Ep.162 How to Add 15 Healthy Years to Your Life: The Power of Data-Driven Healthcare

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michele Folan (00:00):
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(01:05):
I'm your host, michelle Follin,and this is Asking for a Friend
.
What if your annual physicalisn't telling you the full story
?
This week, on Asking for aFriend, we're diving into the
power of personalizeddata-driven healthcare with Dr
Dave DeMarco, a primary carephysician, on a mission to take

(01:27):
prevention to the next level.
Dr DeMarco isn't your typicaldoctor.
He's combining advanced testing, meaningful blood work,
biometrics and scans like DEXAto give patients real answers
and real strategies to supporttheir long-term health.
No more guessing, no moreband-aid solutions, just

(01:48):
evidence-based insights to helpyou thrive in midlife and beyond
.
We're going to talk about whytraditional medicine often waits
for symptoms before it acts,how the right data can
completely change your healthtrajectory, what a DEXA scan
reveals and yep, I had one andwe're going to talk about that.
How he coaches patients usingtools like glucose monitors and

(02:09):
even GLP-1 therapies, and whyit's never too late to get a
clear picture of your health andtake control.
If you've ever felt dismissed,confused or in the dark about
your health, this episode willchange the way you think about
what's possible.
Dr Dave DeMarco, welcome toAsking for a Friend.

Dave DeMarco MD (02:27):
Well, thanks for having me, it's my pleasure.

So I'm going to tell everybody how we met.
I drive past his office, hisDexafit office, multiple times a
day and when I was interviewingDr Doug Lucas, who is an
osteoporosis and orthopedicspecialist, I had told him.
I said I've got to run in there, I just I want to see what

(02:53):
they're doing.
And he's like yeah, do, let meknow.
You know, I'm super interested.
And I immediately walked in.
Two of the women that workthere in the office listen to
the podcast.
And we started chatting and Isaid sign me up, let's do this.
So Dr.
DeMarco is the doctor that ownsthe Dexafit practice near my
house, and I wanted to get himon the show.

(03:15):
Okay, now, enough of me talking.
What really inspired youoriginally to go into medicine
in the first place?

Yeah.
So I think our personal historyreally informs just about
everything about us.
So when I look back at myfamily origin, lots of
cardiometabolic disease runs inmy family.
My dad grew up in Brooklyn, NewYork, one of five boys, and my
grandfather unfortunately diedat age 54 of a massive heart

(03:45):
attack.
I never got to meet him.
Four of the five boys had heartattacks.
My dad was the lucky one thatdidn't have a heart attack but
unfortunately he had diabetes,and diabetes that kind of had
him yo-yo dieting up and down.
Do you remember the cabbagesoup diet?
Does?

that sound yeah.

Our family was doing cabbage soup dieting at
times when I was a kid, so thiswas always front and center,
always in my brain and you knowI saw some of the things that
made it hard for him andultimately, because of his
diabetes, which is so hard onthe kidneys, he had a hard time
even having a simple kneereplacement and that led to
decline in health thatultimately took his life earlier

(04:27):
than we would have liked.
Meanwhile my mom also developedover time just your normal and
this is kind of relevant foryour podcast midlife weight gain
.
It was a combination of stressand perimenopause, I think that
led.
Looking back I can say that nowdidn't know it then, but now I
know that she was dealing with alot of the hormonal changes and

(04:50):
gaining weight and she toobecame diabetic.
So we look at diabetes in myfamily and we say, okay, two
parents that are diabetic, Ihave a hundred percent chance of
becoming a diabetic.
Now you've got my attention,you know.
And looking at thecardiovascular risk that goes on
my dad's side, it's always beenfront and center and something
I care a lot about.

So what was the turning point then in your
career when you said I reallywant to focus more on prevention
rather than just treatment ofdisease?

Right, right.
So I think because I was sointerested in helping prevent
diseases, because I saw it in myfamily and how it affected just
the day in, day out.
Even just the annoyance ofhaving to think about dieting
every day like it's exhausting.
It was exhausting to see themcome in with the next fad diet,
most of which were not thathelpful and ultimately led to

(05:46):
more trouble.
That made me say I really justI want to help people in a deep,
foundational way.
So I've always kind of looked athealth care from a how do we
crack the code?
You know, like there's got tobe.
I really do believe that.
You know, there is no absolutetruth.
Even gravity is basically ahigh, high, high probability

(06:08):
endeavor.
I'm not going to test that, bythe way.
I'm going to trust that gravityis real.
But you know, I think we canget closer and closer to
certainty with science, with theprobability getting closer and
closer to, you know, 100%, butwe never quite hit 100%.
I think that I'm always lookingto crack the code to get a
little closer to that.
So you know 100%, but we neverquite hit 100%.
I think that I'm always lookingto crack the code to get a
little closer to that.
So you know we're trained inallopathic.

(06:29):
You know that's when you havethe MD after your name.
We're trained in allopathicmedicine to diagnose and treat
disease.
And I was a family practiceresident when I left med school.
I went to Ohio State for medschool.
It was great training.
I went to St Elizabeth's nearhere, which is a really rigorous
family medicine program thathad us doing all sorts of really

(06:51):
complicated things and threw usin the deep end of the pool, if
you will, and it really builtme up for being very comfortable
dealing with sick people andbeing able to handle the
sickness.
But I don't like the sickness,if I'm honest.
I don't like working in thehospital.
I prefer to catch people withtheir clothes, their street
clothes on, not a hospital gown.

(07:11):
So I knew right away when I wasin the hospital's training I'm
going to be an outpatient doctorand watching people suffer
really hit me hard.
I really wanted to prevent thatand so I realized, you know, if
we can step back more steps,make one step, two steps before
disease really manifests.
We have a chance of helpingpeople engage with their

(07:33):
lifestyle and I startedrealizing how much lifestyle
makes a difference.
I got board certified a fewyears ago in lifestyle medicine,
which basically looks at sixpillars.
It looks at your nutrition,your exercise habits, your sleep
patterns, your stressmanagement, how you relate to
other people and how you relateto risky substances, whether

(07:55):
that's the illicit stuff likedrugs, alcohol, which is legal
but maybe overused in oursociety, or even just caffeine,
which I'm guilty of big timetaking too much caffeine in, or
sugar, right, and we see all ofthis play into impacting our
health and chronic disease in alot of ways is just completely

(08:15):
related to our lifestyle.
So helping crack this code, asI said, includes learning.
How do you help people withlifestyle and how do you start
soon enough so that you canactually make the difference
when it matters most?

In the years that you've been a doctor, are you
seeing that we're getting sicker?

I think we are in a lot of ways.
Here's the thing I think we aregetting we're living longer
lives but we're not livingbetter lives, if that makes
sense.
So I would argue, when I lookat most of the demographics that
I take care of in my currentpractice, I'll tell them you
know, there's a good chancewe're going to keep you alive to
age 85.
I mean, we can keep peoplealive.

(08:57):
That's not the part I'mconcerned about, it's just will
you enjoy that?
Last 10 years?
Dr Peter Atiyah calls it themarginal decade, which is that
last 10 years or 12 years ofyour life where you're going to
kind of start to decline.
And first of all I havepatients that are starting that
decline in their 50s and 60s andthen others that start around
age 70.
But I tend to see somewherebetween 70 and 80, a big decline

(09:21):
.
And I think that with whatwe're doing at DexaFit and what
I'm trying to accomplish interms of positively disrupting
primary care is, let's get astep, maybe two steps, ahead of
the problem and see what we cando to delay onset of disease so
that maybe what's manifesting at65 doesn't manifest till 80.
So that marginal decade hitswell after that.

(09:44):
And if we can get that going,we're going to not only help
people live better lives andenjoy the ride more, but we're
going to save healthcare dollars.
We're going to make it so thatwe're a healthier society and
hopefully we won't be sicker aswe go.

You know, I had a conversation yesterday with a
new client and Dr DeMarco knowsI'm also a health coach and I
wanted to know what hermotivation was.
What got you to reach out?
Dyslipidemia, triglycerideswere really high, HDL's low.

(10:29):
Her A1C her hemoglobin A1C,which is a glucose marker, is
starting to increase year overyear and it's like she's on the
bubble, right.
She knows that and what you'resaying is if we can get.
And if we can, what you'resaying is if we can get before
we get to that point.
If we can start nipping thingsin the bud earlier, then we've

(10:50):
got a chance, right 100%.
Yeah.

And there are tests out there that help us
triangulate around your healthmuch better than what our
current tools are.
And I'm not bashing our currenttools.
Our current tools are great.
I love having my patients infor a deep dive, looking at
their blood work, their bloodpressure and other vital signs,
but what I find is, especiallyfrom about age 35 to 60, there's

(11:15):
a gap, and the gap is peopledon't feel that bad and they're
busy and they're active, doingother things, and some people
genuinely are already on alifestyle kick, but others are
not yet because of whateverreason.
But oftentimes it's just thebusyness of life and we need to
get people's attention.
And the best way I have foundto get your attention as a

(11:36):
patient is to say well, let'slook actually at year in year
out, what your muscle mass isactually doing.
Let's look year in year out atyour accumulation of visceral
fat and, using those two thingson a DEXA scan, for example, we
look at those and we can measurethem every six to 12 months and
tell you how that's changing.

(11:56):
And let me you know spoileralert it's going to change.
Just because you're on thisearth and living another year,
you know you're getting aroundthe sun one more time, and that
means there's risk for thisgoing down.
I like to use the 401k analogy alot because I talk about.
You have until about age 40 tobuild up as much as you can,

(12:17):
similar to your 401k plan.
You have until retirement tobuild it up, or at least 59 and
a half.
When you have to, you can starttaking it out then.
But how do we get that as bigas possible so that when you
start spending it down you haveenough to last?
And we want to keep your musclemass up so that you have enough
to last.
You ripe into your nineties andbeyond and nobody really wants

(12:40):
to live a long life unless thatthose last 10 years can be
valuable and rich and you have amind that can enjoy the people
around you.
And I think that's what welearn from connected.
You know being connected toother humans.
There's a great book I thinkit's even behind me on that
shelf called the Good Life thatlooks at the Harvard Men's Study

(13:01):
, which had more than men in it.
It was women, men, children,and it's one of the longest
lasting studies that cut to thechase.
They realized it wasn'tsickness or health, it wasn't
wealth or poverty.
It wasn't fame or obscuritythat made people think they had
a good life, it was howconnected were they to other

(13:21):
people.
But that requires a flourishingmind.
That requires a mind thatremembers who you are and who's
important to you.
So all of this ties in to ourtesting and our muscle mass
evaluations, our visceral fat,which drives so much of the
inflammation and chronic diseasethat I've already mentioned.
We haven't mentioned dementia,but definitely I guess we sort

(13:42):
of mentioned dementia there.
But it definitely hits all ofthose areas.
And yeah, when you combine thatwith cardiopulmonary fitness,
which is basically a way ofsaying your VO2 max your VO2 max
is a number that tells us howwell you can use oxygen when you
exercise the higher that numberthere's great science that

(14:04):
shows that it correlates withlongevity and it correlates with
less risk for cardiovasculardisease.
A stress test is only going tobe abnormal.
We all hear about stress tests.
Maybe some of us have had.
I've had one myself and youknow we get on there and what
it's really looking for is isthere enough plaque burden in my
heart arteries to make that anabnormal test and flip it from

(14:28):
normal to abnormal?
But what that really means is70% blockage or more, and I'm
sure we've all heard of someonethat has had a heart attack and
then it's like he just had astress test six months ago.
I can't believe it.
And the reality is you're goingto have a heart attack with 40,
50, 60% blockage, but itwouldn't be a positive stress
test, right?

(14:49):
So how do we know whether yourheart's healthy at a stage where
we can measure it?
Well, there are good tests likea CT angiogram that can look at
the arteries.
You can even use some 3Dmodeling to tell exactly the
first, third, middle, third,last third of that artery where
is the plaque and how much is it.
These are great tests butthey're quite expensive.

(15:10):
There's quite a bit ofradiation that goes with it and
it's not something you can doevery year.
Meanwhile, something like a VO2max test you can do that two,
three times a year.
If you want, you could do it.
It's safe to do as many timesas you want, but I would argue
twice a year if you're trying tomake a difference in your
health journey makes a lot ofsense, because your VO2 max, the

(15:31):
higher it is, the more likelyyou have a good heart.
And if you can measure thattoday and then do some things to
change that and then measure itin six or 12 months.
Now you know whether you'remaintaining or maybe even
improving your VO2 max.
Now you know whether you'remaintaining or maybe even
improving your VO2 max.
That also goes down as we age,but if we can maintain it enough
, man, you will have higherquality of life, and what that

(15:52):
directly relates to is what arethe little things, the
activities of daily living thatyou're going to enjoy doing as
you get older, the more VO2 max,the more chance you are of
being able to go hike with yourfamily.
Not be the one that's theburden, holding the group back,
but the one that maybe even isleading the charge.

Absolutely so.
I love all this.
We are going to take a quickbreak and when we come back, I
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We are back.

(17:16):
I want to first ask thisquestion because I get this
question all the time about yourDEXA scan the DEXA fit, versus
the type of DEXA scan that Iwould get if I want to measure
my osteoporosis.
Let's start there.

Yeah, that's a great question and just I did
listen to your podcast onosteoporosis, which was great.
You did a great job with thatand I definitely think that
there's a difference and we needto make that clear for you guys
.
We are not interested as muchin the bone.
When we think body composition,we are looking at three
compartments which is bone, yes,fat, and then what's not bone

(18:00):
and not fat, which is lean, andso we're going to call three
compartments in your body fatmass, lean mass and bone mass.
Now we differentiate bone witha body composition scan using
DEXA, but mainly just so that weknow how much that bucket
weighs and I'm going to say it'sabout two to 3% of the total

(18:22):
weight.
Then our focus is more or lessgoing to be on your fat mass and
your lean mass.
Now we will give a T-score forthe total body, but a total body
T-score is going to give anumber for an average for the
whole body, so to speak.
So your skull, for example,pretty dense bones or other

(18:44):
bones in your body that are moredense and going to affect the
total T-score.
So I don't want anyone to notget a what we call segmental
DEXA looking at the lumbar spine, the hips.
Sometimes we look at theforearm when we can't get a good
reading in the hip or the spinedue to a replacement or
arthritis.

(19:04):
This is still really importantand I think these two scans
complement each other reallywell and, in my opinion, should
be done potentially at the sametime.
I don't think you need an everyyear segmental DEXA scan,
although it doesn't hurt to getone if you're already on the
machine to get a bodycomposition and so but at the

(19:24):
end of the day, we are reallylooking at your fat mass and
your lean mass, and then asegmental DEXA really looks at
how dense are those bones, arethey going to support me in a
fall and am I going to be atrisk for a hip or a spine
fracture?
Do I need to do more?
And you know I refer to yourother podcast which was so
well-spoken about that side ofthe equation.

Thank you, thank you, yeah, and so, even though I
went and got the body scan withDr DeMarco, I am scheduled for
a regular bone scan at the endof July because, as my listeners
know, I have osteoporosis andthat is of concern.
But we'll talk more about kindof my plan forward that I have

(20:08):
with Dr DeMarco and it's goingto address that too.
All right, so when someonecomes to your office, what would
they expect during their firstvisit with you?

So, first of all, we've got a beautiful space
.
It's going to be very welcomingand hopefully, very comfortable
for you to walk in.
This can be a dicey thing,right Like I'm going to be told
what's actually going on in mybody, and these are tough topics
to talk about.
So we want to create a reallycomfortable environment for you.
The staff is fantastic.

(20:40):
They're going to welcome you,they're going to laugh with you
and it's going to be genuine,it's going to be real.
They're just wonderful,wonderful people.
So we'll bring you in, we willtake you back, we'll weigh you
and get your height and thenwe'll put you on a DEXA scanner.
So a DEXA scanner we didn'treally talk about what it looks
like or what it really is.
A DEXA scanner is a big tablethat you lay on and it's got a C

(21:02):
arm, which is basically thislittle arm that moves kind of
like this across your body,right, and it sounds like a
Xerox machine, but it's veryit's notvasive, there is no
claustrophobia risk and it'sabout a six to 10 minute test
really, depending on your bodyweight and size.

(21:23):
Once you complete that test,we'll get the data right away.
We put it up into our DexaFitcloud, and our cloud contains
over 250,000 de-identified tests, and all those data points then
are used to help you kind oflook at your body compared to
peer groups.
And this is where it getsreally interesting, because we

(21:46):
take the data and we do morewith it than we could otherwise
do.
If you got a DEXA scan for bodycomp somewhere else, the
software is available as an appand you can look at your bone
mass and your lean mass and yourfat mass and the distribution
of those, and there'sexplanations in there to help
you take a deeper dive.

(22:07):
And then, beyond that, you'llbe able to follow it over time
in that same app.
So it becomes like your sourceto see where have I been and
where am I going with thesereally important body
composition metrics.
If you stick around and do morethan just our DEXA scan, we
have two additional tests thatwe do.
Now.
I think you just did the DEXAscan, but that tells us the what

(22:30):
right.
What is the current state of mybody when it comes to two
important metrics?
Visceral adiposity, which isdangerous fat that's deep in our
belly.

And mine was relatively low, which I was glad
.

That's great.
And then number two what isyour lean mass?
And we like to look at leanmass in the same way that we
think about body mass.
And I say it that way becausewe've all heard of the BMI.
The BMI is a body mass indexwhere we take your total weight
on the scale in kilograms,divided by your height in meters
squared, and it gives you anumber.

(23:04):
And we all know that that's afrustrating number because you
would be overweight on the BMI.
But you're not reallyoverweight because you've got a
lot of muscle, and an NFL staris a perfect example of that
person.
They would be clinically obeseby all standards of BMI.
But they are clearly not whatyou would think of as an
unhealthy specimen.
They're the opposite.
And then to be fair, a verythin build person might be under

(23:28):
muscled, but we would neverpick up on that on a BMI.
You know that's going to say,oh, you're fine, you're in the
normal range, which we'd call 19to 25.
But they might actually havemore risk than it shows.
So the BMI is a poor tool.
There's something called an ALMIand the appendicular lean mass
index is what we like to look atto help see if you're

(23:50):
appropriately muscled, do youhave enough muscle to age?
Well, that's the way to thinkabout it.
And if you're in the topquartile, there's some
advantages, according to theresearch, and if you're in the
bottom quartile, there's somerisks.
If you're in the middle, it'sopportunity.
And if you're below thatquartile, that bottom quartile,
we really want to at least getyou to the 30th, 40th percentile

(24:10):
for your gender and age, justto make sure that you're safe
and you're not going to haveincreased health risks as you
age.
Make sure that you're safe andyou're not going to have
increased health risks as youage.
So that really looks at yourlean mass in your arms and your
legs divided by your height inmeters squared.
So it's the same metrics butdifferent things we're measuring
and that really is, in myopinion, going to be helping us

(24:30):
guide patients along theirjourney Because, as I mentioned
earlier, age 40 is when we startto see lots of change.
Journey because, as I mentionedearlier, age 40 is when we
start to see lots of changedecreased muscle mass, little by
little, to not just aboutstrength and independence, but
it's also about metabolism andhow your body handles
carbohydrates, how your bodyhandles hormones and different

(24:52):
things like that.
So all of it's affected by yourlean mass and having more
especially in makes a bigdifference in aging well.

So, so I'm laughing only because I was in
the opportunity class in termsof my lean body mass, and even
though it was super hard to hearthat, because I have been
lifting weights and being veryconscientious about making sure

(25:22):
that I am strong there, Irealize now that I've got some
work to do, because, as I telleverybody, look, this is not
just about my looking good inthe dress I'm wearing at the end
of the month, which I am but Iwant to be able to get off the

(25:46):
toilet by myself, so that Idon't have to be in a nursing
home or in a wheelchair.
And so I want to know this data, even though it's hard to hear,
and I would love to know howyou approach conversations with
patients who receive surprisingor very tough results.

Yeah, it is hard right.
So, again I said, the DEXA scanreally tells you the what of
your body, which is potentiallygood news, potentially bad news.
So we look at everything aseither an opportunity, as you
said and I said earlier, or anasset.
And here's the thing there'svery few people I've seen come
through the door here that don'thave an asset.

(26:28):
If you have a lot of fat mass,you know you need to lose some
of that to be healthier.
We want to know how much ofthat's dangerous, how much of it
is just subcutaneous fat, andwe can talk some of that to be
healthier.
We want to know how much ofthat's dangerous, how much of it
is just subcutaneous fat, andwe can talk through all that and
that might be an opportunity.
But those individuals tend tohave stronger bones.
They tend to have better musclemass.
I kind of joke.

(26:49):
It's like every day you walkthrough life like you're doing a
farmer's carry.
The whole time You're carryingthis extra weight everywhere you
go.
It does have some benefits.
Unfortunately, it's hard on theknees, hard on the back, can
wear down joints and then, ifit's visceral, it definitely can

(27:09):
be dangerous from a metabolicperspective as well.
So we talk in terms of and I'vebeen doing this for 25 years
you have to deliver bad news inmedicine.
You have to tell them about anabnormal cancer screening test,
you have to tell them aboutnumbers that are not favorable
and you learn how to just comedown at it.
Very matter of fact and yetgentle and I think we're always
going to be gentle with thingswe joke a little bit about the

(27:33):
opportunity thing and a lot ofpeople get a kick out of that.
But I think at the end of theday, here's what I like to tell
people If it's, if you don'tknow this information, is it any
less true?
And the answer is no, in factit's.
It's more dangerous not to knowthan to know, and it'd be much
better for us to just kind ofsay okay, listen, I'm Dr D, I'm

(27:59):
your friend and we're going towork through this together.
If it's a bad news, and if westart with what is true and then
build from there, you're goingto do much better.
And the nice thing iseverything about both VO2 max
and visceral fat and lean massindex modifiable.
They're all modifiable.
No one is stuck.
It's not like just a geneticthing.

(28:20):
Where you're stuck with thesethings you can put effort in and
you can put different inputsinto your body mostly lifestyle
medicine related inputs thatwill make a big difference and
help you maintain, if not make,significant gains, and you're
going to be the one that enjoysthe results of that your hard
work.
You'll get the dividends thatpay off later on.

And you know that's why I love what I do,
because my clients, it's theirhard work and dedication that
moves the needle, and I'm sureyou have a patient success story
.
Can you share one that you'vehad?

Oh gosh, I mean , there's so many little success
stories, right, and we couldthink about this in multiple
ways, right.
There are some people that havejust found their way into
lifestyle medicine and justembraced it, and they're eating
much more of a plant-based wholefood diet and they're
exercising regularly and they'rejust feeling great.

(29:24):
But I also think about some ofour patients that are on GLP-1
drugs, and people are nowfinally aware that your muscle
mass might be at risk as you'relosing weight, and this again
gets into the semantics of arewe losing weight or are we
losing fat, and really, what agood GLP-1 response would be.

(29:46):
We want to see a significantloss of fat mass, not lean mass,
and so therefore, if we see 80to 90% fat loss and maintaining
most of your lean mass, that's,in my opinion, an incredible
success story.

But here's the thing, and I'm not everybody
knows I'm not anti-GLP-1, but ifyou are on a GLP-1 and you are
having significant weight loss,how do you know it's not your
muscle If you're not gettingsome kind of a DEXA scan?

You need it.

Yeah.

You need the DEXA scan.
We look at real closely howdifferent tools that are out
there in the community, forexample InBody, that's
bioimpedance analysis, bia, andso basically it's looking at how
electricity flows through thedifferent tissue types and it's
trying to predict then, how muchmuscle mass do you have, how
much fat mass do you have.

(30:43):
It even tries to make aprediction on visceral fat, and
we, luckily, are able to havepeople get that test and then
the same day get our test.
And what all the studies areshowing, of course, is that
sometimes they're accurate, butthey're so fickle, they're so
dependent on time of day andwater, weight and all of these

(31:03):
factors that it's not very goodat predicting your fat mass
especially, and so itunder-reports fat mass and it's
going to over-report lean masspotentially, and so therefore
you need to have a DEXA scan,which is the gold standard test,
to know, and I ask every GLP-1patient to get one while they're

(31:25):
on the GLP-1 every three tofour months.
It'd be preferred to have at aminimum every four months
because you would see thosechanges little by little, and
then you can input more proteininto your diet, you can add more
weight training.
Maybe we want to lower the doseof the GLP-1.
Maybe we find out it's reallynot good for you at all and we
want to stop the GLP-1.

(31:46):
And there's lots of differentoutcomes depending on the
results we see.
But I have had a few peoplevery, very impressively
maintaining their lean mass inspite of a big weight loss on a
GLP-1, but they all havelifestyle medicine in common.
They all are treating the GLP-1like it's a tool, not a magic
pill, and I really recommendpeople not view it as a magic

(32:10):
pill.
It is dangerous that way.
It is actually very safe to useit for a time, but the hope
would be just like trainingwheels on your bike.
You don't want to ride yourbike as a 20-year-old,
30-year-old, 40-year-old withtraining wheels and you don't
want to boast that you're a bikerider if you have training
wheels on.
So again, with healthy living,we want to do the lifestyle

(32:30):
things.
Maybe use the drug if needed,especially if you have high risk
, like if you are alreadypre-diabetic, have fatty liver
disease, have disease concernsrelated to blood pressure and
cholesterol.
By all means, consider usingthe drug for a short term, but,
please, lifestyle medicine iswhere it's at.

Yeah, and so everybody wants the quick fix,
and what I often have to remindpeople is you didn't get to this
place overnight.

Correct.

And so let's not use that as a crutch to have a
quick fix.
Now.
If you truly have metabolicdisease, you're morbidly obese,
you've got a myriad ofcardiovascular issues, I'm all
for it.
But if it's to lose 20 poundsfor the wedding, I got a problem

(33:24):
with that, and so I'm veryhonest.

Well, and this is where our other tests come
into play, because we talkedabout the what with the DEXA?
And then the how comes in withthe other two tests.
So we use gas testing, meaningwe're measuring oxygen
consumption and carbon dioxideproduction.
We call this indirectcalorimetry, and that is gold

(33:48):
standard testing for looking atwhat is your actual resting
metabolism.
I would define that as thenumber of calories you need to
keep the lights on, so to speak,the minimum number of calories
that you should eat to safelyfuel your body.
And if you eat at your restingmetabolic rate, you will be safe
with your weight loss.

(34:09):
The amount of weight that youlose will be dependent on how
much you eat over that number.
So if you eat too many caloriesover your resting metabolic
rate, you will be in a caloricsurplus and you will gain weight
.
If you eat above your restingmetabolic rate but in a caloric
deficit, you will safely loseweight.
And so we talk at Dexafit aboutusing the RMR as the how

(34:34):
nutritionally to do what you'resaying lose the 20 pounds, do it
safely, sustainably, becauseyou never want to eat under that
resting metabolic rate.
When you do, you can do it oneday here, one day there.
But there's a few reallyimportant things to know about
that.
One, your body will stopburning calories and start

(34:55):
reserving those calories andholding on to them.
Your body will go into scarcitymode if it's not getting what
it needs.
And then if you think of yourbody like a factory, what you'll
figure is well, the foreman ofthe factory is going to say,
well, we don't have enough fuelto fuel this whole thing.
Let's shut the West Wing downand we'll keep the North and the
East and the South wings openand ultimately you're not living

(35:17):
a very successful life.
When part of your body is shutdown and people can see you cut
your calorie count 30% belowthat level, you're going to see
a 30% reduction in metabolicoutput and you'll feel tired and
ultimately your body will startto fight back, encourage you to
eat and you won't be able tosay no and you'll yo-yo, you'll

(35:38):
gain the weight back and it'llbe very unsafe.
So knowing your restingmetabolic rate is super
important and it's better toknow the actual gas exchange
data, because the formulas mayor may not be right.
The formula for me is off byabout 400, 500 calories, and so
it doesn't take into accountyour muscle.
It doesn't take into account alot of things that would affect

(36:03):
how fast or slow your restingmetabolism would be.
So it's a very valuable tool tohelp crack the code.
For how do I lose weight safely, sustainably and naturally.
And even if you're on a GLP-1,I think you need to know that
number so you're eating assafely as possible.
Again, starvation diets are notrecommended.
Medically induced anorexia isnot a good solution for

(36:25):
long-term weight loss.

You know.
So this is the comment I getoften from women in my age group
.
I don't understand why I can'tlose weight.
I'm only eating 900 or 1,000calories a day, and I'm walking
and I'm doing all kinds ofcardio and I'm like, well, your

(36:46):
body isn't feeling safe, and soI compare us to being cave
people.
Our bodies are still programmedfor famine and when there was
scarcity of food or childbirth,and so until your body feels

(37:07):
safe.
But what you're saying is youactually have a number that can
be used to determine if yourbody is safe, and I love that
that can be used to determine ifyour body is safe, and I love
that.

Yeah, absolutely yeah.
We want to give handlebars towhat you're doing, so you have a
way to ride and steer your shipin the right direction.
But we can't just say, oh, justeat less and move more.
That's very, in some very basicways, that's correct, and then
there's so much more nuance toit.

Yeah, it's kind of I would say it's archaic,
because it's just not Very muchso.
What I always think isinteresting and this is how I
try to get women to really thinkabout weight training versus
cardio is that your restingmetabolic rate is much higher
after lifting weights than it isdoing cardio, which, yeah, and

(38:03):
I think that's such a greatdangling carrot.

Yeah, and the more muscle you have, the more
you're going to have to fuelthat and you're going to have a
higher resting metabolism.
And so when we see someone getour DEXA and then move to the
next room and get a restingmetabolic rate, we'll again get
that data right away and we'llbe able to see oh, they have a
lot of lean mass.
We just saw that on their DEXA.
No wonder they have a fastmetabolism.

(38:27):
They need to also make surethey're eating enough to support
that muscle, and so everybody,even people that are in a good
place, need to know theirresting metabolic rate so they
don't start to lose muscle atthe age that we are all reaching
.
So, yeah, and then the thirdtest is the VO2 max, which is,
again I mentioned, a marker forlongevity and cardiovascular

(38:49):
risk, but it's also a tool tolook at how do we improve our
body from a fitness perspective.
Because, as you're doingmeasurements of gas exchange,
what you're seeing is when, atwhat heart rates am I burning
fat?
At what heart rates am Iburning carbohydrate?
What heart rates am I burning ablend?
And so low intensity workoutstend to be those that burn more

(39:13):
fat, and we can give you a veryprecise range and say, okay, if
you keep your heart rate withinthis range and kind of the top
of that range, we call that zonetwo training you maybe have
heard that term.
And that's really based off ofhow much you're burning fat at
different heart rates, and we'regoing to define that very

(39:34):
clearly for you at DexaFit andwe'll also then tell you how to
do proper HIIT training becausewe can tell you what type of
heart rate you should beachieving to really experience
either sprint intervals, whichwould be a shorter, 30 to 60
second burst of high intensity,or more of a two to four minute
long high intensity interval.
That's how I would define thedifference between sprint

(39:55):
intervals and high intensityintervals.
Both are important or theycould be equally swapped out and
um, but your heart rate mattersfor that and I think a lot of
people are not understandingenough of that to be able to
take advantage and make theirexercise efficient.
And I hear a lot of people sayI'm working out so hard and so
often I don't think I can domore.

(40:16):
Doc, I don't think I can domore.
And I say, well, let's make itmore efficient, then let's,
let's get the data that you needto make it more efficient, so
that now you not only know thewhat behind your body
composition, but you have thehows for nutrition, the hows for
exercise, to really make yourlifestyle working, for you to
maintain a healthy weight and tolive a long healthy life.

Okay, I want to move on to one other aspect of
your practice that I think hasbeen really helpful for some of
your patients is using thecontinuous glucose monitor as a
tool to help bring someawareness around how people
handle sugar and insulin.

Yeah, I think that's super valuable.
It's not just for diabetics.
Diabetics who have to pricktheir finger multiple times a
day have found so much freedomin having a continuous glucose
monitor because it pushesinformation to their phone and
they can see in real time wheretheir sugars are, and that could
be life or death for a diabeticif it's too low or too high.

(41:19):
For the rest of us, it's moreabout training ourselves away
from high glycemic foods andtowards eating foods that really
support a healthy metabolismand allow us to enjoy the things
in life we love to eat.
I always ask in myquestionnaires what are three

(41:39):
foods you're never going to giveup and I don't expect you to
give those foods up right.
But at the same time, we shouldlearn how to best eat those
foods.
If you eat a lot of what wecall high glycemic foods, you'll
see a big rise like a big risein your blood sugar and it'll
show up on the app that goeswith the continuous glucose
monitor.
But I've had patients tell meif I eat a half a banana, I see

(42:04):
this little bump and I eat theother half and it's a little
bump, but if I eat the wholebanana, it just jumps really
high on me and comes back down,and it's about how much the
different things are that you'reeating.
It's about what the foods aremade of and a lot of us learn
hey, even if it's technically ahealthy food, if my body doesn't
respond the way I want it to dothis, then I think I'm going to

(42:28):
need to eat less of it or justtime it differently.
And, of course, the earlier inthe day you eat certain foods,
the less of a sugar spike you'regoing to get.
So it's fascinating and it's agreat tool for learning how your
body responds to healthy foods,unhealthy foods.
How much is enough, how much istoo much?
And I use it as a deterrent atholidays from having that second

(42:49):
or third, you know, fill in theblank.
I know it's like boy, that'slike Ebenezer Scrooge why are
you wearing that thing atChristmas?
But it really does help me, sayyou know what, I am satisfied
with what I just consumed inthis party setting.
I don't need to have any moreand the CGM tells me that.
So we wear it a few times ayear.

(43:10):
I think is a good goal, likewhen you're in a time of really
strict dieting.
It's good to do that If you'redoing any prolonged fasting,
it'd be really good to know whatyour body's doing during that
time.
When you're on a holiday,you're on a vacation.
It wouldn't hurt to know what'shappening when you have a
little more food and spirit.
You just want to know so thatyou can be aware and be mindful

(43:34):
of your eating.

Speaking to a client the other day and she was
telling me how she goes intothis huge slump in the afternoon
.
You know, just feels terrible,feels awful, and, as we started
digging in a little bit, findingwhat are you eating up until
that point during the day andhow are you eating it?
And one thing that I havenoticed is that, even with fruit

(44:00):
like the banana, or even a bigbowl of berries is, those in
themselves are nutritious andwonderful foods, but pairing
them with some protein or alittle bit of fat, preferably
some protein, can do wonders forhow you feel.
For how you feel, and so what Ilike about the CGM is I think

(44:21):
it gives people a glimpse behindthe curtain of, I know, when my
blood sugar does this.
An hour or two later, I feellike this, so it helps them play
it forward to make better foodchoices.

Absolutely.
And the thing that's happeningscientifically and biochemically
behind the scenes is when youget a big spike in your sugar,
that's the body trying to.
You know it's got to now breakdown all that glucose and every
time your mitochondria breakdown energy, there's something
called oxidative stress thathappens.
So the more sugar spikes youhave, the more oxidative stress

(45:01):
you have, which is just kind oflike damage to the system.
And then this is why we needberries and antioxidants that
come in other forms, becausethat helps with some of the
neutralizing of the oxidativestress.
But oxidative stress leads toaging and part of what we're
doing here is trying to slow theaging process down.
So when you keep your bloodsugar with fine, narrow and

(45:26):
in-range little blubs of goingup and down, staying within
about 15 to 20 milligrams perdeciliter from your average,
never really getting above orbelow that, that's the real
sweet spot for really minimizingoxidative stress.
And we have tools now that youcan do this.

(45:46):
And the thing I like about itis you do it sometimes.
You don't have to wear it allthe time.
A diabetic might need it allthe time for life-saving reasons
.
We just need it enough to learnand then to apply what we learn
to our lifestyle.

Yeah, and I love that.
I just love having data,because to me that's the name of
the game have the data so thatyou can put a plan in place.
And part of that plan for someof your patients is maybe some
supplements, and I know I havetwo things that I'm using now
that Dr DeMarco gave me, and thefirst one was an amino complex.

(46:23):
So let's tell the audience whyI am taking that Sure.

So there's different ways to get amino
acids into your body, andprotein is where we get our
amino acids in general.
So eating protein clean,responsibly raised meat products
, plant-based proteins this isgoing to be a great first choice
, and then some whey protein orpea protein, depending on if
you're plant-based or not wouldbe another choice to get more

(46:50):
amino acids into your system.
But sometimes you want to do,say, a longer fast and you want
to be able to start your dayturning on muscle protein
synthesis without having to eata bunch of calories, and so you
can pre-workout or just at thebeginning of the day and the end
of the day you can keep muscleprotein synthesis on simply by

(47:12):
putting essential amino acidsinto your body.
So for 25 calories you can juststir it into some water and
drink it, and it gets you enoughstimulation of the mechanics of
turning on muscle proteinsynthesis without having to load
up on protein, which for somepeople can make them feel more

(47:32):
full.
I still want you to get proteinin as much as possible, of
course.
It's a great add-on because alot of people tell me you know,
I know I'm supposed to get likepoint eight to one gram of
protein for every pound of idealbody weight and they start
doing the math and they're likeI'm so full, I'm not getting
that much.
This is another way to kind ofkeep things going in the right

(47:54):
direction without having to feelbloated all the time from too
much actual protein in your body.
So yeah, All right.

Well, I'm using it almost every day.
So, yeah, I'm using itappropriately, usually right
before and during my workout.
So hopefully that's okay.

That's great.

All right.
The other thing that I am usingthat you gave me was the
ReversaCell.

Yeah, that's a Thorne-based product and it's
one of their most popular things.
It's associated around longevityand it's really for
mitochondrial health mainly, andcell signaling inside the cell
has to do with something calledsirtuins and we don't have to
get into the details of all ofthat.
But ultimately everything inthat supplement is oriented

(48:44):
around helping yourmitochondrial health, supporting
sirtuin activation, so thatcell signaling internally is
what it needs to be to supportaging well and appropriate
breakdown of the nutrients thatyou're eating.
There's this theory ofmitochondrial aging that is

(49:04):
related to we age because ourmitochondria age and our
mitochondria stay healthier whenwe reduce oxidative stress,
when we exercise adequately,when we take in certain
antioxidants, of course, andthen we really do support the
body with things like thenicotinamide riboside which is

(49:27):
in there.
That's one of the mainingredients and ultimately it
enhances the mitochondrialfunction which hopefully will
keep our mitochondria goinglonger and stronger and we age
slower and feel better along theway, because the more our
mitochondria are efficient withenergy burn, the more like just
vitality we feel.

(49:48):
We have more energy.

And I didn't tell you.
I was going to ask you this,but we talked a little about NAD
.

Yeah.

Will you explain a little bit about NAD and do
you ever do NAD injections forpatients?

No, yeah.
So that's a great.
This comes up in my practice,and so here's what I like to say
about some of this.
I am trained in allopathicmedicine and one of the things
we talk about is, first, do noharm and then help the patient.
And I'm not saying that NADinfusions are harmful, I'm just
saying that the science that Ihave available to me isn't

(50:26):
available.
So I am very open-minded and Ilike to think of myself as
someone who's willing to be inthe middle of the aisle.
I've got some MD doctorcolleagues that would be so
angry that I'd even have aconversation around NAD
infusions, and I think they'rewrong.
I think they need to open theirminds to like, okay, this could

(50:49):
be great and we just don't knowyet.
We need more data.
So let's get the data and let'sdo something with that data as
we go.
And then there are people thatare going to say, well, if some
is good, more is even better,and we've learned from other
areas of science that that's notalways true.
Like another good example ismore weight loss might mean more
muscle loss, and we know that.

(51:11):
Therefore, just losing moreweight blindly doesn't make
sense.
So I think I always ask mypatients that go get the
infusions.
How do you feel like?
Are you doing OK with it and Idon't think anyone's getting
harmed by it, but I also don'tthink I'm ready to start
offering that.

Okay, yeah, and I it's.
It's for longevity, correct,mitochondrial health and
longevity?
Okay, absolutely.

Yeah, so it's just the question of dose, right
, and everything in the worldlike it's all dose dependent.
Too much of a dose like okaywhen we need to thin the blood
with a drug called Coumadin.
If we just use enough, we getthe blood thin and we avoid
blood clots and risk of dyingfrom blood related issues, but

(51:57):
if we take too much it's a ratpoison and we bleed out and die,
and so it's all dose dependent.
And I just think we need tocontinue to learn and grow, and
so my hope is to be kind of avoice of reason in the midst of
a world where there's somepeople that are too stodgy and
others that are too loose.
And how do we block arms andlearn and work together to help

(52:20):
patients live long, happy,healthy lives?

And we do that with data.
Data helps, that's for sure.
Okay, I am really veryinterested to know, pursuing
this avenue of medicine andhealthcare, how has this changed
your view on things?
Obviously, you've made somesignificant changes in your own

(52:45):
lifestyle.
What would those be?

Oh gosh.
So I would say that this isspawned out of my own life
journey right, and I alreadymentioned how I know, as I'm
getting older, there's so muchrisk for me in terms of my
family history.
But I also know that 70% of it,if not more, is related to my
lifestyle and not related to mygenetics, and so I have been

(53:07):
obviously trying to live all sixpillars of lifestyle medicine,
and it's funny because there's atension there and I think life
is full of tension and I thinkwe need to embrace the tension.
You are sort of walking atightrope everywhere you go when
it comes to if I do too muchenjoyment of the finer things of

(53:27):
life, then I will lose some ofmy health, but if I'm too strict
and I never do anything fun,then I might lose some of my
social relationships and thatmight affect me negatively too,
and so we're always constantlywalking a tightrope in this area
.
I think if everyone can focusin, like what I've tried to do
for myself personally is I startwith sleep, and I think sleep

(53:49):
is a linchpin.
I used to believe it was one ofthe pillars.
That might be the mostimportant pillar actually,
because think about a day whenyou know you're underslept, and
how you respond to your family,how you respond to struggles in
life situations.
Food I'm much more likely tocrave the wrong foods.
I'm much more likely to tap outand not work out.
But when you're well rested,you wake up feeling ready to

(54:13):
make better decisions, and so ifI can get seven hours of sleep
preferably seven and a half I'mhaving a better day.
So I always strive for that,and having some device for data
reasons that'll keep track ofthat is very telling.
None of the trackers areperfect, but directionally
they're all great.
So an Apple Watch, an Oura Ring, ultrahuman all of these things

(54:36):
are moving in the rightdirection to help us understand
what our sleep is helping us door not helping us.
And if you have sleep apnea ortrue sleep problems, it's really
important to address that.
First you need to talk to asleep doctor or figure out some
ways that we can under kind ofdig to the deeper levels and
figure out why you're notsleeping well.
But from there then I reallywant to always get two days of

(54:59):
resistance training in.
I want to get zone two trainingin as many days as I can.
What I love about zone twotraining, which is that low to
moderate intensity, endurance orsteady state training.
I call it exercise, and so it'sexercise and listen to a
podcast, exercise and call yourmom Exercise and whatever you

(55:24):
want to do, fill in the blank,because you're not.
You're breathing through yournose.
You should be able to talk ifsomeone asks you a question.
If you're doing more, whereyou're breathing through your
mouth out or breathing throughyour mouth in and out, you're at
a higher intensity and it'sprobably not going to be good.
So you want to be good for thepurpose of fat burn and zone two
training, building upmitochondrial health, so that

(55:44):
you have more endurance.
So I try to get as many days ofthat in as I can, and then
preferably one or more, maybetwo days where there's sprint
intervals and that's going totrain the high end of your
aerobic engine, whereas zone twotrains the lower gears of your
engine, and then strength is soimportant, though, so

(56:07):
progressive overload withfeeling sore muscles.
That's super important and, tobe honest, it's very hard to do
all of those things every week,and so we fight the good battles
and we do the best we can.
This is where, yeah, we just youlearn as you go and grace
should be something you shouldgive yourself, but if you do it

(56:28):
with other people, it's going tobe even more valuable.
So it's said, you can do a lotof hard things for a long time,
as long as you don't have to doit alone.
And I encourage, you know, getin with another person or a
group.
So group training is fantasticif you can do that.
And yeah, those are the thingsI would say.

And it's funny.
So Dr DeMarco andI spoke aboutall this when I was in the
office with him and I had beendoing some sprint training.
I had started doing that priorto seeing him, so that was good.
I have added in some inclinedwalking on a treadmill to get my

(57:08):
heart rate up a little bit more, and that has been very
interesting, already noticingsome body composition changes
with that.
So I will say that's been agood one.
I will say that's been that'sbeen a good one.
And I decided that I wasn'tgetting sore after I worked out.

(57:28):
Even though I was progressivelylifting heavier weights, I
probably still wasn't liftingheavy enough.
So I rejoined the gym and I'mdoing machines and heavier free
weights and I am getting sore,but it's a good sore.
It's not a debilitating sore,it's a hey, I worked out

(57:49):
yesterday kind of sore, andthese are all things that are
simple to do.
I just needed that push ofgetting the body scan to say,
okay, I want this for my next 20, 30 years.
This is what I want for myself,and this has been an incredible

(58:10):
motivating experience for me toget me started on this journey,
and so I thank you for that.

It's my pleasure.

Yeah, and his office really is nice and the
ladies are great too.
And on that note, just what forwomen that are listening,
because I would say typically myaudience is at least 50 plus,
maybe even 55 plus what's onetest or scan or service that you

(58:38):
wish every midlife woman couldprioritize this year?

Oh, I would have to say it's the DEXA scan
for body composition.
It's going to tell youinformation that you just can't
get from other avenues.
The only other tests that canbe as precise or more precise
are thousands of dollars andcause claustrophobia from MRIs.
It's just cost prohibitive andit's not offered and I don't
think you need to go through allthat.

(59:02):
You get great data from a DEXAscan, learn the what, get that
baseline and then from there wecan build out and we can build
precision around the how withnutrition, the how with fitness,
and really help you hone in andwhat we can't do for you.
We can connect you with otherpeople who are capable of

(59:24):
helping you even further from anutrition or dietetics
perspective or fitness training.
We don't want you to get hurtand we want you to do things
well, so we're always going totry to put you in the hands of
competent professionals that canhelp you when it goes beyond
what we're able to do for youhere but there's a whole lot
with lifestyle medicine we cando for you here.

And just before we wrap up.
So Dr DeMarco's office is inCincinnati, ohio, but there are
DEXA-Fit locations around thecountry, correct?

Correct, we're up to about 60 different sites
Now.
Every one is different, not allare run by physicians, but
every single one is going to beable to give you the same data
that I provide through the DEXAscan.
And they're all great, and Iwould say you can find them on
East Coast, west Coast, northand South, and they're even in

(01:00:13):
other countries.
We're in Singapore, we're inSouth Africa, we're in Sofia,
bulgaria, of all places.
So, yes, there's lots oflocations and your data follows
you of all places.
So, yes, there's lots oflocations and your data follows
you.
I've had patients come from anOrlando site and get their
second scan from us and the datais all right there.
They can compare.

Michele Folan (01:00:30):
Oh, fantastic.
Oh, that's great to know.
All right, Dr Dave DeMarco,this was such a fun conversation
.
I am looking forward to seeingyou in five months because I'm
going to come back at thesix-month point and I will
report back then and I inviteeverybody to be on this little
journey with me.

(01:00:50):
So thanks for being here today.

Dave DeMarco MD (01:00:52):
It's my pleasure have a great day.

Michele Folan (01:00:54):
You too.
Hey, thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
.
And did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
Thank you.

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