December 30, 2024 • 49 mins
Dr. Hassan Makki shares his innovative vision for integrating exercise and nutrition into cardiology, underscoring the need for preventative care. The episode highlights the importance of movement, how it improves health outcomes, and the transformative potential of a holistic approach in treating heart conditions.
• Introduction to Dr. Makki and his journey in cardiology
• Shift from traditional treatment methods to a focus on preventative care
• Discussion on the role of exercise in enhancing heart health
• Importance of mobility and its direct correlation with overall well-being
• Overview of The Heart and Wellness Center's holistic approach
• Emphasis on technology in tracking health metrics
• The benefit of resistance training for managing insulin resistance
• Vision for a future where healthcare practitioners work collaboratively
If you'd like to learn more about Dr. Makki or are interested in his services, visit The Heart and Wellness Center website for additional information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hi everyone, welcome back to Exploring Health Macro
to Micro with Parker Condit.
I'm your host today and we'rekind of kicking off season two
with a bit of a differentepisode, obviously recording
live in person.
And I'm here today with DrHassan Maki.
He's the founder and he's alsoa cardiologist.
He's the founder of the Heartand Wellness Center here in
Paradise Valley, serving sort ofthe larger Phoenix Scottsdale
(00:25):
area.
So we're talking today with himbecause he has a very
interesting and innovativevision for what his practice is
going to be in the future andhe's already kind of started
that.
So we're going to discuss alittle bit about your background
and why you have thisparticular vision for your
practice in the future.
So I'd love to start with sortof your background, from how you
(00:46):
got into cardiology and thenwhere your desire and your
passion for integrating otherparts outside of medicine into
your practice came from.
Speaker 2 (00:55):
So nice to meet you, parker.
Thanks for coming in and helloeveryone.
Yes, so my career is likesimilar to a lot of other
cardiologists.
We start off, you know, withundergrad and the sciences and,
uh, I became interested incardiology while I was in
medical school.
I found the heart veryfascinating and, interestingly,
(01:18):
um, in medical school, my, uh,my joy and my for working out
was also reignited at that time,because when you're in that
situation where you're basicallyjust studying and you have time
for maybe one hobby, sure.
So, luckily, one of myclassmates, paul Metcalf he was
(01:41):
like a bigger guy and he, uh,his thing, what.
He was a trainer, you know.
So I had paul at my disposalfor like two years.
We'd work out together.
I had been into likeweightlifting and just athletics
in general my entire life.
That's always been like.
My default setting is is sportsand exercise.
(02:01):
Um, I think that's been like afamily thing.
You know that we're always hadsports and exercise as like a,
as like a fundamental in our, inour household.
Everybody's to play,everybody's playing a sport and
everybody, you know, we studyand everything.
So, yeah, in medical school Istarted exercising, um, like
(02:22):
with more knowledge from atrainer, and I just noticed like
, wow it's, it makes adifference when you train with
someone that knows what they'redoing.
So that was now about 24 yearsago and I've kept it up the
working out and so fast forward.
Like I said, my career issimilar to other cardiologists
(02:44):
you go to residency, thenfellowship and then you start
seeing patients and after doingsomething for a while especially
like the way medicine ispracticed, now I feel like a lot
of it is converter belt, likeeveryone has put on this, this
moving thing where we throw sometests at you, whatever sticks,
(03:08):
uh, we treat you.
But I've been doing this longenough now where, like, it's not
adding up anymore.
You know it's basically, um,let's talk about hyperlipidemia
for for a second.
Like I'm trained from from youknow, our medical school and
residency and fellowshiptraining is like to look for
(03:29):
certain numbers and then, oncewe see these numbers, we're
alerted to prescribe thesecertain drugs and that fits
really nicely for us becauseit's clean, right and it's.
And then, similarly like when Istarted doing interventions,
which is where we go in, we cathpeople, we find blockages, put
a stent in there Very gratifyingfor me, you know, but am I
(03:52):
doing the best thing for thepatient.
I think now the evidence hasshown that maybe we're not doing
the best for the patients.
There was a new article thatcame out this summer that showed
about 25% of stents wereinappropriate.
Okay, okay, and that is usingjust the basic appropriateness
(04:13):
criteria.
This is not to say like thesepeople were put on exercise
regimens.
They were not put on cleandiets.
This is just with our stentsand blood pressure.
Your set of tools, our set oftools our set of tools, yeah, so
so doing that for a while itkind of burns you out.
It's like I I write about thison my website as the rationale
(04:34):
for this place, for the heartand wellness center.
It's like someone is having anemergency, they're having a
heart attack.
We go in, we put a stent andthen we save their life and then
they're right back to wherethey were right before they had
the emergency and there's likeyears of problems and and
preventative things that couldhave happened.
(04:54):
So so, um, for another, foreven more, along with the
explanation.
Um, so you know, I don't.
I delved into, theved into thewellness space very hard.
Some of it was based on my ownknowledge.
You know, I've always kept upwith the current nutrition and
stuff, stuff that were notcovered in our curriculum, you
(05:15):
know, and so I have to become anexpert on all these things I
have to know at least what theYouTubers know, and then add
some actual evidence to what I'mpreaching, and so certain
patterns, you know, came upwhile doing all this research
and just doing like a deep diveinto preventative medicine.
(05:37):
Okay, the number one thing andthis can be debated what is the
number one thing that apreventative cardiologist would
advocate?
I bet you, most of them wouldsay it's nutrition.
Okay, nutrition, nutrition,nutrition, and most of the
well-known doctors arewell-known because of their
nutrition recommendations.
But to me, physicality,physical activity, is number one
(06:01):
, because that is when you lookat a human being walking in
front of you on the street, it'sjust a bunch of muscles and
bones.
We don't see the organs, wedon't.
It's like.
So you know, we're meant to bedoing stuff with these muscles
and bones, and so I think wetalked about this before that
you could not, that I wantpeople to do this, but we could
(06:23):
beat a bad diet with exercise orhold it off, but you the vice,
vice versa is not true, like youcan't eat whatever you want and
then, or eat perfectly andexpect perfect health without
doing exercise and and uh andthings along those lines.
So that's why, that's why I hada gym installed in my place,
(06:44):
that's why it's like the numberone thing on my pyramid is
exercise, and I think that'sthat's how we most clearly
overlap.
Speaker 1 (06:54):
So I agree and this was like one of the fun
questions I would ask peoplejust working in the fitness
industry.
And just to introduce myself toanyone from who's watching from
Dr Mackey's audience, my nameis Parker Condit.
Anyone who's coming from myside, you're familiar with me.
I'm the founder of InTouchHealth and Performance.
I'm a health coach and personaltrainer and I specialize in
aging populations and kind of onthe preventative side when
(07:17):
people care about chronicdisease states that are very
common in this country.
That's where I really focus onpeople of not just getting them
in better shape and betteroverall health, but kind of
trying to attack some of thesechronic diseases that are so
prevalent here in the US.
So, being in the space for awhile, I would often have like
this fun dumb debate of like, ifyou could only pick one
(07:38):
nutrition or exercise, which onewould you pick?
Obviously, being a trainer, Iwas always on the side of
exercise, but I do take it alittle bit more seriously now
and I'm not sure why you land onthat side.
But for me, muscle mass is soimportant, and it's not for the
fact that you need to look likea bodybuilder, you just need to
have enough muscle mass in yourbody to readily store and accept
(08:02):
glucose that is kind of pouringthrough your bloodstream Muscle
mass.
Beyond the aesthetic, I thinkbodybuilders have kind of done a
bit of damage in that peopleare like I don't want to look
like that, I don't want to be inthe gym six days a week, and
that's certainly not necessary.
It's just increasing thequality of muscle tissue that
you have and putting a littlemore muscle mass on.
It's something that's very hardto do with nutrition alone.
(08:26):
Obviously, this is kind of likea moot point because we don't
have to choose just exercise ornutrition.
I think we're just bothhighlighting the importance of
exercise, and for me it's formuscle mass, it's for
cardiovascular health, whereit's like you can't improve your
cardiovascular capacity withoutexercise.
Nutrition's not going to do it.
It'll help minimize damagebeing done from your nutrition,
(08:50):
but exercise just has theseadditional inputs that are
incredibly beneficial.
But yeah, I would like to hearlike what is it about exercise
that you land on that side ofthe argument.
Speaker 2 (09:00):
So, yeah, this is a self-created debate, right,
Exercise versus nutrition.
Why are we even comparing thetwo?
Right, they're natural allies.
They should be done together.
And if you notice, like when youwork out, you don't crave the
bad food, okay, you don't cravethe salty food or the fried food
(09:24):
, like I do stress eat, I'maware, when I stress eat and
like, even this week I had akind of a rougher week stress
wise, so, but I've done thispromise to myself, okay.
And so I'm about to go stresseat.
I'm craving that burger orwhatever, like I know.
(09:44):
I know, like I'm due, I haven'thad one in a long time.
Cheap meal plus, whatever I do.
This one thing I'm like do theexercise, go to the gym, okay.
So I go to the gym, I do atypical exercise, a typical like
circuit of resistance training,which is what I like to do.
I do way more flexibility stuffas I get older, like now.
(10:07):
I like about 20 of the time I'mdoing stretches, you know, in
between, in between theresistance, um, and then after
I'm done, man, that craving isgone.
Now I want to go eat freshapples, um, a clean protein
source, and I just want to, justwant to keep that euphoric
feeling going.
Speaker 1 (10:28):
And.
Speaker 2 (10:28):
I know the burger which I was craving before is
not going to do what my body'sasking me right now.
Now my body is no longerstressed, okay, we have the
dopamine that's been releasedand you're even hungrier.
And I find that food is evenmore delicious when you're, when
you like kind of worked for itand you kind of like, okay, yeah
(10:51):
, maybe if I do end up having alittle bit of fries here and
there, that'll be just like aluxury, but I really want some
substantive food.
So that's another way thatexercise kind of self regulates
you.
It also helps you tease out,because eating is such a
psychological thing, right?
Very emotional, yeah, veryemotional, Like we're babies
crying.
What do we think?
They need?
(11:11):
Food, you know.
So we've been, literally sincewe were born, like conditioned
to have a different relationshipwith food above nutrition.
And I found that exercise, orregular exercise, or even just
that biofeedback you get fromworking out, it kind of
readjusts your mind Like hold on, am I hungry, Am I stressed, Am
(11:33):
I thirsty?
You know what I mean?
Like these things all getjumbled together sometimes when
you're just not sure.
You know.
Just your brain kind ofinterprets it as a binary thing.
But it's actually morecomplicated and if you tease it
out then you'll get what yourbody actually needs.
And I find that exercise is thegreat.
(11:53):
I'll tell you some otherbenefits of exercise for me
personally when we circle back,but I want to just hear your
thoughts about the psychologicalcomponent of exercise.
Speaker 1 (12:06):
Yeah, so as it relates to nutrition, there's
obviously there's particularhormone signaling that when you
exercise it upregulates certainthings.
You become a little bit moresensitive and aware of when
you're getting full and thenyou're a little bit better of
understanding your appetite.
Control gets a little bittighter generally and there
definitely is the very realphenomenon of your body
(12:27):
recognizing what it wants.
You see this a lot with thepregnancy.
When women are like I'm cravingthis thing, it's usually
because their body's deficientin something that that food has.
So we do have this very wildinnate intelligence within us
and I think over time this ispart of where like in touch came
from from my company name.
It's like getting people backin touch with their body and the
(12:49):
intelligence that they have.
We just kind of we, through allof our society and cultural
signaling and upbringing, we dolose a lot of the intelligence
that we have and we're kind oftold not to trust it but
exercise.
Very natural thing.
We were born to kind of moveour bodies.
We're physical beings, as yousaid, like the evolutionary
adaptations we have made us tothis point.
(13:10):
We have these thumbs that allowus to grab things.
We have these feet that areawesome for running and walking.
Um, so there's.
There's just this very naturalaspect to moving your body, and
it doesn't always have to be ina gym.
Like I'm one of the biggestadvocates for walking, um, like
everyone, everyone who's everworked with me, they know it
starts with walking because itjust gets your baseline
(13:33):
throughout the day significantlyhigher, and then we'll add
exercise on top of that.
But, yeah, I'm, there's, I.
I can't be a big enoughadvocate for exercise and I do
count walking in there becauseit's such an accessible form of
exercise for people where it'slike you don't need a gym
membership, you basically justneed a safe area to walk in.
And, granted, not everyone evenhas that, but it's one of the
(14:00):
lowest barriers to entry wherepeople think it's too low
threshold, it's too easy, it'sjust walking, it's not going to
make a difference.
But walking makes an enormousdifference to your overall
health, especially if you don'twalk much.
There's a nonlinear doseresponse relationship which just
means the less you walk, nowanything more is incredibly
beneficial.
If you go from 4,000 steps aday to 5,000 steps a day, that
(14:21):
1,000 step increase, you'll seea bigger impact than if you go
from 10,000 steps a day.
That 1,000 step increase,you'll see a bigger impact than
if you go from 10,000 steps aday to 11,000 steps a day.
So for the people who don't doanything, anything more than
you're doing is very, verybeneficial.
So I try to make exercise muchmore accessible to people and
not thinking oh, it's got to beat least four days a week.
Every workout's got to be hard.
I've got to be doing strengthtraining and doing cardio.
(14:42):
I try to get a lot of people tostart to be like just walk.
Just walk more than you are nowand get people on those early
wins.
Speaker 2 (14:50):
That's my exact recommendation.
Yeah so, cardiovascular healthis intimately related to
mobility.
Yeah, so, 30 to 60 minutes ofwhat we'd call aerobic exercise,
which includes walking Iliterally say that to every
single patient of mine.
Every single patient says sobecause that is like there's so
(15:12):
many, there's so many benefits.
Okay, You're getting mobility.
More than likely, more likelythan not.
You're leaving the device thatyou're looking at.
You're going into nature.
You're getting some fresh air.
You're activating some of thebigger muscles.
And then the vascular system.
If you ever look at an artery,like in cross section, it has a
(15:34):
layer of muscle in it.
Speaker 1 (15:37):
Interesting.
Speaker 2 (15:38):
The entire vascular system has a layer of muscle in
it because it's meant tocontract, like rhythmically, and
throughout the whole system.
So if you dissect any arteryand veins, veins do have a
muscular system, but it's muchthinner and that's why the
arteries are stronger and moreresilient.
And whatever artery we'retalking about, it needs that
(15:58):
movement.
Okay, that walking movementwhen the to and fro of the
vessel.
So let's say we're talkingabout my brachial artery.
Okay, behind my bicep, thismovement right now, just flexing
my bicep, or brachioradialisOkay, if you guys are on his
(16:19):
podcast then you know this isthe brachioradialis mainly, but
anyway.
So when we do these movements toour muscles and bones, the
arteries get stretchedlongitudinally.
Okay.
So not only do they flex, like,for example, they want you know
I'm flexing my artery now, orI'm flexing my radial artery,
like this, it's getting flexedbut when we do the muscles
(16:46):
around them, they also getflexed longitudinally.
So they rely on that, just likewe rely on muscle movements to
maintain our muscle.
The muscle layer in there isalso really important for the
integrity of the artery alsoreally important for the
integrity of the artery, yeah,okay.
So that to me, is proof alonethat you need exercise for the
whole body, and walking is justan easy way to do it.
Speaker 1 (17:08):
So I'd love to hear I think it'd be great if you just
talk through kind of where theclinic is right now, where the
practice is now, from whatyou're doing here, the other
providers you have in the clinic, and then I can go into talking
about the exercise component,and then I'd love to just hear
what your vision is for thefuture.
Speaker 2 (17:28):
Yeah.
So I mentioned why I wanted todo like a more comprehensive
preventative clinic rather thanjust doing the.
So my clinic, I do all thetraditional cardiology stuff.
I don't want that to bemisconstrued at all.
Most cardiologists, even ifthey don't believe anything that
(17:49):
we're saying okay, are actuallyahead of the curve compared to
other doctors with respect tophysical fitness.
It's all over our literatureand now like all over our
literature are the proper diets,the Mediterranean diet, the,
you know, even vegetarianism,like it's now really mainstream,
(18:13):
the things we're talking about.
Even resistance training.
There's some articles now thatcompare people doing HIIT and
not doing HIIT with resistancetraining.
And that's in our literaturetoo, which is phenomenal.
So I do the traditional stuff,all the traditional cardiology
(18:34):
risk factors, screenings.
I'm very high on screenings.
I like to do as muchinformation as we could.
That's covered by insurance.
You know, sometimes some thingsare out of pocket.
So I have the basics of acardiology clinic.
We do the monitoring, thesonography and all that stuff.
But one thing that comes upright away and that's why that's
(18:57):
how we met is through Dr Burkeis that a lot of my patients
have immobility issues that havenot been addressed by anyone
else, and I've seen thatthroughout my career.
I'll see someone come in on awalker or in a wheelchair or
just with a terrible gait andthen I'm supposed to put people
like that on blood thinners andthen constantly increase their
(19:20):
blood pressure medications.
So I'm like, no, I need thesepeople moving, otherwise, if
you're not moving and you'rejust sitting all day, your blood
pressure is going to keep goingup and up.
It's known as one of thesitting diseases.
That and diabetes.
They're just known as sittingdiseases.
So that's how Dr Burke, like weactually, when I was telling her
(19:40):
about the place, we met in acoffee shop and I think she was
doing something.
I don't even know how we werein this.
I honestly don't even know howwe started talking, but we were
like we're very much of the samemind.
You know, she's very athletic,she does a lot of workouts, she
(20:03):
does yoga and Pilates and stuff,so maybe we're talking about
workouts.
And then she's like, oh, I'mgonna get back into physical
therapy.
And she told me I'm like, oh,I'm doing a place, yeah.
And then we literally met, likearound the time I opened and
I'm like, okay, you have a space.
So now, like, my patients loveher because they she's excellent
, um, and the thing that I justgot done talking about is
available here.
That slightly improved access tohealthcare seems to work
(20:24):
wonders for a lot of people Okay, some people you're never going
to get them to and then,similarly, the idea is to have a
trainer that, uh, caters to mypopulation, and then that's kind
of like how we met and so we'vebeen like trying to find ways
to collaborate and for you tolike to see our patients, maybe,
while they're here, evenintegrate.
(20:44):
Like what I see for the futureis like activities going on.
While I'm seeing the patient,while I'm maybe adding on a
blood pressure medication,there's someone doing lunges
behind me, like it needs to benormalized, like those things
need to be normalized.
It's not a weird thing.
The gym is not an intimidatingplace, and now the doctors like
literally want you to do it inthis office.
You know, and I feel like a lotof elderly people especially
(21:11):
are nervous about doing stufflike that, and if I'm around,
like that gives them, you know,a little bit more reassurance
and, like I said, every singlepatient, they get these speeches
about how important mobility isand I feel like, so that's
available.
There's my colleague, my friendand my own doctor is also here.
(21:33):
He's a primary care doctor.
We share the space.
So if a patient doesn't have aprimary care, or so they, we
have that access.
We just got access.
We just have a new providerthat's going to be doing wound
care for us and she and shespecializes in elderly, like
(21:54):
geriatric care as well.
So that's another avenue.
You know, I've spent severalyears treating peripheral
arterial disease and venousdisease and so they get all
kinds of ulcers that are nothealing, which again impact your
mobility.
Like, if you look at thestatistics of someone that gets
an amputation, it's much worsethan someone who just had a
(22:16):
heart attack.
Like their mortality goes uplike fourfold when you have an
amputation and depending onwhere the amputation is, you
know, because of the immobilitycauses, then their mortality
goes up even higher, you know.
So we have wound care here andmy vision on top of that is to
(22:36):
have some social services,because mental health is huge,
and to have that available andnutritional services.
So right now I do have a remotecompany called Nudge that will
help with nutritional servicesfor some patients, but it would
be great and I actually talkedto a dietician when I first
(22:58):
opened um to have one here, butit's also similar that it's not
well covered by insurance.
Nutrition, you know, likephysical therapy, not well
covered exercise um.
Some insurances will pay foryour gym membership, which is
great um but, yeah, better thannothing.
And then nutrition um hit ormiss, you know, so people have
(23:20):
to go out of pocket for, forthings like this.
But I feel like if you havethese essentials covered and
literally under one roof, Ithink you're more likely to get
compliance.
And just for them to get onboard with the mentality of of
of what I'm trying to do.
Speaker 1 (23:34):
Yeah, yeah.
That's why I was so interested.
When I met Dr Burke and she'slike oh, by the way, when you
come in to me cause we were justcoming into chat when I first
met with her she's like, by theway, you should meet Dr, dr
Mackey and then kind of hit itoff from there.
Um, for very obvious reasons,when I first got into the
training industry, it was inColorado and it was at a very.
(23:56):
What I didn't know at the timewas a very progressive building,
so it was one building that wasowned and then there was a
bunch of subcontractors withinit.
So there was a gym, there wasmental health providers, there
was dieticians, there was a labdownstairs, there was primary
care, there was chiropractorsand then across the street,
across the parking lot, wasphysical therapy so a lot of
what you're talking about.
(24:17):
And I was like I just saw, oh,when something was outside of my
scope or I realized they neededsomething else, I would just
walk them down the hallway andjust removing the barrier of
sending somebody out in theworld to figure out how to find
a good dietician or how to finda good mental health provider,
where you can just literallywalk them down I don't know the
(24:39):
numbers on it, but, like carecoordination is a entire
profession for exactly thatreason, because our healthcare
system is not easy to navigate.
So, yeah, that was my firstexposure to it and I was like,
oh, this, our healthcaresystem's awesome.
And then I moved down here toPhoenix.
I was like, oh, that's not howany of this works.
That was a very that was aunicorn, that was a very rare
instance.
So it was very progressive andI really liked the model and I
(24:59):
saw how beneficial it could befor people.
And then so over the years I'vetaken the role of like helping
people.
When I recommend a provider, I'mlike giving the list of
recommendations, I try to makewarm introductions, but when
it's physically in the sameoffice, it's incredibly easy and
it's just, it's much morehelpful and that that's why I
was so interested in kind ofdoing this and pursuing this
sort of partnership with you,just because you know I I love
(25:23):
the vision of.
That's what it should feel likewhen you walk into a doctor's
office.
It shouldn't be the oh, it'sgoing to be full of sick people.
It's we're promoting healthhere.
People are exercising here, thedoctor exercises here.
It's a.
It's a health focusedenvironment, not a sick
environment.
So that's that's why I was sointerested.
I was like this is a it's avery interesting opportunity
(25:45):
yeah, well, we're glad to haveyou.
Speaker 2 (25:48):
Yeah, I, I think you know there's part of this is
still an experiment for me, youknow.
So, uh, we'll see how it goes,because I'm still using the
insurance, our current insuranceplans, and so there's all kinds
of stuff I have to learnbecause I don't know, I didn't
know much about that until I hadto.
But, yeah, I mean, I think Ithink the more of these services
(26:09):
you can have under one roof,the more compliance you're going
to get, the more change in themindset.
This is a very interestinglocation where we're at, okay,
this intersection of Phoenix,scottsdale and Paradise Valley.
You have a lot of healthy andhealth-oriented people here, in
addition to the usual like notso healthy, and I do get some of
(26:33):
my patients from other parts ofthe Valley, some Phoenix and
other other areas, but so thisis like above average, like the,
the level of um knowledge andwhat they should, should and
shouldn't be doing.
So it's in that sense, this,this kind of this type of
thinking, kind of fits in in thearea Um, so I'm reassured by
(26:56):
that.
But, like this is still anexperiment for me, because I
feel like, um, this goes back towhy did I open this clinic.
I feel like I wanted to open uplike a sort of a novel product,
you know, kind of provideconcierge level care okay, but
through the insurance systems wehave, and to get above average
(27:18):
results.
You know, a lot of people inthis space have read like Peter
Artaia's book about, you know,medicine 2.0 and stuff like that
, and I'm really on that mindset.
Like I feel like there's a lotwe can do with the resources we
have now.
I mean, there's so muchinformation we can get.
Like I just recently got intothis aura ring and I'm just
(27:41):
fascinated by, yeah, by all thebiometrics you can get.
Even if it's 80% accurate, youknow, it's still better.
It's good to know.
Like it gives you someinteresting data like heart rate
variability how well did yousleep?
How long did it take you tosleep?
Stuff that if I put a monitoron someone right now, like I can
find a fib but I couldn't tellyou their heart rate variability
(28:02):
.
Yeah, you know so, and to methat is important because that
tells me how they're coping withtheir environment.
What's their vagal tone likewhen people show up on the types
of monitors that I prescribe asa cardiologist.
They're already in trouble, youknow.
But, like, if I have some morebiometric data like the Oura
(28:23):
Ring gives you, like you can gointo another layer of health,
you can go okay.
So why?
What is going on?
Do you need more breathingexercises to get your vagal tone
up?
Do you need more resistancetraining, you know, to bring
down the average number thatit's been for the last few
months?
So, like, there's things likethat that I would love to talk
to people about as well, but I'mstill in the phase of putting
(28:45):
out fires and that is what I seelike going forward.
Another technology that I'mreally fascinated by now, and
the accessibility of it is isthe glucose monitor.
Like that should no longer bejust for diabetics.
I think almost everybody wouldbenefit from knowing that
knowledge, even if you do itjust for three months, if you
(29:08):
just start wearing that monitor.
So now I'm starting to tellpeople about it.
Like you know what, you're notdiabetic, but your sugars are
going up and or you have aninterest in your health.
Why don't you see what thesefoods do to your bodies?
You know and just keep a log.
And then that biofeedback like,oh, when I eat this, that's
(29:28):
what happens to my sugar, butwhen I eat this I still feel
good, but that doesn't happen tomy body.
And just, I think a couple ofmonths of that data you'll
change your life.
I think a couple of months ofthat data you'll change your
life.
I mean, there's a doctor I workwith up north that lost like 30
pounds, like this, I believe it, by just learning about I mean
he's older than me, so it tookhim that long to learn about
that.
But that's just like accessibleinformation, you know.
(29:51):
So there's a lot of informationout there.
You got to be able to integrateit properly and you to get
these good outcomes.
But there's so much help now,you know, it's almost like the
best time to be sick is now.
Yeah, that's.
Speaker 1 (30:06):
That's a an interesting way to put it.
Um, yeah, the cgms are reallyinteresting.
I think there is a push tomaking non-prescription uh cgms
from both uh, abbott and dexcom.
Um yeah, so I think there willbe a, an over-the-counter
consumer grade where it'sprobably more sensitive in the
(30:27):
like, the mid ranges and it'sless sensitive for the highs and
lows.
Speaker 2 (30:30):
So the cgm that's continuous glucose mining.
Yeah, that's, yeah, yeah that'swhat?
Speaker 1 (30:36):
yeah, so I I spent I probably cgm myself for like two
years.
Just you did.
Yeah, I was just very curiousat the time what did you learn
from from that time?
you learn.
I mean, you do all the stupidthings first, where you're like
oh, I wonder how much a tub ofice cream will affect me, um,
fasted, and then can I do abunch of air squats to kind of
blunt the glucose response.
So, beyond, beyond all thatstuff, which so the takeaway
(30:59):
from what I just said isengaging large muscle groups
after a meal is very beneficial.
Um, you're walking 10 minutes.
That's like the standardrecommendation I give people.
But like in uh, japan, there'sa saying it's like 100 steps to
100 years, meaning anytime afteryou eat you should take 100
steps.
So that's like, and that's asaying from like 1,000 years ago
.
So it's like there's thisknowledge that's been kind of
(31:23):
carried through for a long time,where you know we're using
technology now to learn it, butit's nice to see that there's
this, there's wisdom.
Yeah, exactly yeah, but uh, thebiggest thing for me it was it
was mostly what I expected.
The biggest thing I found waslike sleep sleep really affects
glucose, where I could eat thesame thing every day and I
normally do because I'm boringand just that's how I do things
(31:46):
um, but if I sleep, if I get alousy night of sleep, my average
glucose would be like five toten milligrams per deciliter
higher all day that's amazing soyou're just um, and I think
that's been observed in instudies, like they've tried to
isolate that Um.
But yeah, so it.
It gives you information andstarts helping you understand
Cause a lot of people who youknow don't do this
(32:08):
professionally.
I'm sure you just see lots ofdisparate pieces of information
and it is all kind of that.
It's disparate, it'sdisconnected, but then you can
see oh, I do need to prioritizemy sleep because that's related
to blood sugar and now, afterlistening to this, hopefully
they're understanding um, havingmuscle mass can really help
control my blood sugar as well.
So, like exercise, uh,nutrition, diabetes, sleep all
(32:32):
these things can tie togetherand I think that's a.
It's a very interesting pieceof technology to teach people
how these things can tietogether and I think that's a.
It's a very interesting pieceof technology to teach people
how these things are related.
Speaker 2 (32:41):
I'm glad you did that with uh on yourself, because
that's really sometimes the onlyway to learn something is to do
it on yourself.
Well, with respect to umexercise, you know, maintaining
the big muscle groups seems tobe paramount for glucose
management.
That's probably the number oneway to uh to reverse insulin
resistance, which almost atleast 50 to 60 percent of
(33:04):
population is insulin resistant.
Okay, so, so everybody can usemore muscle mass.
But while we were talking, Ialso thought about, like so this
is the state of, this is thestate of our lives now.
Okay, because, if you thinkabout it, most of the food
sources that are readilyavailable are high carbs.
(33:27):
Okay, so an adaptation to thisenvironment is more muscle mass
mass.
But maybe back in the day whenwe walked more naturally and
then had to work for our carbsand mainly a protein slash,
vegetarian diets, more diversediets, you know, depending on
whatever part of the world we'rein, like that cohort of people
(33:51):
back then didn't have to worryabout getting their muscle mass
per se because they weren't justbombarded with carbs and just
terrible food.
You know what I mean.
So, in in and ironically, theywere naturally just more active.
So it's almost like, yeah, theyhad to be.
So it's almost now like adouble whammy where we're kind
of like, um, terrible foodsources and everyone's job is
(34:20):
becoming more and morespecialized where they don't
have to move as much.
I have a stand-up desk and Ibarely sit down, but that was
one of the things I thoughtabout when I put this office
together.
I know sitting is not going tohelp, so we're getting kind of
like we're getting it from bothends, like the environment has
gotten more, more, um, dangerous, if you will, in terms of food,
(34:46):
and our lifestyle is just likenot requiring us to move as much
.
So that's why.
That's why we're, that's whywe're talking here.
If everything was normal or morenatural, we wouldn't even have
to talk about oh, you got tomaintain muscle mass.
Because now you tell someone intheir 70s, hey, you got to bulk
(35:06):
up.
They're like what are youtalking about?
I'm retired.
It's like you're asking them tostart a new job and their
mindset is like, oh, now, thisis when I'm laid up, I don't do
anything, which is the oppositeof actually what I found.
You want to keep it.
Yeah, like the older you are,the more dependent you are on
(35:26):
that muscle mass.
Yeah, you know, the younger youare you can get away with it.
You have more.
You know you have more musclemass just by virtue of your
youth.
But as you get older it'sharder and harder to hold that
muscle mass.
So it's more and more importantto do things to preserve your
muscle mass.
I do have a question for youwhat exercises do you think are
(35:49):
essential for the elderly peopleto maintain those big muscles
in their bodies?
Speaker 1 (35:55):
The primary one I go to is squatting, just because
it's how you get out of a chair.
So I think of it more from likea task completion standpoint,
where it's like do you have thestrength to stand up out of a
chair, do you have the strengthto control yourself back down to
a safe seated position?
Speaker 2 (36:12):
That's hilarious.
You say that Because that'sliterally why I got these really
low chairs in my office.
You can get a picture.
Yeah, people hate me for that.
They think I'm cheap or weird,because it's like these deep
leather chairs that that are noteasy to get out of.
They're not the typical like oh, they're ready to go and I want
to do that just to to see that.
(36:34):
And I want them to know, like,like that's not good, like you
need to be able to get out of achair.
And that's funny that youmentioned the exercise, because
I too believe the squat is.
You know, obviously they'regonna have knee problems.
That will limit how deep, andthey should probably do it
supported with the wall, right,yeah, yeah, it's, it's all, but
it's all buildable you know,yeah, and so I agree that.
(36:55):
I agree that the cardiologistagrees with that one.
So what else do you do for theupper body?
What do you?
Speaker 1 (36:59):
recommend.
So I think of things and thisis why it's great that Dr Burke
is here.
Most people above a certain ageare going to have a shoulder or
a neck or they're going to havesomething.
So you need to work within whatpeople can do, but I think of
like just basic patterns ofpressing and pulling.
And then I within what peoplecan do, but I think of like just
basic patterns of pressing andpulling.
And then I think of horizontaland vertical.
(37:20):
So, if people have full enoughrange of motion, um, think of a
standard bench press, that'slike your standard horizontal
push yep.
And then, um, like a seated row, that's your horizontal row,
yep.
And then pressing overhead,that'd be like a shoulder press,
that's your vertical press.
And then like a lat pull downor a pull up not that I have
many people doing pull-ups, butthat's like that vertical
(37:42):
pulling pattern.
Speaker 2 (37:44):
So that's great.
So you got four quadrants.
Speaker 1 (37:46):
You know, pull down, pull and push, yep, and then,
and then getting yourself up,yep squatting, and then I try to
drive some sort of rotation, ifpeople can, because you know we
we like to be able to turn andhopefully that is something I'm
starting to notice that you, um,as I get older, I'm noticing
(38:07):
that my, my flexibility incertain things is just naturally
going away because I'm notdoing these movements, you know.
Speaker 2 (38:14):
So there's a lot of stuff that I personally you know
someone in their 40s has had tojust like oh, I am getting
older.
Another thing that I've noticedwas our ankles and like foot
issues that that, um, a lot ofpeople have.
I feel like people forget abouteverything below the ankle and
they just keep their feet likewrapped up or in some
(38:36):
ill-fitting shoe wear and thenthey wonder why it's like, oh,
they're all like contracted,they're having neuropathy,
they're like all these things.
It's the same thing.
There's muscles.
There's muscles between ourtiny bones and our feet that
need to be exercised and thatcan only happen with, like,
maybe walking barefoot a littlebit, you know, getting all the
(38:59):
toes engaged, separating thetoes.
There was someone else that Iwas talking to at a Christmas
party recently.
He's like one of those healthguys that's always doing the
trends, and this guy is in his20s and he does all of this
exercises and stuff, but onething that he does regularly is
that he he wears these toespacers when he goes to sleep.
I've never even heard of such athing, but it makes sense like
(39:21):
people need to keep thatdistance in their toes the
individual toes, if you.
Speaker 1 (39:26):
You know about this yeah, yeah, I got uh, it's a
weird statement to make withoutcontext, but I got really into
foot stuff, of feet stuff a fewyears ago.
Yeah, because like feet arereally it's the thing that's in
contact with the ground all day.
So like we threw like kind ofsquishy shoes like this, you
kind of lose your sensory andyour sense of the ground and
(39:47):
kind of, if you start to losethat, balance is going to be
tough.
But yeah, like you have so manymuscles and bones and tendons
in your foot and if you're kindof in this very stabilized shoe
all day, you're saying, hey,none of you really need to work,
the shoe will do the job.
So you get people barefoot.
That helps rebuild the foot alittle bit.
I do a lot of single leg stuff.
Once I can progress people tothat Because you put somebody on
(40:10):
one leg, their foot's going tostart working more than it
normally does.
And when you think about it,walking is a single leg activity
for a very brief period of time, but it's.
It's a single leg activity.
So I train a lot of single legfor, you know, walking, balance,
fall, risk, all of thosecomponents yeah, I also have a
foot fetish.
Speaker 2 (40:30):
No, I'm just kidding.
No, not, yeah, I got into footstuff.
Um, previous practices thatI've been in um have just
exposed me to, like, some reallygreat podiatrists dr zhang and
dr shaw, dr shulman, all theseguys, like I've been my buddies
for years, so I learned a lotabout the feet.
Um, also, like with limbsalvage, you learn a lot about
(40:55):
the feet because you know,talking about amputations and
stuff, when we're trying toprevent amputations and opening
up arteries, you have to know,like, where's a good place.
You know what's the leastamount of amputation that
someone can get away with tomaintain their mobility.
That's an extreme example, butlike day-to-day stuff that I see
(41:16):
, see, I'll see people with,like, discrete swelling around
the ankle.
Okay, 90, some percent of thetime.
When that's the case, their,their arches have fallen.
Sure, okay, um, this is likefrom doing veins for many years.
Is like that that heel to toeis so important?
There's actually a cluster ofveins on the on our arch that
(41:40):
follow the shape of our arch,that only work when it's heel to
toe to help bring the blood outof the foot, and so it's called
a vein pump.
Okay, yeah, so, uh.
If that's not working, imaginethe foot uh situation you
described earlier a foot in ashoe, that's just being ignored.
You're walking around like thiswhen the foot really needs that
(42:05):
effleurage, that massage, thatdeep tissue massage of the fluid
to go back up into the biggerveins and back into circulation.
Speaker 1 (42:14):
But naturally we have it hard.
Speaker 2 (42:16):
Is it the lengthening that sort of activates, that
pump um, well, the the pump isis like spanning the bottom of
the.
You know, the it's like theplantar surface of the of the
foot.
Okay, so if you're not engagingit at all and it's just like
you're walking barefoot or flatfoot, um, you're not using it's
(42:37):
not milking the fluid out ofthere, it's just like smashing
it.
You know what I mean?
It's just smashing and thenwhen the foot collapse,
virtually everyone that hasreally bad feet they're going to
start having swelling in theirankles because you can't
circulate that stuff out ofthere.
You know we do use compressionand stuff like that, but that's
been like a very subtleobservation of many years of, at
(42:58):
the very least, why the foot isimportant.
The other thing is, I've seen somany discrete blockages in the
arteries because we'll doangiograms, that's when we put a
catheter and then put dye intothe vessels.
There'll be so many blockagesthat are very discrete, right at
the flexion point of the feet.
Okay, why is it there in somany people?
(43:19):
It's because of this immobilityof the foot, you know, yeah,
like or the too tight offootwear that have, over time,
just literally blocked yourartery and strangulated your
foot.
You know.
So the foot is fascinating andit's very's, very important, you
know, for our, for our mobility.
And I do end up talking aboutit, looking at it way more than
(43:43):
I, than I enjoy, but but youcan't ignore the whole person,
you know yeah, all the way downto the foot.
Speaker 1 (43:51):
Um, so we're gonna start wrapping up soon.
One last thing I wanted tomention, just because I think
it's very interesting andusually most people don't know
this.
For people who have insulinresistance, pre-diabetes,
diabetes they usually think ofinsulin as being the thing that
helps shuttle glucose into thecells.
But if you're insulin resistant, insulin's obviously not doing
(44:13):
that job as well as it should be, or your muscles aren't
responding to it that well.
But exercising just resistancetraining, moving your muscles
allows that same exact thing tohappen.
So it's called insulinindependent glucose uptake,
which is basically your bodydoing a magic trick where it's
like, oh, you can't do it withinsulin.
Just by moving your body, itallows you to do that, which,
for people who are insulinresistant, it's like that's a
(44:41):
great trick, that's a great toolfor you to have while you work
on these other factors ofadjusting your lifestyle,
prioritizing sleep, walking more, changing your nutrition
because those habits can taketime but you have this exercise
component that can help youimmensely right off the bat.
So it's just like thisfascinating thing that our body
can do.
Speaker 2 (44:57):
I love the resistance training as a treatment for
insulin resistance.
You know, there's all the stuffyou mentioned.
There's hormones that getupregulated and then the insulin
level goes down because thebody's more efficient, doesn't
need as much insulin to handleall the glucose that's
(45:17):
circulating around.
And another, like deeper, layerto this is when you're let's
say you're insulin resistant,you're in like an insulin rich
environment that is upregulatingsome genes in your body.
You know that is signalinggenes that are not necessarily
(45:37):
gonna help body.
You know that is signalinggenes that are not necessarily
going to help you, you know.
And then, conversely, if yourinsulin is low and your sugar is
low, that's also signaling somenew genes.
And that whole fasting separatediscussion okay, that all works
on the genetic level.
You talk about the telomeresgrowing longer with intermittent
(46:00):
fasting.
You know that's like a wholecascade of hormones that were
activated by regulating theinsulin.
So like you literally canredefine your genetic code.
If you resistance train, youknow you're maintaining your
muscles and bones.
I guess one last thing.
I mean you can't I can't talkabout this enough, but I always,
(46:21):
you always think about muscles.
They're being, um, they'rebeing kind of kept in the
framework of bones.
Okay, so the bones are like islike the framework of the body
and the muscles are kind of likethey're doing the work within
the framework of the muscle, ofthe bones.
Okay, because the bones are,you know, these firm things that
(46:42):
are just like concrete, right,but it's actually not the case.
They both work together.
Like you're not going to turnover bones as quickly.
If your muscles are atrophying,okay, the muscle pulls on the
bone and changes the bonestructure, just as you expect
the muscle to be tethered to thebone.
(47:04):
That's why you see a lot ofpeople their gait completely
changes and you see themdeveloping bowed legs, for
example, or other abnormalitieswith their back and spinal
stenosis and all these boneproblems.
Okay, that we think, oh,obviously this is another
discussion and we're going towrap it up.
(47:25):
But, like you think, the boneis like a firm thing that
doesn't change and it'sinevitable that it's going to
compress and break and stenoseand all these things.
But it's not true.
It's actually we have musclesin between our vertebrae that go
up diagonally and sideways.
There's no earthly reason tohave muscles there unless it was
(47:46):
meant to maintain the bone andto help with the rotation and
stuff like that.
So these are the things you gotto keep in mind.
Like, yeah, the bone, I can'twill my bone to grow or whatever
, but when I maintain the musclearound that bone.
Similarly, with knee problems,you know, if you build up the
right muscles I mean, I've donethis just with my own self, with
(48:07):
with shoulder injuries I've had, like I fixed it by just fixing
the muscles around it.
Yeah, it's.
Speaker 1 (48:13):
It's fascinating stuff and we will have to cut
ourselves off because we couldjust keep going on this.
Maybe we'll do a multi-partseries or something into the
future, but yeah, so anyway,hopefully this gave everyone a
decent overview of kind of firstintroducing you, understanding
why you're trying to incorporateexercise into your practice, be
kind of working out of here andjust kind of being one part of
(48:36):
that vision.
Like I said, I love the vision.
It's what I kind of came intothis industry seeing and then to
not really see it replicateduntil this point is sad.
So you know, I want to helpbuild this as a model of.
Like you know, we'll have tofigure out the financial side
because that's you know, it'sinteresting where it's cash, pay
and insurance, but I'd love forthis to be like a model for
(48:57):
other people and other practiceseven in the area to look, to be
like that's a very innovativeway to treat people as whole
people.
So that's that's why I was sointerested in doing this.
Hopefully people that havewatched have gotten something
out of it and if you're in thearea and need a cardiologist, to
come see Dr Mackey.
Thanks so much for comingAppreciate it yeah.
Thanks a lot, hey everyone.
That's all for today's show.
(49:18):
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especially if you've made it allthe way to this point.
If you'd like to be notifiedwhen new episodes are going to
be released, feel free tosubscribe and make sure you hit
the bell button as well.
To learn more about today'sguest, feel free to look in the
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You can also visit the podcastwebsite, which is exploring
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That website will also belinked in the description, as
(49:41):
always.
Like shares, comments are ahuge help to me and to this
channel and to the show.
So any of that you can do Iwould really appreciate.
And again, thank you so muchfor watching and I'll see you
next time.
Hi everyone, welcome back to Exploring Health Macro
to Micro with Parker Condit.
I'm your host today and we'rekind of kicking off season two
with a bit of a differentepisode, obviously recording
live in person.
And I'm here today with DrHassan Maki.
He's the founder and he's alsoa cardiologist.
He's the founder of the Heartand Wellness Center here in
Paradise Valley, serving sort ofthe larger Phoenix Scottsdale
(00:25):
area.
So we're talking today with himbecause he has a very
interesting and innovativevision for what his practice is
going to be in the future andhe's already kind of started
that.
So we're going to discuss alittle bit about your background
and why you have thisparticular vision for your
practice in the future.
So I'd love to start with sortof your background, from how you
(00:46):
got into cardiology and thenwhere your desire and your
passion for integrating otherparts outside of medicine into
your practice came from.
Speaker 2 (00:55):
So nice to meet you, parker.
Thanks for coming in and helloeveryone.
Yes, so my career is likesimilar to a lot of other
cardiologists.
We start off, you know, withundergrad and the sciences and,
uh, I became interested incardiology while I was in
medical school.
I found the heart veryfascinating and, interestingly,
(01:18):
um, in medical school, my, uh,my joy and my for working out
was also reignited at that time,because when you're in that
situation where you're basicallyjust studying and you have time
for maybe one hobby, sure.
So, luckily, one of myclassmates, paul Metcalf he was
(01:41):
like a bigger guy and he, uh,his thing, what.
He was a trainer, you know.
So I had paul at my disposalfor like two years.
We'd work out together.
I had been into likeweightlifting and just athletics
in general my entire life.
That's always been like.
My default setting is is sportsand exercise.
(02:01):
Um, I think that's been like afamily thing.
You know that we're always hadsports and exercise as like a,
as like a fundamental in our, inour household.
Everybody's to play,everybody's playing a sport and
everybody, you know, we studyand everything.
So, yeah, in medical school Istarted exercising, um, like
(02:22):
with more knowledge from atrainer, and I just noticed like
, wow it's, it makes adifference when you train with
someone that knows what they'redoing.
So that was now about 24 yearsago and I've kept it up the
working out and so fast forward.
Like I said, my career issimilar to other cardiologists
(02:44):
you go to residency, thenfellowship and then you start
seeing patients and after doingsomething for a while especially
like the way medicine ispracticed, now I feel like a lot
of it is converter belt, likeeveryone has put on this, this
moving thing where we throw sometests at you, whatever sticks,
(03:08):
uh, we treat you.
But I've been doing this longenough now where, like, it's not
adding up anymore.
You know it's basically, um,let's talk about hyperlipidemia
for for a second.
Like I'm trained from from youknow, our medical school and
residency and fellowshiptraining is like to look for
(03:29):
certain numbers and then, oncewe see these numbers, we're
alerted to prescribe thesecertain drugs and that fits
really nicely for us becauseit's clean, right and it's.
And then, similarly like when Istarted doing interventions,
which is where we go in, we cathpeople, we find blockages, put
a stent in there Very gratifyingfor me, you know, but am I
(03:52):
doing the best thing for thepatient.
I think now the evidence hasshown that maybe we're not doing
the best for the patients.
There was a new article thatcame out this summer that showed
about 25% of stents wereinappropriate.
Okay, okay, and that is usingjust the basic appropriateness
(04:13):
criteria.
This is not to say like thesepeople were put on exercise
regimens.
They were not put on cleandiets.
This is just with our stentsand blood pressure.
Your set of tools, our set oftools our set of tools, yeah, so
so doing that for a while itkind of burns you out.
It's like I I write about thison my website as the rationale
(04:34):
for this place, for the heartand wellness center.
It's like someone is having anemergency, they're having a
heart attack.
We go in, we put a stent andthen we save their life and then
they're right back to wherethey were right before they had
the emergency and there's likeyears of problems and and
preventative things that couldhave happened.
(04:54):
So so, um, for another, foreven more, along with the
explanation.
Um, so you know, I don't.
I delved into, theved into thewellness space very hard.
Some of it was based on my ownknowledge.
You know, I've always kept upwith the current nutrition and
stuff, stuff that were notcovered in our curriculum, you
(05:15):
know, and so I have to become anexpert on all these things I
have to know at least what theYouTubers know, and then add
some actual evidence to what I'mpreaching, and so certain
patterns, you know, came upwhile doing all this research
and just doing like a deep diveinto preventative medicine.
(05:37):
Okay, the number one thing andthis can be debated what is the
number one thing that apreventative cardiologist would
advocate?
I bet you, most of them wouldsay it's nutrition.
Okay, nutrition, nutrition,nutrition, and most of the
well-known doctors arewell-known because of their
nutrition recommendations.
But to me, physicality,physical activity, is number one
(06:01):
, because that is when you lookat a human being walking in
front of you on the street, it'sjust a bunch of muscles and
bones.
We don't see the organs, wedon't.
It's like.
So you know, we're meant to bedoing stuff with these muscles
and bones, and so I think wetalked about this before that
you could not, that I wantpeople to do this, but we could
(06:23):
beat a bad diet with exercise orhold it off, but you the vice,
vice versa is not true, like youcan't eat whatever you want and
then, or eat perfectly andexpect perfect health without
doing exercise and and uh andthings along those lines.
So that's why, that's why I hada gym installed in my place,
(06:44):
that's why it's like the numberone thing on my pyramid is
exercise, and I think that'sthat's how we most clearly
overlap.
Speaker 1 (06:54):
So I agree and this was like one of the fun
questions I would ask peoplejust working in the fitness
industry.
And just to introduce myself toanyone from who's watching from
Dr Mackey's audience, my nameis Parker Condit.
Anyone who's coming from myside, you're familiar with me.
I'm the founder of InTouchHealth and Performance.
I'm a health coach and personaltrainer and I specialize in
aging populations and kind of onthe preventative side when
(07:17):
people care about chronicdisease states that are very
common in this country.
That's where I really focus onpeople of not just getting them
in better shape and betteroverall health, but kind of
trying to attack some of thesechronic diseases that are so
prevalent here in the US.
So, being in the space for awhile, I would often have like
this fun dumb debate of like, ifyou could only pick one
(07:38):
nutrition or exercise, which onewould you pick?
Obviously, being a trainer, Iwas always on the side of
exercise, but I do take it alittle bit more seriously now
and I'm not sure why you land onthat side.
But for me, muscle mass is soimportant, and it's not for the
fact that you need to look likea bodybuilder, you just need to
have enough muscle mass in yourbody to readily store and accept
(08:02):
glucose that is kind of pouringthrough your bloodstream Muscle
mass.
Beyond the aesthetic, I thinkbodybuilders have kind of done a
bit of damage in that peopleare like I don't want to look
like that, I don't want to be inthe gym six days a week, and
that's certainly not necessary.
It's just increasing thequality of muscle tissue that
you have and putting a littlemore muscle mass on.
It's something that's very hardto do with nutrition alone.
(08:26):
Obviously, this is kind of likea moot point because we don't
have to choose just exercise ornutrition.
I think we're just bothhighlighting the importance of
exercise, and for me it's formuscle mass, it's for
cardiovascular health, whereit's like you can't improve your
cardiovascular capacity withoutexercise.
Nutrition's not going to do it.
It'll help minimize damagebeing done from your nutrition,
(08:50):
but exercise just has theseadditional inputs that are
incredibly beneficial.
But yeah, I would like to hearlike what is it about exercise
that you land on that side ofthe argument.
Speaker 2 (09:00):
So, yeah, this is a self-created debate, right,
Exercise versus nutrition.
Why are we even comparing thetwo?
Right, they're natural allies.
They should be done together.
And if you notice, like when youwork out, you don't crave the
bad food, okay, you don't cravethe salty food or the fried food
(09:24):
, like I do stress eat, I'maware, when I stress eat and
like, even this week I had akind of a rougher week stress
wise, so, but I've done thispromise to myself, okay.
And so I'm about to go stresseat.
I'm craving that burger orwhatever, like I know.
(09:44):
I know, like I'm due, I haven'thad one in a long time.
Cheap meal plus, whatever I do.
This one thing I'm like do theexercise, go to the gym, okay.
So I go to the gym, I do atypical exercise, a typical like
circuit of resistance training,which is what I like to do.
I do way more flexibility stuffas I get older, like now.
(10:07):
I like about 20 of the time I'mdoing stretches, you know, in
between, in between theresistance, um, and then after
I'm done, man, that craving isgone.
Now I want to go eat freshapples, um, a clean protein
source, and I just want to, justwant to keep that euphoric
feeling going.
Speaker 1 (10:28):
And.
Speaker 2 (10:28):
I know the burger which I was craving before is
not going to do what my body'sasking me right now.
Now my body is no longerstressed, okay, we have the
dopamine that's been releasedand you're even hungrier.
And I find that food is evenmore delicious when you're, when
you like kind of worked for itand you kind of like, okay, yeah
(10:51):
, maybe if I do end up having alittle bit of fries here and
there, that'll be just like aluxury, but I really want some
substantive food.
So that's another way thatexercise kind of self regulates
you.
It also helps you tease out,because eating is such a
psychological thing, right?
Very emotional, yeah, veryemotional, Like we're babies
crying.
What do we think?
They need?
(11:11):
Food, you know.
So we've been, literally sincewe were born, like conditioned
to have a different relationshipwith food above nutrition.
And I found that exercise, orregular exercise, or even just
that biofeedback you get fromworking out, it kind of
readjusts your mind Like hold on, am I hungry, Am I stressed, Am
(11:33):
I thirsty?
You know what I mean?
Like these things all getjumbled together sometimes when
you're just not sure.
You know.
Just your brain kind ofinterprets it as a binary thing.
But it's actually morecomplicated and if you tease it
out then you'll get what yourbody actually needs.
And I find that exercise is thegreat.
(11:53):
I'll tell you some otherbenefits of exercise for me
personally when we circle back,but I want to just hear your
thoughts about the psychologicalcomponent of exercise.
Speaker 1 (12:06):
Yeah, so as it relates to nutrition, there's
obviously there's particularhormone signaling that when you
exercise it upregulates certainthings.
You become a little bit moresensitive and aware of when
you're getting full and thenyou're a little bit better of
understanding your appetite.
Control gets a little bittighter generally and there
definitely is the very realphenomenon of your body
(12:27):
recognizing what it wants.
You see this a lot with thepregnancy.
When women are like I'm cravingthis thing, it's usually
because their body's deficientin something that that food has.
So we do have this very wildinnate intelligence within us
and I think over time this ispart of where like in touch came
from from my company name.
It's like getting people backin touch with their body and the
(12:49):
intelligence that they have.
We just kind of we, through allof our society and cultural
signaling and upbringing, we dolose a lot of the intelligence
that we have and we're kind oftold not to trust it but
exercise.
Very natural thing.
We were born to kind of moveour bodies.
We're physical beings, as yousaid, like the evolutionary
adaptations we have made us tothis point.
(13:10):
We have these thumbs that allowus to grab things.
We have these feet that areawesome for running and walking.
Um, so there's.
There's just this very naturalaspect to moving your body, and
it doesn't always have to be ina gym.
Like I'm one of the biggestadvocates for walking, um, like
everyone, everyone who's everworked with me, they know it
starts with walking because itjust gets your baseline
(13:33):
throughout the day significantlyhigher, and then we'll add
exercise on top of that.
But, yeah, I'm, there's, I.
I can't be a big enoughadvocate for exercise and I do
count walking in there becauseit's such an accessible form of
exercise for people where it'slike you don't need a gym
membership, you basically justneed a safe area to walk in.
And, granted, not everyone evenhas that, but it's one of the
(14:00):
lowest barriers to entry wherepeople think it's too low
threshold, it's too easy, it'sjust walking, it's not going to
make a difference.
But walking makes an enormousdifference to your overall
health, especially if you don'twalk much.
There's a nonlinear doseresponse relationship which just
means the less you walk, nowanything more is incredibly
beneficial.
If you go from 4,000 steps aday to 5,000 steps a day, that
(14:21):
1,000 step increase, you'll seea bigger impact than if you go
from 10,000 steps a day.
That 1,000 step increase,you'll see a bigger impact than
if you go from 10,000 steps aday to 11,000 steps a day.
So for the people who don't doanything, anything more than
you're doing is very, verybeneficial.
So I try to make exercise muchmore accessible to people and
not thinking oh, it's got to beat least four days a week.
Every workout's got to be hard.
I've got to be doing strengthtraining and doing cardio.
(14:42):
I try to get a lot of people tostart to be like just walk.
Just walk more than you are nowand get people on those early
wins.
Speaker 2 (14:50):
That's my exact recommendation.
Yeah so, cardiovascular healthis intimately related to
mobility.
Yeah, so, 30 to 60 minutes ofwhat we'd call aerobic exercise,
which includes walking Iliterally say that to every
single patient of mine.
Every single patient says sobecause that is like there's so
(15:12):
many, there's so many benefits.
Okay, You're getting mobility.
More than likely, more likelythan not.
You're leaving the device thatyou're looking at.
You're going into nature.
You're getting some fresh air.
You're activating some of thebigger muscles.
And then the vascular system.
If you ever look at an artery,like in cross section, it has a
(15:34):
layer of muscle in it.
Speaker 1 (15:37):
Interesting.
Speaker 2 (15:38):
The entire vascular system has a layer of muscle in
it because it's meant tocontract, like rhythmically, and
throughout the whole system.
So if you dissect any arteryand veins, veins do have a
muscular system, but it's muchthinner and that's why the
arteries are stronger and moreresilient.
And whatever artery we'retalking about, it needs that
(15:58):
movement.
Okay, that walking movementwhen the to and fro of the
vessel.
So let's say we're talkingabout my brachial artery.
Okay, behind my bicep, thismovement right now, just flexing
my bicep, or brachioradialisOkay, if you guys are on his
(16:19):
podcast then you know this isthe brachioradialis mainly, but
anyway.
So when we do these movements toour muscles and bones, the
arteries get stretchedlongitudinally.
Okay.
So not only do they flex, like,for example, they want you know
I'm flexing my artery now, orI'm flexing my radial artery,
like this, it's getting flexedbut when we do the muscles
(16:46):
around them, they also getflexed longitudinally.
So they rely on that, just likewe rely on muscle movements to
maintain our muscle.
The muscle layer in there isalso really important for the
integrity of the artery alsoreally important for the
integrity of the artery, yeah,okay.
So that to me, is proof alonethat you need exercise for the
whole body, and walking is justan easy way to do it.
Speaker 1 (17:08):
So I'd love to hear I think it'd be great if you just
talk through kind of where theclinic is right now, where the
practice is now, from whatyou're doing here, the other
providers you have in the clinic, and then I can go into talking
about the exercise component,and then I'd love to just hear
what your vision is for thefuture.
Speaker 2 (17:28):
Yeah.
So I mentioned why I wanted todo like a more comprehensive
preventative clinic rather thanjust doing the.
So my clinic, I do all thetraditional cardiology stuff.
I don't want that to bemisconstrued at all.
Most cardiologists, even ifthey don't believe anything that
(17:49):
we're saying okay, are actuallyahead of the curve compared to
other doctors with respect tophysical fitness.
It's all over our literatureand now like all over our
literature are the proper diets,the Mediterranean diet, the,
you know, even vegetarianism,like it's now really mainstream,
(18:13):
the things we're talking about.
Even resistance training.
There's some articles now thatcompare people doing HIIT and
not doing HIIT with resistancetraining.
And that's in our literaturetoo, which is phenomenal.
So I do the traditional stuff,all the traditional cardiology
(18:34):
risk factors, screenings.
I'm very high on screenings.
I like to do as muchinformation as we could.
That's covered by insurance.
You know, sometimes some thingsare out of pocket.
So I have the basics of acardiology clinic.
We do the monitoring, thesonography and all that stuff.
But one thing that comes upright away and that's why that's
(18:57):
how we met is through Dr Burkeis that a lot of my patients
have immobility issues that havenot been addressed by anyone
else, and I've seen thatthroughout my career.
I'll see someone come in on awalker or in a wheelchair or
just with a terrible gait andthen I'm supposed to put people
like that on blood thinners andthen constantly increase their
(19:20):
blood pressure medications.
So I'm like, no, I need thesepeople moving, otherwise, if
you're not moving and you'rejust sitting all day, your blood
pressure is going to keep goingup and up.
It's known as one of thesitting diseases.
That and diabetes.
They're just known as sittingdiseases.
So that's how Dr Burke, like weactually, when I was telling her
(19:40):
about the place, we met in acoffee shop and I think she was
doing something.
I don't even know how we werein this.
I honestly don't even know howwe started talking, but we were
like we're very much of the samemind.
You know, she's very athletic,she does a lot of workouts, she
(20:03):
does yoga and Pilates and stuff,so maybe we're talking about
workouts.
And then she's like, oh, I'mgonna get back into physical
therapy.
And she told me I'm like, oh,I'm doing a place, yeah.
And then we literally met, likearound the time I opened and
I'm like, okay, you have a space.
So now, like, my patients loveher because they she's excellent
, um, and the thing that I justgot done talking about is
available here.
That slightly improved access tohealthcare seems to work
(20:24):
wonders for a lot of people Okay, some people you're never going
to get them to and then,similarly, the idea is to have a
trainer that, uh, caters to mypopulation, and then that's kind
of like how we met and so we'vebeen like trying to find ways
to collaborate and for you tolike to see our patients, maybe,
while they're here, evenintegrate.
(20:44):
Like what I see for the futureis like activities going on.
While I'm seeing the patient,while I'm maybe adding on a
blood pressure medication,there's someone doing lunges
behind me, like it needs to benormalized, like those things
need to be normalized.
It's not a weird thing.
The gym is not an intimidatingplace, and now the doctors like
literally want you to do it inthis office.
You know, and I feel like a lotof elderly people especially
(21:11):
are nervous about doing stufflike that, and if I'm around,
like that gives them, you know,a little bit more reassurance
and, like I said, every singlepatient, they get these speeches
about how important mobility isand I feel like, so that's
available.
There's my colleague, my friendand my own doctor is also here.
(21:33):
He's a primary care doctor.
We share the space.
So if a patient doesn't have aprimary care, or so they, we
have that access.
We just got access.
We just have a new providerthat's going to be doing wound
care for us and she and shespecializes in elderly, like
(21:54):
geriatric care as well.
So that's another avenue.
You know, I've spent severalyears treating peripheral
arterial disease and venousdisease and so they get all
kinds of ulcers that are nothealing, which again impact your
mobility.
Like, if you look at thestatistics of someone that gets
an amputation, it's much worsethan someone who just had a
(22:16):
heart attack.
Like their mortality goes uplike fourfold when you have an
amputation and depending onwhere the amputation is, you
know, because of the immobilitycauses, then their mortality
goes up even higher, you know.
So we have wound care here andmy vision on top of that is to
(22:36):
have some social services,because mental health is huge,
and to have that available andnutritional services.
So right now I do have a remotecompany called Nudge that will
help with nutritional servicesfor some patients, but it would
be great and I actually talkedto a dietician when I first
(22:58):
opened um to have one here, butit's also similar that it's not
well covered by insurance.
Nutrition, you know, likephysical therapy, not well
covered exercise um.
Some insurances will pay foryour gym membership, which is
great um but, yeah, better thannothing.
And then nutrition um hit ormiss, you know, so people have
(23:20):
to go out of pocket for, forthings like this.
But I feel like if you havethese essentials covered and
literally under one roof, Ithink you're more likely to get
compliance.
And just for them to get onboard with the mentality of of
of what I'm trying to do.
Speaker 1 (23:34):
Yeah, yeah.
That's why I was so interested.
When I met Dr Burke and she'slike oh, by the way, when you
come in to me cause we were justcoming into chat when I first
met with her she's like, by theway, you should meet Dr, dr
Mackey and then kind of hit itoff from there.
Um, for very obvious reasons,when I first got into the
training industry, it was inColorado and it was at a very.
(23:56):
What I didn't know at the timewas a very progressive building,
so it was one building that wasowned and then there was a
bunch of subcontractors withinit.
So there was a gym, there wasmental health providers, there
was dieticians, there was a labdownstairs, there was primary
care, there was chiropractorsand then across the street,
across the parking lot, wasphysical therapy so a lot of
what you're talking about.
(24:17):
And I was like I just saw, oh,when something was outside of my
scope or I realized they neededsomething else, I would just
walk them down the hallway andjust removing the barrier of
sending somebody out in theworld to figure out how to find
a good dietician or how to finda good mental health provider,
where you can just literallywalk them down I don't know the
(24:39):
numbers on it, but, like carecoordination is a entire
profession for exactly thatreason, because our healthcare
system is not easy to navigate.
So, yeah, that was my firstexposure to it and I was like,
oh, this, our healthcaresystem's awesome.
And then I moved down here toPhoenix.
I was like, oh, that's not howany of this works.
That was a very that was aunicorn, that was a very rare
instance.
So it was very progressive andI really liked the model and I
(24:59):
saw how beneficial it could befor people.
And then so over the years I'vetaken the role of like helping
people.
When I recommend a provider, I'mlike giving the list of
recommendations, I try to makewarm introductions, but when
it's physically in the sameoffice, it's incredibly easy and
it's just, it's much morehelpful and that that's why I
was so interested in kind ofdoing this and pursuing this
sort of partnership with you,just because you know I I love
(25:23):
the vision of.
That's what it should feel likewhen you walk into a doctor's
office.
It shouldn't be the oh, it'sgoing to be full of sick people.
It's we're promoting healthhere.
People are exercising here, thedoctor exercises here.
It's a.
It's a health focusedenvironment, not a sick
environment.
So that's that's why I was sointerested.
I was like this is a it's avery interesting opportunity
(25:45):
yeah, well, we're glad to haveyou.
Speaker 2 (25:48):
Yeah, I, I think you know there's part of this is
still an experiment for me, youknow.
So, uh, we'll see how it goes,because I'm still using the
insurance, our current insuranceplans, and so there's all kinds
of stuff I have to learnbecause I don't know, I didn't
know much about that until I hadto.
But, yeah, I mean, I think Ithink the more of these services
(26:09):
you can have under one roof,the more compliance you're going
to get, the more change in themindset.
This is a very interestinglocation where we're at, okay,
this intersection of Phoenix,scottsdale and Paradise Valley.
You have a lot of healthy andhealth-oriented people here, in
addition to the usual like notso healthy, and I do get some of
(26:33):
my patients from other parts ofthe Valley, some Phoenix and
other other areas, but so thisis like above average, like the,
the level of um knowledge andwhat they should, should and
shouldn't be doing.
So it's in that sense, this,this kind of this type of
thinking, kind of fits in in thearea Um, so I'm reassured by
(26:56):
that.
But, like this is still anexperiment for me, because I
feel like, um, this goes back towhy did I open this clinic.
I feel like I wanted to open uplike a sort of a novel product,
you know, kind of provideconcierge level care okay, but
through the insurance systems wehave, and to get above average
(27:18):
results.
You know, a lot of people inthis space have read like Peter
Artaia's book about, you know,medicine 2.0 and stuff like that
, and I'm really on that mindset.
Like I feel like there's a lotwe can do with the resources we
have now.
I mean, there's so muchinformation we can get.
Like I just recently got intothis aura ring and I'm just
(27:41):
fascinated by, yeah, by all thebiometrics you can get.
Even if it's 80% accurate, youknow, it's still better.
It's good to know.
Like it gives you someinteresting data like heart rate
variability how well did yousleep?
How long did it take you tosleep?
Stuff that if I put a monitoron someone right now, like I can
find a fib but I couldn't tellyou their heart rate variability
(28:02):
.
Yeah, you know so, and to methat is important because that
tells me how they're coping withtheir environment.
What's their vagal tone likewhen people show up on the types
of monitors that I prescribe asa cardiologist.
They're already in trouble, youknow.
But, like, if I have some morebiometric data like the Oura
(28:23):
Ring gives you, like you can gointo another layer of health,
you can go okay.
So why?
What is going on?
Do you need more breathingexercises to get your vagal tone
up?
Do you need more resistancetraining, you know, to bring
down the average number thatit's been for the last few
months?
So, like, there's things likethat that I would love to talk
to people about as well, but I'mstill in the phase of putting
(28:45):
out fires and that is what I seelike going forward.
Another technology that I'mreally fascinated by now, and
the accessibility of it is isthe glucose monitor.
Like that should no longer bejust for diabetics.
I think almost everybody wouldbenefit from knowing that
knowledge, even if you do itjust for three months, if you
(29:08):
just start wearing that monitor.
So now I'm starting to tellpeople about it.
Like you know what, you're notdiabetic, but your sugars are
going up and or you have aninterest in your health.
Why don't you see what thesefoods do to your bodies?
You know and just keep a log.
And then that biofeedback like,oh, when I eat this, that's
(29:28):
what happens to my sugar, butwhen I eat this I still feel
good, but that doesn't happen tomy body.
And just, I think a couple ofmonths of that data you'll
change your life.
I think a couple of months ofthat data you'll change your
life.
I mean, there's a doctor I workwith up north that lost like 30
pounds, like this, I believe it, by just learning about I mean
he's older than me, so it tookhim that long to learn about
that.
But that's just like accessibleinformation, you know.
(29:51):
So there's a lot of informationout there.
You got to be able to integrateit properly and you to get
these good outcomes.
But there's so much help now,you know, it's almost like the
best time to be sick is now.
Yeah, that's.
Speaker 1 (30:06):
That's a an interesting way to put it.
Um, yeah, the cgms are reallyinteresting.
I think there is a push tomaking non-prescription uh cgms
from both uh, abbott and dexcom.
Um yeah, so I think there willbe a, an over-the-counter
consumer grade where it'sprobably more sensitive in the
(30:27):
like, the mid ranges and it'sless sensitive for the highs and
lows.
Speaker 2 (30:30):
So the cgm that's continuous glucose mining.
Yeah, that's, yeah, yeah that'swhat?
Speaker 1 (30:36):
yeah, so I I spent I probably cgm myself for like two
years.
Just you did.
Yeah, I was just very curiousat the time what did you learn
from from that time?
you learn.
I mean, you do all the stupidthings first, where you're like
oh, I wonder how much a tub ofice cream will affect me, um,
fasted, and then can I do abunch of air squats to kind of
blunt the glucose response.
So, beyond, beyond all thatstuff, which so the takeaway
(30:59):
from what I just said isengaging large muscle groups
after a meal is very beneficial.
Um, you're walking 10 minutes.
That's like the standardrecommendation I give people.
But like in uh, japan, there'sa saying it's like 100 steps to
100 years, meaning anytime afteryou eat you should take 100
steps.
So that's like, and that's asaying from like 1,000 years ago
.
So it's like there's thisknowledge that's been kind of
(31:23):
carried through for a long time,where you know we're using
technology now to learn it, butit's nice to see that there's
this, there's wisdom.
Yeah, exactly yeah, but uh, thebiggest thing for me it was it
was mostly what I expected.
The biggest thing I found waslike sleep sleep really affects
glucose, where I could eat thesame thing every day and I
normally do because I'm boringand just that's how I do things
(31:46):
um, but if I sleep, if I get alousy night of sleep, my average
glucose would be like five toten milligrams per deciliter
higher all day that's amazing soyou're just um, and I think
that's been observed in instudies, like they've tried to
isolate that Um.
But yeah, so it.
It gives you information andstarts helping you understand
Cause a lot of people who youknow don't do this
(32:08):
professionally.
I'm sure you just see lots ofdisparate pieces of information
and it is all kind of that.
It's disparate, it'sdisconnected, but then you can
see oh, I do need to prioritizemy sleep because that's related
to blood sugar and now, afterlistening to this, hopefully
they're understanding um, havingmuscle mass can really help
control my blood sugar as well.
So, like exercise, uh,nutrition, diabetes, sleep all
(32:32):
these things can tie togetherand I think that's a.
It's a very interesting pieceof technology to teach people
how these things can tietogether and I think that's a.
It's a very interesting pieceof technology to teach people
how these things are related.
Speaker 2 (32:41):
I'm glad you did that with uh on yourself, because
that's really sometimes the onlyway to learn something is to do
it on yourself.
Well, with respect to umexercise, you know, maintaining
the big muscle groups seems tobe paramount for glucose
management.
That's probably the number oneway to uh to reverse insulin
resistance, which almost atleast 50 to 60 percent of
(33:04):
population is insulin resistant.
Okay, so, so everybody can usemore muscle mass.
But while we were talking, Ialso thought about, like so this
is the state of, this is thestate of our lives now.
Okay, because, if you thinkabout it, most of the food
sources that are readilyavailable are high carbs.
(33:27):
Okay, so an adaptation to thisenvironment is more muscle mass
mass.
But maybe back in the day whenwe walked more naturally and
then had to work for our carbsand mainly a protein slash,
vegetarian diets, more diversediets, you know, depending on
whatever part of the world we'rein, like that cohort of people
(33:51):
back then didn't have to worryabout getting their muscle mass
per se because they weren't justbombarded with carbs and just
terrible food.
You know what I mean.
So, in in and ironically, theywere naturally just more active.
So it's almost like, yeah, theyhad to be.
So it's almost now like adouble whammy where we're kind
of like, um, terrible foodsources and everyone's job is
(34:20):
becoming more and morespecialized where they don't
have to move as much.
I have a stand-up desk and Ibarely sit down, but that was
one of the things I thoughtabout when I put this office
together.
I know sitting is not going tohelp, so we're getting kind of
like we're getting it from bothends, like the environment has
gotten more, more, um, dangerous, if you will, in terms of food,
(34:46):
and our lifestyle is just likenot requiring us to move as much
.
So that's why.
That's why we're, that's whywe're talking here.
If everything was normal or morenatural, we wouldn't even have
to talk about oh, you got tomaintain muscle mass.
Because now you tell someone intheir 70s, hey, you got to bulk
(35:06):
up.
They're like what are youtalking about?
I'm retired.
It's like you're asking them tostart a new job and their
mindset is like, oh, now, thisis when I'm laid up, I don't do
anything, which is the oppositeof actually what I found.
You want to keep it.
Yeah, like the older you are,the more dependent you are on
(35:26):
that muscle mass.
Yeah, you know, the younger youare you can get away with it.
You have more.
You know you have more musclemass just by virtue of your
youth.
But as you get older it'sharder and harder to hold that
muscle mass.
So it's more and more importantto do things to preserve your
muscle mass.
I do have a question for youwhat exercises do you think are
(35:49):
essential for the elderly peopleto maintain those big muscles
in their bodies?
Speaker 1 (35:55):
The primary one I go to is squatting, just because
it's how you get out of a chair.
So I think of it more from likea task completion standpoint,
where it's like do you have thestrength to stand up out of a
chair, do you have the strengthto control yourself back down to
a safe seated position?
Speaker 2 (36:12):
That's hilarious.
You say that Because that'sliterally why I got these really
low chairs in my office.
You can get a picture.
Yeah, people hate me for that.
They think I'm cheap or weird,because it's like these deep
leather chairs that that are noteasy to get out of.
They're not the typical like oh, they're ready to go and I want
to do that just to to see that.
(36:34):
And I want them to know, like,like that's not good, like you
need to be able to get out of achair.
And that's funny that youmentioned the exercise, because
I too believe the squat is.
You know, obviously they'regonna have knee problems.
That will limit how deep, andthey should probably do it
supported with the wall, right,yeah, yeah, it's, it's all, but
it's all buildable you know,yeah, and so I agree that.
(36:55):
I agree that the cardiologistagrees with that one.
So what else do you do for theupper body?
What do you?
Speaker 1 (36:59):
recommend.
So I think of things and thisis why it's great that Dr Burke
is here.
Most people above a certain ageare going to have a shoulder or
a neck or they're going to havesomething.
So you need to work within whatpeople can do, but I think of
like just basic patterns ofpressing and pulling.
And then I within what peoplecan do, but I think of like just
basic patterns of pressing andpulling.
And then I think of horizontaland vertical.
(37:20):
So, if people have full enoughrange of motion, um, think of a
standard bench press, that'slike your standard horizontal
push yep.
And then, um, like a seated row, that's your horizontal row,
yep.
And then pressing overhead,that'd be like a shoulder press,
that's your vertical press.
And then like a lat pull downor a pull up not that I have
many people doing pull-ups, butthat's like that vertical
(37:42):
pulling pattern.
Speaker 2 (37:44):
So that's great.
So you got four quadrants.
Speaker 1 (37:46):
You know, pull down, pull and push, yep, and then,
and then getting yourself up,yep squatting, and then I try to
drive some sort of rotation, ifpeople can, because you know we
we like to be able to turn andhopefully that is something I'm
starting to notice that you, um,as I get older, I'm noticing
(38:07):
that my, my flexibility incertain things is just naturally
going away because I'm notdoing these movements, you know.
Speaker 2 (38:14):
So there's a lot of stuff that I personally you know
someone in their 40s has had tojust like oh, I am getting
older.
Another thing that I've noticedwas our ankles and like foot
issues that that, um, a lot ofpeople have.
I feel like people forget abouteverything below the ankle and
they just keep their feet likewrapped up or in some
(38:36):
ill-fitting shoe wear and thenthey wonder why it's like, oh,
they're all like contracted,they're having neuropathy,
they're like all these things.
It's the same thing.
There's muscles.
There's muscles between ourtiny bones and our feet that
need to be exercised and thatcan only happen with, like,
maybe walking barefoot a littlebit, you know, getting all the
(38:59):
toes engaged, separating thetoes.
There was someone else that Iwas talking to at a Christmas
party recently.
He's like one of those healthguys that's always doing the
trends, and this guy is in his20s and he does all of this
exercises and stuff, but onething that he does regularly is
that he he wears these toespacers when he goes to sleep.
I've never even heard of such athing, but it makes sense like
(39:21):
people need to keep thatdistance in their toes the
individual toes, if you.
Speaker 1 (39:26):
You know about this yeah, yeah, I got uh, it's a
weird statement to make withoutcontext, but I got really into
foot stuff, of feet stuff a fewyears ago.
Yeah, because like feet arereally it's the thing that's in
contact with the ground all day.
So like we threw like kind ofsquishy shoes like this, you
kind of lose your sensory andyour sense of the ground and
(39:47):
kind of, if you start to losethat, balance is going to be
tough.
But yeah, like you have so manymuscles and bones and tendons
in your foot and if you're kindof in this very stabilized shoe
all day, you're saying, hey,none of you really need to work,
the shoe will do the job.
So you get people barefoot.
That helps rebuild the foot alittle bit.
I do a lot of single leg stuff.
Once I can progress people tothat Because you put somebody on
(40:10):
one leg, their foot's going tostart working more than it
normally does.
And when you think about it,walking is a single leg activity
for a very brief period of time, but it's.
It's a single leg activity.
So I train a lot of single legfor, you know, walking, balance,
fall, risk, all of thosecomponents yeah, I also have a
foot fetish.
Speaker 2 (40:30):
No, I'm just kidding.
No, not, yeah, I got into footstuff.
Um, previous practices thatI've been in um have just
exposed me to, like, some reallygreat podiatrists dr zhang and
dr shaw, dr shulman, all theseguys, like I've been my buddies
for years, so I learned a lotabout the feet.
Um, also, like with limbsalvage, you learn a lot about
(40:55):
the feet because you know,talking about amputations and
stuff, when we're trying toprevent amputations and opening
up arteries, you have to know,like, where's a good place.
You know what's the leastamount of amputation that
someone can get away with tomaintain their mobility.
That's an extreme example, butlike day-to-day stuff that I see
(41:16):
, see, I'll see people with,like, discrete swelling around
the ankle.
Okay, 90, some percent of thetime.
When that's the case, their,their arches have fallen.
Sure, okay, um, this is likefrom doing veins for many years.
Is like that that heel to toeis so important?
There's actually a cluster ofveins on the on our arch that
(41:40):
follow the shape of our arch,that only work when it's heel to
toe to help bring the blood outof the foot, and so it's called
a vein pump.
Okay, yeah, so, uh.
If that's not working, imaginethe foot uh situation you
described earlier a foot in ashoe, that's just being ignored.
You're walking around like thiswhen the foot really needs that
(42:05):
effleurage, that massage, thatdeep tissue massage of the fluid
to go back up into the biggerveins and back into circulation.
Speaker 1 (42:14):
But naturally we have it hard.
Speaker 2 (42:16):
Is it the lengthening that sort of activates, that
pump um, well, the the pump isis like spanning the bottom of
the.
You know, the it's like theplantar surface of the of the
foot.
Okay, so if you're not engagingit at all and it's just like
you're walking barefoot or flatfoot, um, you're not using it's
(42:37):
not milking the fluid out ofthere, it's just like smashing
it.
You know what I mean?
It's just smashing and thenwhen the foot collapse,
virtually everyone that hasreally bad feet they're going to
start having swelling in theirankles because you can't
circulate that stuff out ofthere.
You know we do use compressionand stuff like that, but that's
been like a very subtleobservation of many years of, at
(42:58):
the very least, why the foot isimportant.
The other thing is, I've seen somany discrete blockages in the
arteries because we'll doangiograms, that's when we put a
catheter and then put dye intothe vessels.
There'll be so many blockagesthat are very discrete, right at
the flexion point of the feet.
Okay, why is it there in somany people?
(43:19):
It's because of this immobilityof the foot, you know, yeah,
like or the too tight offootwear that have, over time,
just literally blocked yourartery and strangulated your
foot.
You know.
So the foot is fascinating andit's very's, very important, you
know, for our, for our mobility.
And I do end up talking aboutit, looking at it way more than
(43:43):
I, than I enjoy, but but youcan't ignore the whole person,
you know yeah, all the way downto the foot.
Speaker 1 (43:51):
Um, so we're gonna start wrapping up soon.
One last thing I wanted tomention, just because I think
it's very interesting andusually most people don't know
this.
For people who have insulinresistance, pre-diabetes,
diabetes they usually think ofinsulin as being the thing that
helps shuttle glucose into thecells.
But if you're insulin resistant, insulin's obviously not doing
(44:13):
that job as well as it should be, or your muscles aren't
responding to it that well.
But exercising just resistancetraining, moving your muscles
allows that same exact thing tohappen.
So it's called insulinindependent glucose uptake,
which is basically your bodydoing a magic trick where it's
like, oh, you can't do it withinsulin.
Just by moving your body, itallows you to do that, which,
for people who are insulinresistant, it's like that's a
(44:41):
great trick, that's a great toolfor you to have while you work
on these other factors ofadjusting your lifestyle,
prioritizing sleep, walking more, changing your nutrition
because those habits can taketime but you have this exercise
component that can help youimmensely right off the bat.
So it's just like thisfascinating thing that our body
can do.
Speaker 2 (44:57):
I love the resistance training as a treatment for
insulin resistance.
You know, there's all the stuffyou mentioned.
There's hormones that getupregulated and then the insulin
level goes down because thebody's more efficient, doesn't
need as much insulin to handleall the glucose that's
(45:17):
circulating around.
And another, like deeper, layerto this is when you're let's
say you're insulin resistant,you're in like an insulin rich
environment that is upregulatingsome genes in your body.
You know that is signalinggenes that are not necessarily
(45:37):
gonna help body.
You know that is signalinggenes that are not necessarily
going to help you, you know.
And then, conversely, if yourinsulin is low and your sugar is
low, that's also signaling somenew genes.
And that whole fasting separatediscussion okay, that all works
on the genetic level.
You talk about the telomeresgrowing longer with intermittent
(46:00):
fasting.
You know that's like a wholecascade of hormones that were
activated by regulating theinsulin.
So like you literally canredefine your genetic code.
If you resistance train, youknow you're maintaining your
muscles and bones.
I guess one last thing.
I mean you can't I can't talkabout this enough, but I always,
(46:21):
you always think about muscles.
They're being, um, they'rebeing kind of kept in the
framework of bones.
Okay, so the bones are like islike the framework of the body
and the muscles are kind of likethey're doing the work within
the framework of the muscle, ofthe bones.
Okay, because the bones are,you know, these firm things that
(46:42):
are just like concrete, right,but it's actually not the case.
They both work together.
Like you're not going to turnover bones as quickly.
If your muscles are atrophying,okay, the muscle pulls on the
bone and changes the bonestructure, just as you expect
the muscle to be tethered to thebone.
(47:04):
That's why you see a lot ofpeople their gait completely
changes and you see themdeveloping bowed legs, for
example, or other abnormalitieswith their back and spinal
stenosis and all these boneproblems.
Okay, that we think, oh,obviously this is another
discussion and we're going towrap it up.
(47:25):
But, like you think, the boneis like a firm thing that
doesn't change and it'sinevitable that it's going to
compress and break and stenoseand all these things.
But it's not true.
It's actually we have musclesin between our vertebrae that go
up diagonally and sideways.
There's no earthly reason tohave muscles there unless it was
(47:46):
meant to maintain the bone andto help with the rotation and
stuff like that.
So these are the things you gotto keep in mind.
Like, yeah, the bone, I can'twill my bone to grow or whatever
, but when I maintain the musclearound that bone.
Similarly, with knee problems,you know, if you build up the
right muscles I mean, I've donethis just with my own self, with
(48:07):
with shoulder injuries I've had, like I fixed it by just fixing
the muscles around it.
Yeah, it's.
Speaker 1 (48:13):
It's fascinating stuff and we will have to cut
ourselves off because we couldjust keep going on this.
Maybe we'll do a multi-partseries or something into the
future, but yeah, so anyway,hopefully this gave everyone a
decent overview of kind of firstintroducing you, understanding
why you're trying to incorporateexercise into your practice, be
kind of working out of here andjust kind of being one part of
(48:36):
that vision.
Like I said, I love the vision.
It's what I kind of came intothis industry seeing and then to
not really see it replicateduntil this point is sad.
So you know, I want to helpbuild this as a model of.
Like you know, we'll have tofigure out the financial side
because that's you know, it'sinteresting where it's cash, pay
and insurance, but I'd love forthis to be like a model for
(48:57):
other people and other practiceseven in the area to look, to be
like that's a very innovativeway to treat people as whole
people.
So that's that's why I was sointerested in doing this.
Hopefully people that havewatched have gotten something
out of it and if you're in thearea and need a cardiologist, to
come see Dr Mackey.
Thanks so much for comingAppreciate it yeah.
Thanks a lot, hey everyone.
That's all for today's show.
(49:18):
I want to thank you so much forstopping by and watching,
especially if you've made it allthe way to this point.
If you'd like to be notifiedwhen new episodes are going to
be released, feel free tosubscribe and make sure you hit
the bell button as well.
To learn more about today'sguest, feel free to look in the
description.
You can also visit the podcastwebsite, which is exploring
health podcastcom.
That website will also belinked in the description, as
(49:41):
always.
Like shares, comments are ahuge help to me and to this
channel and to the show.
So any of that you can do Iwould really appreciate.
And again, thank you so muchfor watching and I'll see you
next time.
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