Does Your Doctor Take Creatine?

Hey everybody, welcome Welcome to two docs, one mic. I'm Adil and this is Homayo. >> Hey guys, how are you all doing? >> Hey, hey, hey. >> Who am I even asking? >> I don't know. We're not even talking to anyone. >> Can you imagine? >> Can you imagine if someone who's watching was like just sitting there on their computer listening and they're like, "No, I'm fine. >> It's just answers." Yeah, I'm doing well. >> It would be great. I mean, >> yeah. Well, we'll get an answer.

You know, this podcasting thing is is new to us. It's a midlife crisis for me pretty much. >> Oh, I know. >> Going through a midlife crisis. uh recording podcast episodes, you know, getting tired from my clinic, uh you know, exhausted this week. Uh you know, it's it's hard, man. It's hard uh keeping up with everything when you when you have a busy clinic, we have busy careers, uh you have families, it's just hard to keep up with everything.

And then I've been trying to make a point to make time for exercise. You know, that's part of my midlife crisis, too. You know, I'm starting to exercise more now for the past six months. I've been very consistent. I'm going two to three times a week. I play pickle ball once a week. Uh but it's hard to manage that. You know, I know I see a lot of my patients that uh you know on a daily basis I talk to them about exercise. Hey, we need to exercise. We need to do this.

And the only people I feel like who exercise regularly and are very committed to it are people who started exercising in their teens or 20s. >> Yeah, man. And I mean it's just very difficult to get into it.

You know, especially like a lot of people tell me this too, you know, my patients, but even other like just friends who haven't been very active or athletic for most of their life is it's almost like a daunting thing to get into the gym um and start exercising, start weightlifting because you look around and seems like everyone else knows what they're doing. Um it can be a little nerve-wracking. People can get anxious about that.

Uh it's definitely a thing and it's also shown right like people that exercise and develop that habit and it just becomes a lifestyle more than even a habit it's a lifestyle of exercise and fitness from their youth I mean they keep it up. >> Yeah. You know I think uh like previous to this stretch of exercise that I'm doing. I would I would get a gym membership. I would go on my first day motivated with my new gear. I would show up.

I would have a plan and I as soon as I would get there the machine I wanted to do workout on was already taken and I okay I can go to my second machine and that would be taken too maybe I get on the treadmill and maybe do some cardio and then I'd get on there then by the time I'm finishing cardio I'm like I don't know if I want to do weight weight training today I'll do it tomorrow and next day it'd be the same story and sometimes you know it's it's hard to have a plan when you go to the gym knowing what exercises do how to modify like you know you could have a plan I'm going to workout on my biceps today.

Okay, this machine's taken. So, which machine can I go on to next? You know, and that's kind of what I figured out. I mean, you know, I I was very committed to uh developing exercise plans. So, I personally um uh trying to work with a trainer to kind of train me and kind of help me get in better shape and help me work out. But, uh that's also very hard too for a lot of people. Uh that's not possible. So, sometimes, you know, how how do regular people get into exercise?

How do people, you know, people who want to exercise, who want to work out, who want to get in better shape, how do they get in exercise? I know you you've been exercising pretty much all your life, you've been into it, uh, since your high school time, right? I mean, so I think, um, you would be a good person to kind of talk about this and see what kind of things you've done. >> Yeah. I mean, you know, I just got into it through sports.

You know, when you're in high school and you play sports, I mean, lifting weights is kind of part of the game. um with track and then wrestling and then I wrestled for a little bit in college. Um and a lot of martial arts. I've done martial arts total for like 18 years. Um so yeah, I've been active and I've tried to keep that up and I I still lift weights pretty regularly. Um and I think that is challenging for a lot of people who have not done that. Um is how to do it, how to do it safely.

Um people have this notion that, oh, weightlifting isn't for me. I'm not trying to bulk up. I'm not trying to, you know, go do bench press and get super strong. I mean, I I am not really going for massive muscles either. It really, it's the benefit of weightlifting and strength training. I mean, it's huge. It's probably the most important exercise because it not only gives you strong muscles, but it's critical for your bone, for your skeleton. Um, and I think that's a big motivator.

Uh, that wasn't a motivator for me when I was a child. Obviously, I was doing it for fun, but now as an adult, I mean, I I keep it up for that reason. And um you know in terms of people who want to get into the gym, I think it's really important to do it properly with good form.

You mentioned a personal trainer um to make sure you do it right because if you don't do exercises, for example, like a bicep curl, it's so often that you go to the gym, you see people, they're picking up a weight clearly too heavy for them. And the way that they're lifting is they're barely getting like the full arc of motion from the curl. They're moving their shoulder forward. They're swinging their back into it, you know, like that.

That's so common because they just want to lift a heavy weight and they think that's what they should be doing. I mean, pick up a weight that is laughably light and just master the form. It's the total arc of joint motion, the full range of motion that is far more important than just the weight that you lift because your muscle has to contract throughout the entire length of your motion at that joint.

That's how you get maximum muscle contraction, maximum muscle fiber recruitment is again using the biceps as an example from full elbow extension to full flexion. That's what your biceps is designed to do. And it needs to be loaded through the full arc of motion, not just 50% of that when you kind of scrunch in and swing your back and stuff like that.

So most people when they're lifting in that fashion, sure the weight might look big when they're holding that 40 lb dumbbell in their hand, but they're not getting nearly as much benefit as if they went down to a 20 lb dumbbell and did it properly. Yeah, that's a huge factor. >> You know, that's a that's pretty important thing because form is very important rather than the amount of weights you're lifting.

But that's also very um very daunting for a person that's very naive or new to the gym to go into the gym and kind of know and have a plan and know that is is the form right? Uh luckily I think uh there's a lot of new technology now, a lot of new uh online apps, a lot of videos on YouTube that are showing us good forms, right? Have you ever used any of those to kind of guide yourself or guide others or like teach others about that? >> Yeah.

You know, I mean, when I was younger, not really, cuz you know, you kind of just do the workouts you're used to doing and you're comfortable with and familiar with. But I I think, you know, it's very easy to plateau. Like the human body gets used to things very quickly. And I change up my workouts pretty often now. And I'll pretty often I I'll just go on YouTube. I shamelessly will admit I don't have a Tik Tok, but like I'll go to YouTube and just search for new exercises.

Like for example, the other day I was looking at different core exercises. Um, and I saw this one uh that was like it was basically the guy that posted it was calling it dragon flies. And you know, you're on a bench and you keep your buttocks and your legs off of the bench and you just raise them all up as a unit and come down, up and come down. It's kind of like an exercise that was popularized by St. Sylvester Stallone in one of the Rocky movies when he was working out.

But like I had never thought about doing that exercise, you know what I mean? So even though I've worked out pretty much consistently since I was 13 years old, that's just an example of a new exercise that I found online. And I just watched it a few times. I found a YouTube video and I I put it on my phone. I went to the gym. I watched it again right before I did it. I did it a few times and it was new, so it felt weird. I wanted to really make sure my body mechanics were okay.

So, I did it in front of a mirror. And then I watched the video again to make sure that I did it the same way that this guy was doing and showing. Um, and the key points he was emphasizing, you know, like tighten your core, make sure you arch your back, keep your knees straight, all all those little things. It's very easy. It's like a domino effect. You get fatigued, you get tired, one thing goes, the next thing goes, and now you've totally lost the crux of the exercise.

So, I I mean, I personally do that, and I've been working out for well over half my life. I think it's really important to have new exercises constantly and just challenge yourself.

>> Yeah, that's very interesting because, you know, now that you say that, you know, I've been working with this uh personal trainer and um he started we started off with like a different exercise and we would do something for six weeks or five weeks and when we start off this these new exercises we're doing seem very very hard, very very hard and my form is horrible.

I'm falling off and the first day I always struggle and then as we go on towards the third week or the fourth week I'm doing it uh very easily and he starts starts uh adding weight starts adding different more difficult forms and by the sixth or seventh week uh he changes it up again >> and then again in that in the high water where I'm on the first day I'm struggling again.

So, it's it's been a revelation to me because before in the past when I've done workouts, it's been it's been the same workout for a long time and keep doing it, it gets easy and you get bored of it, right? Um that's why I think some of these uh exercise classes like the Orange Theory, F45, I mean, I did those for a a couple of years. I used to go to Orange Theory. I used to go to F45 and uh they change up their classes pretty regularly every day.

So I think um you know for a lot of people that are not very that are very new to exercising or very new to strength training uh some of these group classes are are pretty useful as well because yeah it's not as um you know um it's not one-on-one attention but I think group classes show you kind of right form sometimes can show you different exercises can change it up and can work in a group setting to motivate you.

Uh but I think uh what you said was uh the key changing up exercises and doing strength training. Um that's one thing I've emphasized a lot with my patients. The quality of muscle and we're learning that with a lot of the cardabolic research that's going on. The quality of your muscle, the quality of the muscle fiber is uh is the key and building good muscle and having healthy muscle leads to better cardioabolic health and not just bone health but even heart health, you know. Oh yeah.

I mean it's huge like that that whole concept now is becoming much much more popular and also well known of sarcopenia right everyone has heard of osteopenia osteoporosis just the gradual loss of bone density over time and your bones get brittle and they're much higher risk of fracturing uh as you get older but in concert with that your skeleton doesn't exist in isolation right the muscularkeeletal system is called that because it's a very very interwoven machine um as you lose bone density You also lose muscle mass and the loss of muscle mass.

Sarcopenia, sarco meaning muscle, pineia meaning the loss of right. The loss of muscle mass as we age is a huge factor and is so strongly linked to a ton of different diseases. Heart disease, cancer risks, dementia. And it's not necessarily a direct causation. That's not what I'm saying that oh because muscle goes down now you become demented. No, it's just your general whole body health has deteriorated to the point that you've lost a lot of muscle mass across the board.

And muscle is a protective tissue. Muscle stores all kinds of energy. Muscle keeps you healthy, keeps you from getting metabolic syndrome, all of that stuff keeps your basil metabolic rate high where you burn fat just sitting there, right? That's a huge factor. So, I mean that whole idea sarcopenia and keeping muscle mass as much as possible throughout your life is huge. And the only thing that does that really is weightlifting and strength training. You can't just rely on cardio.

You can't just walk in the neighborhood. Those things are better than nothing. But you have to have to do real strength training. It's it's been shown study after study. It's proven itself time and time again. It's not even debatable. It's just an important thing to do. >> I agree.

That's a that's a big discussion I have in my clinic since you know in in cardiology and cardioabolic disease there's a big rise of uh GLP-1 uh medications with you know a lot of people losing a lot of weight rapidly and some of the nutritional deficiencies that sometimes that come with it uh can lead to some muscle loss as well and that's a big discussion I have with them that they have to keep building muscle uh keep working on building muscle keep eating right working on in intaking as much protein.

But one thing that kind of um you know stands out to me for a lot of patients uh a lot of our patients have joint disease. You know a lot of our patients that are older uh have arthritis um you know a lot of patients I see have had knee replacements have had shoulder replacements hip replacements uh a lot of joint disease and initially you know so I kind of wanted to get your view on this of what you think about you know exercising preventing joint disease.

I think I think that's a huge component of that, right? I mean, strong muscle leads to better joint health. >> Yeah. I mean, it certainly does, you know. I mean, joint health, it's a combination of things. Joint health being several factors, right? Like arthritis mainly is the deterioration of a joint. It's the loss of cartilage. I mean, a simple way as I tell the patients in clinic, people like people have this notion that arthritis is a thing. Like, oh, now I have arthritis. Oh, no.

Is there a way to get it out? It's not a thing. It's actually the absence of a thing. It's like brake pads on a car. You use it, it gradually wears away and now you have less material. You have less brake pad. You have less cartilage in your joints. Eventually the bones rub and it leads to pain, stiffness, all of that stuff, right? And so what is protective for that? I mean your bone health for one is a huge factor. Proper calcium and vitamin D which are critical minerals for the bone.

Um weight lifting and strength training because demand is what keeps bones strong. Um, basically like all of us, including me and you, the average adult male hits their peak bone density, peak bone mass at about 20 years of age. And it's a very slowly but surely deterioration every single year from your 20s and females is a little lower than that. So your peak bone mass is at age of 20.

I mean, if we're average living into our mid to late 80s, I mean, your bone mineral density is deteriorating constantly throughout your life and doing strength training in specifically heavy weights and weightlifting is the only thing that consistently keeps your bone mineral density from decaying other than supplementation and medications like bisphosphinates and stuff which are given to people with osteoporosis.

So getting back to the question and the topic of joint health, I mean really preserving your bone health, bone quality and bone density with weightlifting is huge. You obviously need protein too, right? To keep the muscles strong because that's what weightlifting does. It strengthens the muscles. The muscles are attached to the bone and when they contract with force, it exerts force on the bone. The bone is a very dynamic tissue.

And your body will actually deposit new bone cells, new bone tissue, and the minerals that solidify and harden bone, which is calcium, phosphate, all of that stuff into that area. And it physically hardens. It changes the bone. The structure of the bone in someone who has weightlifted their whole life and is very strong. It's high bone mineral density is marketkedly different when you see it.

Like when I see it in surgery, like when a patient comes in with an injury where I do a joint replacement on them, it's very apparent how sound their bone is. I mean, some patients bone is so hard, you literally have to change a drill at a certain point in the case because it blunts the drill. Other patients, you barely have to pulse the drill, it goes right through. I mean, it the bone is so soft, it's almost like tissue paper. You can bend it with just two fingers.

That I'm not even exaggerating. That happens in a lot of patients, especially older patients who have osteoproic fragility fractures. So the difference in bone just shows how dynamic it is. Um and it's very important emphasizing again weightlifting for that and then the supplementation right because >> let me ask you a little bit more about that.

We we'll get to supplementation a bit because I want to stay on topic a little bit but you know now you you're not one of those people that have exercised all your life. 20s and 30s, you know, you made some wrong decisions. And 40s, 50s, now you've kind of been sedentary. And in your late 50s, now you've developed arthritis. You've developed some hip pain, sciatica. Uh now, does exercise help with arthritis or cuz I see a lot of patients and you know, I I I talk to them about their heart health.

I tell them, hey, you have to exercise. You have to strength train. And a lot of times I hear back, hey, I have a lot of joint pain. and I have knee issues and I'm not and I try to talk to them. I'm like, "Hey, I'm not even asking you to go run. I'm not asking you to go uh, you know, jog around or do anything. I want you to do some more strength training. I want to focus on your big muscle parts." So, am I will advise them that, hey, you know, exercising will actually help your joints or no?

>> Yeah. I mean, ex So, nothing is going to bring back the cartilage that's lost. I mean, there's there's a lot of pseudocience and charlatanism out there about inject this magic substance, take this pill, eat shark cartilage, blah blah blah, but nothing has been proven to consistently and reliably regrow lost cartilage in an arthritic joint. It has not yet happened. Uh, we can replace cartilage in very specific cases surgically, but that's not your average patient.

That's not your average scenario. for the average person. Again, going to your example of a relatively sedentary 40, 50 year old person who kind of wants to make a change, wants to get back into becoming more active, maybe not necessarily becoming an athlete, but just being more active, being more healthy, losing some weight, changing their body composition. I mean, it is critical to preserve what is left in the joint by moving.

Cartilage is known to be preserved and get nutrients because cartilage doesn't have blood vessels into it. It gets its nutritional supply almost primarily from diffusion from the joint itself. And that process is aided by motion. Motion is critical. Not impact necessarily. High impact activity is detrimental to your joint. But motion like swimming, riding a bike, those kind of things, rowing, those things are very beneficial and they're low to no impact. They're very good exercises.

They keep the muscles strong. The muscles protect and offload the joints. And the muscles are also a very dynamic organ just like the bone. I mean there's hormonal effects that the that the muscles contribute um again storage of uh different uh like proteins and your energy stores. It's very really important for the whole uh body metabolism.

So it protects the joints but it also keeps your whole body healthy and and that's a big factor right because if someone who hasn't exercised you know is coming to you as a cardiologist asking is it safe? you evaluate them from the cardiovascular standpoint. Um, and when they come to me, an orthopedic surgeon, like, is it safe? What exercises should I do? There's not really that interplay of like it's okay for them to lift weights.

It's okay for them to do these low impact or no impact exercises for their bone health and start doing weightlifting. What about from the cardiac side? And and that's something that I think is a genuinely a little bit of almost like lost in the clinical interaction with the patient because you really need both. I mean even when you weightlift, think about it like us. I mean your your heart rate is going very fast.

I mean you you sometimes redline when you're in a really really heavy workout, especially if you're doing compound lifts, things like that. So weightlifting I I just don't think should be thought of as a purely anorobic activity. It's not. It it it has a very strong aerobic component and in fact sometimes it can push your heart rate to levels that are much higher than just going for a 45minute jog. >> Yeah.

Whenever a person asks me and comes to my clinic and asks me if I can exercise, I'm always never hesitant to tell them, "Hey, no exercise." I'm never going to say, "No, don't." You know? >> Yeah. Exactly. Now, it's it's never thing, oh no, I don't want you exercise unless unless I've done a hard cath on them and they have very critical left main disease or proximal LA disease. It's like severe coronary disease and they're waiting for a bypass surgery or stent placement.

Only then I'm like, hey, just take it easy. Maybe just go for a walk. Maybe do some light biking, maybe some zone 2, zone 3 cardio. Uh just to kind of get those uh you know um in simple words, blood flowing. uh but nothing nothing strenuous at that point but otherwise I almost never say don't exercise. My answer is always like yes exercise because I know how important exercise is. Um it's just sad that a lot of people and majority of the people we know uh do not exercise as much as we want to.

Now, there's there's been a lot of uh you know, a talk I feel like there's there's a lot of talk about supplements and um you know, take this or take that. And I see a lot of people taking a lot of supplements but not exercising. And that frustrates me. They they they they show me their I'm taking this supplement, I'm taking this supplement, I'm taking, you know, zinc, I'm taking magnesium, I'm taking uh, you know, fish oil, I'm taking vitamin D, I'm taking creatine, but are you exercising?

And mostly the answer is no, I don't have time for that. You know what I understand and correct me if I'm wrong, but supplements maybe can help you a little bit and for for when they do help maybe get you from that 95% to 99%. That the gap from like being at 40% to get to that 80% that's that's mainly exercise in motion. You know what do you think about that? >> Yeah, I mean it it's like a very simple example.

So uh take an example of someone who starts taking anabolic steroids because they want to get jacked. They want to get really strong uh and very big muscles. Just taking steroids is going to do essentially almost nothing for your muscles. You need to lift weights with steroids. That's that's what it is. That's what the counseling is for people who are on steroids is that just doing the juice alone is not going to cut it.

The steroids simply allow your muscles to grow, heal, recover, and repair faster and permit you to exercise more often and with more intensity so that you grow and bulk faster, right? It also has secondary effects, cellular signaling effects, all that stuff. But that that's the primary thing. Um, you don't just sit there and grow. And so the same thing with these supplements. And these supplements are far less potent on purpose and for good reason than anabolic steroids.

That was just an extreme example. But like you can't just sit at home, put a little creatine powder in your water, chug it, take some vitamin D, take some magnesium, and say, "Okay, I'm good for today." Like I'm healthy now. Those things are good. I mean, those are supplements and stuff that I take, too, but they're not the end- all beall. I mean, this all of it is holistic.

You you need to really peak of health is to do everything well, which no one can do perfectly, but that's what you should strive for. exercise with an emphasis on strength training, diet, sleep, probably supplementation. I mean, all of it together. And then genetics. Genetics is what you can't control. That was the last part about joint health is there is a very strong genetic component to arthritis. And that's a component we cannot change. Um, at least not yet.

Um, but all the stuff that is modifiable, we should do everything we can to modify it. >> Yeah. So, one thing patients always ask me uh in my office, hey, what kind of exercise should I do? And uh no, I'm and most people are mostly comfortable doing cardio since the threshold to get into cardio is much lower, right? It's easy to go on a run, easy to get on a bike and do biking. So, what what role does cardio play versus strength training?

And which what is the balance of the amount of cardio and and strength training? >> You know, it's a good question. I I mean I personally will be very forthcoming that I I don't know an exact answer to that question. I mean I I don't know if anyone knows you know what I mean because it's very different depending on one's goals.

Uh for instance if someone's goal is to train like for a marathon obviously doing cardio for that person at that moment in time is more critical than doing repetitive strength training you know for those weeks leading up to the marathon. But for an average person in their average life, um the emphasis should be on strength training because it's again it's important for the bone health and density, your muscle mass density, basil metabolic rate, uh glucose control, all that stuff.

Uh which you mentioned, it is certainly easier to walk into a gym and get onto a treadmill, stationary bike or the stairmaster and just kind of start going. Um, it's harder to go to the free weight section. For one, figure out what weight to do, how many reps to do it. Is your form good or not? How long to take in between? Do you super set it? Do you not? Do you just do one exercise, weight, do the same exercise, weight, do the same exercise, weight, then go to a different one?

Are you doing compound movements or single arc motion? You know, like all of this stuff. There's a lot of questions to be asked and to answer when you do weightlifting. Personally, what I think is that the best exercises in terms of lifting efficiently and recruiting maximal muscle fiber contraction and the most muscle groups are to do compound movements.

So, rather than just doing a bicep curl, I think it's a lot better to do pull-ups because a pull-up will recruit your biceps, will also recruit your uh back muscles, your latisimus. Um, or for example, rather than doing shoulder press only, get in the gym, get a barbell, do a hang clean, do a squat, and then do a shoulder press. That's one repetition because you're forcing your body to recruit more muscles, which is better in terms of efficiency for exercise.

For one, you spend less total time in the gym. Time is a huge rate limiting step for people. You finished work, you get out of the gym.

I mean sorry you get out of work you sit in traffic for like 30 40 minutes you get to the gym you work out by the time you get home it's late in the evening so that in itself for family time if you have young kids is a factor so I think exercising efficiently is going to make one a lot more likely to continue doing it and so in addition to recruiting the muscle fibers and fatiguing faster you also getting in and out of the gym quicker.

Um, you know, the other thing too you were mentioning about this, uh, just to go back to it for a second about how you quickly become accustomed to exercises, um, and how like your trainer for you will switch them up every so often. I mean, that that's a well-known thing in the, uh, strength and conditioning community. It's just muscle confusion, um, is what it's termed. And by doing compound movements, you're not just doing one exercise and then go back up.

Like, for example, just doing squat and go back up. squat and go back up. Your body's used to it. It's like a springing motion to it. The fact that you're adding a lot of different exercises, movements, and lifts in the same repetition. Um, it just confuses your body. And then the the last thing too is the, you know, almost like neuromuscular control. It's just how people get more athletic with practice. Like you get better at shooting a free throw when you practice.

It's not that you are getting stronger or throwing it harder or anything like that. You're just getting more accustomed to this movement with a basketball. Weightlifting is really very similar. You are getting your body, your muscles, your skeleton, your joints, your propriceptive ability, your position of your body in space, all of it collectively, your nerve fibers controlling your muscles, your sense of self in space. Everything is getting better.

It's getting more honed in this specific motion. And the more you incorporate any balance component to an exercise, the more muscles are recruited, the more your nerve fibers are actually really recruited. And that's why I think these compound movements are critical because it involves a strong element of balance. And balance is huge. Balance prevents falls.

It keeps you athletic, keeps your muscles strong, keeps your joints supple, keeps your fast twitch fibers, you mentioned different muscle fibers earlier, keeps your fast twitch fibers stronger and firing. Um, and those have huge uh dividends for you as you go through life, right? fall risk is is a giant factor.

So that those are all long list of reasons but that's why I think compound movements are really important >> and for diabetes and uh hyper lipidmia and hypertension to muscle health is uh paramount. >> Oh yeah >> paramount. Now u you know the way I've been counseling my patients because a lot of them have a lot of things going on there's not enough time for almost everyone I know.

So you know most of the guidelines in cardiology recommend 150 minutes of exercise a week moderate to sever you know uh moderate intensity exercise a week.

So what I tell them and this might not be exact science or exact thing to recommend but it's the most practical I think where I tell them have two sessions of strength training 50 minutes each a week and the other session if you want you can do strength training again or do 25 minutes of cardio two days you know so two days of strength training for 50 minutes and two days of cardio 25 minutes each um if they can do that I think that's more than doing nothing uh you know and that's a good start sometimes and then move on to more complex, longer exercises, more focused on strength training.

But almost always my my recommendations are regarding strength training. I think it used to be cardio. I think the more I've educated myself, the more I've learned about this thing, the more I'm starting to realize that strength training is more important than cardio. >> Oh, totally, man. And I mean, you know, something is always better than nothing, right? Like as you counsel your patients, do two days a week of strength training. I mean, that's so much better than nothing. Like that's awesome.

If someone does more, that's even better. I mean, if you if you really like break it down and think about it, um, you know, you want to hit all of your major muscle groups. And I don't mean that in the sense of like, okay, I got to get my biceps, my deltoids, my traps. Like, that's not what I mean. What I mean is like your major functional muscle groups, like meaning activitybased weightlifting. Like pushing is an activity that is using a lot of different muscle groups.

pulling is using a lot of different muscle groups. Like you don't have to in isolation work out your biceps and then work out your rhomboids, you know, like I'm not trying to become a powerlifter or a bodybuilder to have those show muscles. This is functional strengthening which is for lifespan and health span, right? And so if you think about it, if you want to break down a week, right? Let's say you have three days where you can realistically get into the gym and work out.

If you think there's really 12 major muscle groups in your body. You have your forearms, your biceps and triceps. So that's three. Shoulders is four. Chest and upper back is five and six. Your abs and lower back which together make your core is seven and eight. Your quads, your hamstrings, and your glutes is 11. And then your last is your calves. Those are your 12 muscle groups, right? And so if you have three days a week that you can go to the gym, just split it up.

do four muscle groups in a day and mix them up. You don't have to do the same ones together. Some are synergistic, right? Like you're going to get with rowing or doing lateral pull downs or pull-ups. You're going to get your biceps, your forearms, and your upper back, right? That's three right there with a single exercise if you do pull-ups. And obviously do more than just one set of these, right? And you mix them up. You do rows and pull-ups or something like that.

Um, but if you think of it in this way, that way each week your whole body is getting strengthened and you don't really leave anything behind. The most common things that people ignore honestly are their legs and their core. It's very often that people will do especially in their torso, the the front part of the torso. People will do chest, they'll do shoulders, they'll do biceps feel like you're your jack when you do that. >> Yeah. >> Not even the most important.

I mean core I think unless you have a strong core, all the other exercises are much harder to do. >> Oh yeah. It's honestly core is the probably the most important. I mean again balance your core is your balance. It's your foundation of your body. >> Yeah. So let's let's kind of get into the a little bit more the unknown like you know dive into the unknown a little bit. And I always talk to my patients about you know because everyone has a drawer full of supplements.

Uh and it's very hard to kind of counel on what supplements are good, what supplements are bad. There's a whole movement around these peptides now that I kind of want to get into some other day. There's a whole movement around vitamin D, zinc, magnesium, especially after COVID, there was a lot of talk about, hey, why are you taking these medications? Just do natural treatment. And I agree, natural treatment is is the best.

I mean, exercise and good nutrition is the key, but what supplements truly have data behind them and what supplements are more anecdotal right now, you know, that's that's a big question. >> Yeah, it's true.

I mean and even the data right like if we're talking about scientific studies I mean there's so much conflicting data out there because so many studies are observational studies or you know metaanalyses of a series of retrospective plus observational studies I mean true prospect of randomized trials are very few in this space because it's so difficult to not only just randomize but also control all the variables like is everything else in two let's say we're looking at vitamin D in these two groups to people that let's say we properly and successfully can randomize and the patients don't know, the researchers don't know, it's all in a database.

This group got vitamin D supplementation, blank I international units per day. This group got a placebo and they lived their life for 10 years and they then looked at the effects on cardiovascular disease prevention, stroke, muscle mass, bone mineral density, all this stuff.

It's so difficult to control all other variables like how many patients in each group had a lot of sunlight exposure, who took a vacation three times a week, three times a year, sorry, um to the beach and had a lot of sunlight exposure and therefore had more vitamin, you know, like who ate a better diet consistently over time. It's impossible in these long-term prospective trials to track everything and account for all variables.

So, I think all of it realistically should be taken with a grain of salt. It doesn't mean don't trust the data. That's not at all what I'm saying. the data is all we have and you use that and you try to have some logical thought process behind the data you read and you apply it to your life. And so personally for me, I look at the data because I'm interested in this stuff about nutrition and supplementation.

Anything I can do other than just trying to be healthy diet-wise and exercise-wise, I take vitamin D every day. I take magnesium because there's some evidence. It's not groundbreaking, but there's some evidence that magnesium is synergistic in the absorption of vitamin D. Um, I take creatine, uh, just five grams a day, just a scoop of powder. Um, and then I take a multivitamin, just a routine men's multivitamin, and then, um, vitamin C, just for an antioxidant purpose.

Um, and so that's what I take. I don't take any extra protein. I don't do protein shakes. Um I eat a lot of protein. I eat a lot of eggs and um meat and stuff like that, but that that's pretty much what I do. And I've researched it a lot.

And I'm not claiming I'm like an expert or nutritionist in this stuff, but from the data we have, vitamin D is very beneficial because the vast majority of us are indoors and even when we're getting sunlight, like in a car and stuff, vitamin D is only made when you get direct UVB light onto your skin. Okay? Or when you eat it. And if you're in a car or an office, even if the sun is shining through the window, glass blocks UVB.

So you're getting actually zero vitamin D production from sunlight if it's through glass. It has to be direct sunlight exposure. And now you got to balance the risk of skin cancer, all that stuff. So realistically, exposing yourself to UVB radiation on a regular basis probably not the most sound or reliable way to get vitamin D production. So really, you're eating it. And are we eating enough food with it?

mainly animal food, animal fats, because even the amount that's supplemented in milk, I mean, I don't drink milk anymore. I drank it when I was a kid, but most adults don't drink milk anymore. Um, so are we eating enough of it, I don't know. I mean, very high amount of Americans are deficient in vitamin D. And it's not just a vitamin by the name. There's a lot more data showing that it has hormonal effects. It affects so many things.

I mean depression, your overall mood instability, cardiac function, dementia risk, muscle function, cramping, bone health. So th that's why I take vitamin D. Um and then like I said, the magnesium is just basically as a synergistic agent for it. Um but that that's me personally. >> Yeah, you know, vitamin D, um a lot of people, you know, it show up with low vitamin D levels and there's even different thresholds of what units to take.

So on someone with a very low vitamin D levels, you you know there's prescribed medications, you know, of the 50,000 units once weekly. You do that for eight weeks and then you move on to the more the lower thousand I use or the 5,000 I use, you know. So is there a dose that you uh recommend for uh daily or weekly supplementation versus like a you know the prescribed dose, talk to your doctor based on your vitamin D. What is your recommendation on that? Yeah.

I mean, so for myself who like I have my labs checked and stuff, I I'm not deficient in it, but I still take 2,000 IU a day. Um because to get hyper vitaminos D, I mean, you have to take remarkably high levels. I'm not really worried about overdosing on it. It's extremely difficult to do.

Um but so what I recommend mainly when I recommend it homeayo it's in the context of someone comes to my clinic um a patient who has a fracture someone who broke their bone and I'm treating them whether I'm treating them in a cast or a sling if it's not a fracture that requires surgery or if it's a surgical fracture you fix them u but all patients that come to me with a fracture I explain to them the importance of calcium and vitamin D and the effect on bone and basically having a fracture shows that you have a failure of your skeleton.

You had a trauma and injury that was enough to break your bone. And most of these patients are old. Like if you fell out of your chair right now or I fell out of my chair right now, I would be embarrassed and I would get up and I would make a joke on the podcast.

But a lot of these patients that are in their early even early mid late 60s, I mean even some people in their 50s, especially postmenopausal women uh who have not done regular strength training, they'll fall out of a chair or just from standing height. They'll fall and they'll break their hip. They'll break their lumbar spine, they'll break their distal radius, they'll break their humorris. I see that all the time in my clinic. I mean, those are defined fragility fractures.

Like that patient has osteoporosis. They just don't know it yet. Um, and for those patients, calcium vitamin D supplementation can be a huge factor in preserving bone mineral density or in fact slowing the rate of loss of bone mineral density. is when you're deficient in vitamin D.

Um I mean, you know, the the cascade of signaling and stuff in your body is maybe beyond the scope of our talk, but it increases a hormone which dissolves your bone to increase the amount of calcium present in your blood system, parathyroid hormone. It resorbs your bone and so your bones become more brittle at a faster rate because you need blank amount of calcium floating around in your blood because calcium is a critical signaling molecule all over the place.

And so taking calcium and vitamin D, especially for those patients that already have shown skeletal failure, I mean it's huge. It could potentially save them from having another fracture because I mean this stuff isn't just, oh, you broke your bone, that sucks. Get it fixed. Okay, you're fine. I mean, in the United States, these are real numbers. About almost 25% of all patients that break their hip die within a year. 25%, one in four. It's not that the broken hip kills you.

you're it's just a sign that your overall body your whole health as a human has deteriorated to the point that a simple ground level fall will break one of the hardest bones in your body your femur.

So that's what I harp on in clinic and that's what I try to emphasize is for those patients specifically the importance of calcium and vitamin D and I have all of them see an endocrinologist and get a DEXA scan a bone mineral density scan to see if calcium and vitamin D alone may not cut it for them if they are severely osteoprotic and there's real like it's qu it's quantified I mean if you are severely osteoporotic you should be on something stronger like bisphosphinates to really stop your bone density loss and to build backbone >> yeah I mean you know uh just a fall in the fracture can lead to a lot of dability for a lot of patients you know minimize their motion their movement uh makes them very sedentary and worsens their diabetes worsens their hypertension and eventually the >> you know heart disease kills them.

So yeah you know bone health in many ways is uh very connected to heart disease. Now you know um there's a there's a weird um uh conflict between mainstream medicine and vitamins and supplements. You know, a lot of mainstream doctors like us, like, you know, we see patients in the clinic every day, treat patients with with, uh, a lot of medications, uh, we don't believe until something has a big randomized control trial at multiple centers with strong data, right?

And a lot of the vitamin supplements are naturally occurring, there's no IP behind them. There's no, you know, there's there's not much money to be made. So, there a lot of a lot of research is not done. We don't do large multi-center uh placeboc controlled uh you know randomized trials to study these supplements because they're naturally occurring. No one is going to make money on them.

No one's will have a patent on vitamin D or you know vitamin C or you know zinc these are these >> they may try someone will try >> yeah someone will try but then then it's hard to know how these are affecting right and then there's a lot of a lot of companies that are making vitamins in the name of vitamins but they're really not as high there's not much high quantity of the the actual vitamin that you're supposed to be taking and there's really no way of knowing what is in your pill what is in your in that supplement that you're taking.

>> Oh, totally. I mean, even just to to remark on that for a sec. I mean, even like like vitamin D, I mean, there's different isoforms, right? Like there the different like hydroxilation groups. I mean, there's D2, there's D3, you know, then it becomes activated in the body, which you can't take the activated form because it's half life is like minutes, you know what I mean? So, like which vitamin D are you even taking and are they equivalent?

You know, all these studies that are out there, what did they supplement the patients with? Is it apples to oranges comparison? >> You know what I mean?

So like that that stuff is very real with a lot of these vitamins and minerals because a lot of them are co-actors and co-enzymes for other reactions in the body to take place and you may take something and it may get metabolized in the body almost instantly become something else and now is it the question of do we try to get to that exact molecule directly that's kind of the this more so push with protein just taking protein powder and all that stuff your simple protein whether whey soy whatever versus do I try to go direct to peptides and amino acids kind of skip that process of requiring protein to be metabolized into those agents.

But then what happens if you just take amino acids directly? Are those even metab like absorbed? Do they actually require proper metabolism to get to the right spot within our gut for it to be metabolized? You know what I mean? Like these are different things. And it's like with vitamin D, patients that have had gastric bypass, they're going to be deficient because the area that absorbs that specific type of vitamin D has been bypassed when you have that surgery.

>> And and there's and it's very hard to know uh which vitamins are I mean, if you start vitamin supplementation, you can have a drawer of 25 different vitamins that you're taking. >> Yeah.

and and you can try to supplement every single uh substrate that's needed in our body to produce something else and can add on peptides and can add on B12 injections and you can add on you know all these supplements but where is the limit and how much are they helping us how much are they hurting us are they hurting us are they helping us I mean there's no way of knowing without uh large scale studies but it's hard to have large scale studies unless there's money to be made and That's that's the that's the >> the problem with our healthcare system in a way that it's hard for doctors to even recommend certain vitamins cuz uh most >> data on this is through retrospective trials through trials where you look at previous data and and just assume that maybe there is some correlation between these two supplementations rather than actual prospective trials that are randomized.

and we're comparing, you know, the supplementation with not supplementating and seeing if if that makes a difference. Uh so when when um you go on and go talk to your doctor about supplementation, um the your doctor has very has very limited data to work with on what to recommend. Now that we know things like vitamin D, there's a lot of good data behind that.

uh you know uh as you said magnesium supplementation uh you know vitamin C in terms of your immune system uh now talk about creatine a little bit I get a lot of questions about creatine what to take how to take it uh why how does it help uh what's what's the deal with creatine >> yeah I mean you know creatine it uh it's a energy system you know like we all learn about the KB cycle and oxidative phosphorilation ATP all that stuff I mean creatine is also an energy store and an energy source for our body and for muscles more rapid acting energy source um without going more biochem on us because that's the probably limit of my knowledge about that but uh but it's a it's a rapid energy source so energy for one fuel uh meaning it allows you to exercise and to maintain um muscle contraction and all of that it also has some data um for dementia that p patients that take creatine even older patients not just for young people trying to get buff in the gym um that that's kind of like the the old school thought and the cliche regarding creatine, but that that's really not the main purpose of it.

Um it has a lot of effects on mentation too and dementia prevention. And in fact, there was there was actually a recent study, and again, it's just one data point, right? No one study is groundbreaking or should be what you base your life on or supplementation on. But there was a recent study that did show that uh older patients that took creatine and it was more pronounced in women than men. Exerts a protective effect uh against dementia.

So it's not just for muscle bulk and muscle energy source. It has other effects too. Um there's some uh there's some data about sleep that and again I'm I'm not positive about the mechanism for this. I'm not going to pretend or postulate, but there's some data about it improving your sleep. Um, and it may just be because it's an energy source. Your body is energized. It has the fuel it needs. You can have more rest. Um, but I but I don't know. That's just my guess.

Um, but basically, there was enough data when I was looking it up and thinking about it and talking to people about it that there really doesn't seem to be much harm. And if you're otherwise healthy, have healthy kidneys.

This is a question that um has come up before and I've talked to people about it is what about my creatinine you know on your blood tests you know which is which is a marker of kidney function like now that I'm taking creatine is my kidney going to look like it's maybe in a state of Aki is my creatinine going to be high or is my doctor going to be worried I really don't know I mean at the levels that most people take which is recommended between 3 to 5 grams in a day um that's not a tremendous amount of creatine and it doesn't really lead to a huge bump at all in your creatinine levels.

But if conversely, if you have kidney disease, right, you have known kidney disease, that I'm not sure, that is probably something you should look into a little more because now your kidneys are not functioning and you're adding more creatine to your system. That may not be a good idea. >> Yeah.

I mean you know it's a creatinin is a is a product of muscle breakdown that kidneys supposed to clear out but when kidneys are not working that rises in our blood and it it indicates towards kidney disease. Now doctors are checking a lot of different types of markers for kidney disease like the protein and urine and urine albumin creatin ratio uh things like that to also further assess kidney function. creatin is just one of the markers.

But yeah, I don't know if someone who has renal disease should take creatine or not. Uh you know, those are some things that we don't really study and we don't really do trials on you know uh because again there's not much money to be made and unfortunately everything in in in you know accepted or not uh a lot of things are driven by money. A lot of research is driven by money. Oh man, like almost almost all of it is unfortunately or fortunately.

I mean, however you want to look at it, it's just the truth. >> Yeah. Yeah. So, a lot of research and a lot of trials and a lot of the research industry is driven by money cuz if if money is to be made, companies will put in money into it, which scares me. a lot of uh you know a lot of the uh um government grants going away.

A lot of research that's not forprofit or not not um um kind of encouraged from profits but rather more uh novel research might go away as well as we don't fund those kind of trials anymore or lose subsidies for those trials now. >> Yeah. you know, like like antibiotics are actually like a huge thing that it's a big worry in the infectious disease community. Um because antibiotics in general are not as consistent like very very few patients are on chronic antibiotics.

That would be in a very rare setting where you need lifetime suppression for some infection that can't be cleared or something like that. But for the average patient, you maybe take antibiotics a couple times a year when you have a sinus infection or something like that. So the consistency compared to a medication for diabetes or heart disease, for chronic disease, you basically have from the company's standpoint, you have a customer for life. This patient needs a statin for their cholesterol.

They need to remain on this cardiac medication, their beta blocker. But for antibiotics, there's so many multi-drugresistant bacteria and so many antibiotics that are no longer effective and we have to use stronger and stronger antibiotics because there isn't consistent research to develop new ones. >> Um, that research is really lacking and the number of disease resistant species of bacteria um are growing like crazy that it's a problem that we see all the time.

I mean, with joint infections, oh my gosh, there are some very aggressive bugs that it's very difficult in some cases to even find an antibiotic that they're resistant to. I mean, that that's digressing from our our talk, but it just highlights again that same point you made about the funding. I mean, you follow the money trail and that that's where a lot of the a lot of the studies go. >> Yeah. Well, you know, maybe we'll be funding more vaccine trials in the future. >> That's not happening.

depends who's at the health and human services. We'll see. >> Uh but let's see. You know, this is another topic for another day. But uh you know, good good stuff, man. This is a lot a lot a lot of things we can talk about there. A lot of stuff we can keep going. I learned a lot today. Uh I think I might I might implement some supplementation in my in my daily life. Maybe we'll get a sponsor from a supplement company. >> Oh, there we go. >> Yeah.

Take some supplements, take the good ones, and then go to the gym, lift weights, and do compound movements. I think strength training strength training is paramount. >> Yeah, we don't like sarcopenia. Say no to sarcopenia. >> All right, man. Well, see you later. >> All right, guys. Take care.