April 17, 2025 • 50 mins
In this episode of Prevention Over Prescription with Dr. K, we're joined by psychiatrist Dr. Nick Fabiano to answer a powerful question: Can exercise be a true game-changer in mental health care? We explore how physical activity impacts conditions like depression, anxiety, and schizophrenia and how the FIT framework can guide effective exercise prescriptions. What role does metabolic health play in psychiatric illness? How can lifestyle interventions empower patients and enhance outcomes? Tune in to discover why a more holistic, movement-based approach could be the future of mental health treatment.
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Speaker 1 (00:00):
The views expressed in the following program are those of
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Speaker 2 (00:18):
Quocast Nation. I just wanted to inform you how excited
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We go through worksheets. We put together a concise book
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that twenty eight day reboot course on us. Let's start
getting healthy together, folks. Welcome to Prevention Over Prescription, the
podcast where we focus on what truly matters, taking control
of your health before it takes control of you. I'm
doctor Cordio Karen Mantang. I see you physician, health advocate
and your guide to living stronger healthier and longer, and
(01:24):
each episode we'll explore how you can prevent illness and
thrive through practical advice on nutrition, movement, stress management, and
building a supportive community. Because prevention isn't just better than prescription,
it's the key to showing up as your best self.
Let's get started, Cool Cassation, Welcome back to Prevention Oval
(01:45):
Prescription with doctor Kurt Babbe got a wicked episode with you.
We got doctor Nick Fabiano, thirty year residents in psychiatry.
At this stage, I'm gonna call him pretty prolific in
terms of publications. But he has taken an interest of
looking at exercise and the impact it has on our
(02:07):
mental health, and the evidence and the data to support
this is significant enough that man, I think we should
be amplifying as message. Big time movement is medicine, not
only physically but mentally, folks, and we dive into the impacts,
and honestly, this kid's inspirational. He's already looking at root causes.
(02:32):
He's not just taking the information and taking it out
of its word, looking at alternative reasonings in terms of
why we're seeing so much mental health, And I just
think it gives leaves me with some optimism about the
future of a lot of our youth are thinking this way.
We're going to be in a good place in our
not so distant future. So this is this is awesome.
(02:55):
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That's Drink Element dot Com Backslash KWA Dcast. All right, folks,
doctor Nick Fabriano in the house Quocas Nation. There's very
few times I come on here that I'm this excited
to cover a topic, folks, because this is real. This
(05:28):
conversation we're having with doctor Nick Fabriano is going to
open your eyes in terms of taking the power back
when it comes to our mental health, the importance of exercise.
It's so oh, I'm totally jazzed up. So Nick, welcome
to the show, my friend.
Speaker 3 (05:46):
Yeah, thank you for having me.
Speaker 2 (05:48):
Absolutely. So, you're young in your career, you clearly saw
at affinity for looking at mental health and exercise. Maybe
let's start with like what drew you to this link?
Speaker 3 (06:03):
Mm hmm.
Speaker 2 (06:04):
Yeah.
Speaker 3 (06:05):
I think there's a few things.
Speaker 4 (06:06):
So as myself right now as a third year psychiatrist,
and I've always been really interested in kind of that
overlap between mental and physical health. And one thing that
I noticed is my own bias coming in. I've always
been someone who played soccer, went to the gym. I
really like that sort of things, and anecdotally throughout medical school.
In my whole life, I just noticed that exercise was
so beneficial to me both physically but mentally as well
(06:27):
too provide that sense of clarity. And I always wondered,
when we're seeing these patients, we have this dichotomy between
mental and physical health, and from the psychiatry side of things,
oftentimes we don't really fully pay attention to the physical side.
And I thought that was really really interesting and interesting,
but also kind of problematic. So as I started to
see more and more patients, I thought, you know, why
(06:50):
don't we have an intervention that we can help with
both sides. And something that has the unique position of
that is exercise. Right, if you can get people to exercise,
get moving, it can help with their mood, it can
help with the physical ailments that come with it, and
we know that if we're speaking about depression, for instance,
that's something that's very highly comorbid with a lot of
(07:11):
other physical ailments and they go hand in hand. So
that's where that idea really came from first. And then
the other arm of it, too is the medications we use.
They have a lot of metabolic burden to them, and
by that I mean a lot of weight gain associated
with it a lot of issues with controlling your sugars,
and sometimes we follow up the blood work, we kind
(07:31):
of follow those things, but we're not directly tackling some
of those side effects. So I think it's a responsibility
for us as physicians too to address both sides. So
I think for both of those reasons, it really got
me interested in looking at the field of exercise to
kind of both help treat but also prevent some of
these side effects from medications that someone might be on,
and looking into ways on how we could do that better.
Speaker 2 (07:54):
Boy, do I love this. I've been a big believer
of movement is medicine, and not only for the physical side,
but the mental health side. And you're part of that
solution in terms of creating that evidence to suggest that.
So us give us a sense of like, has this
(08:16):
been studied? Has this been looked at, whether we're talking
depression or any other mental health disturbances, Like, what's the
level of evidence that's out there that exists.
Speaker 4 (08:26):
Yeah, that's a great question, and I think it's an
area that's been rapidly and rapidly growing more recently. If
you were to look at this, say twenty years ago
and you said I'm going to prescribe someone exercise for depression,
for instance, they look at you like you're crazy.
Speaker 5 (08:39):
Right.
Speaker 4 (08:39):
And over time though, the literature has built up more
and more and more, which is good to see because
we have more solidified evidence to really see the antidepressant
effects of exercise, so much so that I believe in
the last year or two there was a meta analysis
that was published or network meta analysis that was able
to compare the different interventions. So when we're in psychiatry,
(09:00):
we often are met with this dichotomy of do we
prescribe medications do we do therapy? And it's just kind
of simplistic terms, that's kind of what we do, and
there was not really a whole lot in between. And
what we're seeing is interesting. The evidence base now is
that's comparing these treatments shows that their effect on depression
is pretty similar. So when you're looking at medications, therapy, exercise,
(09:24):
and those are all very broad terms. I acknowledge that
there's different types of therapy, there's different types of medication,
there's different types of exercise, but across the board, when
you're looking at randomized control trial data, the effects or
antidepressant effects are pretty much the same, which is reassuring.
But again there's a lot of nuances that we can
speak about in between in terms of the differences. And
(09:47):
one that I'll quickly highlight is, as I mentioned before,
the multi system benefits of exercise. So again it's not
just treating the depression per se, but it's treating other
physical ailments that may be there, or bolster someone's physical
reserve that might be there, which has preventive value as
well too, which is really really important.
Speaker 2 (10:07):
Absolutely, and before I forget, is there a cumulative effect
if you do say, for example, all three.
Speaker 3 (10:15):
Mm hmm, yeah, for sure.
Speaker 4 (10:17):
There's lots of evidence to point that these these these interventions,
they don't need to be used in isolation. I think
oftentimes what happens is when people hear the word exercise
or even diet for instance, you think that there's these
separate camps that you have to be in that if
you're doing exercise, you can't use antidepressants or you can't
(10:39):
do therapy, and it couldn't be anything further from the truth.
There's more, there's smaller trials that are putting them all
together as an intervention, but they do show this synergistic
effect when you're combining multiple interventions, which I think is
an important point to highlight because if we keep them separate,
we create, as I mentioned, these camps of treatment, when
in reality, it's best to tea use all of them together,
(11:02):
or better phrase that, what the patient wants stewards able
to do, it's best to kind of run with that
because that will lead to the best results.
Speaker 2 (11:10):
You are listening to Prevention Over Prescription with Doctor k
featuring our special guest, doctor Nick Fabriano.
Speaker 6 (11:16):
H to be today is as Hizuzu used to drive
down NBA's turning them in a home and the Turbans
got a ther cheap for them, plus they would short
with cheese that would.
Speaker 2 (11:27):
Work with them.
Speaker 1 (11:29):
Stream us Live at SAGA nine sixty am dot Cy.
Speaker 2 (11:41):
Welcome back to Prevention Over Prescription featuring doctor Nick Fabiano. Yeah, Nick,
I'm hearing you see say this all like this is
another another opportunity for personalization, like to look at ways
that really suit the patient and would they what would
(12:02):
they would benefit or more likely allow themselves to succeed in,
Like if you've got somebody that's really keen on moving
and less keen on taking something adding the therapy. Maybe
the therapy plus the exercise might make sense. If they're
someone that's not going to get off that couch, then
the other two might make more sense. So I really
(12:25):
think that what you're highlighting of allowing us like using
these tools to meet patients where they're at, is huge.
Speaker 4 (12:36):
And to speak to that point too, I think you
bring up a good point indirectly in the sense that
exercise in any intervention for that isn't necessarily appropriate across
the board for any illness, but also any stage of
illness too. So again to keep it simple and speaking
about depression, sometimes we separate it into mild, modern, or severe.
(12:56):
And as you gave in the example before, someone who's
like sitting on the couch which they don't have the
energy to get up and eat or even do self
care things, it would probably be inappropriate to even suggest, like, hey,
you should just get up an exercise sort of thing.
But when we look at different kind of severity levels
and depression, and most of the research is based on
mild and moderate depression, So in simplicity's sake, just kind
(13:17):
of the people that have these depressive symptoms, but it's
not significantly impacting their functional capabilities. That's where exercise may
have a role. And even then to the personalized point,
just because someone has mild or modern doesn't mean that
they would want exercise. But I think our job as
a provider is to at least provide them with the
(13:37):
education and the option and be able to help them
do that if so that they are interested in taking
that path.
Speaker 2 (13:46):
Absolutely giving that option, and so what does that look like?
And maybe we could reference the studies or how you
might have approached this in your practice when they looked
at exercise as something to prescribe, is that weight training?
(14:08):
Is it taking a fitness class? Like, what does that
look like?
Speaker 4 (14:12):
So, like we mentioned before, actually is a very very
broad term, right, So how I like to simplify it
is if you were to prescribe a medication. As a doctor,
you're going to tell them the medication. You're going to
tell them the route they take it. You're going to
tell them the frequency, the dose. But as physicians, not
to overgeneralize, but oftentimes when you're speaking to a patient,
(14:33):
you tell them go exercise, you tell them go for
a run. It's not really actionable. So what we discussed
in our paper and This isn't a framework that we made,
but a framework that we've adapted for our paper. It's
called the fit framework, so it's FI and it breaks
down exercise into a prescription for lack of a better word,
where F stands for frequency, So how often you are
(14:55):
setting that expectation of working out per week. Let's say
I is the intent, so that can be you know,
a lower intensity, it can be moderate, or it can
be a vigorous intensity. The T is the type of exercise,
so that's what you were alluding to before with aerobic
so things like running resistance would be something like weight training,
or mind body is something like yoga, and of course
(15:16):
there's stuff in between that, but we keep it in
kind of general terms. And then the timing of exercise is,
you know, how long are those sessions. So we spoke
about frequency like how often you're going per week, but
timing is how long is that session, Like you're doing
it for forty five minutes or you're doing it for
an hour. And it's important to talk to your patient
in these terms because again it breaks it down into
(15:38):
something that's actionable. Number one, but number two, at fall
of appointments, you can have metrics to kind of speak
about it. So rather than just saying, you know, how
was the running going or something, they're like, oh, I
hated that, Like that was horrible. You can set them
up with realistic goals, right Like you can say, maybe
you started a really low frequency, really low intensity, and
you build up from there. Because the one thing that
(16:00):
I like to tell people is that any exercise is
better than none for both your physical and mental health.
And I'm sure we'll get into it a little bit later,
but one of the other things is they've done meta
analysis looking at a dose response association between exercise and
antidepressive effects, and essentially how that curve is shaped is
those first little bits of exercise you see an exponential
(16:22):
benefit to antidepressant effects and eventually it tapers off. And
you know, it can even go the either way if
there's too much exercise. But that should be something that's
really motivating for people, because even if you're not hitting
that quote unquote optimal level, each little bit more that
you're doing has so much benefit. And you know, starting
low and going slow can be beneficial for someone. It's
(16:43):
not that you have to go from not exercising it all
as all of a sudden're running a marathon next week.
That's not realistic and it's going to set yourself up
for defeat. But using that fit principle to kind of
guide almost increasing the dosage of a medication similar to
what you would do for an antidepressant too. You wouldn't
start it at max dose, give the mother all the
side effects, and probably wouldn't tolerate that as well too,
So the same principles apply for prescribing exercise.
Speaker 2 (17:06):
This is brilliant because this is my one of my
biggest pet peeves when it comes to exercise. As clinicians,
we often just say run more, start lifting weights, with
no guidance and no ramp up. And I can't agree
more with your nick that what people need is wins.
(17:29):
So if you're giving them something that is incremental and
feasible and the data is supporting an exponential rise in
mood as a result of you making the right steps,
that is huge. That's a beast And as you mentioned before,
(17:50):
you're not only just tackling their mental health, you're dealing
with the potential side effects with the medication. Or they
might not be physically healthy, maybe they're metabolically unhealthy at
the same time, so you're addressing those needs too, kill
in multiple words with one stone. So to me, this
is definitely on point. So just to elaborate to on
(18:14):
the fit method, like, what was the results of this
of the study?
Speaker 4 (18:18):
Yeah, so for the fit method, that wasn't necessarily a
study with an outcome. It was more of a framework
in terms of how to apply. And actually, to my knowledge,
I don't know that there have been studies in terms
of applying the fit principle and seeing the outcome in
terms of adherence, And I think that would be beneficial
to see because you know, in clinical practice it seems
to work, but it's always interesting to see when you
(18:40):
put it in the real study setting does that work.
I also acknowledge, though a caveat to that too is
sometimes these RCT settings that we put people in they're
not representative of a real world sample, so you might
see false increase adherence, you might see the opposite too.
So I think it's interesting And I'm not aware of
literature about the fit principle in terms of application for
(19:01):
adherence antippresion in facts, but I think it would be
interesting to see.
Speaker 2 (19:05):
You know, I agree this would be on paper that
it definitely sounds like this would be very promising. So
I have been recently following Chris Palmer, got to meet
him at a couple of conferences, and he has been
(19:25):
a big proponent of metabolic disease being a risk factor
for mental health. And I'm curious to hear your point
of view, in your perspective or your opinion, because when
I hear how exercise can be beneficial to improving people's
(19:49):
mental health, to me, I directly make a link to this,
like the metabolic health side. So and this is definitely
not something I learned in medical sk So I'm just
curiously what's your opinion on the metabolic health side and
mental health?
Speaker 4 (20:07):
So, yeah, no, I personally know Chris's ball too. We're
actually working on a paper together too, so he's he's
a great guy. Yeah yeah, yeah, So I really, I
really I'm interested in the metabolic side of things too,
because I do agree that to take step I guess
one step back. If we're looking at the path though
physiology of depression, like what causes it, we don't actually
(20:28):
really know yet. Like in medical school, we're taught like
neurotransmitters like serotonin, dopamine, EUROP and ephrin. But we know simplicity,
why is it's not causative, Like, it's not a drop
in serotonin that's causing you to be depressed. There's so
many other factors that go into it. And I think
we know that there are a lot of bi directional
associations with depression too, and one of the large ones is,
(20:52):
you know, these metabolic features that someone may have either
as a result of depression or causing the depression. But
I think think it's at least to say that those
metabolic side effects or whatever is going on within that
person can really perpetuate those depressive symptoms and make stuff
a lot harder. So I think where Chris is coming
from in terms of his kind of metabolic origins of
(21:14):
the mental illness in general, is kind of breaking it
down all the way to the mitochondria and saying that
this mitochondria is responsible for making energy, and simplicity's sake,
it's responsible for all the kind of behaviors and depressive
phenotypes and stuff of that sort. And I think there's
a lot to learn from a framework. My opinion is
(21:35):
that nothing you can kind of simplify it. There's nothing
that you can simplify too much down to one mechanism
causing depression, because it's such a big disorder with so
many different causative mechanisms and so many different things. But
I do think that you can say that there are
significant causative factors. And to go back to the mitochondria,
(21:57):
we know that exercise is one of the most beneficial
things for your mitochondrial health, and there's also a recent
review on how exercise influences your mitochondria, and I can't
speak to the specific details there, but nonetheless is just
to say that we know that mechanistically exercise can help
with the mitochondrial function, and by virtue, we also see
(22:18):
changes in antidepressant effects, so one could draw kind of
an arrow between those, and I think it's one of
the potential mechanisms that could describe the antidepressant effects of exercise.
But I think it's also important to reframe it from
like a biopsychosocial lens, so that would be the bioside
when we're speaking about neurotransmitters. We're speaking about the mitochondrial function,
(22:40):
but we also need to talk about the social aspect
of it, like exercise. Some people when they're exercising, you're
on a team, You're talking to other people. Even if
you go to the gym and you're gyming alone, there's
other people there. You're talking to people. You go spot
someone that in itself also has value too, right, and
that can result in those psychological benefits. And how I
see it as this really big kind of intertwined web
(23:03):
where all these factors impact one another. So as Chris
mentioned before and his theory regarding the mitochondrial health and
mental illness, I think is very important within this web.
But there's so many different factors that go together into
either producing depression or antidepression in the facts. And this
extends beyond depression too in terms of other mental illness.
(23:24):
But I think it's a very interesting framework and I
think it fits well into this big causal web of depression.
Speaker 2 (23:31):
You are listening to Convention over Prescription with Doctor K
featuring a special guest, doctor Nick Fabrianc.
Speaker 1 (23:49):
No Radio, No Problem stream is live on SAGA ninety
sixty AM dot C.
Speaker 2 (23:54):
A welcome back to Prevention over Prescription featuring doctor Nick
Fabiano is a bit of a paradigm shift to which
I think in an area where there's a lot of
(24:16):
people with mental illness, and I feel like it's without
knowing the epidemiology, I feel like it's not getting better.
But yeah, so anybody that's kind of looking at it
differently at least and asking tougher questions to me, I
really I think it should be championed and explored for sure.
(24:40):
So we talked a lot about exercise and depression. I
wanted to just get a sense from you if you
feel like there's other mental health disorders that are going
to be impacted by exercises.
Speaker 4 (24:54):
I think across the board there's almost you'd be hard
to find a mental health disorder that wouldn't benefit from exercise.
But I think, just for discussions sake, and this is
not an area of expertise of mind, but something that
I've just read a little bit about, if we were
to think of kind of one of the more severe
mental disorders, even something like schizophrenia, and when I say that,
(25:15):
that's someone who may be experiencing symptoms, whether they're hearing
things or seeing things, or be very paranoid and have
cognitive impairment as a result of that. Exercise even has
benefits for a severe mental illness, as well too, not
to say that it's going to treat all these symptoms
and cause someone to be in remission with schizophrenia, but
when you think and break it down symptom wise, and
(25:38):
there is meta analysis kind of to show this, we
know to speak about cognition first. People with schizophrenia overtime,
they have an increasing cognitive impairment, and one of the
best tools that we have to combat cognitive impairment schizophrenia
or even other disorders is exercise. Just being able to
kind of keep moving and have a healthy lifestyle us
(26:00):
one component of it too. The meta analysis that I'm
referring to as well too also looked at the positive
and negative symptoms of schizophrenia, and by that I mean
positive are the things that are there, so they're either
seeing something hearing something that isn't there. Negative symptoms are
the lack thereof so you know, maybe a very flat
affect or lack of motivation. Exercise also showed improvement in
(26:22):
those symptoms too, again not to the point where you
could say no medications are required, but that it's significantly beneficial.
And the last point that I want to mention too
that I spoke with depression, but It's even more important
here is the medications we used to treat schizophrenia are
oftentimes antipsychotics, and these have huge metabolic burdens on these patients,
(26:43):
which are often the reasons for lack of adherence and
medication discontinuation. So when I say that, like antidepressants, we're
talking about like maybe a few pounds of weight gain
sort of thing antipsychotics in a year. I've seen people
that gain sixty pounds in a year, and that's a
lot for any want to gain. And if you're on
that medication and you're gaining this much money, I don't
(27:03):
know anyone that would want to continue that. And not
just what you see on the outside too, like in
terms of their glycemic control and all these other metabolic markers,
it can get really out of control quickly. So I
think exercise is a great tool to combat a lot
of those metabolic side effects. Again, there are medications we
can use, like metformin to kind of combat some of that,
but sometimes it's best to avoid polypharmacy and if the
(27:25):
patient's willing to be able to get them into too engaging.
So I think in summary, there is like utility across
the mental disorder spectrum. But if we're looking at kind
of at a SEVERI index again for schizophrenia, when we
break it down by the symptoms, there's utility for each aspect,
and again not as just a monotherapy, but as an
adjunct to current treatment.
Speaker 3 (27:45):
And I think it.
Speaker 4 (27:46):
Also gives patients that sense that they're in control of
their own care too, and they're not just being given
medications and told what to take, but they're an active
member of their of their care.
Speaker 2 (27:56):
Yeah, gives them agency. It's brilliant. I really feel like
this is powerful, especially when you hear about one of
our most significant mental health disorders and the impact that
that can't have on the positive negative symptoms, Like that's
that's it really is powerful. What about anxiety? I like,
(28:21):
personally I feel like this is this would be have
a significant impact, But just in terms of any evidence
to support that.
Speaker 4 (28:30):
Yeah, I'm not aware of the specific effect size as
compared to other treatment btalities, but I have read RCTs
in terms of anxiety related symptoms and seeing improvements and
one could just imagine that as well as in terms
of with a lot of anxiety disorders. Anxiety is there
because it's normal to have anxiety as a human being.
(28:50):
Like if the example people give is if you're outside
and you see a lion, you should probably be a
little bit afraid, Like that's that's normal, but it's one
that worry gets out of control when it's kind of
not in you're controlling more when a stimulus that shouldn't
cause anxiety is really inducing that. So something like exercise
can benefit some of the things that we discussed before,
(29:12):
but it can also serve as almost a sort of
exposure therapy to different environment. So, say someone's primary anxiety
is social related, so it's a social anxiety. Exercise might
be a good way to kind of ease into that.
So maybe just starting to run and running alone and
then you run into some people on the street, you
say hi to some people.
Speaker 3 (29:30):
That can be a good start.
Speaker 4 (29:31):
And then all of a sudden you can start going
to the gym and there's lots of people there that
can be very overwhelming. And again it's a similar approach
where you don't want to just throw someone in the
deep end and say okay, good luck, have fun, but
you can take this a stept approach, so similar to
depression and working your way up and again not just
acknowledging exercise for the exercise component, but that biopsychosocial model
(29:53):
where you can incorporate the social aspect of it too,
which may be something that is quite difficult for some
of anxiety, but a so important and empowering.
Speaker 3 (30:01):
For them to be able to overcome.
Speaker 2 (30:04):
I love this. I love this because it's once again
to use that term agency people. People can take the
power back to a certain degree by incorporating exercise in
their lives. Wait, where do you see this going? Neck like,
I feel like you're I mean, my bias is not
(30:30):
everyone's seeing this the same way, and maybe maybe they are.
I don't know. You're you're closer to it. But where
do you see this going in terms of therapeutic options
for patients?
Speaker 3 (30:43):
Mm hmm.
Speaker 4 (30:44):
I think this area will continue to develop, and as
I mentioned, beyond exercise, other lifestyle measures, so things like
diet and even optimization of sleep I think will continue
to grow out. Of the three fields that I mentioned,
exercise is probably the most developed right now, but the
other ones are quickly catching up with different RCTs and
things like that. I think the issue stems from what
(31:04):
we discussed at the beginning of this episode where we
as physicians, regardless of specialty, you are taught that exercise
is good for so many conditions, whether it be physical
or mental. But speaking for myself, in medical school, I
was never taught how to prescribe exercise or how to
talk to a patient about getting into it, which I
(31:25):
think if we take a bottom up approach, once we
have the evidence space for its effect, this should be
something that's taught in both medical school and residency to
a level where we're able to speak to patients. Like
in my psychiatry asgency, we do a lot of interviewing techniques, etc.
Prescribing different drugs. I have a textbook over here besides
reading all the mechanisms of different things. But in all
(31:47):
these textbooks, we don't really talk about exercise beyond oh
it's good.
Speaker 3 (31:51):
Same with diet, oh it's good.
Speaker 4 (31:53):
And that doesn't make it conducive for someone to be
able to feel confident to talk to a patient about it.
And there's been research on that to not specifically within psychiatry,
but looking at family physicians, and those who exercise themselves
were way more likely to counsel their patients on exercise
and those that didn't weren't. Now that could reflect their
(32:13):
own bias, but it could also reflect just not being
comfortable talking about it with the patient, which I think
our training should. We should leave our training feeling comfortable
discussing first line options and where this goes further for
the field of psychiatry. In our current guidelines, so can
matt guidelines that we follow we study for our exams.
Exercise is actually a monotherapy first line for depression. But
(32:38):
when I tell that to a lot of people, people
are surprised, like even in psychiatry, so I think we
need more. We have the evidence, but we need to
spread the word and teach people how to speak to
their patients because it is one of the treatment options.
Because as I mentioned before, we oftentimes look at treatment
from a simple leens of meds or therapy or both,
(33:00):
but there's so much more between. I know we're mostly
speaking about exercise, but there's room for optimization of someone's
diet and that goes to the metabolic side as well too.
There's a room for optimization of exercise and sleep, and
all of these things contribute to the symptoms of depression, schizophrenia, anything.
They're all kind of intertwined and sometimes I think that
our approach currently is very much kind of like a
(33:20):
bandage solution, where you're giving someone a medication which helps
but doesn't solve the underlying pathology or what might be
going on to perpetuate that.
Speaker 2 (33:28):
Only you are listening to Prevention over Prescription with Doctor
K featuring our special guest, doctor Nick Fabian.
Speaker 5 (33:37):
Where the Street, else in the basement, Partner with one
of your friends, and the tapships all night, Water, torture
and sink, the furnaces.
Speaker 1 (33:50):
Burns, dreamers Life at SAGA nine six am dot CA.
Speaker 2 (34:04):
Welcome back to Prevention Over Prescription featuring doctor Nick Fabiano.
I'll say Nick, this finding this conversation so encouraging because
one of my concerns in healthcare and medical education right
now is we don't have We rarely ask ourselves what's
the root cause, like, what's what is actually happening? And
(34:27):
how can we have non band aid solutions to many
of our problems? And hearing you speaks, it's inspirational. Here
in night as an example, I want to learn how
to talk to patients about exercise. Why isn't that part
of the curriculum? Or as a as a medical student
or as a resident, even to be honest with you,
(34:49):
even as a cme as a staff doc, I'm not
aware of any of this. You got to you gotta
come on prevention over prescription to find out. But same,
I'm assuming you probably feel similar about nutrition and other
areas sleep. You mentioned sleep. Oh my god, we're very
(35:10):
good at prescribing these medications that don't necessarily help with
deep sleep or like restorative sleep. I should say, but
I'm hoping your generation and maybe the one a couple
of years after you, will thrive for this knowledge because
(35:31):
what you're going to see, Nick, in my opinion is,
and I don't have data to support this, but this
is just my opinion, is that you're going to get
more buying. You're going to get way more people that
are going to be motivated and feel.
Speaker 3 (35:46):
Empowered to.
Speaker 2 (35:49):
Use these methods that are lifestyle modifications to impact their illness.
I feel that energy coming. I hear it every day,
they see it online. I really think it's time. So
I hear you in terms of we got it. We
got some work to do, but man, once we get there,
(36:11):
I think it's going to be pretty powerful.
Speaker 4 (36:16):
No, I agree, I really agree, and I hope to
see that, and I hope to be able to be,
at least within Canada a part to make a difference
from that. And you know, whether it's doing the research
or spreading the word, or even just with that individual
patient in front of you, I think getting those reps
in and being able to feel comfortable talking to them
too is so important because you know, it's one thing
(36:37):
to have all this data, but it's another thing to
put it into practice.
Speaker 3 (36:41):
And that's something I hope to be able to do.
Speaker 2 (36:44):
And I'm going to go on the record. We're at
the tail end of this nick, but I'm going to
go on the record I don't like creating more work,
but certainly from a research side, I'm always open to
collab for sure, But more importantly, I think hearing your
voice being a Canadian advocate for trying to create these
(37:08):
lifestyle changes to help people's mental health if you want to,
if you want some mentorship or some guidance on how
to get your word out and building some platforms that
people can get a hold of what you got to
say and your research, and I think you should be
doing more stuff like this. I think it could be
(37:29):
I honestly think it could be significant for people's lives.
So yeah, I appreciate it. I'm opening that door if
you ever want to explore that.
Speaker 4 (37:38):
No, for sure, I really appreciate it. Maybe we could
have another chat sometimes.
Speaker 2 (37:41):
Absolutely so, Nick, how do people get a hold of you?
How do people learn more about all the amazing work
you're doing?
Speaker 4 (37:49):
Yeah, so if the primary thing that I'm active on,
I'm just active on acts or Twitter. There I like
to post out in my own studies or other people's studies.
So my handle is just anty, so it's nt F
A B, I A n O. So if you're interested
in just reading studies and a shorter form content, I
do that every day there.
Speaker 2 (38:09):
So yeah, amazing all right, Nick youture just looking bright, folks,
So tap in, follow, follow Nick on X and brother.
Thank you so much for joining us on the show.
You're doing incredible work and we're real proud, real proud
of you. Thank you for having me right quld questination
(38:30):
aging parents. This is what we're talking about, because I
have had so many people approach me in the last
little while here struggling with their parents, saying they're in
this funny area where they are have their young families,
but they're also having those aging parents where they're seeing
(38:50):
to mention mobility issues, disposition issues, as in where they're
going to live, where they're gonna how are we going
to be able to take care of them. They're experiencing
more falls, they're losing weight, and I gotta tell you,
I wanted to come on to say, like if I
had my parents were still with me, how about of
(39:11):
it approach things? How about I approach things if I
knew I was having that aging parent and do everything
I can to mitigate their risk of becoming frail, losing
their independence, keeping them sound of mind. And honestly, the
framework is simple. It's very similar to many of the
(39:33):
things that we talked about. And the first thing we'll
talk about is the nutrition side. As we see people age,
their appetites go down, they become more frail, they lose
their body, their lean muscle mass. So, as you can imagine,
my emphasis is on protein intake. How do we guarantee
(39:54):
our parents, our grandparents get enough protein intake during the day,
And sometimes it's about choosing foods that really peel to them.
If it's for example, on the ethnic side, my parents
were Ghanian. They had a lot of rice dishes that
have a little bit of protein in it. I always say,
(40:16):
just double up the protein in that in the rice dish,
jell of rice. Those that know what I'm talking about
Ganyans and Nigerians at double the chicken that's that involved
there and that will go a long way in terms
of supplement. You'll see people get boost, which is better
than nothing. But in my opinion, tons of sugar highly processed.
(40:39):
I'm a big fan of just throwing some protein powder
in the mix. And one of my good friends Gianni
and Jen there, I think it's almost like a grandmother,
or sorry, like a grandaunt. If that's the thing she did.
There's amazing recipe where she takes orange jew and puts
(41:01):
vanilla protein. Got of the vanilla protein in that bad
boy tastes like a creamsicle, guaranteeing Grandma's getting close to
thirty grams of protein just from that. And it's just
setting you in the right direction because, as we talk
about with protein, you want to maintain that lean muscle mass,
(41:21):
you want to have better control your blood sugar. You
want to be less likely to grab crappy foods. Crappy
process foods like to me This is a real nice
lever in terms of making sure your family members are
getting enough nutrients. I would, in fact even add some
(41:43):
creatine in there. Like you, Maybe I don't know how
well it's been evaluated in our senior population, but to me,
maintaining that lean muscle mass is so important because what
we see people die of as ay age is frailty.
It's weakness. Said many times on our show, when people
die in the ICU, it's not usually because the machines
(42:05):
ain't workings, because they have become so frail that their
quality of life is compromised. They're not going to be
that same person. So before we get to that point
with our elderly population, with our parents or our grandparents,
let's do everything we can to prevent that. So focusing
on protein, focusing on muscle, maintaining muscle mass, so using
(42:28):
that creatine as an example, Vitamin D. Everybody should be
on vitamin D. You want to make sure that their
bones are intact, you want to make sure that their
communities all point like. That's another one where I would
definitely consider supplementation. All right, So in terms of that's nutrition,
(42:51):
Then there's the movement side, and this is tricky as
we h people are to get their their joints are compromised,
they're not as comfortable with mobility. But this is something
where I think you work with the with what's in
front of you. This could be doing with air squads,
this could be doing push ups on your knees. But
(43:13):
some form of resistance training would be amazing. And I
think we just got to normalize it, folks, And it's
got to These trends got to start earlier. You know,
when we got postman apausal women with their osteoporosis in
there and the loss of their lean muscle. This is
this is so important. I think creating that healthy habit
(43:35):
earlier on is is the ticket. But it's never too late.
We see those videos of nine year olds pushing more
weight than I do. But if you don't have access,
if you feel like you're your loved one, there's no
way they're going to get to the gym or workout
from home. To me, it's getting their steps up, step
(43:58):
count get them out side and moving and being in
Ottawa and in Canada, it's not always easy to get
them outside, but get their step counts out up, whether
they're on a walker or not getting them moving, getting that,
getting that stimulating more of their muscles. It's going to
(44:19):
improve their cognition, it's going to improve their strength, it's
going to prove their sleep, which we're going to talk
about in a second. But we have to be very
proactive in the setting. I can't just be wait for
a bad thing to happen. In my mind, be proactive
with our parents and grandparents, get them moving, because the
other side of that is not pretty. Third thing I
(44:42):
will say is in terms of stress management or specifically sleep,
I really want to focus on. Sleep becomes more challenging
as we age, but to me this is probably something
that as we agent arguably becomes more or more important.
(45:02):
The ability to stay active during the day is going
to help with sleep pressure. And so I think for
our parents and grandparents, staying active during the day is
what we were talking about really important. Not eating too
close to bedtime so they get that enhanced sleep. If
we need supplementation, to me, magnesium is a way to go.
(45:24):
Magnesium glycinate very little downside, maybe some gi upset if
you take too much, but reducing that overall stress response,
feeling more calm align for enhanced sleep because if they're
more well rested, appetite is better, they're more active during
the day, mood is better because I think sometimes too
(45:47):
with the fourth topic, we're going to talk about connection.
If if you're not if your mood is down, if
all this is going to decelerate. And we saw that
during the pandemic, with all the loneliness and inability to
connect on how that how we saw a significant decrease
(46:08):
in quality of life and and and longevity of some
of our elderly population. So I think really putting that
emphasis on how grandma, mom, grandpa is going to sleep,
I think it's super important. And the last part I'll
say is about creating that connection, and that could be
(46:28):
through exercise, which I think is the nice way to
kill two birds with one stone. Are you going to
get to be part of an exercise group, aqua aerobics,
I don't care what it is, that's it's it's so
important to have that that that that connection, that that
psychological aspect where you you feel purpose and feel like
(46:49):
you're part of something. And so that could be through
family making sure you can now to see grandma and grandpa.
Enough clubs, uh, whether that's batchy, whether that's card games.
Whatever it is that they feel connected at the time
is really important and so aud of foster that you
(47:13):
could be creative. But to me this is this and
the other part of that is like enhances their mood.
You don't want them to be down and out. So
these are these are the aspects for me if my
parents were still around, what I would kind of focus
on to try and get them the best health spent,
(47:34):
not just lifespan, but health spent being healthy during the
a lot of half of their life or a lot
of third of their life. So once again on the
nutrition sides, focus on protein, focus on keeping that lean
muscle so to avoid frailty. Get them move in My
bias is on the resistance training of some sort, but honestly,
(47:54):
if they're not interested in that, any form of movement,
walking more and the sport if it's swimming, I don't care.
But get them moving for sleep is vital in terms
of maintaining cognition, being sharper during the day. We'll trying
to be more energetic so you avoid those falls, better appetite,
(48:16):
better mood, more willingness to try things, So get that
sleep on point. And lastly, making sure that they're feeling connected,
feel that purpose, that there's their value, and that could
be in terms of cooking together, working out together, exercising together,
whatever works. To me, this is such an important message,
(48:41):
all right, So let me know where your thoughts are
on agent population and then your parents and grandparents. If
you have any questions, reach out quodcast nine to nine
at gmail dot com or just leave them in the
comment section. And once again, when it comes to prevention
over prescription, we need to be proactive with our health
(49:01):
and that includes the health of our parents and our grandparents.
And I'm hoping this serves as a bit of an
inspiration to be proactive. All right, folks, Please, if you
enjoyed that, please leave us any comments at quodcast ninety
nine at gmail dot com. Leave a five star rating.
Follow us on TikTok, Instagram, YouTube, Facebook, Twitter at quodcast,
(49:23):
Jump on our newsletter, jump on our community, check out
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getting behind is on that preventative side, on that proactive side,
so that you show up as your best self, show
(49:45):
up guide, A strong baby. Here we go. Let's do
this all right, people, I hope you're feeling a little
bit more jumping your step after that episode. Thanks for listening.
Talk real soon.
Speaker 1 (49:56):
Pose.
Speaker 2 (49:58):
It's like you want to with me. You don't even
know what rout is looks if.
Speaker 6 (50:02):
You want to get clean, you want to get thirty,
you want to go left right.
Speaker 2 (50:05):
This is what we're doing.
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Want us to knock up?
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That's just rock Hub forty while I drinking.
Speaker 1 (50:10):
No Radio, No Problem. Stream is live on SAGA nine
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The views expressed in the following program are those of
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Saga nine sixty am or its management.
Speaker 2 (00:18):
Quocast Nation. I just wanted to inform you how excited
we are about our latest book, Prevention Over Prescription. This
is a new project we put together to distill the easiest,
most efficient ways to get healthy again. Focusing on purpose
on nutrition, movement, stress management, and the power of connection.
(00:40):
We go through worksheets. We put together a concise book
that will allow you to get the tools to take
the power back, get your health back, and restore the
vitality that you deserve. If you're interested in getting Prevention
over Prescription, sign up now at doctor Quadro dot Ca
or check the link in the captions, and as a
bonus you sign up for the pre order, you get
(01:02):
that twenty eight day reboot course on us. Let's start
getting healthy together, folks. Welcome to Prevention Over Prescription, the
podcast where we focus on what truly matters, taking control
of your health before it takes control of you. I'm
doctor Cordio Karen Mantang. I see you physician, health advocate
and your guide to living stronger healthier and longer, and
(01:24):
each episode we'll explore how you can prevent illness and
thrive through practical advice on nutrition, movement, stress management, and
building a supportive community. Because prevention isn't just better than prescription,
it's the key to showing up as your best self.
Let's get started, Cool Cassation, Welcome back to Prevention Oval
(01:45):
Prescription with doctor Kurt Babbe got a wicked episode with you.
We got doctor Nick Fabiano, thirty year residents in psychiatry.
At this stage, I'm gonna call him pretty prolific in
terms of publications. But he has taken an interest of
looking at exercise and the impact it has on our
(02:07):
mental health, and the evidence and the data to support
this is significant enough that man, I think we should
be amplifying as message. Big time movement is medicine, not
only physically but mentally, folks, and we dive into the impacts,
and honestly, this kid's inspirational. He's already looking at root causes.
(02:32):
He's not just taking the information and taking it out
of its word, looking at alternative reasonings in terms of
why we're seeing so much mental health, And I just
think it gives leaves me with some optimism about the
future of a lot of our youth are thinking this way.
We're going to be in a good place in our
not so distant future. So this is this is awesome.
(02:55):
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have to go to Drink Element dot Com backslash podcast.
That's Drink Element dot Com Backslash KWA Dcast. All right, folks,
doctor Nick Fabriano in the house Quocas Nation. There's very
few times I come on here that I'm this excited
to cover a topic, folks, because this is real. This
(05:28):
conversation we're having with doctor Nick Fabriano is going to
open your eyes in terms of taking the power back
when it comes to our mental health, the importance of exercise.
It's so oh, I'm totally jazzed up. So Nick, welcome
to the show, my friend.
Speaker 3 (05:46):
Yeah, thank you for having me.
Speaker 2 (05:48):
Absolutely. So, you're young in your career, you clearly saw
at affinity for looking at mental health and exercise. Maybe
let's start with like what drew you to this link?
Speaker 3 (06:03):
Mm hmm.
Speaker 2 (06:04):
Yeah.
Speaker 3 (06:05):
I think there's a few things.
Speaker 4 (06:06):
So as myself right now as a third year psychiatrist,
and I've always been really interested in kind of that
overlap between mental and physical health. And one thing that
I noticed is my own bias coming in. I've always
been someone who played soccer, went to the gym. I
really like that sort of things, and anecdotally throughout medical school.
In my whole life, I just noticed that exercise was
so beneficial to me both physically but mentally as well
(06:27):
too provide that sense of clarity. And I always wondered,
when we're seeing these patients, we have this dichotomy between
mental and physical health, and from the psychiatry side of things,
oftentimes we don't really fully pay attention to the physical side.
And I thought that was really really interesting and interesting,
but also kind of problematic. So as I started to
see more and more patients, I thought, you know, why
(06:50):
don't we have an intervention that we can help with
both sides. And something that has the unique position of
that is exercise. Right, if you can get people to exercise,
get moving, it can help with their mood, it can
help with the physical ailments that come with it, and
we know that if we're speaking about depression, for instance,
that's something that's very highly comorbid with a lot of
(07:11):
other physical ailments and they go hand in hand. So
that's where that idea really came from first. And then
the other arm of it, too is the medications we use.
They have a lot of metabolic burden to them, and
by that I mean a lot of weight gain associated
with it a lot of issues with controlling your sugars,
and sometimes we follow up the blood work, we kind
(07:31):
of follow those things, but we're not directly tackling some
of those side effects. So I think it's a responsibility
for us as physicians too to address both sides. So
I think for both of those reasons, it really got
me interested in looking at the field of exercise to
kind of both help treat but also prevent some of
these side effects from medications that someone might be on,
and looking into ways on how we could do that better.
Speaker 2 (07:54):
Boy, do I love this. I've been a big believer
of movement is medicine, and not only for the physical side,
but the mental health side. And you're part of that
solution in terms of creating that evidence to suggest that.
So us give us a sense of like, has this
(08:16):
been studied? Has this been looked at, whether we're talking
depression or any other mental health disturbances, Like, what's the
level of evidence that's out there that exists.
Speaker 4 (08:26):
Yeah, that's a great question, and I think it's an
area that's been rapidly and rapidly growing more recently. If
you were to look at this, say twenty years ago
and you said I'm going to prescribe someone exercise for depression,
for instance, they look at you like you're crazy.
Speaker 5 (08:39):
Right.
Speaker 4 (08:39):
And over time though, the literature has built up more
and more and more, which is good to see because
we have more solidified evidence to really see the antidepressant
effects of exercise, so much so that I believe in
the last year or two there was a meta analysis
that was published or network meta analysis that was able
to compare the different interventions. So when we're in psychiatry,
(09:00):
we often are met with this dichotomy of do we
prescribe medications do we do therapy? And it's just kind
of simplistic terms, that's kind of what we do, and
there was not really a whole lot in between. And
what we're seeing is interesting. The evidence base now is
that's comparing these treatments shows that their effect on depression
is pretty similar. So when you're looking at medications, therapy, exercise,
(09:24):
and those are all very broad terms. I acknowledge that
there's different types of therapy, there's different types of medication,
there's different types of exercise, but across the board, when
you're looking at randomized control trial data, the effects or
antidepressant effects are pretty much the same, which is reassuring.
But again there's a lot of nuances that we can
speak about in between in terms of the differences. And
(09:47):
one that I'll quickly highlight is, as I mentioned before,
the multi system benefits of exercise. So again it's not
just treating the depression per se, but it's treating other
physical ailments that may be there, or bolster someone's physical
reserve that might be there, which has preventive value as
well too, which is really really important.
Speaker 2 (10:07):
Absolutely, and before I forget, is there a cumulative effect
if you do say, for example, all three.
Speaker 3 (10:15):
Mm hmm, yeah, for sure.
Speaker 4 (10:17):
There's lots of evidence to point that these these these interventions,
they don't need to be used in isolation. I think
oftentimes what happens is when people hear the word exercise
or even diet for instance, you think that there's these
separate camps that you have to be in that if
you're doing exercise, you can't use antidepressants or you can't
(10:39):
do therapy, and it couldn't be anything further from the truth.
There's more, there's smaller trials that are putting them all
together as an intervention, but they do show this synergistic
effect when you're combining multiple interventions, which I think is
an important point to highlight because if we keep them separate,
we create, as I mentioned, these camps of treatment, when
in reality, it's best to tea use all of them together,
(11:02):
or better phrase that, what the patient wants stewards able
to do, it's best to kind of run with that
because that will lead to the best results.
Speaker 2 (11:10):
You are listening to Prevention Over Prescription with Doctor k
featuring our special guest, doctor Nick Fabriano.
Speaker 6 (11:16):
H to be today is as Hizuzu used to drive
down NBA's turning them in a home and the Turbans
got a ther cheap for them, plus they would short
with cheese that would.
Speaker 2 (11:27):
Work with them.
Speaker 1 (11:29):
Stream us Live at SAGA nine sixty am dot Cy.
Speaker 2 (11:41):
Welcome back to Prevention Over Prescription featuring doctor Nick Fabiano. Yeah, Nick,
I'm hearing you see say this all like this is
another another opportunity for personalization, like to look at ways
that really suit the patient and would they what would
(12:02):
they would benefit or more likely allow themselves to succeed in,
Like if you've got somebody that's really keen on moving
and less keen on taking something adding the therapy. Maybe
the therapy plus the exercise might make sense. If they're
someone that's not going to get off that couch, then
the other two might make more sense. So I really
(12:25):
think that what you're highlighting of allowing us like using
these tools to meet patients where they're at, is huge.
Speaker 4 (12:36):
And to speak to that point too, I think you
bring up a good point indirectly in the sense that
exercise in any intervention for that isn't necessarily appropriate across
the board for any illness, but also any stage of
illness too. So again to keep it simple and speaking
about depression, sometimes we separate it into mild, modern, or severe.
(12:56):
And as you gave in the example before, someone who's
like sitting on the couch which they don't have the
energy to get up and eat or even do self
care things, it would probably be inappropriate to even suggest, like, hey,
you should just get up an exercise sort of thing.
But when we look at different kind of severity levels
and depression, and most of the research is based on
mild and moderate depression, So in simplicity's sake, just kind
(13:17):
of the people that have these depressive symptoms, but it's
not significantly impacting their functional capabilities. That's where exercise may
have a role. And even then to the personalized point,
just because someone has mild or modern doesn't mean that
they would want exercise. But I think our job as
a provider is to at least provide them with the
(13:37):
education and the option and be able to help them
do that if so that they are interested in taking
that path.
Speaker 2 (13:46):
Absolutely giving that option, and so what does that look like?
And maybe we could reference the studies or how you
might have approached this in your practice when they looked
at exercise as something to prescribe, is that weight training?
(14:08):
Is it taking a fitness class? Like, what does that
look like?
Speaker 4 (14:12):
So, like we mentioned before, actually is a very very
broad term, right, So how I like to simplify it
is if you were to prescribe a medication. As a doctor,
you're going to tell them the medication. You're going to
tell them the route they take it. You're going to
tell them the frequency, the dose. But as physicians, not
to overgeneralize, but oftentimes when you're speaking to a patient,
(14:33):
you tell them go exercise, you tell them go for
a run. It's not really actionable. So what we discussed
in our paper and This isn't a framework that we made,
but a framework that we've adapted for our paper. It's
called the fit framework, so it's FI and it breaks
down exercise into a prescription for lack of a better word,
where F stands for frequency, So how often you are
(14:55):
setting that expectation of working out per week. Let's say
I is the intent, so that can be you know,
a lower intensity, it can be moderate, or it can
be a vigorous intensity. The T is the type of exercise,
so that's what you were alluding to before with aerobic
so things like running resistance would be something like weight training,
or mind body is something like yoga, and of course
(15:16):
there's stuff in between that, but we keep it in
kind of general terms. And then the timing of exercise is,
you know, how long are those sessions. So we spoke
about frequency like how often you're going per week, but
timing is how long is that session, Like you're doing
it for forty five minutes or you're doing it for
an hour. And it's important to talk to your patient
in these terms because again it breaks it down into
(15:38):
something that's actionable. Number one, but number two, at fall
of appointments, you can have metrics to kind of speak
about it. So rather than just saying, you know, how
was the running going or something, they're like, oh, I
hated that, Like that was horrible. You can set them
up with realistic goals, right Like you can say, maybe
you started a really low frequency, really low intensity, and
you build up from there. Because the one thing that
(16:00):
I like to tell people is that any exercise is
better than none for both your physical and mental health.
And I'm sure we'll get into it a little bit later,
but one of the other things is they've done meta
analysis looking at a dose response association between exercise and
antidepressive effects, and essentially how that curve is shaped is
those first little bits of exercise you see an exponential
(16:22):
benefit to antidepressant effects and eventually it tapers off. And
you know, it can even go the either way if
there's too much exercise. But that should be something that's
really motivating for people, because even if you're not hitting
that quote unquote optimal level, each little bit more that
you're doing has so much benefit. And you know, starting
low and going slow can be beneficial for someone. It's
(16:43):
not that you have to go from not exercising it all
as all of a sudden're running a marathon next week.
That's not realistic and it's going to set yourself up
for defeat. But using that fit principle to kind of
guide almost increasing the dosage of a medication similar to
what you would do for an antidepressant too. You wouldn't
start it at max dose, give the mother all the
side effects, and probably wouldn't tolerate that as well too,
So the same principles apply for prescribing exercise.
Speaker 2 (17:06):
This is brilliant because this is my one of my
biggest pet peeves when it comes to exercise. As clinicians,
we often just say run more, start lifting weights, with
no guidance and no ramp up. And I can't agree
more with your nick that what people need is wins.
(17:29):
So if you're giving them something that is incremental and
feasible and the data is supporting an exponential rise in
mood as a result of you making the right steps,
that is huge. That's a beast And as you mentioned before,
(17:50):
you're not only just tackling their mental health, you're dealing
with the potential side effects with the medication. Or they
might not be physically healthy, maybe they're metabolically unhealthy at
the same time, so you're addressing those needs too, kill
in multiple words with one stone. So to me, this
is definitely on point. So just to elaborate to on
(18:14):
the fit method, like, what was the results of this
of the study?
Speaker 4 (18:18):
Yeah, so for the fit method, that wasn't necessarily a
study with an outcome. It was more of a framework
in terms of how to apply. And actually, to my knowledge,
I don't know that there have been studies in terms
of applying the fit principle and seeing the outcome in
terms of adherence, And I think that would be beneficial
to see because you know, in clinical practice it seems
to work, but it's always interesting to see when you
(18:40):
put it in the real study setting does that work.
I also acknowledge, though a caveat to that too is
sometimes these RCT settings that we put people in they're
not representative of a real world sample, so you might
see false increase adherence, you might see the opposite too.
So I think it's interesting And I'm not aware of
literature about the fit principle in terms of application for
(19:01):
adherence antippresion in facts, but I think it would be
interesting to see.
Speaker 2 (19:05):
You know, I agree this would be on paper that
it definitely sounds like this would be very promising. So
I have been recently following Chris Palmer, got to meet
him at a couple of conferences, and he has been
(19:25):
a big proponent of metabolic disease being a risk factor
for mental health. And I'm curious to hear your point
of view, in your perspective or your opinion, because when
I hear how exercise can be beneficial to improving people's
(19:49):
mental health, to me, I directly make a link to this,
like the metabolic health side. So and this is definitely
not something I learned in medical sk So I'm just
curiously what's your opinion on the metabolic health side and
mental health?
Speaker 4 (20:07):
So, yeah, no, I personally know Chris's ball too. We're
actually working on a paper together too, so he's he's
a great guy. Yeah yeah, yeah, So I really, I
really I'm interested in the metabolic side of things too,
because I do agree that to take step I guess
one step back. If we're looking at the path though
physiology of depression, like what causes it, we don't actually
(20:28):
really know yet. Like in medical school, we're taught like
neurotransmitters like serotonin, dopamine, EUROP and ephrin. But we know simplicity,
why is it's not causative, Like, it's not a drop
in serotonin that's causing you to be depressed. There's so
many other factors that go into it. And I think
we know that there are a lot of bi directional
associations with depression too, and one of the large ones is,
(20:52):
you know, these metabolic features that someone may have either
as a result of depression or causing the depression. But
I think think it's at least to say that those
metabolic side effects or whatever is going on within that
person can really perpetuate those depressive symptoms and make stuff
a lot harder. So I think where Chris is coming
from in terms of his kind of metabolic origins of
(21:14):
the mental illness in general, is kind of breaking it
down all the way to the mitochondria and saying that
this mitochondria is responsible for making energy, and simplicity's sake,
it's responsible for all the kind of behaviors and depressive
phenotypes and stuff of that sort. And I think there's
a lot to learn from a framework. My opinion is
(21:35):
that nothing you can kind of simplify it. There's nothing
that you can simplify too much down to one mechanism
causing depression, because it's such a big disorder with so
many different causative mechanisms and so many different things. But
I do think that you can say that there are
significant causative factors. And to go back to the mitochondria,
(21:57):
we know that exercise is one of the most beneficial
things for your mitochondrial health, and there's also a recent
review on how exercise influences your mitochondria, and I can't
speak to the specific details there, but nonetheless is just
to say that we know that mechanistically exercise can help
with the mitochondrial function, and by virtue, we also see
(22:18):
changes in antidepressant effects, so one could draw kind of
an arrow between those, and I think it's one of
the potential mechanisms that could describe the antidepressant effects of exercise.
But I think it's also important to reframe it from
like a biopsychosocial lens, so that would be the bioside
when we're speaking about neurotransmitters. We're speaking about the mitochondrial function,
(22:40):
but we also need to talk about the social aspect
of it, like exercise. Some people when they're exercising, you're
on a team, You're talking to other people. Even if
you go to the gym and you're gyming alone, there's
other people there. You're talking to people. You go spot
someone that in itself also has value too, right, and
that can result in those psychological benefits. And how I
see it as this really big kind of intertwined web
(23:03):
where all these factors impact one another. So as Chris
mentioned before and his theory regarding the mitochondrial health and
mental illness, I think is very important within this web.
But there's so many different factors that go together into
either producing depression or antidepression in the facts. And this
extends beyond depression too in terms of other mental illness.
(23:24):
But I think it's a very interesting framework and I
think it fits well into this big causal web of depression.
Speaker 2 (23:31):
You are listening to Convention over Prescription with Doctor K
featuring a special guest, doctor Nick Fabrianc.
Speaker 1 (23:49):
No Radio, No Problem stream is live on SAGA ninety
sixty AM dot C.
Speaker 2 (23:54):
A welcome back to Prevention over Prescription featuring doctor Nick
Fabiano is a bit of a paradigm shift to which
I think in an area where there's a lot of
(24:16):
people with mental illness, and I feel like it's without
knowing the epidemiology, I feel like it's not getting better.
But yeah, so anybody that's kind of looking at it
differently at least and asking tougher questions to me, I
really I think it should be championed and explored for sure.
(24:40):
So we talked a lot about exercise and depression. I
wanted to just get a sense from you if you
feel like there's other mental health disorders that are going
to be impacted by exercises.
Speaker 4 (24:54):
I think across the board there's almost you'd be hard
to find a mental health disorder that wouldn't benefit from exercise.
But I think, just for discussions sake, and this is
not an area of expertise of mind, but something that
I've just read a little bit about, if we were
to think of kind of one of the more severe
mental disorders, even something like schizophrenia, and when I say that,
(25:15):
that's someone who may be experiencing symptoms, whether they're hearing
things or seeing things, or be very paranoid and have
cognitive impairment as a result of that. Exercise even has
benefits for a severe mental illness, as well too, not
to say that it's going to treat all these symptoms
and cause someone to be in remission with schizophrenia, but
when you think and break it down symptom wise, and
(25:38):
there is meta analysis kind of to show this, we
know to speak about cognition first. People with schizophrenia overtime,
they have an increasing cognitive impairment, and one of the
best tools that we have to combat cognitive impairment schizophrenia
or even other disorders is exercise. Just being able to
kind of keep moving and have a healthy lifestyle us
(26:00):
one component of it too. The meta analysis that I'm
referring to as well too also looked at the positive
and negative symptoms of schizophrenia, and by that I mean
positive are the things that are there, so they're either
seeing something hearing something that isn't there. Negative symptoms are
the lack thereof so you know, maybe a very flat
affect or lack of motivation. Exercise also showed improvement in
(26:22):
those symptoms too, again not to the point where you
could say no medications are required, but that it's significantly beneficial.
And the last point that I want to mention too
that I spoke with depression, but It's even more important
here is the medications we used to treat schizophrenia are
oftentimes antipsychotics, and these have huge metabolic burdens on these patients,
(26:43):
which are often the reasons for lack of adherence and
medication discontinuation. So when I say that, like antidepressants, we're
talking about like maybe a few pounds of weight gain
sort of thing antipsychotics in a year. I've seen people
that gain sixty pounds in a year, and that's a
lot for any want to gain. And if you're on
that medication and you're gaining this much money, I don't
(27:03):
know anyone that would want to continue that. And not
just what you see on the outside too, like in
terms of their glycemic control and all these other metabolic markers,
it can get really out of control quickly. So I
think exercise is a great tool to combat a lot
of those metabolic side effects. Again, there are medications we
can use, like metformin to kind of combat some of that,
but sometimes it's best to avoid polypharmacy and if the
(27:25):
patient's willing to be able to get them into too engaging.
So I think in summary, there is like utility across
the mental disorder spectrum. But if we're looking at kind
of at a SEVERI index again for schizophrenia, when we
break it down by the symptoms, there's utility for each aspect,
and again not as just a monotherapy, but as an
adjunct to current treatment.
Speaker 3 (27:45):
And I think it.
Speaker 4 (27:46):
Also gives patients that sense that they're in control of
their own care too, and they're not just being given
medications and told what to take, but they're an active
member of their of their care.
Speaker 2 (27:56):
Yeah, gives them agency. It's brilliant. I really feel like
this is powerful, especially when you hear about one of
our most significant mental health disorders and the impact that
that can't have on the positive negative symptoms, Like that's
that's it really is powerful. What about anxiety? I like,
(28:21):
personally I feel like this is this would be have
a significant impact, But just in terms of any evidence
to support that.
Speaker 4 (28:30):
Yeah, I'm not aware of the specific effect size as
compared to other treatment btalities, but I have read RCTs
in terms of anxiety related symptoms and seeing improvements and
one could just imagine that as well as in terms
of with a lot of anxiety disorders. Anxiety is there
because it's normal to have anxiety as a human being.
(28:50):
Like if the example people give is if you're outside
and you see a lion, you should probably be a
little bit afraid, Like that's that's normal, but it's one
that worry gets out of control when it's kind of
not in you're controlling more when a stimulus that shouldn't
cause anxiety is really inducing that. So something like exercise
can benefit some of the things that we discussed before,
(29:12):
but it can also serve as almost a sort of
exposure therapy to different environment. So, say someone's primary anxiety
is social related, so it's a social anxiety. Exercise might
be a good way to kind of ease into that.
So maybe just starting to run and running alone and
then you run into some people on the street, you
say hi to some people.
Speaker 3 (29:30):
That can be a good start.
Speaker 4 (29:31):
And then all of a sudden you can start going
to the gym and there's lots of people there that
can be very overwhelming. And again it's a similar approach
where you don't want to just throw someone in the
deep end and say okay, good luck, have fun, but
you can take this a stept approach, so similar to
depression and working your way up and again not just
acknowledging exercise for the exercise component, but that biopsychosocial model
(29:53):
where you can incorporate the social aspect of it too,
which may be something that is quite difficult for some
of anxiety, but a so important and empowering.
Speaker 3 (30:01):
For them to be able to overcome.
Speaker 2 (30:04):
I love this. I love this because it's once again
to use that term agency people. People can take the
power back to a certain degree by incorporating exercise in
their lives. Wait, where do you see this going? Neck like,
I feel like you're I mean, my bias is not
(30:30):
everyone's seeing this the same way, and maybe maybe they are.
I don't know. You're you're closer to it. But where
do you see this going in terms of therapeutic options
for patients?
Speaker 3 (30:43):
Mm hmm.
Speaker 4 (30:44):
I think this area will continue to develop, and as
I mentioned, beyond exercise, other lifestyle measures, so things like
diet and even optimization of sleep I think will continue
to grow out. Of the three fields that I mentioned,
exercise is probably the most developed right now, but the
other ones are quickly catching up with different RCTs and
things like that. I think the issue stems from what
(31:04):
we discussed at the beginning of this episode where we
as physicians, regardless of specialty, you are taught that exercise
is good for so many conditions, whether it be physical
or mental. But speaking for myself, in medical school, I
was never taught how to prescribe exercise or how to
talk to a patient about getting into it, which I
(31:25):
think if we take a bottom up approach, once we
have the evidence space for its effect, this should be
something that's taught in both medical school and residency to
a level where we're able to speak to patients. Like
in my psychiatry asgency, we do a lot of interviewing techniques, etc.
Prescribing different drugs. I have a textbook over here besides
reading all the mechanisms of different things. But in all
(31:47):
these textbooks, we don't really talk about exercise beyond oh
it's good.
Speaker 3 (31:51):
Same with diet, oh it's good.
Speaker 4 (31:53):
And that doesn't make it conducive for someone to be
able to feel confident to talk to a patient about it.
And there's been research on that to not specifically within psychiatry,
but looking at family physicians, and those who exercise themselves
were way more likely to counsel their patients on exercise
and those that didn't weren't. Now that could reflect their
(32:13):
own bias, but it could also reflect just not being
comfortable talking about it with the patient, which I think
our training should. We should leave our training feeling comfortable
discussing first line options and where this goes further for
the field of psychiatry. In our current guidelines, so can
matt guidelines that we follow we study for our exams.
Exercise is actually a monotherapy first line for depression. But
(32:38):
when I tell that to a lot of people, people
are surprised, like even in psychiatry, so I think we
need more. We have the evidence, but we need to
spread the word and teach people how to speak to
their patients because it is one of the treatment options.
Because as I mentioned before, we oftentimes look at treatment
from a simple leens of meds or therapy or both,
(33:00):
but there's so much more between. I know we're mostly
speaking about exercise, but there's room for optimization of someone's
diet and that goes to the metabolic side as well too.
There's a room for optimization of exercise and sleep, and
all of these things contribute to the symptoms of depression, schizophrenia, anything.
They're all kind of intertwined and sometimes I think that
our approach currently is very much kind of like a
(33:20):
bandage solution, where you're giving someone a medication which helps
but doesn't solve the underlying pathology or what might be
going on to perpetuate that.
Speaker 2 (33:28):
Only you are listening to Prevention over Prescription with Doctor
K featuring our special guest, doctor Nick Fabian.
Speaker 5 (33:37):
Where the Street, else in the basement, Partner with one
of your friends, and the tapships all night, Water, torture
and sink, the furnaces.
Speaker 1 (33:50):
Burns, dreamers Life at SAGA nine six am dot CA.
Speaker 2 (34:04):
Welcome back to Prevention Over Prescription featuring doctor Nick Fabiano.
I'll say Nick, this finding this conversation so encouraging because
one of my concerns in healthcare and medical education right
now is we don't have We rarely ask ourselves what's
the root cause, like, what's what is actually happening? And
(34:27):
how can we have non band aid solutions to many
of our problems? And hearing you speaks, it's inspirational. Here
in night as an example, I want to learn how
to talk to patients about exercise. Why isn't that part
of the curriculum? Or as a as a medical student
or as a resident, even to be honest with you,
(34:49):
even as a cme as a staff doc, I'm not
aware of any of this. You got to you gotta
come on prevention over prescription to find out. But same,
I'm assuming you probably feel similar about nutrition and other
areas sleep. You mentioned sleep. Oh my god, we're very
(35:10):
good at prescribing these medications that don't necessarily help with
deep sleep or like restorative sleep. I should say, but
I'm hoping your generation and maybe the one a couple
of years after you, will thrive for this knowledge because
(35:31):
what you're going to see, Nick, in my opinion is,
and I don't have data to support this, but this
is just my opinion, is that you're going to get
more buying. You're going to get way more people that
are going to be motivated and feel.
Speaker 3 (35:46):
Empowered to.
Speaker 2 (35:49):
Use these methods that are lifestyle modifications to impact their illness.
I feel that energy coming. I hear it every day,
they see it online. I really think it's time. So
I hear you in terms of we got it. We
got some work to do, but man, once we get there,
(36:11):
I think it's going to be pretty powerful.
Speaker 4 (36:16):
No, I agree, I really agree, and I hope to
see that, and I hope to be able to be,
at least within Canada a part to make a difference
from that. And you know, whether it's doing the research
or spreading the word, or even just with that individual
patient in front of you, I think getting those reps
in and being able to feel comfortable talking to them
too is so important because you know, it's one thing
(36:37):
to have all this data, but it's another thing to
put it into practice.
Speaker 3 (36:41):
And that's something I hope to be able to do.
Speaker 2 (36:44):
And I'm going to go on the record. We're at
the tail end of this nick, but I'm going to
go on the record I don't like creating more work,
but certainly from a research side, I'm always open to
collab for sure, But more importantly, I think hearing your
voice being a Canadian advocate for trying to create these
(37:08):
lifestyle changes to help people's mental health if you want to,
if you want some mentorship or some guidance on how
to get your word out and building some platforms that
people can get a hold of what you got to
say and your research, and I think you should be
doing more stuff like this. I think it could be
(37:29):
I honestly think it could be significant for people's lives.
So yeah, I appreciate it. I'm opening that door if
you ever want to explore that.
Speaker 4 (37:38):
No, for sure, I really appreciate it. Maybe we could
have another chat sometimes.
Speaker 2 (37:41):
Absolutely so, Nick, how do people get a hold of you?
How do people learn more about all the amazing work
you're doing?
Speaker 4 (37:49):
Yeah, so if the primary thing that I'm active on,
I'm just active on acts or Twitter. There I like
to post out in my own studies or other people's studies.
So my handle is just anty, so it's nt F
A B, I A n O. So if you're interested
in just reading studies and a shorter form content, I
do that every day there.
Speaker 2 (38:09):
So yeah, amazing all right, Nick youture just looking bright, folks,
So tap in, follow, follow Nick on X and brother.
Thank you so much for joining us on the show.
You're doing incredible work and we're real proud, real proud
of you. Thank you for having me right quld questination
(38:30):
aging parents. This is what we're talking about, because I
have had so many people approach me in the last
little while here struggling with their parents, saying they're in
this funny area where they are have their young families,
but they're also having those aging parents where they're seeing
(38:50):
to mention mobility issues, disposition issues, as in where they're
going to live, where they're gonna how are we going
to be able to take care of them. They're experiencing
more falls, they're losing weight, and I gotta tell you,
I wanted to come on to say, like if I
had my parents were still with me, how about of
(39:11):
it approach things? How about I approach things if I
knew I was having that aging parent and do everything
I can to mitigate their risk of becoming frail, losing
their independence, keeping them sound of mind. And honestly, the
framework is simple. It's very similar to many of the
(39:33):
things that we talked about. And the first thing we'll
talk about is the nutrition side. As we see people age,
their appetites go down, they become more frail, they lose
their body, their lean muscle mass. So, as you can imagine,
my emphasis is on protein intake. How do we guarantee
(39:54):
our parents, our grandparents get enough protein intake during the day,
And sometimes it's about choosing foods that really peel to them.
If it's for example, on the ethnic side, my parents
were Ghanian. They had a lot of rice dishes that
have a little bit of protein in it. I always say,
(40:16):
just double up the protein in that in the rice dish,
jell of rice. Those that know what I'm talking about
Ganyans and Nigerians at double the chicken that's that involved
there and that will go a long way in terms
of supplement. You'll see people get boost, which is better
than nothing. But in my opinion, tons of sugar highly processed.
(40:39):
I'm a big fan of just throwing some protein powder
in the mix. And one of my good friends Gianni
and Jen there, I think it's almost like a grandmother,
or sorry, like a grandaunt. If that's the thing she did.
There's amazing recipe where she takes orange jew and puts
(41:01):
vanilla protein. Got of the vanilla protein in that bad
boy tastes like a creamsicle, guaranteeing Grandma's getting close to
thirty grams of protein just from that. And it's just
setting you in the right direction because, as we talk
about with protein, you want to maintain that lean muscle mass,
(41:21):
you want to have better control your blood sugar. You
want to be less likely to grab crappy foods. Crappy
process foods like to me This is a real nice
lever in terms of making sure your family members are
getting enough nutrients. I would, in fact even add some
(41:43):
creatine in there. Like you, Maybe I don't know how
well it's been evaluated in our senior population, but to me,
maintaining that lean muscle mass is so important because what
we see people die of as ay age is frailty.
It's weakness. Said many times on our show, when people
die in the ICU, it's not usually because the machines
(42:05):
ain't workings, because they have become so frail that their
quality of life is compromised. They're not going to be
that same person. So before we get to that point
with our elderly population, with our parents or our grandparents,
let's do everything we can to prevent that. So focusing
on protein, focusing on muscle, maintaining muscle mass, so using
(42:28):
that creatine as an example, Vitamin D. Everybody should be
on vitamin D. You want to make sure that their
bones are intact, you want to make sure that their
communities all point like. That's another one where I would
definitely consider supplementation. All right, So in terms of that's nutrition,
(42:51):
Then there's the movement side, and this is tricky as
we h people are to get their their joints are compromised,
they're not as comfortable with mobility. But this is something
where I think you work with the with what's in
front of you. This could be doing with air squads,
this could be doing push ups on your knees. But
(43:13):
some form of resistance training would be amazing. And I
think we just got to normalize it, folks, And it's
got to These trends got to start earlier. You know,
when we got postman apausal women with their osteoporosis in
there and the loss of their lean muscle. This is
this is so important. I think creating that healthy habit
(43:35):
earlier on is is the ticket. But it's never too late.
We see those videos of nine year olds pushing more
weight than I do. But if you don't have access,
if you feel like you're your loved one, there's no
way they're going to get to the gym or workout
from home. To me, it's getting their steps up, step
(43:58):
count get them out side and moving and being in
Ottawa and in Canada, it's not always easy to get
them outside, but get their step counts out up, whether
they're on a walker or not getting them moving, getting that,
getting that stimulating more of their muscles. It's going to
(44:19):
improve their cognition, it's going to improve their strength, it's
going to prove their sleep, which we're going to talk
about in a second. But we have to be very
proactive in the setting. I can't just be wait for
a bad thing to happen. In my mind, be proactive
with our parents and grandparents, get them moving, because the
other side of that is not pretty. Third thing I
(44:42):
will say is in terms of stress management or specifically sleep,
I really want to focus on. Sleep becomes more challenging
as we age, but to me this is probably something
that as we agent arguably becomes more or more important.
(45:02):
The ability to stay active during the day is going
to help with sleep pressure. And so I think for
our parents and grandparents, staying active during the day is
what we were talking about really important. Not eating too
close to bedtime so they get that enhanced sleep. If
we need supplementation, to me, magnesium is a way to go.
(45:24):
Magnesium glycinate very little downside, maybe some gi upset if
you take too much, but reducing that overall stress response,
feeling more calm align for enhanced sleep because if they're
more well rested, appetite is better, they're more active during
the day, mood is better because I think sometimes too
(45:47):
with the fourth topic, we're going to talk about connection.
If if you're not if your mood is down, if
all this is going to decelerate. And we saw that
during the pandemic, with all the loneliness and inability to
connect on how that how we saw a significant decrease
(46:08):
in quality of life and and and longevity of some
of our elderly population. So I think really putting that
emphasis on how grandma, mom, grandpa is going to sleep,
I think it's super important. And the last part I'll
say is about creating that connection, and that could be
(46:28):
through exercise, which I think is the nice way to
kill two birds with one stone. Are you going to
get to be part of an exercise group, aqua aerobics,
I don't care what it is, that's it's it's so
important to have that that that that connection, that that
psychological aspect where you you feel purpose and feel like
(46:49):
you're part of something. And so that could be through
family making sure you can now to see grandma and grandpa.
Enough clubs, uh, whether that's batchy, whether that's card games.
Whatever it is that they feel connected at the time
is really important and so aud of foster that you
(47:13):
could be creative. But to me this is this and
the other part of that is like enhances their mood.
You don't want them to be down and out. So
these are these are the aspects for me if my
parents were still around, what I would kind of focus
on to try and get them the best health spent,
(47:34):
not just lifespan, but health spent being healthy during the
a lot of half of their life or a lot
of third of their life. So once again on the
nutrition sides, focus on protein, focus on keeping that lean
muscle so to avoid frailty. Get them move in My
bias is on the resistance training of some sort, but honestly,
(47:54):
if they're not interested in that, any form of movement,
walking more and the sport if it's swimming, I don't care.
But get them moving for sleep is vital in terms
of maintaining cognition, being sharper during the day. We'll trying
to be more energetic so you avoid those falls, better appetite,
(48:16):
better mood, more willingness to try things, So get that
sleep on point. And lastly, making sure that they're feeling connected,
feel that purpose, that there's their value, and that could
be in terms of cooking together, working out together, exercising together,
whatever works. To me, this is such an important message,
(48:41):
all right, So let me know where your thoughts are
on agent population and then your parents and grandparents. If
you have any questions, reach out quodcast nine to nine
at gmail dot com or just leave them in the
comment section. And once again, when it comes to prevention
over prescription, we need to be proactive with our health
(49:01):
and that includes the health of our parents and our grandparents.
And I'm hoping this serves as a bit of an
inspiration to be proactive. All right, folks, Please, if you
enjoyed that, please leave us any comments at quodcast ninety
nine at gmail dot com. Leave a five star rating.
Follow us on TikTok, Instagram, YouTube, Facebook, Twitter at quodcast,
(49:23):
Jump on our newsletter, jump on our community, check out
guid a nutrition. We've got put in podcasts fifteen for
your fifteen percent off, the bundles and the supplements, all
these things that we're promoting, all these things that we're
getting behind is on that preventative side, on that proactive side,
so that you show up as your best self, show
(49:45):
up guide, A strong baby. Here we go. Let's do
this all right, people, I hope you're feeling a little
bit more jumping your step after that episode. Thanks for listening.
Talk real soon.
Speaker 1 (49:56):
Pose.
Speaker 2 (49:58):
It's like you want to with me. You don't even
know what rout is looks if.
Speaker 6 (50:02):
You want to get clean, you want to get thirty,
you want to go left right.
Speaker 2 (50:05):
This is what we're doing.
Speaker 3 (50:06):
Want us to knock up?
Speaker 5 (50:07):
That's just rock Hub forty while I drinking.
Speaker 1 (50:10):
No Radio, No Problem. Stream is live on SAGA nine
sixty am dot ca A
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