Troy: That's my kind of breakfast. I had a banana for breakfast.
Scot: He has a banana every day.
Troy: A banana, yeah. It's good driving food.
Scot: It is. Apples can squirt all over the place, get on your windshield.
Troy: Yup. Oranges, don't even try it. Bananas are . . .
Scot: Especially if you're trying to peel.
Troy: Yeah. Do not try an orange.
Scot: Because that first initial peel . . .
Troy: Do not try an avocado.
Scot: It's "Who Cares about Men's Health?" where we have a theory that, contrary to what people say, men do care about their health. Now, they might not talk about it, might not go to the doctor as often as they should, but yes, men do care about their health. My name is Scot Singpiel. I'm the senior producer of The Scope Health Sciences Radio and I care about men's health.
Troy: And I'm Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Thunder: My name is Thunder Jalili. I'm a professor and director of graduate studies in the Department of Nutrition and Integrative Physiology, and I've cared about men's health for a long time.
Scot: I love it. We've got another supporter, Troy.
Troy: We do.
Scot: How about that?
Troy: We've recruited someone else to the team. Okay.
Scot: Thunder is an expert in nutrition. So, we're going to talk about some nutrition stuff today, more specifically, just the importance of food and your health. And it just impacts every aspect of your health in ways that you might not realize. And we kind of hope to get bombarded by all these things in hopes that a listener might go, "Wow, I guess this is something I should pay a little bit more closer attention to."
So, before we jump in to the actual conversation though, one of the things we talk about on the show is that moment where we realized we needed to . . . you know, there is a turning point in our health. Like, we are probably pretty healthy in high school or whatever and then, there becomes a time where you're not quite so healthy and you're like, "Oh, wait. I got to get back on track." Did you have one of those or have you been just 100% A-plus-plus all along?
Thunder: No. I actually thought I was 100% A-plus-plus when I was in my 20s. My moment was when I was 29 years old. I was doing a post-doctoral fellowship in the Division of Cardiology at the University of Cincinnati Medical Center and I went to my first American Heart Association meeting. And at that meeting, they had free cholesterol screenings. So I thought, "All right, I'm going to get my cholesterol screened. This should be awesome." But it was not awesome.
Scot: Oh, no.
Thunder: I shocked it was actually really high. It was like 280, my total cholesterol, and my HDLs were on the low side. They were, like, about 40. And so, it was really shocking to me because I had, you know, up until the point, I'd ski raced and been a, you know, bike rider and just felt that was very healthy. But I had some genetic issues going on. I wasn't aware of it at the time. And that cholesterol test really brought everything to light. So from that point on, I started to actually practice what I preach because my background was in nutrition. That's where I got my PhD in.
And so, that was my moment from thereon out. And I begin to see, you know, working in the cardiology division how actually unhealthy a lot of our practices were. Like, you know, we would go to, like, grand rounds and there'd be cookies and, you know, treats and things like that at every one. The cardiology fellows would all go to, like, their cath conferences and they would have, like, pizza and cookies, and muffins. And, you know, I used to partake in all that stuff thinking, "Oh, it's fine. I'm healthy." But I actually wasn't as healthy as I thought.
Troy: That's amazing. I mean, I feel like you must have listened to this podcast and stolen my story because that's pretty much my story. I think I was the exact same age as you and I think my numbers were pretty close to yours. But this is sort of a recurring theme where we're seeing where people in their late 20s are getting some sort of health screen like this. And we just think everything's going to along wonderfully. And we get these numbers back and we're shocked. It sounds like that was exactly your experience.
Scot: So, genetics was part of it. Was there also a disconnect with your nutrition really wasn't as good as you thought it was or your activity level, or was there a little bit of "I'm bulletproof because I do exercise and do all these things a lot?" Where do that come?
Thunder: I think a lot of my issues, so genetics, of course, was part of it because my father also had high cholesterol. But layered over top of that at the time was really my diet because looking back, I did consume a lot of sugar and a lot of simple carbohydrates and there wasn't as much attention on sugar as there is now. And so, I think my problem was I just ate a lot of sugar and simple carbs and that there's a mechanism for that to be converted into LDL that probably not the scope with this podcast, but trust me, it's there and that's what led to my issues.
So, when I went on a kind of a more healthy diet where I try to reduce the amount of sugar and carb intake, you know, and it wasn't that hard. Like, I didn't have the cookies anymore at the grand rounds and things like that. Then it actually, my cholesterol dropped quite a bit and it dropped to under 200. And then, yeah, I've just been careful since then.
Troy: It sounds like you really just focused on diet. You were already very active, exercising a lot. It was more just making adjustments in the diet and realizing you're not bulletproof and . . .
Thunder: Yeah, exactly. And that's something I try to emphasize to people, is it's two sides of the same coin. And you can, you know, have a really shiny, nice-looking one side. But if the other side isn't working well, then you're still not going to, you know, be at optimal health. So, you have to pay attention to both. Even if, you know, you look great and you look healthy, you still have to pay attention to the food. Because also with men, you know, as you kind of plow through your 30s, you know, you get a little less resilient and bulletproof, and the diet becomes even more important.
Scot: Cholesterol, of course, leads to cardiovascular disease. What are some of the other things that high cholesterol could potentially lead to, Troy?
Troy: Well, then you're also thinking about strokes, which is tied to cardiovascular disease. You know, certainly, once you start thinking about high cholesterol, then you start to think, yeah, potentially, you're talking about metabolic syndrome, diabetes, obesity. Those are maybe more a cause or more related to high cholesterol. But the big things I think about are things that affect the vessels in the body. Heart disease, strokes, peripheral vascular disease where you get narrowing of the arteries, you know, issues with your leg swelling, things like that, so . . .
Scot: Quality of life issues, too.
Troy: Definite quality of life issues, absolutely.
Scot: Yeah, in addition to potentially deadly issues.
Troy: Exactly.
Scot: All right. Let's talk about other aspects of food. We talked about high cholesterol. What are some other areas of our health that eating well now is going to be an investment that pays off in the future?
Thunder: It's really hard to separate, like, the dietary effects that may impact cholesterol. It's hard to separate that from so many other things such as gaining weight and increasing, like, central obesity, which is basically, you know, belly fat. And that ends up increasing the risk for, you know, so many issues surrounding vascular disease as Troy talked about. You know, diabetes risk goes up. So, when we talk about, you know, good nutrition, it's not just we're zeroing in our cholesterol. It'll affect everything in a beneficial way, and even cancer risk. So, that's not, you know, one of our topics today. You got to keep that in mind, too. A lot of stuff we talk about, it's kind of good for everything, not just for cardiovascular.
Scot: Yeah. We have some doctors on from Huntsman Cancer Institute and diet is a big part of preventing cancer. And then, when somebody actually is going through cancer treatment, a part of the treatment is eating the right foods.
Thunder: Exactly. That's really an important thing they're working on right now.
Troy: I think this is also what's really tough for a lot of people because, as you saw, you thought you were in great health. You weren't seeing any ill-effects from the high cholesterol because we're talking about risks that's 20, 30 years down the road. And so, it's not, like, my issues that I'm seeing on my lab results are having any effect on me at this point in my life and, you know, in my 20s or 30s.
Thunder: Yeah, yeah. And that's also a tough thing to sell, you know. Like, when I ask students in class, undergrads and graduate students, when we talk about these issues, you know, I try to emphasize to them that, you know, look, it's . . . you may have vascular disease going on. You can't feel it. You can't sense it. You can't smell it. You can't touch it. I mean, it's completely silent.
And usually, like, the first time that, you know, something happened, you're middle age or you're, you know, beginning your elderly years and you have a heart attack or maybe you're lucky and you have, like, a little bit of chest pain, and you then get treated for the vascular disease. But that's, like, your first warning sign. Sometimes, the first warning sign is the last warning sign too because it's fatal. So, you just don't want to get there.
So, it all starts when you're young. It all starts with, you know, good nutrition even in your teenage years. So there's evidence that, you know, vascular disease can start, you know, when you're a teen.
Scot: So, what is exactly healthy eating? I mean, that's a term that's kind of thrown around a lot, right? And it depends on who you talk to. Like, if somebody talked to me, I'd have a whole different definition than maybe Troy, than maybe yourself, than maybe when you go to the internet, you know, which is, like, "You got to eat all protein, man. It's all Paleo all the time." That's the internet. That's my . . .
Troy: That's what I do. I mean, [crosstalk 00:08:36] . . .
Scot: That's my impersonation of the internet. Yeah, right.
Thunder: Just gnaw on hunks of beef all the time.
Scot: Yes, exactly, right?
Troy: I kill my own food and . . .
Scot: If you didn't kill it, you shouldn't eat it.
Troy: Yeah. If you can't kill it with your bare hands, it should not be eaten.
Scot: So, what is healthy eating exactly? Is it fewer microwaved burritos? Is it more healthy food? I mean, what's that balance?
Thunder: So, I have a really simple thing that I talk to, like, with a lot of the freshmen that come into my intro nutrition class.
Scot: We like simple. That's good.
Thunder: Yeah, because there are so much information out there about what is healthy and what is not. But the simplest way to look at it is if it is a whole food that is not packaged or processed, that is the healthiest form of food. So we were talking about, like, bananas, you know, before the podcast, like, that's a great example of a healthy snack [inaudible 00:09:25].
Scot: But on the internet, I think I saw a thing that said you should never eat bananas. This is the one food you should not eat if you're trying to lose body fat.
Troy: I've seen that, too.
Thunder: But the microwaved burritos are okay.
Troy: Yeah, but bananas?
Thunder: You know, the thing is natural foods tend to have less calories, less sugar, and you know, less sodium than other foods that are processed. So, if you really want to eat healthy, just try to cut out the stuff that is processed and focus on natural food. It's really not that hard and it's not, like, you know, particle physics where it's really complex. You just go after stuff that came from a tree, came from a plant that is somehow unprocessed and try to avoid the things that are in a box. Now you can't always do that. I understand that. But you try to minimize the stuff that came into a box or fast food.
Troy: My rule of thumb and maybe I'm off here, but I've told people . . . because sometimes this topic comes up in the ER not often, but now and then, but I tell them is the more you can focus on fruits, vegetables, legumes, and nuts, the better you're going to be doing because those are the things, again, that are the simple things and it seems study after study has shown that those are the things that really make a difference in terms of heart disease, obesity, diabetes, all those things.
Thunder: Exactly. And I think, you know, we have the same message. It's just maybe said slightly different way because all those things are . . .
Troy: Not in the box.
Thunder: . . . whole foods. They're not in the box, yeah. And, like, you know, a few exceptions, like, oatmeal can come in a box or come in a bag. That's okay, yeah, you know.
Scot: As long as the ingredient say, "oatmeal."
Thunder: Oatmeal, yeah, yeah, like . . .
Troy: Oats. Keep it simple.
Thunder: Keep it simple. The unprocessed, you know, either one-minute oats or old-fashioned oats, those are the way to go, not the stuff that's in a box that has . . . you know, it has some . . .
Scot: Apple cinnamon.
Thunder: Yeah. It's interesting. If you actually look at one of those little paper packets of, like, Quaker instant oatmeal, I mean not to slam on all things Quaker, but you look at that and you look at the amount of sugar that's in the packet, it's about 30% or more of the weight of that little paper packet is sugar.
Troy: Oh, wow.
Thunder: So that means you have . . .
Troy: That's unbelievable. Thirty percent?
Thunder: At least. And some flavors that you get have more sugar. So, it depends on the flavor, right? So, you know, I tell people, "Why don't you just buy your own oatmeal and then you can add kind of stuff that you want to it, and you can control the composition of the ingredients."
Scot: Right, like natural fruit, if you want to put little natural fruit or some almonds, or a little dollop of honey.
Thunder: Exactly, exactly, like, peanut butter, or you can put, like, walnuts in there. You have all kinds of flexibility. And then, it's actually filling because the paper packets, they're actually quite small. In order to get the amount of fiber that you need, like, if you're interested in reducing your heart disease risk, you know, there's a specific amount of fiber you need. That paper packet doesn't cut it. You usually have to have at least two or three of them. Now, if you do that, you've also plowed through at least 60 grams of sugar, which is a lot. That's as much as you have in, you know, say, 18 ounces of Coke, more or less. I mean, that doesn't seem so healthy. But if you make your own oatmeal, you're not going to have that much sugar.
Troy: So, I love it. You know, I mean it sounds like just the whole message you're sending here is just keep it simple. Look at ingredients, very simple ingredient list, ideally stuff that's not even in a box, and you'll be eliminating so many of these hidden sugars, things that we probably have no idea that are in there.
Thunder: Yeah, exactly. And we don't have an idea that they're in there because they are hidden, you know. Flavored yogurt is another great example. You know, there's a lot of sugar in flavored yogurt. I mean, it tastes great because it usually has, you know, a couple tablespoons of sugar.
Scot: And it doesn't take much sugar to crank up those calories either.
Thunder: No, it doesn't. It doesn't. And, you know, I mentioned earlier, there is, like, a route between eating sugar and having that eventually be converted to LDL cholesterol.
Scot: Well, what do you think, Troy?
Troy: I mean, I'd . . .
Scot: Are we good?
Troy: I don't know. The whole flavored yogurt thing, that just hit home for me because I like Greek yogurt, but it's all flavored. And as you mentioned, that's one thing . . .
Scot: You can get the unflavored stuff.
Thunder: Yeah. You can get plain.
Troy: You can, but it doesn't taste as good. Why would I want to eat that?
Scot: Well, but if you throw some frozen fruit or something in there, then it's great. That's what I do.
Troy: Yeah, exactly. That's . . .
Scot: What's wrong with you?
Troy: That's what's wrong with me. Well, you have your morning concoction you make, but I still can't figure out what you put in there, but . . .
Scot: I'm starting to sound like the internet now.
Troy: You do?
Scot: You need to eat regular yogurt with frozen fruit in it, Troy.
Troy: I know. I'm getting the sugary stuff that even, you know, things like that where I think I'm eating fairly healthy and in my mind I'm saying, "I'm eating Greek yogurt. This is good. I'm getting protein," I'm getting a lot of sugar in that, too.
Thunder: You are. But as Scot said, super easy to get plain and modify it to something good. Add blueberries. Add like a tablespoon of maple syrup if you want it a little sweeter. I mean, that's a lot better than, you know, how it would come from our processed version.
Troy: That's a great point.
Scot: All right. So, it sounds like if somebody wanted to start taking steps to watching their eating, it's just start trying to eat more natural foods and start pushing out some of those canned, processed, packaged foods. And that would be a good first step.
Thunder: Yeah, yeah, yeah. People travel, people have jobs, people who are on the road, I mean, those are the times where you maybe can't stick to what you do. So, fine. Don't beat yourself up. If you have to get processed stuff or fast food sometimes, that's the way it is. But when you're at home and when you're in your regular routine and you can control it, that's when you follow it. And in reality, for most of us, that's 80% of our time.
Scot: Well, thank you very much. We're glad that you care about men's health. You are a powerful advocate to the cause.
Thunder: Thank you.
ER or Not: I Suddenly Have a Rash
Scot: All right, time for an episode of "ER or Not." That's what you get to play at home. Going to throw out a scenario, decide whether or not you'd go to the ER for that, and then Dr. Troy Madsen, who is an emergency room physician, will tell us if we chose properly. So, ER or not. Just woke up one day and I noticed I've got this rash, like, it just came out of nowhere. Went to be the night before, it wasn't there. Woke up, there it is. ER or not?
Troy: So, rashes are interesting. I think you'd be surprised that we do see a lot of rashes in the emergency department. A large majority of these could go to an urgent care. So, the exceptions to this would be cases where there are potentially other issues along with the rash. So, if it's, like, an allergic reaction, you have lip swelling as well and you have trouble breathing, absolutely go to the ER. If there are other cases where maybe you have a high fever with the rash, the rash feels really warm to you, maybe you're lightheaded, you feel kind of dizzy, you feel weak, there I'm more concerned about a skin infection causing the rash and leading to sepsis, which is a much more severe infection. So, if there are other things with the rash, go to the ER, those sorts of things. But in most cases, these rashes, you can absolutely be seen in an urgent care for these and they should be able to treat you appropriately there.
Scot: And what's causing the majority of these rashes? Like, what are some of the . . . I don't even know what would cause a rash other than poison ivy.
Troy: Right. In most cases we see are allergic reactions, most rashes we see. Some of the more serious rashes we see are allergic reactions, like I mentioned, that progressed through airway involvement, that sort of thing. We do see reactions to drugs at time, to medications, and sometimes, you can have really severe reactions with these that you have to almost treat like a burn.
So, some of these can be really severe if it's a rapidly progressing rash. If it's involving your lips, your gums, inside of your mouth, the palms of your hands, the soles of your feet, these sorts of things and it's like the skin is peeling off, if you see this, I think you're going to be concerned. So, these can be really scary rashes and these, absolutely, you need to go to the ER for. But the run on the mill, you wake up in the morning, you see a rash on your arm. It's kind of itchy. You're not sure what happened. Maybe you bumped into something, maybe a bug bite, absolutely go to an urgent care.
Just Going to Leave This Here...
Scot: Time for Just Going to Leave This Here. It's our opportunity to just talk about something. It could be health-related. It might not have anything to do with health. Just going to leave this here. There's a video game, Troy, that I thought you might find this kind of interesting and it terrifies me, that says, "It can detect early stages of Alzheimer's better than medical tests."
Troy: I saw that and that scared me, too. I don't want to play the game.
Scot: I don't want to play that game.
Troy: I don't want to know.
Scot: No. So, it's called Sea Hero Quest and what they've determined is that people who start developing Alzheimer's have directional challenges. Like, I guess that's why people with Alzheimer's tend to get lost a lot, right? So in this game, you have to navigate the ship and they can collect data based on the routes that you're choosing whether or not you might have the tendency to have Alzheimer's, which scares me to death because I've never been very directionally savvy. So now, I'm like, "Does that mean, I might have this . . . ?
Troy: Oh, wow.
Scot: It's also cool because with this video game, they were able to do, like, 60 years' worth of research in literally days. Sixty years' worth of data they were able to collect. So, I tried to find Sea Hero Quest. It was an app on, you know, iPhone and android. I can't find it in the app stores anymore because this article is actually a couple of years old. And it resurfaced because they were talking about the story again. However, there is a virtual reality system that you can play this game. And I'm much like you, I don't know if I want to try it or not.
Troy: I know.
Scot: Like, I kind of do but I kind of don't.
Troy: That's kind of how I am, too. Now that you're telling me about this, I'm really curious. But what if it says I've got early Alzheimer's and I'm just . . . yeah, how you interpret that and . . .
Scot: What do you do with that?
Troy: I know. That's the problem for me with a lot of the data, is, like, "Well, what do you do with it besides just get anxious and say, "Well, I don't know what to do but I'm concerned." Well, I'm just going to leave this here. Scot, I've taken to heart your steps per day. I know you're all about steps, 10,000 steps per day.
Scot: What?
Troy: Well, this is how I've taken it to heart. I'm now counting 5,000 steps every time I work a shift in the ER. It was actually a study that was done with emergency physicians where they put a pedometer on them to see how many steps they took during a shift. Five thousand steps, that was the average. So now, every time I work a shift, I can say I did 5,000 steps. It's a little reward for myself knowing that I'm on my feet most of the time at work. You know, I've sort of taken it to heart.
Scot: I don't know how I feel about this.
Troy: I'm not making fun of you. I really admire you.
Scot: Well, I know you're not, but . . .
Troy: I kind of like, too, that I work in a job where I do get to be on my feet a lot. It can be a little bit tiring at times. But it's also nice to be on my feet and know that I'm getting 5,000 steps. So, I don't know. It's kind of cool.
Scot: And there's so much research that shows that if you do a sedentary job, which tends to be more of what I do during the day, you need to get those steps. And I think it just goes to say if you don't have such a sedentary job that, you know, maybe that's not the important thing. Maybe you should be focusing on nutrition now because you're probably getting the activity you need, so . . .
Troy: Getting a lot of steps. At least I know that. Thank you.
Scot: Well, congratulations. Congratulations on your 5,000 steps. You should be very proud.
Troy: Thanks. I appreciate it.
Scot: Okay. It's time for the post show. That's where Troy and I discuss how we think things went because why not? What did you learn from this interview? What were your takeaways? My takeaway is I didn't know that sugar can impact cholesterol levels. I found that fascinating when he mentioned that, so another reason to kind of watch your sugar intake. And that there's no super-secret code for eating right, it's just eat whole foods. You know, try to eat as few of the prepackaged stuff as you can and just have single-ingredient things in your life. And that's generally how I eat. So, I feel pretty good that I'm on the right path.
Troy: And that's one of my takeaways, too. Keep it simple. I love when you can just keep things simple and you don't make it too complex. And that was his whole theme, and then fasting. The simplicity of really incorporating fasting into your daily routine where it's not, like, trying to carve out a day for this or trying to make it more complex or difficult than it needs to be, just stop eating at 6:00, 6:30.
Scot: And then, don't have breakfast until 6:00 or 8:00 the next morning.
Troy: Yeah. It's so easy, like, make your routine exercise at 6:00, 7:00, whenever, and then eat at 8:00. It's easy enough.
Scot: All right. I think that was an A-plus show. How would you grade it?
Troy: I'll give it an A-plus-plus, with the extra plus for Thunder.