The Dr. and Dad Healthcast

In our first podcast in over six months we chat about Nicole's experiences running her first (maybe last?) Boston Marathon.

Ever hear of the naked mole rat? He's as photogenic as his name implies but he also may hold the key to significantly longer healthspans.

After months of rigorous preparation, The Dr. completed her first marathon. We discuss her training regimen and the physical challenges she faced along with why in the world she wanted to do it.

Inflammaging is a mash-up of "Inflamation" and "Aging". It refers to chronic, sterile, low-grade inflammation that develops as we age. Researchers are discovering links to inflammaging and a number of cancers which may also lead to treatments.

Episode 1 of The Dr and Dad podcast was published on February 1 2019. A LOT has changed since then - In the world at large and especially in the world of medicine. We recap the highs and lows and make some predictions.

What do you do when you aren't feeling well? How long do you just take some ibuprofen and suck it up? When do you contact your doctor, or even go to the ER?

The Dr and Dad talk about Dad's project: To Love and To Grow - Our Common Purpose. If, as the Buddhists believe, life is inevitably full of pain, how can we transcend suffering. Listen in and find out.

We know that creatine is useful for muscles but it also turns out that research is indicating creatine can help our bones, brains and more!

Our guest Dr. (and brother) Bob joins to chat about his childhood idol - Dr. Red Duke and his experiences as an anesthesiologist.

Childhood vaccines cause autism, statins are dangerous, alcohol is good for your heart. Have you heard these claims and others? Confused about what to believe?

We're back! After a lengthy hiatus, we cover topics from DEXA scans to SSRI's for kids and a bunch more interesting medical topics.

We're back! After a summer hiatus, we're discussing claims that GLP-1 drugs such as Ozempic have beneficial effects beyond treating diabetes and obesity.

We’re all creatures of habit - sometimes good ones, sometimes bad ones. We share our favorite healthy habit hacks and provide some suggestions on how to create your own.

In The Art of War, Sun Tzu wrote “If you know the enemy and know yourself, you need not fear the result of a hundred battles”. In the battle for our physical and emotional wellbeing, the enemy is the the disconnect between our modern environment and our evolutionary biology.

Amare e Crescere (To Love and To Grow): Our Common Purpose is “The Dad’s” new Substack publication exploring love and growth as the path to meaning and happiness.

We are in (the beginning stage of) the artificial intelligence (AI) era.  Ever since ChatGPT was released to the public in December 2020, this technology has captivated us with its possibilities, for better and for worse.  AI will undoubtedly affect our lives in profound and, as of now, inestimable ways.  This includes our economy - how we work to produce goods and services.  The healthcare sector is no exception, and because of the size of this industry, seeing target many efforts to use AI to lower costs and improve outcomes.

There were 153,000 new cases of colorectal cancer diagnosed in the US in 2023 and 52,500 people died due to the disease with another 1.4 million Americans living with it. However, colorectal cancer is also a disease which is almost assuredly avoidable - with proper screening.

Resistance training (RT) associated with various health benefits that are under-appreciated compared with the perceived benefits of aerobic-based exercise. For example, RT participation is associated with reduced all-cause mortality and reduced incidence of cardiovascular disease, cancer, hypertension, and symptoms of both anxiety and depression.

It was a year filled with amazing new treatments addressing some of the most challenging medical conditions as well as the continued battle against several intractable diseases.

There are several things happening within primary care medicine that are very interesting so wanted to have a general discussion around these trends and also get an update on the Dr’s direct primary care practice.

We’re fast approaching the 4 year anniversary of the emergence of Covid-19, the disease associated with the Sars-Cov-2 virus. And, although the US declared pandemic emergency ended three months ago, the disease is still with us – As we learned in our home last week when Nonna contracted it (for the first time). She’s recovering but it kicked her butt.

Going to the dentist has always been one of my least favorite things to do.  It seems people generally fall into 2 camps when it comes to dental hygiene – Some are like me.  They have problems with cavities, gum disease or both and dental visits are long, painful and somewhat shaming – “Do you floss? You should waterpick, etc, etc”. Others who have been blessed by genetics or disciplined maintenance with pristine teeth and gums are rewarded with short, simple and affirming visits. Certainly, for appearances, we don’t want our teeth falling out, but how important is this for overall healthspan?

The evolutionary basis for hypercholesterolmia. The Bayesian model of brain function. mRNA Cancer vaccine. A wristband hearing aid.

Are Rapamycin and Metformin safe (and effective) longevity drugs? Do the the new class of weight loss medications - Mounjaro and Wegovy, promote muscle loss? Where are we at with Covid and vaccines? Should we be worries about bird flu now?

We can’t fool ourselves any longer.  It’s becoming clear there are NO net health benefits to drinking alcohol. We’re generally all aware of the downsides of alcohol consumption: liver damage, impaired activities such as driving, risk of addiction, excess calories, hangovers and poor sleep quality.  But when we thought people who imbibed moderately lived longer than teetotalers, we could rationalize drinking as beneficial – as long as it was “moderate” – 2 drinks/day for men and 1 for woman. A new meta-study puts the final nail in “alcohol helps you live longer” coffin.

“To every thing there is a season, and a time to every purpose under the heaven…”    Pete Seeger The song became a hit in late 1965 when it was adapted by the American folk group, the Byrds  The lyrics are taken almost verbatim from the book of Ecclesiastes in the King James Bible.  What does this have to do with health?  Well - maybe we can use the concept of aligning times in our lives with our health goals to produce better results.

In both Western and Eastern philosophy, craving has been considered a source of suffering and unhappiness. While craving is an important feature of substance use disorders, eating disorders, and other psychiatric conditions, it is also a general aspect of human experience. Identifying the neurobiological basis of this driver of human behavior is thus an important step in mapping brain circuits to fundamental thought processes.

In 2011 Marc Andreessen, the founder of Netscape and the A16Z VC firm, famously wrote “software is eating the world”.  Meaning, software companies would significantly disrupt traditional industries.  And, we’ve seen that happen – almost every company needs an IT person or department.  Now, we’re hearing AI will eat the world.  And, there are some incredible things happening in AI.  Healthcare, since it’s huge and important and somewhat broke, seems like a great AI target and there have already been some interesting developments.

We’re taking a look back at the major health stories of the past year.  Yes, COVID is still a big issue but the flu and RSV are on the rise too.  The Dr is annoyed and frustrated about a number of things having to to with vaccines, new weight loss drugs, abortion rights and more. 

There are three “macro” nutrients – Carbohydrate, Fat and Protein.  We generally consume fats and carbs for energy to fuel our bodies.  Protein is different.  While it can be converted to fuel if needed, or if consumed in greater quantities than is required by the body, our protein consumption drives the processes that build lean mass and the creation of a host of protein dependent metabolic processes.  So, how much protein do we need? Does it matter if it’s from animals or plants?

Should we get another COVID booster shoot? Can I get the flu shot at the same time?  What’s this miracle weight loss drug all about?  The Dr answers these and several more questions on another AMA.

It’s been a recurring theme of ours - To maximize your healthspan you need to include some resistance training, aka strength training.  While aerobic exercise (everything from brisk walking to jogging, biking, etc.) is also important, both are needed to get the best results – according to a study published in The British Journal of Sports Medicine this August.

Recent headlines include: Direct primary care provider Everside Health scores $164M Hint Health Announces $45 Million In New Funding To Fuel Growth Of Direct Primary Care Direct primary care: A path to achieving the Quadruple Aim of health care - Lower cost, better health, improved patient AND provider experience Why all the buzz?  

While the absolute number of people suffering from A/D in the developed countries of the world is growing, that is due to the general aging of the population.  The age-specific incidence of dementia has fallen in many countries and the reasons for this decline point to some of the ways we may be able to control our risk for developing A/D.  This is particularly useful info because efforts to develop drugs to treat A/D have been fairly futile.

There have been a number of studies that indicate coffee drinkers live longer than non-drinkers.  Previous research has linked coffee consumption with a lower risk of Parkinson’s disease, heart disease, Type 2 diabetes, liver and prostate cancers and other health issues.  Of course, all of these studies are observational epidemiological studies that cannot prove causality – that coffee drinking causes us to live longer, or the converse – not drinking coffee shortens our lives.

We humans evolved in a very challenging and uncomfortable environment.  Threats of all types prevailed – predation, rival attacks, hunger, cold/heat, and significant physical exertion was required to survive.  The fact that we’ve not only survived but thrived is testament to our ability to adapt.  That adaptation includes genetic predispositions such as our affinity for calorically dense food, our bodies resistance to weight loss and our natural anxiety.  But what about now?  Our environment is very different from our hunter/gatherer ancestors.  Are we maladaptive for the mostly comfortable reality of our modern life?  Should we purposely introduce discomfort into our lives in order to maintain physical, mental and emotional health?

Since we ran out of time in the last ATDA, as promised, we focus on activity and exercise in this episode.  It’s a good thing we saved a whole episode for this subject because it went longer than we’d expected.  Lots of great info on things like - Is all activity actually exercise? What’s the minimum effective dose of exercise? Should I focus on Zone 2 cardio exercises or high intensity? And much more!

Another ATDA with Dr Ascanio covering topics from the pandemic and what we may expect this Spring to the epidemic of mental health issues we seem to be experiencing and finishing up with answer to a variety of nutrition questions - “Is peanut butter a health food?”

Today most of us know that fast and processed foods are generally unhealthy.  For example, it’s not like people are confused about whether a carrot or a cookie is a healthier food choice. So, why do we eat so much crap?  It appears the reason many of us crave and consume fast and processed foods is that we are addictively drawn to these foods.  Furthermore, the food industry understands this fact and then engineers foods to make them more irresistible. However, you can defend yourself from this ”conspiracy”.  

The Dr & Dad podcast debuted on February 1, 2019 with the goal of bringing new, interesting, evidence based methods for extending our healthspan to our listeners.  While that still remains our mission, we’re shifting our emphasis a bit and focusing on how we can better help people adopt healthy habits and live longer, better lives. 

It was a pretty shitty year – We lost Nonno and Anthony, Covid wasn’t conquered by vaccines, political divisiveness reached new highs and our nations capital (and our democracy) was attacked.  Inflation is high, supply chains are broken, climate catastrophes are becoming commonplace and I (the Dad) have to have more surgery… Despite all of this, there were some good things that occurred this past year.

We recorded our first COVID-19 podcast on 2/21/20 and our last one in early September of this year when we updated listeners on the Delta variant.  We speculated about whether it’d be the last time we talked about COVID and also if a new problematic variant would arise. Well…

It’s almost impossible to consistently eat healthy if you don’t regularly prepare your own food.  This is a special holiday season episode and it also may be one of the most useful podcasts we’ve done because proper nutrition (eating healthy food) is one of the most important things we can do to support a longer healthspan.  In this episode we share our go to ingredients, equipment, techniques and a few recipes.

The American Cancer Society estimates 600,000 Americans will die from cancer this year making it the second leading cause of death behind CVD.  Finding cancer early, before it has metastasized and spread, is still the best way to fight this disease.  Today, effective screenings are available for only five types of cancer – breast, cervical, colorectal, lung and prostate, and over seven of 10 cancer deaths result from types of the disease for which we currently don’t have screening exams.  So called liquid biopsies promise to be a new breakthrough in cancer screening; allowing physicians to tell whether someone has one out of dozens of cancers with a single blood draw.

We’ve released several podcasts recently that focused on metabolic health including maintaining a healthy weight level.  And, we’ve discussed that nutrition is a more potent lever than exercise if you’re looking to lose fat. In fact, lots of previous studies have documented the relative futility of relying on exercise for weight loss. However, instead of looking at the exercise/weight loss connection, since our real objective should be a longer healthspan (the period of your life when you are generally healthy, active and have good cognitive function), shouldn’t we ask: What’s more important for our healthspan – a healthy weight or exercise?

The US, and the world in general, is experiencing yet another surge in COVID-19 infections, hospitalizations and deaths.  It was expected that the distribution of vaccines would protect us from this surge, but the variant of the virus spreading now (named Delta) is much more infectious and probably also causes more severe disease.  So, we have some questions for the Dr…

A cardiac calcium scan (CCS) lets us know the extent of calcium within our cardiac artery walls.  This Is important because this calcium forms over plaques which are the hallmark of cardiovascular damage.  We have many tests that provide insight on our risk of developing cardiovascular disease (such as blood cholesterol levels, blood pressure, etc.) but a CCS lets us see how much damage has already occurred.  It’s also proven to be helpful in estimating future cardiac event risk.

We’ve discussed metabolic health and the benefits of carbohydrate restriction on a number of our past podcasts so listeners may wonder why we’re going back to this subject.  Well, there are a number of new studies that have recently been published that have really put an exclamation point on the efficacy of carbohydrate restriction in treating things like diabetes and obesity and we just felt we had to share them. “Miraculous” probably isn’t to strong a word to use to describe the impact this strategy is having on some of the most intractable challenges facing healthcare professionals and their patients.

Dr. Julie Foucher is a board-certified family physician. She completed her medical school and residency training at the Cleveland Clinic, holds a Master’s in Nutrition from Case Western Reserve University, and has completed the Integrative Medicine in Residency curriculum through the University of Arizona. Julie competed in the CrossFit Games from 2010-2015 where she consistently finished among the top 5 women with two podium finishes. Her passion lies in bridging the gap between fitness and medicine to empower individuals to live healthier, more fulfilling lives. She continues to do CrossFit for health and longevity and hosts a popular health and fitness podcast called Pursuing Health.  Julie and The Dr. met while both were at the Cleveland Clinic.

At the beginning of 2021 The Dr left the large hospital system’s family medicine clinic where she’d worked for several years to open her own direct primary care practice. So, how has it gone? Does she have patients? Does she love it? These and other scintillating questions are answered!