The Dr. and Dad Healthcast

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.

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!

We know that aerobic exercise is an important component of a healthy, active lifestyle.  But, what type of aerobic exercise should we be focusing our time and energy on – Relatively low intensity workouts (so called “ Zone 2”), or high intensity interval training (HIIT)?  Some recent studies may be helpful in answering this question.

What is “metabolic health and why is it important?  As its name implies, metabolic health is related to our metabolism which is the set of chemical reactions that support life. Metabolic dysfunction, including obesity, high blood pressure, diabetes and other problems is rampant within industrialized countries and the Dr’s primary patient challenge. 

Ophthalmologist Dr. Brandon Baartman, aka the Dr's husband, makes a guest appearance to tell us (almost) everything he know's about the amazing eye and how we can best protect our vision.  We discuss how Brandon became interested in this specialty and his experiences in medical school, residency and during a fellowship. He explains the amazing physiology of our eyes and how we see, as well as how we should be caring for our eyes. Hint - Don't stare at the sun. 

It seems as if Allulose has gone from a relatively unknown sweetener to our preferred type in about 3 months. (Except spellcheck on Word still doesn’t recognize it and marks Allulose as a misspelling)  The average American consumes about 53 lbs. of sugar annually contributing to obesity, diabetes and other metabolic disorders. Could Allulose help solve that problem?  What is it about Allulose that so miraculous? 

It should be pretty simple – Begin or increase your exercise routine and weight loss becomes easier.  We know from experience though that isn’t necessarily true.  So why doesn’t the added caloric deficit of exercise translate to success in managing our waistlines?  Is there a some amount of exercise that is likely to deliver weight loss results?

Dr. Ascanio received the initial shot for the Pfizer/BioNTech COVID-19 vaccine about 10 days ago.  We discuss her experience as well as the vaccine rollout process and concerns around the possibly more virulent UK strain in our final episode for 2020.

As the so-called “third wave” of the COVID-19 virus rages across the US and the world, encouraging news is coming from projects aimed at creating vaccines to protect us from getting the disease. Of course, the two questions on everyone’s mind are: “When can I get it?“, and “Will it be safe?” We offer our perspective and opinion on these issues and more in this episode.

Humans are opportunistic omnivores.  We eat everything available that doesn’t outright poison us. The omnivore’s dilemma is the question of what should we be eating within such a large and diverse set of options.  A new research paper asserts that a Pesco-Mediteranian diet along with intermittent fasting is best supports a lengthy healthspan.

The Dr. is making the transition from working for a large hospital system to private practice in a fast growing healthcare model.  It’s called ”Direct Primary Care” (DPC) because the relationship between Dr. and patient is exactly that - direct.  There’s no insurance carrier or corporate bureaucracy in the way and that allows for a much better healthcare experience.  Plus, instead of having 1,500 - 3,000 patients, Dr. Ascanio will have a maximum of 600 to focus all her attention on.  This episode explores what led the Dr. to make the change to DPC and why patients will benefit. 

We're beginning to hear that a COVID-19 vaccine is getting close to approval.  Maybe more than one.  But, given the shortcuts in the process (compared to the usual vaccine development timeline), can we be sure it will be safe to take?  In this election year, of course this issue has become highly politicized and particularly confusing.  Listen in to sort some of it out and understand what to expect.

We all have a weak link - no matter how healthy we are.  This reality recently slapped me (The Dad) in the face.  Like many people, I ignored my weak link and assumed, since I was in generally excellent health, I had nothing to worry about.  Well, I learned my lesson and you can too by listening to this episode.

Back in Episode 20 (August 2019) we talked about Lou's participation in a study called Predict 2. A home-based study that opened in June 2019 that eventually involved about 1,000 volunteers across the US, measuring nutritional responses to food over a period of 11 days.  After almost a year of waiting we have the results and they offer interesting insights on how we respond to the foods we eat.

“We are what we repeatedly do. Excellence then is not an act, but a habit” Aristotle

It seems like “bad” habits, particularly ones related to our health, are much easier to develop than “good” ones. Why is that the case? Particularly considering all the information we have on what we should do to maintain our health. Clearly, there’s more than reason and logic at work here. Just as health science has made tremendous progress in defining healthy behaviors, scientific studies are uncovering why we fall into bad habits and how we can take back control.