In this episode 49 protocols
▶ 16:33 Maintain Blood Pressure at 120/80 or Lower Behaviors “the data are becoming clearer and clearer that the more aggressively you manage blood pressure to be within the 120 over 80 range, the better. If you want to reduce heart attacks and strokes, it's better to be 120 over 80 than 135 over 85.” ▷ 17:55 Measure Blood Pressure After Sitting Quietly for 5 Minutes Behaviors “the right way to do it is the person has to be sitting like this for five minutes doing nothing. Okay, folks, so when you go to the doctors now, you don't let them take your blood pressure until you've been sitting for five minutes.” ▷ 18:16 Manual Blood Pressure Cuff Tools “A manual cuff is better than an automated cuff, but not enough people use manual blood pressure. So a manual blood pressure means they put a cuff on you and they actually put a stethoscope on the brachial artery and they're using the human ear to listen, which believe it or not, you would think a machine is better, but it's not.” ▷ 18:43 Confirm Suspect Automated Blood Pressure Readings with a Manual Reading Behaviors “when an automated cuff gives you an answer that is, you know, potentially suspect, always back it up with a manual.” ▷ 20:04 Automated Blood Pressure Cuff Tools “I use two automated cuffs. One's called Withings. The other one's made by a company called OMRON, O-M-R-O-N. And they're both decent, but again, they tend to run high.” ▷ 20:53 Monitor Blood Pressure at Home Behaviors “First of all, I would just have people start with an automated cuff to begin with, and just start with there.” ▷ 23:38 Train VO2 Max Behaviors “So, the three big ones we've talked about, one, blood pressure. So if your blood pressure is 120 over 80 or better, that's important. The second is not smoking. So it turns out that smoking and blood pressure are both devastating for arteries, but for different reasons, right?” ▷ 23:44 Do Not Smoke Behaviors “The second is not smoking. So it turns out that smoking and blood pressure are both devastating for arteries, but for different reasons.” ▷ 27:10 Nicotine Lozenges or Gum Instead of Smoking or Vaping Supplements “If nicotine is what you're after, there are better ways to get nicotine, for example, through lozenges and gum and things like that.” ▷ 29:31 Use Non-Smoked Cannabis Forms Instead of Smoking Diet “And cannabis, tinctures and patches and gums and things that, edibles, that if people choose to use those substances, they can offset.” ▷ 29:31 Cannabis Patches Tools “And cannabis, tinctures and patches and gums and things that, edibles, that if people choose to use those substances, they can offset.” ▷ 30:22 Avoid Air Pollution Behaviors “the PM2.5 data is pretty good. I think once you, so particularly particulates that are less than 2.5 microns are getting straight into the body, which is like a great argument for avoiding air pollution, right?” ▷ 33:59 Do Not Vape Behaviors “Let's just throw in don't vape. Sure. I'm going to just plant my flag on it. Just don't vape.” ▷ 51:11 Lower ApoB as Much as Possible Behaviors “If your objective is to not die from heart disease and only to die with it, then you want ApoB as low as possible... we might be satisfied with a person's ApoB being at the fifth percentile of the population, which would be about 60 milligrams per deciliter... we'll treat ApoB to 30 to 40 milligrams per deciliter.” ▷ 58:20 CT Angiogram Tools “we do CT angiograms on our patients. If the CT angiogram shows no evidence of calcification, no evidence of soft plaque, that means grossly their coronary arteries are still normal.” ▷ 1:02:24 Optimize Triglycerides Behaviors “if a person has elevated triglycerides and I consider anything over 100 to be elevated, even though most laboratory tests would consider normal to be up to 150 milligrams per deciliter, we would want to fix their insulin resistance.” ▷ 1:03:58 Statins Supplements “the most obvious and the one that most people are aware of are called statins... Statins do have side effects. So five percent of people genuinely and legitimately get a muscle soreness that can be debilitating.” ▷ 1:05:02 Ezetimibe Supplements “another class of drug is called ezetimibe... Ezetimibe has virtually no side effects.” ▷ 1:10:26 PCSK9 Inhibitors Supplements “The next one that is really the big one are PCSK9 inhibitors... So it's an injectable drug. I take it every two weeks and it's called a PCSK9 inhibitor.” ▷ 1:16:12 Measure ApoB Behaviors “So by all this logic, everybody should get their ApoB measured. How early in life should people do that? Starting in their 20s, in their 30s? Certainly, if you have a family history that is of any concern... yeah, I would have had mine measured in my 20s.” ▷ 1:19:53 Exercise Regularly Behaviors “If we could get a person to lose 10 pounds and exercise every day, we see great effects with zone two stuff, right?” ▷ 1:19:53 Lose Excess Weight to Help Lower Blood Pressure Behaviors “If we could get a person to lose 10 pounds and exercise every day, we see great effects with zone two stuff, right?” ▷ 1:19:58 Zone 2 Cardio Behaviors “we see great effects with zone two stuff, right? So kind of the low intensity cardio... Yeah, I'd like to see three to four hours a week of zone two.” ▷ 1:20:19 Prioritize Sleep Behaviors “And sleep is an important piece. So get the sleep right. Get the exercise right.” ▷ 1:21:47 Measure Kidney Function with Cystatin C Behaviors “We rely very heavily on something called creatinine as opposed to looking at another biomarker called cystatin C, which is far more accurate.” ▷ 1:24:38 Avoid Alcohol Behaviors “it's actually pretty clear that there is no dose of ethanol that is healthy... if you can not drink at all, you're better off not drinking at all.” ▷ 1:32:20 Screen for Colon Cancer Behaviors “Prostate cancer, colon cancer are cancers that no one should ever die from because they're so easy to screen for. They are so easy to treat when they are in their infancy.” ▷ 1:32:20 Screen for Prostate Cancer Behaviors “Prostate cancer, colon cancer are cancers that no one should ever die from because they're so easy to screen for. They are so easy to treat when they are in their infancy.” ▷ 1:39:10 Maintain Insulin Sensitivity Behaviors “you have control over insulin sensitivity.” ▷ 1:47:40 Ask How Much Radiation an Imaging Study Delivers Behaviors “do not get a ct scan or any imaging study without asking how much radiation am i seeing and if a person can't tell you how many millisieverts of radiation you're being exposed to then just say i'm going to wait a minute until somebody can tell me that” ▷ 1:48:40 Whole Body MRI Tools “for that reason we prefer MRI scanners because there is no radiation... when you use, as we do, whole body MRI for cancer screening, we tell our patients going in, it's like a 25 percent chance we're going to find something that is not cancer, but will require us to do further investigation.” ▷ 1:52:10 Control the Timing and Frequency of Cancer Screening Behaviors “What I can control is the timing and frequency of my screening.” ▷ 1:52:50 Genetic Screening for ApoE Behaviors “So we do genetic screening for certain things, like ApoE is a gene we want to know in everybody. For its role in neurodegenerative disease. Correct. Specifically in Alzheimer's disease.” ▷ 1:53:38 Colonoscopy Tools “colon cancer historically was not covered by, colonoscopy screening for colon cancer was not covered until you were 50... We still think everybody should be screened no later than 40.” ▷ 2:15:54 Avoid Head Injury Behaviors “What about head hits? Don't get, don't hit your head. Seems almost assuredly true in a susceptible individual, for sure.” ▷ 2:17:18 Hyperbaric Oxygen Tools “the use of hyperbaric oxygen immediately following a TBI, a traumatic brain injury... I would do this. If I was in a car accident tomorrow and sustained a concussion... I would absolutely use hyperbaric oxygen if I suffered a concussion.” ▷ 2:19:47 Hyperbaric Oxygen Protocol for TBI Behaviors “I think the TBI protocol that's most commonly used is… God, I want to say it's pretty intense. It's like five 60-minute sessions a week at two atmospheres.” ▷ 2:20:39 Theracurmin Supplements “What about Theracumin?... many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs. But the evidence is really unimpressive for most of those other interventions.” ▷ 2:20:41 Methylated Vitamins Supplements “What about methylated vitamins that lower homocysteine?... many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs. But the evidence is really unimpressive for most of those other interventions.” ▷ 2:20:41 Magnesium Threonate Supplements “What about magnesium with L3 and 8, the transporter?... many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs. But the evidence is really unimpressive for most of those other interventions.” ▷ 2:20:44 EPA and DHA Supplements “What about EPA and DHA?... many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs. But the evidence is really unimpressive for most of those other interventions.” ▷ 2:33:16 Strength Training Behaviors “you cannot age well if you are not doing the type of training that is there to strengthen and delay or minimize the hypertrophy of your type two fibers... You have to be doing strength training.” ▷ 2:33:46 Reactivity and Explosive Training Behaviors “You have to be doing reactivity training.” ▷ 2:34:06 Train Eccentric Strength Behaviors “one of the pillars of strength training is eccentric strength, which is breaks... when you step down, you have to apply the breaks. And that's where most people falter.” ▷ 2:37:39 Train Aerobic Efficiency Behaviors “strength, stability, aerobic efficiency, and aerobic peak output.” ▷ 2:37:39 Train Stability Behaviors “strength, stability, aerobic efficiency, and aerobic peak output.” ▷ 3:06:24 Use Therapy Regularly Behaviors “still one to two times a week, I'm still working with a therapist.” ▷ 3:16:09 Dialectical Behavioral Therapy Behaviors “I use a system called dialectical behavioral therapy that is a regular part of the therapy that I do.” ▷ 3:20:49 Replace Harsh Self-Talk with the Way You'd Speak to a Close Friend Behaviors “every single time I did something where I would have that self-talk, I would have to immediately stop myself and pretend that it wasn't me that just did that, but it was one of my closest friends. And instead I would audibly speak to that person as though they are the one that made the mistake.”