Episódios
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Quote: “The greatest wealth is health”
- Virgil, Roman poet < 2000 years ago
Higher VO2 Max = Much Lower Risk of Dying…….Get off your ass! Let's illustrate this point:
ICU Patient
68 year old man with diabetes type 2 presenting with weakness and shortness of breath found to have sepsis due to pneumonia. This man is critically ill with sepsis.
His vitals:
Heart Rate 150 (100% of estimated max heart rate: 220 – Age)
Respiratory Rate 54 breaths per minutes
Sweating and looks exhausted.
This man is literally fighting for his life. Can you see why fitness matters so much? How long can he hold on? Many of us will have to fight for our lives in this way at some point. FITNESS REALLY REALLY MATTERS
The Gold Standard for measuring cardiorespiratory fitness = VO2 Max
What is VO2 Max
VO2 Max = the maximum volume of oxygen that can be utilized per kilogram of body weight during maximal exertion
Most often Expressed as:
ml/kg/min (milliliters per kilogram of body weight per minute) [1ml = 1cm3]
This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research.
Humans range from of VO2 max of 5 (bedbound) to 90s (elite endurance athletes)
Hummingbirds VO2 max = 600 ml/kg/min
Exercise training will improve VO2 Max
So, I hope since listening to part 1 you have gotten “off your ass”
Check out Longetrics.org or Fullscope.org for the complete post! -
Title: VO2 Max, Part 1
This is just the 101 course:
Quote: “If you don’t make time for exercise, you will probably have to make time for illness”
- Robin Sharma, Attorney, Writer, Consultant
What is VO2 Max
Perhaps the most important metric for longevity and health in 2024
V=Volume (actually volume per unit time in this case)
O2= oxygen
VO2 = volume of oxygen that can be utilized per unit time
VO2 Max = the maximum volume of oxygen that can be utilized during maximal exertion
Most often Expressed as:
ml/kg/min (milliliters per kilogram of body weight per minute)
This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research. The best way to measure VO2 max is with a cardiopulmonary exercise test (CPET test). This is performed by hooking a person up to a closed breathing circuit via a facemask and measuring both inhaled and exhaled O2 and CO2. Other methods for estimating VO2 Max also exist. We will discuss measuring VO2 Max more thoroughly in part 2.
VO2 Max Record Holders
Check out Longetrics.org or FullScope.org Blogs for the complete post -
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Title: Health Report Cards
Quote:
“what gets measured gets managed”
- unknown source
When you measure something you become aware of it and can objectively manage it.
Potential Pitfalls: The right things must be measured. Measurement must be accurate.
What is a Report Card:
- an evaluation of performance
Benefits of Report Cards:
- attempts to measure strength and weaknesses
- allows for awareness of weaknesses (so they can be targeted and improved)
- provides objective measures of performance normalized to the rest of the group (lets one know exactly how they measure up)
- allows outsiders to evaluate and make decisions
Negatives of Report Cards
- can hurt feelings (who fucking cares, life is tough, competitive, and requires constant improvement)
- can leed to discrimination (of course….people, companies, and things with bad reports should be discriminated against). Discrimination = pressure to improve
- the wrong things are often measured or given too much importance. If not, you will manage things that don’t matter. Importance of asking the right questions.
- the things measured may be wrong or inaccurate. This is a big deal! Measuring things inaccurately is probably worse than not measuring things at all
- subject to the bias of those creating report cards. We all remember that teacher that just didn’t seem to like us…..
See the full post on the Longetrics.org blog -
Title: Longevity Conferences (ARDD and Dublin Longevity)
Quote: “Its not what you know but who you know”
Said by many across multiple cultures
Today we review:
The Aging Research and Drug Discovery Conference in Copenhagen, Denmark
The Dublin Longevity Summit in Dublin, Ireland
3 Plugs
- keep moving until you find your place and your people
- go to places where you can be useful and contribute
- try not to lose what makes you, you along the way.
Hallmarks of Both Conferences
- I highly recommend attending both of these events (and conferences in general)
- Europe was a blast. People are out and about. The downtowns I went to were generally flourishing
- Work Hard Play Hard – Lots of lectures, lots of late nights at the bar
- All Day Every Day
- Leaders in the field of Longevity Research (highly research focussed)
- Research Focused, Less Clinical (but still some clinical content)
- Startups and Funding/Funders was a big focus
- Eccentric Personalities
- Lots of Fun! Met a lot of great people
See full blog post at fullscope.org and longetrics.org -
Quote: “The best physician is also a philosopher” – Galen (Claudius Galenus)
Reflection is key! What can I do better and why am I doing it in the first place? Harness failures as the great teachers that they are and constantly improve.
Why this person is important:
Roman and Greek Physician, Surgeon, and Philosopher (129-216 AD, 87 years). Used anatomy based care (from observing the corpses of dead gladiators) and this allowed him to outperform his piers.
Bags the Question: What are we not using right now in medical practice that will be obvious to future doctors that we should be using?
- I think about bedside ultrasound in this light
-I also think about capturing more exam data through photos, sound clips, and videos and then harnessing new technology and big data insights to learn things not previously known
- photos, sound clips, and videos have so much more data than a written physical exam in a note.
Philosophy Take: Asking the right questions is the key
In a changing world, answers, like epidemiology, are always changing. So in some ways all we will ever have are questions.
The Longevity Physician
We are going to talk about medical providers and physicians in this discussion. But the ideas may be useful for multiple other disciplines within healthcare. Everything from coaches, to personal trainers, physical therapists, pharmacists, etc. There is plenty of room for everyone in longevity and it will take a village to solve aging.
See Fullscope.org for the complete post -
Quote: “Death gives meaning to our lives. It gives importance and value to time. Time would become meaningless if there were too much of it”
- Ray Kurzweil
Too much time…..
Why this person is important:
Computer scientist, inventor, and futurist (one of the greatest of the modern era)
What is Longevity
- Dictionary – long existence or service
- Medicine and Science – long duration of individual life
What is Geroscience:
- Gero (Greek - old)
- A field of biomedical research that focusses on understanding the biology of aging and how aging contributes to disease
- Geroscience, geroscientist, geroprotective, gerontocracy, gerontophobia
Why Longevity
- Longer Life? People want to live longer and better? More time young. Not more time old.
- live forever? Scares many. Plasticity of youth would be so important in this case
- look good and do the things we love for longer? Yes!
I believe: Longevity and understanding/controlling aging are key to human advancement and long-term success.
See FullScope.org blog for complete post -
Death is coming for you, me, and all of this.
If you seek Longevity, stop avoiding this, assess your risks, and make a plan.
Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blog
How to assess death- What are my current medical problems, risks, and exposures. Advanced diagnostics and biomarkers can help with this. But just asking some simple questions like:
a. What medical problems do I have?
b. How is my current level of fitness and where will it likely be in the final 1 to 2 decades of my life on my current trajectory.
c. What do my behaviors put me at risk of dying from (e.g. smoking tobacco or junk food addiction = multiple forms of cancer.
d. What environmental risks am I exposed to (e.g. polluted air = COPD and lung cancer)- How have genetically related family members have died. These people share your genetics and often times your environment. They are a window into your own mortality.
a. What things have killed my 1st and 2nd degree relatives?
b. At what age did these problems begin and at what age did they result in death.
c. Do I have a genetic predisposition to certain medical problems?- What things am I most worried about regarding death. People have strong intuitions that when trained can be incredibly accurate. Intuition is simply your brain analyzing a huge amount of data and coming to a conclusion that seems as if it came from a higher knowledge or being. The brain is a powerful supercomputer. If program members are worried about something, I am worried too, full stop. Granted, if someone is worried about everything due to severe anxiety they are essentially worried about nothing. If you goal is everything, it will in fact become nothing by default.
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Live Better, Longer
A Longevity Physicians Secrets to Health and Fulfillment
Available for free at: wondermedicine.com
See full written episode description on our blog available at:
https://www.wondermedicine.com/wonder-medicine-blog
4 Amazing Ways Ketamine Will Change Your Brain
Ketamine is an amazing medication. It is an anesthetic, painkiller, mental health treatment, and entheogen all wrapped into one. We have successfully treated hundreds of patients with depression, anxiety, PTSD, OCD, suicidal ideation, and addiction using ketamine at Wonder Medicine. Greater than 90% of the people we treat get better. But, having the right plan for therapy will greatly increase your odds of success.What is an Entheogen?
An entheogen is a mind-altering substance that helps people develop spiritually. Ketamine causes a profoundly mind-altering experience that expands consciousness, understanding, and connectivity when used with intention in the right therapeutic setting.
Why do some Patients Not Respond to Ketamine?
Some people do not respond to ketamine treatments. Most often there is an identifiable reason. Some of these reasons include:
- Abusing substances actively while undergoing therapy (e.g. going home and drinking a bottle or two of wine after therapy)
- Not enough treatments received (major illness requires more therapy, sometimes > 6 treatments for response)
- Trauma or Mindset roadblocks that prevent patients from continuing therapy.
- Some people just don’t respond. This may be due to their underlying biology (estimated < 2%)
Why do > 90% of Ketamine Patients Experience Benefit
Ketamine does 4 amazing things that help people get their lives back on track.
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Executive Summary
The Longevity and Performance Program at Wonder Medicine is a physician directed-proactive healthcare program for high performing individuals. Its principle aims are health optimization, disease prediction and prevention, exceptional performance, emotional wellness, and longevity.The program is anchored by a full day executive physical that we refer to as a program members “Biological Birthday”. On this day, program members subjective and objective biomarkers most strongly linked to health, performance, and longevity are collected and fed into a robust data structure. A report is then generated that predicts biological (functional) age and predicted death age. The report utilizes proprietary algorithms and technology to inform both patients and their care team regarding overall health status and disease risks. The Biological birthday is performed every year and information is tracked in real time so that any health issues can be identified at the earliest stage possible.
A multidisciplinary team including a physician, longevity coach, exercise physiologist, technician, registered nurse, and member concierge execute the program. This small team is in constant communication and reviews all patients as a group multiple times a year. Patients in the program will have encounters with each team member at least 3 to 5 times a year. These team members will know you and care deeply about your success.
Every year, program members have a 90-minute Longevity Visit with the physician. At this visit all data obtained is reviewed and a personalized longevity and performance plan is provided to be executed over the following calendar year.
Wonder Medicine is a research-based institution that runs clinical trials on all patients at all times with the goal of discovering those inputs that deliver exceptional longevity and performance. All program members have the opportunity to enroll in additional longevity focused clinical trials that include pharmaceuticals, nutraceuticals, regenerative therapeutics, and lifestyle protocols. Additionally, many chronic medications can be managed through the program. But optimizing mindset, behaviors, and environment to align with program member current and future goals is Wonder Medicine’s principle aim.
Being enrolled in the program affords members several additional benefits and add on services. These include movement therapy, behavioral change therapy, additional testing, and discounts on all Wonder Medicine services including IV infusions, ketamine therapy, and aesthetic services.
If exceptional health, longevity, disease prevention, emotional wellness, and high performance are desired, this is the program for you. If data, research, and the advancement of knowledge in longevity are important to you, this is your Center. The Program is capped at 360 members every year so that outstanding attention, communication, and collaboration can be provided to all members. Wonder Medicine is healthcare that performs at the same level you do. Join today and become exceptional!
Thanks,
Bill Brandenburg, MD
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Holiday Season
October 31 – January 2nd
Halloween to New Years
- Tough time of year
- Loved ones, memories of past loved ones, relationships gone bad, events, obligations, good memories, bad memories, and even trauma.
- Can be the best time of the year or a time of pain.
- Take care of yourself, set an example for loved ones, and double down on pro-longevity behaviors during this holiday season.
Remember
Longevity = Health over a lifetime
By striving for longevity you must become the best, most-high performing version of yourself right now.
Ok so 4 tips. Plus two very important bonus tips at the very end that you will not want to miss!
See Wonder Medicine Blog for complete post at: https://www.wondermedicine.com/wonder-medicine-blog -
Benjamin Franklin: “Search others for their virtues, thy self for thy vices”
- Poor Richards Almanac
The best way to maximize longevity in 2023 is not a drug, supplement, or other high tech therapeutic; its Lifestyle medicine.
Wonder Medicine specializes in the translation of longevity technologies into clinical practice. This includes things like rapamycin, exosomes, and metformin. But we would be misguiding you if we did not focus, first and foremost, on lifestyle.
What is Lifestyle Medicine?
Per the American College of Preventative Medicine: Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to prevent, treat and manage chronic disease.
I would take this a step further even. For me, Lifestyle includes:
1. Thoughts
2. Behaviors
3. Environment
4. The People Around Us
With environment being particularly relevant and underappreciated in most medical settings. These 4 things drive both health and un-health. By optimizing these four things, a person can greatly extend both lifespan and health span.
Focusing on behaviors alone, will not be enough. This may be why conventional medicine downplays lifestyle changes. If you only address behaviors, changes don’t happen, and as such, the strategy fails.
But this is a shame because lifestyle changes are the only definitively proven way to extend the length of human life in 2023. From epidemiological studies, it appears that people who live a healthy lifestyle can add approximately twelve years to their life (range: 5-15 years).
Death at 88 instead of 76 years, most often accompanied by contraction of morbidity.
For the full post check out the Wonder Medicine Blog Available at: https://www.wondermedicine.com/wonder-medicine-blog -
Dia de Los Muertos and Longevity
The day of the Dead. What can the dead and this Mexican cultural holiday teach us about longevity?
Is there more to the story than candy, spooky witches, monsters, tricks, and treats. Let's find out
What is day of the Dead?
- A holiday most often celebrated on Nov 1st or 2nd.
- Its strongest traditions and ties are to the Mexican culture.
- On Dia de los Muertos, people remember and honor their past loved ones.
- Representations of human skulls, marigold flowers, home alters with pictures of passed loved ones, pan de Muertos (the sharing of alimentacion or “nourishment”), are the hallmarks of this day.
- The roots are debated, but this tradition may date back to Aztecs society.
- Dia de los Muertos brings families and communities together, celebrates life, and death.
- I encourage you to Celebrate this magical holiday, Dia de los Muertos, along with all the fun and spookiness of Halloween, and depending on your beliefs, along with Christian traditions of All hallows eve (all Saints Day and All souls day – that actually has a similar message that just isn’t really practiced in my experience)
See complete blog post at: https://www.wondermedicine.com/wonder-medicine-blog -
The 6 BIG Benefits of Longevity
Be a victim or conquer longevity. You must choose!
Longevity
- Longevity Definition: Long existence or service
- Human longevity relates to both existence (remaining alive) and service (remaining useful).
- I strive for nothing less than long existence and long service for both my patients and myself
My favorite part of Avatar II, Way of the Water:
- “Teach them our ways so they don’t have to deal with the shame of being useless”
- It blows my mind how many people are ok with being useless to society in 2023
My hospitalized elderly patient: “Keep me alive doc”
Me: “what makes you want to keep living”
Patient: “I have grandkids”
- But these people cannot watch their grandkids because their health is too poor. In fact, they need assistance even to perform activities of daily living (ADL)
- Like avatars of the sea, I would find this inability to contribute meaningfully: shameful.
- Being useful is about more than just pride. It is about service to the community.
- Service is what life is all about. If you are unhappy with your life, I suspect this is huge part of the problem.
Longevity is the Key
- By striving for longevity you are forced to become the best version of yourself right now.
- The best version of you, right now, will be able to live, thrive, and serve the longest.
- As such longevity, or as we call here, the Full Scope, is your best vehicle for health, extreme productivity, and service both now and in the future
See Wonder Medicine blog for complete show notes. -
Live to 100: Secrets of the Blue Zones
- 2023 Netflix documentary, 4 episodes
- Based on the 2008 book: “The Blue Zones: Lessons for Living Longer from People Who’ve Lived the Longest.”
- By Dan Buettner, Journalist, National Geographic Explorer, New York Times Best Seller
What is a Blue Zone
- Geographic location where people’s life expectancies are much much higher than in other parts of the world
- A much higher percent of people live to 100 years of age than other areas. 4x more people than in the USA.
Original 5 Blue Zones
- Started with Gianni Pes and Michael Poulain's 2004 paper: Identification of a geographic area characterized by extreme longevity in the Sardinia Island.
- Dan Buettner read this and then established 4 more Blue Zones with the help of epidemiologists (bluezones.com)
- SARDINA, ITALY
- OKINAWA, JAPAN
- NICOYA, COSTA RICA
- ICARIA, GREECE
- LOMA LINDA, CALIFORNIA, USA
4x more likely to live to 100 than in the US. Life expectancies > 85 years, apposed to 76 years in the US.
Dan Buettner’s Theory on Why People in Blue Zones Live Longer
- CONNECT (INVEST IN RELATIONSHIPS MORE. KEEP FAMILY AROUND MORE, FRIENDS)
- OULOOK (DAILY RITUALS, FAITH, SHOW UP, PURPOSE VOCABULARY)
- MOVE NATURALLY, (GARDEN, WORK, WALK everywhere, sit on the floor),
- EAT WISELY (WHOLE FOODS, HEAVY PRODUCE, WINE, MODERATION)
According to the US CIA, Singapore has the second highest life expectancy at birth in the world at 86.5 years (second to Monaco, 89.6 year average life expectancy, < 1 sq mile in the French Riviera, < 40k residents, tax haven, wealthiest location in the world, high performers flock to Monaco)
SINGAPORE
- Island in SE Asia. 2nd highest population density of any country in the world, globalized, one of four main languages is English. 283 square miles. 5.5 million residents.
- 80% of people own CARS in the US. 11% of people own CARS in SINGAPORE, PUBLIC TRANSIT USED BY HALF THE POPULATION EVERY DAY. Build in natural scapes in cities, good city planning with lots of walkways, < 10% obesity, Low healthcare costs (in spite of living longer)
- KEEP OLDER FAMILY MEMBERS OUT OF CARE HOMES - (NEEDS TO BE EARNED, HARDER IN THE USA per below)
Singapore Physician Philosophy and how to live a long time.
Why do you like being a doctor?
1) TREAT A PATIENT, FEEL JOY (enjoy the process)
What advice would you give someone who wants to live a long time?
2) WORK HARD EVERYDAY, BE HONEST, HUMBLE (get to work)
- Work hard and enjoy the process. No wonder the people in Singapore are living longer…..their doctors are giving much better advice and generally enjoying their job as a physician.
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We all have weaknesses.
These weaknesses will eventually limit your life and longevity tremendously.
Train these weaknesses out and become the best version of yourself.
See full notes at:
https://www.wondermedicine.com/wonder-medicine-blog -
Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blog
Three Things to improve your longevity today.1. Exercise
- Stop pretending to care about longevity or health if you are not exercising
- Bodies in motion stay in motion, bodies that stop, soon stop forever
- Plus the best way to keep your brain health and prevent dementia is to exercise regularly.
- Build your bank account of muscle and movement reserve
- Your job is not exercise. Walking is not enough unless your are elderly. But even then you should be strength training as well
- Dynamic movements through big ranges of motion always better. Don’t limit yourself
- Be results driven. Measure strength, VO2 max, and other objective metrics.
- Avoid injury by starting slow and progressing slow, injuries are killers as we get older.
- Learn how to fall
- Focus on Eccentric strength as well as concentric, stop dropping the weights.
- You will only be is strong as your weakest component and this will be your Achilles heal when you age, so stop ignoring it and fix it. Stop skipping leg day
- If you would talk to our exercise physiologist, Callie, ditch the chair
2. Sleep
- Give yourself 8 protected every night. Don’t stress if you cant sleep the whole 8 hours
- Living a healthy lifestyle will improve sleep. Do more during the day. Think and move more, vigorous exercise and light exposure early in the day can really help
- Give your kids more time, particularly in the morning
- Avoid z drugs, benzos, alcohol
- Cannabis, makes you wake up more groggy, less REM sleep, people often require more sleep to feel the same amount rested
3. Perseverance with positivity
- I have asked every person above 90 I have taken care of their secret to longevity. I am over 300 people at this point. 90+ percent of the time they either say “keep moving” or “stay positive.
- Toughen up, life is hard
- Work, retirement is a killer, work gives people meaning and keeps the brain active.
- Force yourself to do hard things that are uncomfortable, cold plunge.
- Lean into all your weakness always
- Don’t give up.
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Overview
- new 10-to-20-minute podcast every Monday
- the science, philosophies, and actional information around health, longevity, and performance
- meant to help listeners become the highest performing individual possible
- Increase your lifespan, healthspan, and view your life through the full scope
See a blog about this episode at: https://www.wondermedicine.com/wonder-medicine-blog
Disclaimer- Free content, no adds, no junk, just the facts
- This podcast does not create a provider patient relationship between the listener and the full scope team.
- This podcast is not intended to treat, diagnose, or cure your personal medical problem.
- If you want professional medical advice, check out Wonder Medicines Longevity and Performance Program -
Summary
Phosphocreatine is a molecule that can recharge ADP into ATP. This provides energy to skeletal muscle and the brain. Dietary and supplemental creatine can raise the bodies stores of phosphocreatine, providing additional energy. In this podcast, we discuss creatine, what is is, how it works, why it is useful, and how to supplement it.
Morbidity and Mortality
After age 30, most people loose around 5% of their muscle mass per decade. Six million people in the United States are diagnosed with Alzheimer’s dementia and this number is increasing every year. As such, preserving muscle and brain function are cornerstone of all anti-aging strategies.
Story
Creatine was first discovered in muscle in 1832. For over 100 years, it has been known that supplementing creatine increases phosphocreatine levels in skeletal muscle. Since the early 1990s, creatine has been marked as a dietary supplement. The use of creatine has become extremely popular over the last 3 decades and its potential benefits to cognitive and nerve function have only recently been explored/discovered.
Key Points
1. Creatine is a small amino acid like, nitrogenous molecule found in skeletal muscle and the brain.
2. Creatine is phosphorylated to phosphocreatine by creatine kinase. Phosphocreatine can then transfer a phosphate to ADP, making ATP. ATP is a molecule that is the main source of energy for the body.
3. Improved strength, bone health, cognitive function, recovery from TBI, heart health, and improvements in triglyceride are often seen with creatine supplementation.
4. Supplementing 5 to 10g of creatine a day should be considered in many individuals, including non-athletes. Creatine has an excellent track record for safety, but possible side effects will be discussed.
5. Muscle cramps are common when taking creatine. Stay hydrated and consume adequate salt. Be careful not to overuse your muscles or injure yourself when taking creatine.
References
- Forbes SC, Cordingley DM, Cornish SM, Gualano B, Roschel H, Ostojic SM, Rawson ES, Roy BD, Prokopidis K, Giannos P, Candow DG. Effects of Creatine Supplementation on Brain Function and Health. Nutrients. 2022
- Creatine. Wikipedia.
- de Souza E Silva A, Pertille A, Reis Barbosa CG, Aparecida de Oliveira Silva J, de Jesus DV, Ribeiro AGSV, Baganha RJ, de Oliveira JJ. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019
- Aguiar AF, Januario RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013
- Chilibeck PD, Chrusch MJ, Chad KE, Shawn Davison K, Burke DG. Creatine monohydrate and resistance training increase bone mineral content and density in older men. J Nutr Health Aging. 2005
- Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005
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Summary
Metabolic syndrome is a medical condition characterized by unhealthy and markedly deranged metabolism. Over 50% of United States adults have metabolic syndrome and another 40% are at risk of developing it (90% of US adults!). Metabolic syndrome is the great killer of our time, a global pandemic, and the leading risk factor for most all major chronic diseases.
Story
Chronic diseases are contagious. This is because thoughts and behaviors are contagious. As fast food companies, ultra-processed food, soda and other sugar sweetened beverages, and the American lifestyle spreads around the globe, so too does metabolic syndrome.Key Points
1 Metabolic syndrome is both caused by and can be cured by the way a person lives their life (behaviors).
2. Insulin resistance, unhealthy cholesterol, high blood pressure, and weight gain are symptoms of metabolic syndrome.
3. The risk of multiple chronic diseases including diabetes, heart attacks, strokes, and even cancer is increased in those with metabolic syndrome.
4. Avoiding ultra-processed foods, exercising regularly, sleeping adequately, and managing stress are the best ways to prevent and treat metabolic syndrome.
References
-https://www.nhlbi.nih.gov/health/metabolic-syndrome/diagnosis
- Lustig, Robert. Metabolical: The Lure and Lies of Processed Food, Nutrition, and Modern Medicine. Harper Wave, 2021.
- Saklayen MG. The Global Epidemic of the
Metabolic Syndrome. Curr Hypertens Rep. 2018- Lemieux I, Després J-P. Metabolic Syndrome:
Past, Present and Future. Nutrients. 2020- Shi TH, Wang B, Natarajan S. The Influence of
Metabolic Syndrome in Predicting Mortality Risk Among US Adults: Importance of
Metabolic Syndrome Even in Adults With Normal Weight. Prev Chronic Dis. 2020.- https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndrome
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Summary
What is your plan for medical care as you get older? Most people don’t know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more.
Morbidity and Mortality
Medical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks.
Story
In 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward.
Key Points
1. Comfort care is when the main goal of care is person’s quality of life
2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.
3. Code Status concerns a patient’s wishes when they are dead. It has nothing to do with their medical care while alive.
4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it.
References
- Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46.
- https://hospicefoundation.org/Hospice-Care/Hospice-Services
- Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.
- Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)
- Adair T
- Who dies where? Estimating the percentage of deaths that occur at home
- BMJ Global Health 2021
- QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020
- Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016
- Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”
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