focus on my nutrition more. I wasn't very good today," or, "I need to focus on . . ." This is a recurring theme for years throughout my life.

And recently I heard about a book by an evolutionary biologist that basically said exercise isn't natural. The concept of exercise is a pretty new concept in our society. It used to be activity was a necessity and a part of life. And now we've kind of eliminated that for a lot of us where we don't have to move because of our jobs or whatever.

Being able to watch what you eat is a new thing as well. It used to be we were in more of a starved state than we were in a food abundance state like we are now. So that requires mental energy and discipline in a way that we didn't have to exercise before.

I keep coming back myself personally to "This isn't natural." It is hard, because sometimes I get hard on myself and I'm like, "Oh, come on. Just exercise and eat better. What's your problem? Why do you keep whining about this?" But I don't think it's natural.

And I think it is individual. I think one of the great things about this podcast and the guests we bring on and the three of us talking about our own experience is, hopefully, maybe one of the things that's worked for us might work for somebody else. You know what I'm saying? Because it is so individual, what might work for Mitch might not work for me, and that's fine. But maybe what worked for Troy works for me. That's great. That's my final thoughts.

Troy: I agree. Scot, I love it. Occasionally now I talk to people. I talked to someone recently who just started listening to our podcast in January and has gone back from Episode 1 and just working his way through.

Scot: Oh, that's awesome.

Troy: And to hear him just quoting some of the episodes and talking about the way he's tried to change his diet, eliminating sugars, trying to increase fruits and vegetable intake, exercise routine, incorporating that, and just the changes he's seen from that. So you hear from people like that and it's like, "Hey, it's absolutely worth it." I love that we have people out there who have found value in some stuff we've talked about, and incorporating some of these things and really seeing changes in their lives. So it's great to see that. We are making a difference for some people. Good to know. This isn't all about us.

Scot: I don't think we've hurt anybody that's listened to the podcast.

Troy: I don't think so.

Scot: I think our biggest struggle now is getting more people to jump on board.

Troy: Exactly.

Scot: All right. Guys, it's always just a pleasure to be able to sit down and talk about health and talk about these things with you. So thank you for being on as always, and thank you for caring about men's health.