ZACH: Welcome to the On Health podcast by Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I've worked in multimedia and television for over 15 years — and I'm also a longtime podcaster.  

KATIE: I'm Katie McCallum. I'm a former researcher turned health writer, mostly writing for our blog.

ZACH: And Katie, we have Scott Jones with us today — one of our fellow team members.

KATIE: We do. We're going to do something new today. I think the audience is really going to enjoy this. Scott has done a first-person health journey, essentially. Scott, welcome.

SCOTT: Thanks. Happy to be here.

ZACH: And Scott, what do you do here at Houston Methodist, to give the listeners some context?

SCOTT: So, I'm a creative services manager. I manage our video and photography team. I'm also the resident old guy, so that's how this came about. We talked about this topic of healthy aging, which is something I'm keenly interested in now that I'm getting up in the in my seventh decade. But we did a first-person account of my primary care visit in January and then a follow up visit in March. I did some research in between, learned a lot. And, actually, I think this project, this podcast sort of forced me to really dig in and understand what the doctors were saying. And so it's fascinating.

KATIE: Tell us who you talk to.

SCOTT: I talk to my primary care physician, Dr. Josh Septimus, who is terrific. And I talked to Emma Willingham, one of our nutritionists.

ZACH: Awesome. So, what inspired you to document your health journey this way, Scott?

SCOTT: When you get to be my age, you start really wanting to understand, okay, what can I do to be as healthy as possible and to make the most out of the years that I have coming up that I have left? You know, most of the time when we go to the doctor and they're flooding us with information, you know, we take in a certain percentage of it. We don't really fully understand maybe everything is being told to us. For instance, insulin. I had sort of a vague idea of how insulin works and it was really having the recording of the exam and being able to go and parse that and really do research and understand, okay, here's what insulin does and here's how it works. It was really helpful because once I understood the process of things that lead to chronic inflammation, which you'll hear is the big boogeyman for aging, it really motivated me to do more. So that's what inspired me to really understand, you know, what habits I can develop, what things I should be avoiding so that I can make the most out of the upcoming years.

KATIE: Yeah, that makes a lot of sense actually. Because you're reminding me, I did a I did a blog post recently on salt and how salt essentially affects your blood pressure. We hear that all the time. Everyone knows high salt food can cause higher blood pressure. It wasn't until I talked to one of our metabolic specialists and she literally explained the whole process of how salt first affects your arteries and then it affects your kidneys. And then your kidneys are having trouble so that pushes back on the arteries. And when you hear the whole process, you're like, Oh, wow, yeah. It's very clear how something that I hear all the time and kind of brush off now becomes this this sort of complex, sort of — I don't want to say scary — but you can see how putting an actual mechanism behind it kind of forces you to reconcile with the damage it can cause.

SCOTT: It really does. You know, when you're looking at that piece of pie or cake and thinking about eating it and going, oh, no, I shouldn't eat that because sugar is bad for me. It goes much further than that because then you understand, okay, if I eat that, I'm going to flood my bloodstream with glucose and it's going to lead to all these cascading effects. And you can think through what those things are and it's much easier to say no.

KATIE: Yeah, I totally agree.

ZACH: Yeah. And this topic applies to people of any age because we're all aging, right? So, we all want to age healthily.

SCOTT: It absolutely does. And I think that, you know, the healthier you go into your older years — your golden years, so to speak — the better.

ZACH: Let's get into it then: Healthy aging.

[Sound effect to signal beginning of interview]

SCOTT: [narrating] For those of us lucky enough to enjoy good health when we're young, old age and the infirmities that come with it are always off in the distance — until they're not. I recently turned 61, and as I approached my seventh decade, I became increasingly interested in what it takes to increase not just lifespan, but health span. What can we do to make the golden years more golden? Both of the experts I talked with identified a condition that's problematic no matter how old we are and that becomes even more dangerous as we age: chronic inflammation. When we get injured, inflammation is what helps us heal. But chronic inflammation can lead to serious health problems, including heart disease, stroke, depression, Alzheimer's disease, cancer and even osteoarthritis like I have in my hands. We'll start with Emma Willingham, a clinical dietitian at Houston Methodist, specializing in weight management and exercise nutrition.

SCOTT: Hi, Emma.

EMMA: Hello.

SCOTT: How does our body composition change as we age?

EMMA: Yes. So, as we age, we start to see some shifts. A lot of people have told me, oh, I notice I have more of like an inner tube around my midsection — that tends to be related to the way that our muscle mass and fat mass is changing. And, so, as we age, we tend to see a decline overall in muscle mass, and that's called sarcopenia. We also tend to see that there is an increase in fat mass as we age as well. And health care professionals care not so much about the fat mass increasing in general, but it's more the way that it's distributed. So, it does tend to distribute more in the centralized region of your body, which has been shown to be tied to certain metabolic or cardiometabolic diseases. Some other shifts that we see are we see a decrease in bone density, a decrease in total body water. So, our fluid status changes a little bit. Our thirst response is muted because of that. Sometimes it's hard for older adults to get the amount of fluid that they need because they don't necessarily feel thirsty as easily. So that's something to kind of watch out for and just know and make sure that you're getting enough fluid throughout the day. And then also the mass of all of our tissues and organs, that tends to decline a little bit as well. And all of these changes are kind of related to more of a persistent, low grade level of inflammation — and also a decline in a lot of hormones and molecules that help us build up our tissues. So, because of that persistent and low-grade systemic inflammation, a lot of health care professionals call it “inflammaging” because it's associated with the aging process.

SCOTT: [narrating] When I visited Houston Methodist primary care physician Dr. Josh Septimus in January, he echoed Emma Willingham's assertion that inflammation is a major concern as we age. He verified that the chronic pain I'd been feeling in my hands for the last year or so was in fact osteoarthritis — one of the most common early indicators of aging. I was also a bit overweight, which I knew, of course. And he found some mild neuropathy or numbness in my feet, which I had not been aware of. But there were other problems. My cholesterol and sugar levels were on the high side, putting me too close to diabetes for Dr. Septimus’ comfort. Here's Dr. Septimus.

DR. SEPTIMUS: But you also had one other very important thing on your cholesterol profile, which was an elevated “L-P-little-A” [or Lp(a), also known as lipoprotein (a)]. So, L-P-little-A is an emerging risk factor. It's kind of making it to prime time now. It's something that acts as kind of a super booster for bad cholesterol. And I don't like using bad cholesterol and good cholesterol because it oversimplifies things. But, in this case, L-P-little-A is just the stickiest of sticky cholesterol particles and it is lumped in with LDL cholesterol on a routine cholesterol panel. But, when we measure it individually, if you have more than 75 nanomoles per liter, you have an increased association with stroke, very, very significant association with heart attack and with aortic stenosis. We don't exactly know why with the aortic stenosis association. Your L-P-little-A was 164 nanomoles per liter, so more than double the high end of normal. So, very significant. And that's why, even though you had a coronary calcium score two years ago that was zero, we're very aggressively addressing this — because coronary calcium score just tells us if there's hard calcified plaque. Your elevated inflammatory markers, your elevated apolipoprotein B, your or elevated L-P-little-A tell me you have soft plaque that's inflamed. So, we need to do everything we can to stabilize it to keep you from ever developing a heart attack or a stroke. We don't have a particular treatment available for L-P-little-A. So, what we do in patients who have an elevated L-P-little-A is we treat their LDL and their APO B. So, hence the aggressive LDL lowering therapy or apolipoprotein B lowering therapy. And then we never measure an L-P-little-A again because it's a genetically determined number. It's just another marker of risk for you.

SCOTT: [narrating] Collectively, the problems Dr. Septimus identified in me are known as metabolic syndrome. Statistics vary depending on the source, but it's estimated that one in three adults, more than 85 million people in the U.S., have metabolic syndrome. The percentage is even higher for people my age and older, more than 50%.

DR. SEPTIMUS: Metabolic syndrome is a constellation of five things, and you have to have three of the five to be diagnosed with metabolic syndrome. It's elevated triglycerides, low HDL, central obesity, elevated blood pressure — not necessarily hypertension, but elevated — and impaired glucose tolerance. And when you have three of those five it is predictive of diabetes and inflammation and heart disease.

SCOTT: [narrating] All of this was a little confusing and overwhelming. So, I decided to take a deeper dive into what it all meant. Since metabolic syndrome affects so many people and can lead to so many serious problems, I wanted to know what we can do to avoid some of the worse pitfalls of getting older. And, not surprisingly as we'll see, the problems Dr. Septimus identified were all related.

DR. SEPTIMUS: At your wellness exam, we did baseline labs that showed a number of things actually. So, first and foremost, from last year you had a mildly increased hemoglobin A1C, which is a three-month sugar average. When you have an elevation in your hemoglobin A1C, it means that you have already had insulin resistance for a decade on average. And then once your sugar does show evidence of increase, it becomes an alarm bell type symptom. And that's why people who have what's called metabolic syndrome are at such high risk for developing diabetes, and it's really all associated with that insulin resistance.

SCOTT: [narrating] While scientists have identified several genes that make us more or less likely to develop insulin resistance, the main factors contributing to it are things we can control: a poor diet, physical inactivity, excess body fat — especially around the belly — and stress, among others. No matter what the cause, left unchecked insulin resistance will lead to a lot of serious problems. But what exactly is it? To understand insulin resistance, we need to first understand how insulin works in a healthy person. First, the food you eat is broken down into glucose or blood sugar. When blood sugar enters your bloodstream, it signals your pancreas to release insulin. Insulin then helps blood sugar enter your body's muscle cells — so it can be used for energy — and it signals the liver to store blood sugar for later use. As blood sugar enters cells and levels in the bloodstream decrease, this signals your pancreas to decrease insulin levels. And, as your insulin levels drop, the liver begins releasing stored blood sugar so energy is always available — even if you haven't eaten for a while. This finely tuned system can get out of whack when too much blood sugar enters the bloodstream. To try and keep up, the pancreas pumps out more insulin to get all that blood sugar into your muscle and liver cells. But, over time, the cells become overwhelmed and stop responding to the excess insulin. They become insulin resistant. That causes an increase in insulin and glucose in your bloodstream, both of which are damaging to the body. Chronically elevated insulin levels tell the liver and muscle cells to store blood sugar. But when they're full, the liver sends the excess blood sugar to fat cells to be stored as body fat. Thus, the dreaded spare tire. And chronically elevated glucose levels, known as glucose intolerance, can damage your pancreas and lead to diabetes and hardening of the arteries, among other things. Chronically elevated glucose and insulin levels — and insulin resistance — are a primary cause of chronic inflammation, and that can lead to a whole host of problems, many of them serious.

DR. SEPTIMUS: When your insulin levels go up, it's like the tip of the iceberg. Underneath the big part of the iceberg is that insulin resistance and those high insulin levels are driving up inflammatory levels, which again, you saw in your advanced cholesterol panel. They're driving up the risk of adenocarcinomas. So, things like prostate cancer, breast cancer, colon cancer have all been associated with insulin resistance in central obesity. And then — this is not something that has been proven definitively — but there's a suggestion, and it makes sense physiologically, that increased insulin resistance increases your risk for dementia as well because of inflammation in the brain. So, it's very important to try and address insulin resistance before your sugars go up with things like healthy lifestyle.

SCOTT: [narrating] The more I learned about metabolic syndrome, insulin resistance and chronic inflammation and the serious diseases they can lead to, the more motivated I became to do something about it.

SCOTT: So, Emma, what are some foods, drinks and habits that we should avoid as we age?

EMMA: I like to think about eating patterns. And if we think about the traditional Western diet, it's characterized by high sodium content, high carbohydrate, high sugar. And so those are a lot of the things that can make that inflammation worse. So, we want to avoid excessive sugar, excessive sodium. Some other things that can exacerbate the aging process, food wise, could be things like alcohol — especially if it's excessive alcohol intake. Red meats or processed meats, those are a little bit higher in saturated fat, which can negatively impact our heart health. Drinks with added sugars, so like sodas or juices, sports drinks if we don't need those.

SCOTT: [narrating] Knowing I needed to lose weight, I began researching diets. I became interested in intermittent fasting as a way to lose weight and potentially extend lifespan.

DR. SEPTIMUS: What I would say about it is there's certainly no harm to it. There is probably some benefit to increasing your metabolic flexibility. You know, teaching your body to run off of ketones is a valuable thing for your body to know how to do. And it's clear that cells have an easier time repairing themselves, all the way down to the DNA, when they're running on ketones, as opposed to running off of sugar. Those are the only two sources of energy that our cells have, they run off glucose or they run off of ketones. I think the value of intermittent fasting is probably being overstated right now because it's kind of the thing of the moment, but I do think that it's useful as an adjunct to healthy diet and exercise. I also think it's really important not to take it to the extreme, and it's really important to make sure that when you do eat that you're eating healthy foods. It's all about metabolic flexibility, which is what I like.

SCOTT: [narrating] Intermittent fasting made sense to me as a way to reduce calories and develop metabolic flexibility by telling me when to eat. But what about what to eat?

EMMA: The Mediterranean diet that's characterized by a lot of know anti-inflammatory foods, really good quality protein sources, that's a really good eating pattern to kind of emulate on a day to day basis for older adults. We've seen in research that they're not able to hold on to and build muscle as easily as younger adults and therefore it takes a little bit more protein. We want to make sure that we are maintaining — and even building if we can — muscle mass. And there are some really great ways to do that lifestyle-wise. One is making sure that you are getting enough protein on a daily basis. So, metabolically, the best way to do that is by spreading out your protein intake throughout the day. We want to make sure that you're getting a good portion of protein at every single meal and even snacks as well. If you can, it's important to try to aim for 20 to 35 grams of protein per meal or per snack, evenly spread out throughout the day. So, 20 to 35 grams like four times a day. It's important to make sure that you're getting good variety. All of your protein sources should be lean. So things like fish or seafood, eggs, dairy, plant-based proteins like beans, lentils, quinoa, those are all going to be great sources to help you get the nutrients you need to kind of hold on to that muscle. Resistance exercise also helps to build and maintain muscle similarly to protein. So, they work independently, but together they can make a really big difference if you are implementing those things on a daily basis. Another thing that can really help maintain and hold on to that muscle is making sure that you're getting omega threes. Omega threes are a type of fatty acid that have been strongly associated with having anti-inflammatory properties, so they can kind of mitigate that inflammation, aging effect. And they also help to transport nutrients into the muscle that help you hold on to your muscle mass. So, we want to cook with olive oil, canola oil, try to eat oily fish like salmon whenever you can. Get some nuts and seeds for snacks or, you know, add to your salads or things like that.

DR. SEPTIMUS: Muscle building, to me, is one of the most important things that you can do to improve your cardiometabolic health. Continue to exercise five times a week. We want you to be strength training twice a week. And we want you to do interval training at least once a week, because interval training is associated with a reduction in insulin resistance and strength training is associated with a reduction in insulin resistance.

SCOTT: [narrating] I had gone into my January wellness exam with Dr. Septimus thinking I was in pretty good shape for my age. But the experts I visited made it clear I needed to make some changes if I wanted to increase my lifespan and my health span. Dr. Septimus recommended I lose weight, ramp up the exercise and do what I could to manage stress. He also prescribed two medications: metformin to help control my blood sugar and rosuvastatin to reduce my cholesterol.

DR. SEPTIMUS: The initiation of metformin reduces insulin resistance along with healthy lifestyle changes. The other thing that we found on your cholesterol panel beyond just elevated cholesterol, I alluded to the increase in inflammatory panels. So that's associated with increased risk for cardiovascular disease because heart attacks and strokes are actually acute inflammatory events. So, when you have increased inflammation, your risk of an acute event is higher and statin drugs help stabilize that inflammation.

SCOTT: [narrating] So, I started taking the medications and began resistance training and walking regularly. I also started intermittent fasting on an 8/16 schedule, meaning I eat every day within an eight-hour window and then fast for the remaining 16 hours. I made sure that what I did eat was healthy, with plenty of protein. A few months later, I saw Dr. Septimus for a follow-up exam.

DR. SEPTIMUS: So, we're following up on your sugars and on your cholesterol today. So dramatically positive results. Just to put this in perspective, you've lost eight pounds. You've gone down by 3/10 of a percent on your hemoglobin A1C, from 6.1 to 5.8%. And your apolipoprotein B, which is the most important measure — it's an advanced metric a lot of physicians don't use it, but I do — has dropped down from where it was at 112 milligrams per deciliter down to 60. So, you've had a 50% reduction practically in the most predictive measure on your cholesterol panel with the rosuvastatin. To also put that in perspective, an apolipoprotein B of 112 milligrams per deciliter would put you in certainly the worst quartile and an apolipoprotein B of 60 puts you in the top 10th% of the United States. So very, very, very good in terms of reducing your risk of a heart attack or stroke. We still have work to do when it comes to the insulin resistance, but that doesn't surprise me. I mean, it takes time and a lot of effort to get insulin resistance down. We're headed in the right direction.

SCOTT: (narrating) By the time I recorded this a few months after my follow-up exam with Dr. Septimus, I'd lost another 14 pound, that's a total of 22 pounds — or just under 10% of my body weight in the first six months of the year.

DR. SEPTIMUS: You never want to lose more than about 10% before you hold because your body needs time to adjust to that new normal. My experience has been when people lose a lot of weight, their body goes into crisis mode, thinks that you're in a state of famine and holds on to fat. So, we need to give your body time to adjust to its new dry weight, so to speak, and then you can lose another 5 to 10%. We'll recheck your labs at your physical next year. I don't see any reason to do it between now and then unless you feel like it's motivating. So, some people I see every three months who are on this journey because they need that little extra push, that little extra accountability. But I think the most important thing was, you know, dropping you off the cliff. You know, we're no longer standing on the edge with being too close to diabetes for comfort. Your cholesterol numbers are now really, really outstanding. So, I see no burning need to do anything until your wellness exam next year.

SCOTT: (narrating) If there's one thing I'd like listeners to take away from this episode, it's that we can all have a positive impact on our health by making healthy choices, and it's never too late to start. There's no guarantee that by practicing healthy self-care will extend our lives or prevent a life-threatening illness. But it will certainly improve our chances. And if you choose to eat and drink well, exercise, get plenty of sleep and minimize stress, you'll most certainly feel better. Today, I feel lighter, stronger and mentally sharper than I did just a few months ago. And if I can make these changes, you can too.

[Sound effect signaling end of narration and interview]

KATIE: Scott, I'm so glad you did this. One big takeaway that I had listening to your conversations was it's not just one thing that you do to stay healthy. You do have to do all of these things. You have to be eating right. You need to be exercising — and not just hopping on the elliptical a couple of times a week, you need to also be doing strength training. It's something that I've had to come to terms with entering my thirties even, and so it was a nice validation of how I need to keep those things up. I'm not doing them for no reason. They really do matter. Because I think sometimes that can all feel very far away and there's no immediate, tangible effects. And, so, it's nice to kind of hear it all come back around. And, yes, the you know, on Tuesdays and Thursdays when I try to do bodyweight exercises like it's worth it, I'm setting myself up for something better. So, I really appreciated hearing kind of these in-depth conversations you had with people and reminding me that it's important for me to do all this now. It also reminds me too, of some — sometimes when I speak with some of our experts, I frequently get this message of “Just do something.” Walk for 10 minutes or walk for 20 if that's all you have time for and all you can fit in today. It’s better than not walking at all. And I think that's something I've had to kind of step into later in my life as well.

SCOTT: Yeah. The good thing is that if you if you do all of these things, you start to feel better and sort of that feeds more into it. It motivates you to do it more. So, you get to the point where it's really not hard.

KATIE: And yeah, it's an interesting concept though, because if you don't feel bad, you know, if you're someone who already feels fine, you know, keeping yourself doing it I think can be challenging at times. But hearing kind of all these experts say, no, you need to be doing it is for me was a nice kind of another reminder that it's such an important thing to do.

ZACH: Yeah. And they hit on all these different areas as well. Like they all really complement each other.

SCOTT: They do. And the thing we have to be careful of and the thing that I realized is that it's very gradual, like, you know, you just you start with some of these bad habits, oh, I'm going to have a burger every now and then. Then you're eating burgers, you know, three or four times a week. And before you know it, you've developed a series of bad habits that lead gradually into just poor health.

KATIE: Yeah. And, Scott, you know another thing I think our listeners might be interested in is how this whole experience, me listening to your journey, I think you going through this experience, encouraged us both to sign up for the exact same wellness class here at Houston Methodist that we're offered called Blue Zones. And, just for our listeners who don't know, Blue Zones is this theory or concept supported by data that there are these regions of people around the world who have really good long term health outcomes. And so people have looked into these groups of people and said, why is that? You know, what are these cultures or segments of people doing to stay healthy for so much longer? For instance, risk of heart disease is much lower in some of these populations and things like that. And Scott, I don't know what have you taken away from blue zones, because I know I've really been enjoying it.

SCOTT: Well, when they compared the lifestyles and habits of all these people in these different blue zones, they found a lot of commonality. And a lot of those things align with the things we've talked about on this podcast.

KATIE: Absolutely. It's been really interesting, and I think everybody can take away a lot from it.

ZACH: All right. Well, thanks for listening, everyone. I hope you guys enjoyed our topic today. That's going to do it for us this time. But if you enjoy these kinds of conversations and topics and are looking for more discussions, be sure to share, like and subscribe wherever you get your podcasts. And for more like this, visit our blog at www.houstonmethodist.org/blog. Stay tuned and stay healthy. 

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