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When Melissa left a little over a month ago, I took some time to assess the space and determine what I should do with it. I treat so many disc herniations that a spinal decompression table is tempting–the modern units are amazing (they can sense muscle guarding and back off until it passes, for instance).

I may still move in that direction at some point, but for now, I feel like massage is such a perfect therapy to use in conjunction with what I do. The hardest part for me was knowing I had to find a therapist to work alongside, and after five years with Melissa, I’ve grown accustomed to a certain rhythm.

Fortunately, I have a resource for massage therapists, located just around the corner. I asked around for who might be the one to come over from Hand and Stone and do the more ‘medical massage’ that happens over here.

Enter, Liz

Liz has over 20 years of experience with massage. In the last year, she moved to our spa from one across town, and a huge group of her clients have followed her from her old location to here, driving 30 minutes away from her old spa to reconnect with her.

Liz has a keen sense of how different anatomical regions interact with one another. She’s also excited to work with me to better work with you. One of the benefits of getting a massage here is that if I’ve seen you first, I can report to Liz what’s going on and identify some areas that she should pay special attention to.

Most importantly, Liz will listen to your concerns and not just go through the motions. Have a shoulder complaint you want to focus on? Let her know, and it’s off to the races.

Liz will be here a few days a week, with her first availability being Thursday this week. Rates are $120 an hour. Give us a call at 832-203-5884 to schedule, or you can now text us at 346-739-7839

If your doctor told you to take it, I’m not telling you to stop. But I would encourage you to read the rest of this email and maybe have a conversation about the current research.

I’ll make this short and sweet–calcium supplements don’t appear to work all that well for keeping your bones strong, although dietary calcium from actual food does offer a modest benefit. And there’s some evidence that calcium supplements do some harm by causing calcification of arteries, which you don’t really want.

But back to bone health. What can you take or do to increase the strength of your bones and prevent fractures?

As usual, exercise is at the top of the list. There’s a law in physiology called Wolff’s Law that states that bone adapts to the loads placed upon it. Load your bones with more force, and they’ll get stronger.

The research shows that two types of exercise work the best, especially in combination: weightlifting and running (or jumping). Weight lifting stresses the bones from within, and the pounding of the pavement from running and jumping stresses the bones from the outside.

Supplementing for bone health is still a thing, but it’s not just about calcium, as we’ve all been led to believe. Our old friends, magnesium, vitamin K-2, and vitamin D, are the combination shown to work best for optimal calcium absorption.

But the exercise part is the most important. I’ve been touting the benefits of K-2, D3, and Magnesium for years (all of those are on my list of basics here at the office), but the exercise component is the most important. If we could put the effects of exercise in a pill, it would be the most potent supplement on earth.

Last Christmas, my wife bought me what has become my secret weapon for boosting my protein intake in the most delicious way possible: the Ninja Creami Deluxe.

I had never heard of such a thing, but let me tell you, it’s been fantastic. For the uninitiated, the Creami is an ice cream machine that makes high-protein, very low-calorie ice cream. I’ve been experimenting with different recipes and the macros and calories for my nightly snack break down to:

• Calories: 255
• Protein: 44.5g
• Carbs: 14g
• Fat: 1g

And it’s super delicious. My wife and I split that, and she rarely finishes hers (so I help). Knowing I have that coming after dinner helps me put the brakes on the serving size of whatever dinner is so I’ll have room for ice cream.

My general recipe, by the way, is:

1 teaspoon vanilla

Two tablespoons of monk fruit sugar 

1 serving of whey protein (mine is unflavored, but plenty of people use flavored powders as a part of the flavor of the finished product)

pinch of salt

two tablespoons of sugar-free pudding mix (this gives flavor and body)

And the remainder is Fair Life skim milk, which is high in protein and lower calorie.

Freeze for 24 hours, and then the Ninja “creamifies” it into a delicious ice cream that compares to soft-serve in texture and flavor.

In my books, I make a firm case for increasing protein while in a calorie deficit is one of the best cheat codes for losing body fat more efficiently. Protein increases satiety and gives you the building blocks necessary to maintain lean mass (muscle) while in the deficit, especially if you’re doing some resistance exercise.

Plenty of Instagram accounts and YouTube channels are dedicated to exploring recipes for this thing, so you’ll never be at a loss for ideas.

I still have my daily “Poor Man’s Ozempic,” but now I have it right before I eat lunch. The fiber, collagen, and creatine all have health benefits that extend far beyond helping with weight loss, but it does keep me from hogging out at lunch too much, although that’s never been much of a problem for me. The after-dinner session of standing in front of the fridge, eyeing the cheese and crackers, has been my downfall over the years.

Ours came from Costco, but you can get them on Amazon or pretty much anywhere that sells Ninja stuff.

When I added creatine to my “Poor Man’s Ozempic” last year, I had no idea how powerful that addition would be. I only added it because research shows potential cognitive benefits, and I always look for ways to keep my edge in that department.

I experimented with creatine in the 90s when I began my weightlifting journey. But then, in my 20s, I wasn’t exactly fastidious about tracking progress or even warming up very well. I was mostly freestyling it in the gym. I still made progress because youth goes a long way in helping overcome stupidity, but, man, could old me tell young me a few things.

Things like: write down your lifts. Make goals and try to improve. Warm up your shoulders before lifting heavy. And invest in Google when it becomes a thing.

Now, though, I do all that stuff and can quickly tell when things change for the better or the worse. And my lifts, especially upper body lifts, have taken off like I’ve never seen before.

I also don’t get nearly as sore as I used to after lifting heavy. I’m not sure about the cognitive benefits, although it looks like the most significant benefit is if one is sleep-deprived, which I never am. I sleep like a tired puppy.

But another benefit is that I’ve been in a calorie deficit since January, and I’m holding on to the lean mass while the fat is dropping away. The goal of dieting should never be sheer weight loss. It should be fat loss.

One of the problems people are experiencing on actual Ozempic is that they are losing a lot of both very quickly, and although losing a lot of weight can be healthy if you have a lot to lose, losing a bunch of muscle in the process is no bueno.

So, whether you’re trying my Poor Man’s version or the real thing, creatine would be helpful (especially if you’re doing some resistance exercise a couple of days a week).

A quick list of the benefits of creatine for those who prefer the bullet point format:

Improves strength gains

Possible improvement in cognitive function, especially when sleep-deprived

Improves anaerobic output

Improves muscle retention when dieting

Faster recovery from exercise

Reduction of sarcopenia in older individuals, especially when combined with weight lifting.

AND, the latest study that hit my inbox just this morning:

Improvements in symptoms of depression. Here’s the study.

My grandmother just turned 99 in December. Until her 93rd birthday, she still drove to the grocery store. But at 98, she started having falls, and once she went down, she couldn’t get herself back up (when I saw her last Thanksgiving, she told me, “I wasn’t uncomfortable; I was on the carpet.”)

She’s held on to her strength pretty well, but had she been doing some form of resistance exercise (and taking creatine), she may still be in her house instead of the assisted living center we moved her to last year.

The way to take it is simple: Add one scoop, which is five grams, to water or juice. (I add it to the psyllium husk/collagen combo I slam down every night after dinner.) Time of day doesn’t matter; get your levels up and reap the benefits.

The type of creatine you should take is monohydrate. It’s the most effective, cheapest, and easiest to find. I use Thorne, which we have here at the office and available at my Fullscript store, which you can find here. 

You have to make an account, but once you do and get into the site, there’s a tab called “community plans.” You will see the Poor Man’s Ozempic plan there, and you can add the creatine to your cart from there.

There’s one more way I’ve been making this diet phase easier than ever, but this has gone longer than intended already. More soon!

I have many conversations about diet and exercise here at the office, often after the person to whom I’m talking has been told they have “insulin resistance” and should start some new medication.

But when I ask if anyone explained what insulin resistance is, the answer is almost always no. And knowing, as they say, is half the battle. So, allow me to explain.

Insulin is a storage hormone. It’s made in the pancreas, the organ that senses increases in blood sugar, which triggers insulin to be released to tell that blood sugar (glucose) to be stored (the storage form of glucose is called glycogen).

There are two places where glucose is stored: the liver and your muscles.

To explain insulin resistance, I compare those two storage areas to hotel parking lots. Cars enter the freeway (glucose enters the bloodstream), and the traffic cop (the pancreas) wants them off the street and parked.

But you’ll run out of parking space if there are too many cars. The traffic cops still won’t like all the traffic, so they’ll keep directing cars into the lot. The hotels won’t like all the extra traffic, so at first, they’ll turn on the “no vacancy” sign. On a cellular level, the “no vacancy” sign is the first bump in insulin resistance, and that bump will cause an increase in fat storage and a bump upward in cholesterol.

Keep adding traffic, though, and the hotel manager gets more irritated. He is so annoyed that he builds a gate that goes down in front of the entrance to keep cars from entering at all. On the cellular level, this is called the “downregulation of insulin receptors.” In other words, muscle cells reduce the number of insulin receptors available since the cells are full of glycogen, and there’s nowhere to put more.

Once the arms go down—the downregulation of insulin receptors—you’ve reached full-on insulin resistance. This eventually wears out the beta cells in the pancreas, leading to diabetes.

So–Insulin resistance. Not good. But what do you do about it?

I’m glad you asked.

There are a few strategies to regain your sensitivity. To return to the parking lot analogy, you can add more parking spaces and/or (preferably both) decrease the traffic trying to park.

If you decrease calories, you decrease traffic to the hotel parking lot. The calories that make the most sense to decrease are processed carbohydrates–things high in calories but low in nutritional value. I make the case in my books that someone with a lot of fat to lose can cut carbs quite a bit.

In my recent article about zone two training, I mentioned that those with the most mitochondrial dysfunction will have the most difficulty accessing their fat stores for fuel. I had a patient just yesterday who I hadn’t seen in a while and had lost around 50 lbs since I’d last seen him. When I asked him about his strategy for losing weight, he replied, “Walking.”

Walking, especially for someone who hasn’t been exercising, is enough to nudge the body into a much more positive metabolic state. The patient in question told me he gets up early, walks for a while, and then does more at work and lunch, about eight miles a day.

And walking eight miles a day burns about as many calories as running the same distance–it just takes longer.

So, to clear the parking lot, eat less cars, and walk some of them off. Those are the “decrease the traffic” strategies.

My next strategy is to add parking spaces. You can’t add more liver, but you can add more muscle. The best way to add muscle is to lift weights and get stronger. You don’t have to spend hours in the gym to do that. I only lift three days a week, and each session lasts about 30 minutes.

I admit that I push myself hard for those 30-minute sessions, but nothing worth having comes easily, and keeping my strength and resilience as I age is worth an hour and a half a week under a barbell.

The final piece of good news on this subject is that as you empty those parking spots while simultaneously building more, your insulin sensitivity will improve, which means you can eat more carbs to fuel your workouts. I love carbs, so I keep the workouts going.

October is a special month for me because it signals another year in practice. This year it marked my 14th year at this. If you’re thinking that doesn’t seem long enough, given the amount of gray in my hair, it’s because I started doing this as a second career after teaching English first.

When I opened my practice, I was already 40. And now, I’ve been at it long enough to see kids who were coming in with their parents become patients themselves.

I’ve also seen my more adult patients, who were my age now when I met them, age into the Medicare bracket. And I can tell you the ones who are doing the best when it comes to physical health all have one thing in common:

Health and fitness is a part of their identity.

Because of my weight loss books, nearly everyone who’s lost a lot of weight and kept it off talks to me about it. Without fail, they keep it off by finding some form of exercise they like and then doing it regularly. Often, the exercise in question was something they could only tolerate, but with reps, they made it a part of their core identity.

Weight lifting, running, cycling. It’s all fair game. One guy who just came in again after several years away has taken to ultra marathons (100-mile races).

But here’s the cool part: The benefit of going from sedentary to moderately active is huge compared to going from moderately active to very active. You don’t have to devote endless hours to fitness to get the most results. But if you don’t do anything, it’s not good. Check out the graph below:

You definitely want to be on the solid line camp.

But what does it take to get there? As always, it depends on many factors, including genetics, previous levels of activity (muscle memory is a real thing I plan on writing about in the future, but a history of working out is a win), and how active you are at work.

If, for example, you take a complete couch potato who works from a computer all day and get them walking for just ten minutes three days a week, their level of fitness will grow to a degree that will keep them above the dotted line in the graph for years longer than if no changes were made.

The results are even better if you add strength training to the equation. Just a couple of sessions a week of focused weight lifting can add much life to the years of the average Medicare-aged human. You don’t have to subscribe to Olympic levels of training to get results. But you do have to start.

I recently went to the funeral of an old friend from high school. It was the first time I’d been around many of my old high school friends in years, and I wanted to shake them by their lapels and beg them to do the basics.

Not smoking and not drinking too much is not enough. You have to challenge the system. But if you do, you’ll find that the second half of your life can be as rewarding as the first.

Until next time,

Doc G

P.S. I added creatine to my “poor man’s Ozempic” because some solid research shows an increase in cognitive function, and I’m always looking to keep my edge in that regard. But this weekend, at 54 years old, I set a new personal best on the bench press, so clearly, the tried-and-true strength gains creatine is known for are coming.

That’s right–today (Saturday, Sept 28th) makes 1,000 days since my last drink. For over two and a half years, I’ve dodged the booze bullet but have still gone to concerts, sung karaoke, and even released a solo album of original songs on which I played all the instruments and recorded the whole thing at home on my lunch breaks.

Now, I’m not saying I was an alcoholic and just had to stop before bad things happened. However, during the COVID phase of 2020 and 2021, I started drinking more out of habit than any other reason, and that’s not a habit I felt good about.

I’m also not saying that list in the first paragraph wouldn’t have happened had I been drinking–but I think I can say that I’ve been more productive in this last 1,000 days than I would have been otherwise.

I once took a year off from drinking (in 2017), and it was an excellent year for my business and health. So, I was hopeful that this break would yield similar results. This time, I planned on taking a year off and then reassessing.

And man, that year went by fast. My sleep improved significantly, I was lifting heavy in the gym, and I lost weight in the process. The more I thought about it, the more I realized that I just wasn’t ready to start back up. So, I decided on another year.

I’ve been enjoying being more present in my daily interactions with my patients and friends here at the office. My guitar playing has improved dramatically, and there’s always something to think about or handle with the spa business (in case you don’t know, my wife and I own Hand and Stone Oak Forest right around the corner).

So, here we are—1,000 days dry. Although there is still an occasion here and there where a drink sounds good—mostly at nice restaurants and such—but when the moment passes, and I’m driving home, I’m always glad I skipped the sauce. And I’m even more happy about that decision the next day when I get up ready to rock. At this point I have so much inertia not drinking that it would take more effort to start again than it does to stay on the train I’m on.

I can’t say I’ll never have another drink, but for now, I will keep on this path. I wrote more about this subject at the end of my first year, and you can read about that here.

Thanks for reading, and have a great weekend.

Doc G

P.S. I had multiple people ask what the actual recipe is for the Poor Man’s Ozempic I wrote about recently (it was a very popular article), so I updated the post to add the exact measurements of everything. I also put the three ingredients together in one place to make it easier to see/find.

I typically gain a few pounds during the winter and then spend spring trimming back down for my July birthday, where I do nothing because it’s too hot outside. But in my mind, I will have a pool party every year, so I start trimming down for the imaginary birthday bash that never materializes.

This year, I got a late start on the trimming down part of the tale. There were a few reasons, like crazy storms and the fact that my bench press is better when I have a few extra pounds on me. I’m trying to stay ahead of my son, who is now taller and heavier than me.

But I finally decided to tighten back up. This time, I’ve incorporated a secret weapon: my “poor man’s Ozempic,” known as my nightly Sludge.

The Sludge has three ingredients: psyllium husk fiber, collagen, and creatine. I call it “poor man’s Ozempic” because of the mechanism of action for Ozempic: increased satiety (feeling full) decreases appetite.

Ozempic delays gastric emptying, which in turn helps one stay full for longer. It has other mechanisms of action, too, but hunger is the enemy of weight loss, and reducing hunger is the primary way it works.

And nighttime after-dinner snacking is my enemy. Enter–The Sludge.

There are several reasons for the mix of the three ingredients. Let’s break them down individually.

Psyllium husk is the most essential of the three because it’s essentially liquid fiber. Fiber is good for the gut microbiome, increases satiety, and even helps reduce cholesterol. Once in your system, psyllium becomes a gel-like substance that increases the bulk in your GI system. That extra bulk increases the feeling of fullness, which keeps me out of the pantry after dinner. For more about psyllium, read this helpful article.

I should also mention that psyllium is the active ingredient in Metemucil, so it can also help with constipation.

Next, in order of importance, is collagen. Collagen is protein, and protein is also highly satiating. In my books on weight loss, I encourage eating more protein and fiber to win the war against hunger; this concoction is an easy way to do that.

Collagen can also increase skin elasticity and help lubricate joints as you age. I’ve been taking it for many years, but I’ve been more consistent since I hit my 50s. The list of things collagen supplementation can help with is pretty awesome. There are even studies showing supplementing can help with bone density.

To complete the trifecta, I add creatine to The Sludge. Creatine is well-known for its muscle-building effects. It helps your mitochondria regenerate ATP more quickly, enabling you to knock out those last few demanding reps when you’re working hard. Adding reps over time helps build strength and muscle density.

However, more and more studies show that creatine also has cognitive benefits. I’m always looking for ways to keep my edge and age gracefully, so a supplement that helps my muscles and brain is on the list of molecules I’m willing to pay for. And, bonus, creatine is pretty cheap. For a quick video review on creatine, watch this short video.

Put it all together, and this nightly concoction helps keep me from late-night snacking, lowers my cholesterol and blood sugar, fuels tissue repair, and increases muscle growth and cognition. The dosage is one tablespoon each of the collagen and fiber and a scoop (5 grams) of the creatine.

If you’re interested in trying this for yourself, I added the three base ingredients to my Fullscript store–all the basics are under “Doc G’s Monthly Supplement List.”

Win some, lose some…

In my last post, I talked about my fitness triumphs—things I’m glad I’ve done over the last 10-15 years to age as gracefully as possible. Today, I’m not going to be so nice to myself. We can all improve, and maybe reading my regrets will spark action for you so you don’t have similar regrets yourself.

My number one regret is avoiding cardio like the plague for way too many years than I’d like to admit. When I was younger, I played tennis and surfed whenever there were waves. But since I’ve been married (22 years now!), I don’t get to the beach nearly as often as I used to except when I was in chiro school and lived two blocks from the ocean. That was pretty sweet.

I regret this mistake because I wasted time that I could have used to improve my heart health. I was erroneously conflating body composition with health. I was decently lean and muscular, so I figured I was good.

But my family history says otherwise. My dad had to have an emergency heart surgery that almost killed him a few weeks after competing in a bodybuilding competition. He’s a walking medical miracle today, just because he lived after spending a solid month in the ICU in what was essentially a coma.

And he was leaner than I’ve ever been leading up to that show.

But did I get busy with heart-friendly exercise after all of that? No. No, I did not. I blamed Dad’s issues on him getting pretty heavy in his 50s and figured that’s when he did the damage. I wasn’t going to do that, so I thought I was good.

But then, in my late 40s, I sent myself for a coronary calcium scan, which is a CT scan of the heart that will show calcifications in the arteries that bring blood to the heart itself. And, low and behold, I had some calcification, which is consistent with arterial plaque buildup.

After an initial freakout, I assessed my options. And, my friends, it became apparent. Imagine a medication that would improve every health metric you can think of–sleep, resting heart rate, blood pressure, cholesterol, cognition, and more (including slowing the progression of arterial calcification).

You’d want to take that medication, right? Well, now imagine that you have to put in a couple of hours of exercise a week to qualify to receive it. Most of us would still want it. And the rub, of course, is that the exercise is the medication.

But if I had only started taking my medicine years ago, when I was in my 20s instead of my 50s, I would be so much better off today. Still, there are plenty of benefits to get, even starting now. Everything from that list of benefits above is my current experience. But, still. Dangit.

So, if you’re younger, let my hindsight be your foresight. Start doing some form of cardio. The single best metric for predicting longevity is your VO2 max, and the only way to get that number up is by consistently working your heart at the top of its range. This video gives more detail about improving your max (including defining it).

If you want to learn how to measure your VO2 max, this video shows a couple of dudes doing just that at a lab and then comparing the numbers their Apple and Garmin watches got. And this video shows some other ways to measure if you don’t have one of those fancy watches.

If you’re older, the best time to start is 30 years ago, but the next best time is today. Even upping your step count by walking a few miles daily can help. And if you really want to make some changes, I suggest finding a group exercise class to join.

The research shows that adherence to a program is the most critical piece of the puzzle when making the changes I’ve been writing about. People are typically more likely to keep showing up when there’s the added benefit of seeing a friend or two when you get to the class—and then suffering together.

I have more regrets than this, but the lack of cardio is far and away my biggest one, so I’ll stop here for now.

My annual thoughts on aging well

Birthdays always make me look back on the last year and ahead to what’s to come. I’m writing a two-part series on the things I’ve done, both right and wrong, regarding healthy living. 

Since today (Saturday) is my birthday, I’ll be generous with myself and talk about the good stuff. It’s a short but profound list.

First, I’ve lifted weights steadily since I was in my mid-20s. I started for vanity, but now I’m doing it for the increased health span. One of the most significant detriments to our health as we age is sarcopenia, the age-related decline in muscle mass. However, research shows that lifting weights can keep your muscles and strength well into your elder years.

I recently set a personal best on bench press, and I’m definitely not getting any younger, so I feel good about that.

Next–I stopped drinking two and a half years ago. I know that’s a massive deal for many people, and I’m not here to try and convict you about your choice in the matter, but I wrote about it at the one-year mark here, so check it out if you want to hear that story.

Two years ago, I started seriously doing cardio. I’ve written about that here and here. Adding cardio to weight training has made me feel younger than ever.

Regarding supplements, I’ve maintained healthy vitamin D levels all these years. I’ve also been taking a magnesium supplement for about 15 years now. Magnesium prevents DNA replication errors when cells divide, a significant part of cellular aging. For a deep dive into magnesium supplementation, watch this video (it’s long but worth it if you like to geek out on this stuff like I do).

Also, since about 2016, I’ve been taking a collagen supplement, and I’ve been consistent with it for the last few years. In the last two years, I’ve been adding psyllium husk to the collagen (I call it my “nightly sludge”), which keeps me from overeating, lowers cholesterol, and regulates the ol’ GI tract. And lately, I’ve been adding creatine to the sludge for a triple threat of benefits. 

Creatine deserves its own post, which I’ll do shortly. Here’s a short video to whet your appetite. The benefits extend far beyond the strength training stuff most people think of when they think about creatine.

One final thing on the “things I’ve done right” list is getting my sleep schedule down better than ever. I’ll admit I spent too many nights staying up too late in 2019 when my wife and I were singing karaoke twice a week at the dive bar down the street, but right around that time, I read Matthew Walker’s book on sleep and decided to make some changes. I’m glad I did. Watch this video to get a taste of what he says about the subject.

My next post will be on my list of fitness regrets. Check back soon.