A Lifelong Medicine to Maintain Vitality

Tom Butler: 0:04

Welcome to the Cycling Over 60 podcast, season 2, episode 19,. A lifelong medicine to maintain vitality. And I'm your host, tom Butler. I got a big asset this week to help me with my challenge for this season. The map from Adventure Cycling Association arrived and it is awesome. As a reminder, the map is the first section of the Northern Tier Bicycle Route. The whole route goes from Anacortis, washington, to Bar Harbor, maine. I will only be doing Anacortis to Newport, washington. Section 1 actually goes a little further, to Sandpoint, idaho. The route is also called US Bike Route 10.

Tom Butler: 0:54

This is the first map I have ever seen that is specifically made for cycling and it is just packed full of useful information. I'm not going to take the time here to go into everything because it would just be too long, but go online to Adventure Cycling Association and take a peek at what their maps include. I do want to highlight their field notes. The map even includes these neat little infobytes about things along the route, like how the Douglas Fur got its name. It's just a fantastic job by the Adventure Cycling Association cartographers. In my opinion, there is one reason the map is important to me, and that is because my wife is really questioning my decision to ride across Washington. Now she sees it as not the right challenge for this time. Personally, I'm not questioning this decision at this time, but she will need some perspective that it is safe. The map helps with that, but I think we're going to have to drive a part of the route at some point. That will either confirm her fears or show her that the route is safe. There's also the element that she doesn't think that this physical challenge is really what I need right now. But I don't really think it's going to be that physically demanding, although I might find out I'm wrong about that.

Tom Butler: 2:16

I did another bike fitting this week, this time for my Roubaix, and, just like before, I found it to be extremely helpful. I went to Eric Mohan here in the Seattle area. He is a physical therapist and a bike fitter. For me, this is basically an essential combination. His practice is called Corpore Sanio, inspired by a Roman concept of health. Corpore Sanio means healthy body in Latin. Eric is the full deal and was extremely thorough. It is hard for me to imagine that anybody could do a better job. He even gave me a pedaling lesson. He exceeded my expectations in so many ways.

Tom Butler: 2:57

I will highlight just two adjustments that I believe will make my bike significantly more comfortable. First is that he put spacers to move the pedals out a little. That puts my feet in more alignment with my hips. I figure there aren't many things more important than avoiding thousands and thousands of pedal rotations with my feet out of alignment with my hips. He also put wider bars on, which puts my wrists and elbows in a better position, another important change. Once again I received feedback from Eric that I'm not even close to where I should be from a flexibility perspective. Am I the only one out here who has a hard time keeping limber? My flexibility had a real impact on what he was able to do with my bike setup. He would have liked to put a longer stem on my bike to fit my upper body better. However, he didn't because my lack of flexibility would have meant that the more aggressive position would have created strain. So I need to make improvements in my flexibility and then readjust again later.

Tom Butler: 3:51

Four more weeks of continuous glucose monitoring left. That means I have four more weeks to really dial in how to turn the bike into a fat burning machine. I know that 90 minutes of low intensity really eats up the blood glucose, but I want to see what happens when I extend it to two hours and also what happens when I ramp up the intensity. Eric recommended that I spend time on rides maintaining a 20 mile an hour pace as long as I can. That would definitely be a higher level of intensity for me. It would, in my opinion, be a form of interval training. I think I need that and I think that would help me maintain or even raise my metabolism. There are still so many things for me to figure out when it comes to fueling longer rides. What foods can I eat and how do I avoid not spiking my glucose?

Tom Butler: 4:45

I have been interested in bringing on the podcast a physician that is also a cyclist and get their perspective. I was able to find someone who I think is perfect. Dr Patrick Hogan is a neurologist and has been an endurance athlete for decades. I was really happy to be able to get his thoughts on how maintaining fitness benefits his patients and also hear stories from his personal fitness journey. Here is our discussion. I am joined today by Dr Patrick Hogan and, dr Hogan, I want to welcome you to the Cycling for 60 podcast.

Dr. Patrick Hogan : 5:16

Thank you, tom, it's a pleasure to be here.

Tom Butler: 5:19

Now. I wanted you on this podcast from the very beginning. I didn't know it was you that I wanted, but I wanted someone with your professional and personal background. This is great to be able to get your perspective on things. You have been in private practice since 1988, so you're not new to the field by any means. You currently are the director of Puget Sound Neurology, which is your clinic. I believe that's the right way to say it.

Tom Butler: 5:52

You've been the past president of the Pierce County Medical Society and have received many awards for your community service, which I think is awesome, and I was particularly interested in your work on the tobacco free coalition of Washington. What great work that was. Then also just working with numerous support groups for patients with varying neurological conditions. The final thing I want to point out is that you've been granted recognition as a center of excellence by the National Parkinson's Foundation. I think that's impressive. The impact that you've had with patients and in the community and professionally. I just see, all in all, that that is an awesome career. The first thing I want to ask is something that I ask almost everybody, and that's what is an early memory you have about biking?

Dr. Patrick Hogan : 6:40

Yeah, it starts really early, then skips a few decades. I can actually I'm not sure why I have this little early memory of getting on a bicycle, bicycle and transitioning from training wheels Is it is like I have very few memories of really early but I somehow that sticks in my mind. Maybe was a momentous occasion or whatever.

Dr. Patrick Hogan : 7:00

I think it is yeah, but at that point, why is it stuck in my mind? There wasn't that much into major biking is a usual things, you know, until I started training for trathons while I was stationed in the hospital in Hawaii. In about nineteen, eighty four, can I get the little marathon? I was kind of inspired to start doing trathons and start getting on the bike. That was a steel truck bike at that point, you know, but it carried me over. It's kind of interesting, you know it's not about the bike. You know, even now my S works specialized experts and my fancy Try bikes. I don't think I'm that much faster. You know it's all about this, about the bike. But anyway, that's my earlier, my early memories.

Tom Butler: 7:52

You said nineteen, eighty four in Hawaii. Is that right? That's a pretty interesting time as far as the iron man triathlon is concerned. Were you from? Where are you at that time?

Dr. Patrick Hogan : 8:03

yes, yeah, I was. I was when is head and started much earlier than that, actually in the later seventies, you know. But this is an olympic rathons I train for. That was Be on my capacity at that point. You know, subsequently done iron man, but at that point the. But I was where the of the developing interest in crazy for a drathons at that point in the early eighties.

Tom Butler: 8:25

So you have made a commitment, you bat. Commitment was, you know, higher than typical commitment to exercise into performance. And you made that commitment and you stuck with that commitment. How did that come about? Part of your life.

Dr. Patrick Hogan : 8:40

Yes, it's a great question. I really wasn't until probably I got to washington state in the end of the eighties, early nineties, where I became more committed to Endurance athletics and I think it's a kind of blessing that I had. You know, it just fit with me. It's almost another major question of why do people not do that or why do they stop? You know we can get to that, you know. But after that point, you know, then I just it became part of my daily routine over the last thirty some years that I can. I hadn't been as committed during my residency in medical school but then afterwards really got, you know it was. It felt that it just fit with my, with my personality, in my goals to have what to have, goals. I guess that's what you would do, but it, which is me, is, you know they have a goal because goals kind of pull me over and to the next day and make me want to do that exercise and days which are not really motivated otherwise to do so.

Dr. Patrick Hogan : 9:41

But in the long, the same line. You know, the main one major questions. I always wonder about that. That question is you know, why is it that everybody doesn't do that? And you know part of it.

Dr. Patrick Hogan : 9:51

I think people have had a negative experience with, with exercise even growing up and they and so it Do you become the challenge or chore to them rather than a pleasure, and then that's you know it. Kind of along the line I've been sponsoring a yearly run, a mildly program for young kids. In this area you spend national program. We've kinda carried on with the idea of making exercise of fun and ever, rather than a or punishment as it was in some situations back then, and we also sponsor a, an annual swim event in minnesota that gets a lot of young people out In this, in this endurance swim. You know these are things that you know positive experiences and carry on throughout life.

Dr. Patrick Hogan : 10:35

But I think most people don't have that and some holiday think of exercise as a chore or punishment and don't and don't feel the the need to be uncomfortable.

Dr. Patrick Hogan : 10:45

You know we need to be uncomfortable sometimes to be comfortable long term. And the other aspect is is people get excuses. You know it in the whole, the whole idea to be committed to exercise is not to have excuses and people obviously you know my knee hurts, back hurts, or my it's too cold or is too hot or raining. You know you should be a concept of you can always do something. You know, even if it's one, if you're limited, some aspect, you always can do something, and so we try to get that across the patients all the time, because there's a lot of people that have good excuses Not to do some forms of exercise, but but they should never be a time when they don't do it at all and so it's still a major goal is to try to get in a try work with all the time, try to get more people and involved in exercise that's interesting to me and for myself.

Tom Butler: 11:38

I mean, this is true, I'm not immune of all these challenges to actually being active, you know. But our bodies seem to be made for activity and centuries ago we had to be very active just as part of how we live. And now we can choose how we're active. You know, I can jump on a bike and go out on a beautiful trail and get my activity that way, whether rather than having to lift bells of hay or dig or whatever you know was the physical demands of just living ages ago. You are part of the cycling over sixty club and also swimming over sixty and running over sixty. I'm wondering if you have some highlights from your years of participating in events or training, things like that.

Dr. Patrick Hogan : 12:27

I do have a lot of highlights that I can think back and be proud of, but I always think, you know, it's these highlights are really like my goals that pull me forward.

Dr. Patrick Hogan : 12:36

And but these three, you know I was really telling people that you know my patients, you know that, you know the goal is gratifying but it should be the steps toward the goal that should just be rewarding. So you, each thing I do, you know I've done over 150 triathlons now and I'm proud of the three. Iron man is a major goal, but all those steps to get to the goal or just as rewarding and we did some major long bikes in the dolomites, the stelvio bike ride up the hill and the cell around the past me wife and I did this a calabra climb up in the new york off the spain. So all these are already so I feel, some of my highlights and some of my long distance ramrod, you're right around modern year Good goals. You know I like looking back on the goals but then also think of what it takes to get there and how rewarding that is.

Tom Butler: 13:33

I'm gonna, if you could talk a little bit more about ramrod. Did you feel like you knew what you were getting into? Was it kind of what you expected? How was that experience?

Dr. Patrick Hogan : 13:42

The first time I did it was it was pretty brutal because I didn't. I didn't have a good climbing bike and I thought what's always the big deal? I guess it was pretty bad, you know, but we made it. But the subsequent I did a few more times and and had I got really good experience in the. I was more trained again to go around the mountain and it's a for people don't know is it's a rider on modern year, but one hundred sixty miles in one day and a lot of climbing and pretty intense but very rewarding.

Tom Butler: 14:14

And a pretty majestic experience.

Dr. Patrick Hogan : 14:16

I think probably that's a good point for all these things, you know that is that besides the, the endurance and the exercise and accomplishment, what you have around you and being with other people that's one of the things that I really have. It has driven me is not to keep going at prathons and some of these events is to be around a whole group of people that are all like minded. That all that I'll have. This idea of maintaining fitness and enjoying the outdoors and join the majesty of mountains and countryside agree with you.

Tom Butler: 14:48

You talked about that. People have to, I think, make a decision that they're going to do something uncomfortable to elevate their fitness, to maintain fitness, and one of those, I think, is that it's hard with a busy lifestyle. And you are a neurologist, you own your own clinic, which is a business, so you're a business owner and there's things that you have to do on that side as well as the clinical side, and your business is called Puget Sound Neurology and yet you've been able to fit in training with a busy life that, I'm sure, also includes family.

Dr. Patrick Hogan : 15:25

Right, exactly, yeah, it's a lot of different interruptions or obstacles, like you would say. Yeah, I think it's really important for medical providers in general to be fit, and we'll get back to the second one, how I maintain my fitness. But I started a number of years ago, when I was president of the Medical Society, of a coalition called the Coalition for Healthy, active Medical Professionals Channel, and it was the whole idea that exercise is very important for providers, you know, and but still, even to this day, it's just so hard to get people with that just accurate, which you just said, when they're busy in life, to recognize that maintaining fitness not only is good for their mental health and physical health but transmits an example to their patients. So, yeah, I think it's an important part of just being a medical provider to be fit, but I think what requires and this is again a goal for anybody is to make it a routine. You know routine is so important. You know exercise should be as important and routine as sleeping, eating and breathing, and so we do.

Dr. Patrick Hogan : 16:37

I make it a daily routine six days of aerobic and one day off which is yoga and weights, and I like to work one day a week, 18 miles each way, you know. So I kind of keeps you know, so I can't stop halfway. You know I got to get there. So again, it's a motivator, you know, and so you know that pushes me along. I think what's so important, I think what really is I've been blessed with, is I have an exercise partner. My wife is also an athlete and triathlete and having an exercise partner so much that makes you accountable, it really helps you on days that when your motivation is floundering and you need someone else to have to be going to push you along that way. So it's been, that's been an inspiration and helps me to avoid excuses. And you know other things I do to maintain that I try to do consecutive days, you know, and that's really a good thing, for we try to encourage people to do so, to get on a goal, so that you're doing something every day. So, for example, I have every day I do a yoga strengthening and stretching program along with my meditation that I do with Insight Timer, and so I now have 1,962 days this morning in a consecutive days, and so you don't want to start over again if you miss a day and at a certain point, when you get to 100 or 200 days, I don't want to go back to one. And then you get to 500, 600. So I think that's, you know, something like that.

Dr. Patrick Hogan : 17:59

I've heard a number of people in the past, you know, that have gotten into that routine. Well, they don't want to break their streak. Now we all have to play mind games with us. I think sometimes, because there's so many, so many little obstacles that come into our mind, they say, ah, not today or let's do it later. But the idea is, if you say you're going to do it later, most of the time people don't get to it. You hear it all the time that it was my patients oh, I plan on doing exercise but I just didn't get to it. You know, if you don't, if you don't put it in your schedule, make it routine, most of the time you just don't get to it. So that's the whole idea of avoiding excuses. You know, do whatever you can, keep exercising and make it a routine.

Dr. Patrick Hogan : 18:38

Well, there is some balance to that. You know, after my Achilles tendon ruptures, I determined I'm not going to make this an excuse, I'm going to keep going. And I did a bike ride and just six weeks later, in the Sonoma bike ride, I'm not even able to clip in yet. And then about two months afterwards, I wanted to do the Washington DC triathlon, which was it happened to be on a 9-11 day, so it was really inspiring, but I had to run it in a boot, but that was a mistake. So that's my example. So sometimes you can make, don't make excuses, but you got to have wisdom. I think wisdom has come with age. To realize, wait a second, there's a time when you do got to heal, you know, and you don't. You just have to divert to another form of exercise, you know. So it's a balance. You know, not exercise, don't have excuses, but yet realize when you do have your limitations.

Tom Butler: 19:36

It's nice to hear that a physician can even make those kind of mistakes.

Dr. Patrick Hogan : 19:40

For sure.

Tom Butler: 19:41

I find it kind of interesting. You know we don't have to me natural pressures to be active. You know we don't have a lot of social pressure to be active. If I'm not eating, I feel hunger, you know, and my body is like pushing me to eat and eat, and I don't have that. You know that same kind of thing If I'm not being active. I mean there are subtle cues like oh okay, my mood is the way it is because I haven't been active for a while, or whatever, but there's not really like a lot of things that are really driving us to be active.

Dr. Patrick Hogan : 20:18

Yeah, that's correct. You know we're just in the opposite. You know we're so programmed to just the opposite. To preserve energy. Everything we do is preserve energy drive-throughs. You know remotes. You know everything we do is try to save energy when we should be doing just the opposite. You know of looking for ways to be more active. You know to stand up throughout the day and rather than sitting. And that's right. We don't. We, unless you really have habituated to it and that's what we try to do in our situation, my wife and I is be so habituated to it that you don't feel good unless you do it. And but you're right, there's something wrong with that in our brains that we don't feel that same compulsion to do what's really good for us and to lose a lot of the benefit even after a pretty short time of not exercising. Yeah, so that right it takes, you know, truly cognitive awareness that this is something that's as good for us as as sleeping and eating and breathing.

Tom Butler: 21:20

Now, one thing that I know, and actually listeners of this podcast know, is that you have another, another member of your family, dr Adrienne McNamara, who is your daughter, and she's very active too. I'm wondering if you could talk a little bit about the benefit of having an active family, not just a spouse.

Dr. Patrick Hogan : 21:38

Right Again, it inspires you. And my son is also very active. He's a wellness practitioner in movement and posture training in New York. So he's very, also very active. For both of them and I think that part of it was because they did have positive exercise experiences when they were growing, growing up, and that's going to maintain them throughout their life. It is inspiring we I learned from Adrienne a lot and inspired by Adrienne so often when she has her challenges, but she keeps going, no matter what her excuses are. She's a perfect example of someone who has got some good excuses not to some exercise because of her physical limitations that she's had and but she keeps going. And same thing for my son. He doesn't. We've learned a lot from him far as different posture training exercise that we we implemented in our daily life.

Tom Butler: 22:26

At Puget Sound Neurology you take a what you call a whole body perspective to treatment, which I think is awesome. Can you talk about what that means and why you've chosen that focus?

Dr. Patrick Hogan : 22:38

I think that it's so important that is not focused very often in in in many medical practices is that you really shouldn't be focusing on one organ. You know and you know people do they'll they'll be a heart doctor and they got doctor or the brain doctor but rather than bring the whole body into the experience, the holistic treatment is medicine in itself. People are limiting the, their response to therapy by by not encouraging people to, to live with the, with positive lifestyle medicine. In our practice we have a dietitian with to deal with nutrition, we have Adrian who helps to develop exercise, physiologists to help develop exercise programs and we have a yoga a yoga instructor, pilates instructor and dance instructor that come in to the room room and have in our office for for encouraging people to give them kind of avoid some of the excuses they have looking for some place to exercise. It's crucial, important. You know exercise is medicine and we I'm sure you've talked about that in some of your programs already. You know.

Dr. Patrick Hogan : 23:40

But you know especially for neurology, because you know there's a chemical process that occurs when the muscles are activated. So when the brain activates the muscles, the muscles release the chemical in the muscles to feed back to the brain to release another chemical called BDNF BDNF brain derived neurotrophic factor which is the only way that we can really develop new neurons and new synaptic connections. It's an effect that you can't get in any in appeal. There's no medicine that can do it, and so this is truly is why exercise truly is a medicine. In fact, I coined a term a number of years ago in my lectures because exercise is medicine but doesn't have a name like other drugs, and so I call it does it all and does it all because it does, and so does it all is a medicine. That that we need to develop in a neuroplasticity and we talk a lot about that in the neurology nowadays. You know neuroplasticity, that the brain is not a solid structure, it doesn't change, it's constantly plastic and moving and developing, but you have to make it to happen. It's not going to happen automatically. So we need with with the right nutrition, the right stress release, sleep control and especially exercise to produce that to happen. And along. That's another.

Dr. Patrick Hogan : 25:02

Another word that we use a lot is something called hormesis. Hormesis means that the body adapts to to stress, so you have to be uncomfortable sometime, so put your body through some stress in order for for this to happen or the positive effects to happen. But it needs to be challenging and needs to be diversified, because if you do one thing all the time, your brain adapts and it doesn't have any reason to have to get improved further. So so we're always encouraging people to find different ways, you know, because biking is a wonderful spectacular exercise that we can do throughout our life.

Dr. Patrick Hogan : 25:41

But we but it's pretty important to to do alternate exercises for for bone loading with its weight training and running and lateral movements. You know, my wife, my wife and I do ballroom dancing for the past 18 years, you know, but probably five hours a week in that area. That you know, because it develops other forms of stimulation to your brain and the lateral movement. So all these things are are crucially important with every patient to get the most out of out of their treatment. If I just use their medication, they're going to get some benefit. But if you, if you include all the holistic aspects of this, you know, nutritional and exercise program and sleep control, stress control you have a great rewards and everybody and people appreciate it.

Tom Butler: 26:33

Well, you're really triggering me when you talk about dancing. I went contra dancing a couple of times years ago and I don't know that I could handle ballroom dancing. I don't feel like I'm good at that.

Dr. Patrick Hogan : 26:46

People always say that they don't have rhythm it's a very common thing or they feel intimidated by dance. But if you think of dance as a sport like if you went outside to learn how to play tennis or if you learned other sports that you're not used to doing we all have innate rhythm. If you look at a little two-year-old and they start putting music on, they'll bounce around and they have rhythm, but then we don't use it and we suppress it over all the years. Dancing, I think, for us, is a crucial part of our exercise routine because it brings in so many different aspects of movement rather than the more straight-ahead program that we do with swimming, biking and running, and it kind of fills out the gaps.

Tom Butler: 27:32

It sure seems like a compliment to a lot of different exercises.

Dr. Patrick Hogan : 27:36

It does. Yeah, I agree, I think it's fun. See, that's the thing about exercise. Some exercise we do, as we've talked about, is there's a lot of suffering. That goes into a lot of what we do with exercise. Unfortunately, that holds some people back. So it's nice to do exercise. That's fun. Dancing is not only a good union with your partner, but it also has laughter and fun associated with it.

Tom Butler: 28:02

Talking about whole-body approach, bringing in so many different things here, including the fun and that being part of good medicine and good treatment. I'm wondering also about the social aspects. That's one thing. When I think about contra-dancing. There's a real social aspect to it. Do you feel like socialization is part of a whole treatment modality?

Dr. Patrick Hogan : 28:28

That is a great perspective. I'm glad you brought that up, actually, because there's been good studies that have shown that networking and being associated with groups one of the factors that has been shown to be associated with longevity. So the people that, for example, people that are involved in religion it's not so much their religion itself that has the most longevity, but being involved with the group. That's one reason we have our support groups. I've been maintaining a dystonia support group now for going on 30 years and it gets people together with like conditions. It produces this networking. I think that's also very important for our brain. It does something in our body. That is, whether it's I'm not sure if it's a stress release or some other neuroplasticity effect that has been shown to be a factor in long-term health.

Tom Butler: 29:23

A while ago I was talking to my physician and I had seen some bad numbers my blood pressure, my blood glucose, they were all heading in the wrong direction. And so I told him that I was going to make a change to a vegetarian diet. Now he did not understand that. My family, a lot of my social, the people around me, they are vegetarians, so I have that kind of support. So when I told him that I'm going to stop eating all meat, he was like, uh no, I don't think you should. You don't have to go that far. I don't think you should do that.

Tom Butler: 30:06

And the way that I interpreted that is that he was used to people making these statements like that in the face of some you know bad health information they were seeing and they wouldn't stick with it. There wouldn't be the compliance. And I'm sure that as a practitioner you have given a lot of direction for patients and have not seen compliance. That's. I think that's a good guess and I wonder if you could talk about that a bit. What are kind of your perspective on what makes a difference when people try to make a significant change?

Dr. Patrick Hogan : 30:42

Right. And this on the side you know we're, we're also my wife and I are also vegetarian for many years, and people have that misconception that you can't get enough protein. You know, and you can have wonderful meals that are much healthier and give you just and for athletes, you get plenty of nutrition and protein with the right, right strategy. There's someone, some of the major athletes in the world are vegetarian or even vegan. It takes strategy and ingenuity to maintain that. But on the line of compliance, that is one of the major challenges, because and it's and I totally admit that that I'm not as good as it as I would like to be because I give people opportunities. I tell them every visit about, about exercise and nutrition, and most of the time they don't, they don't follow it and it's always frustrating. Why don't they show up for this class I'm giving them? It's free, it's come to you know, but why don't they want to change their lifestyle? And because it's just hard for people to make that step.

Dr. Patrick Hogan : 31:47

You know my son, patrick, who's again the come over wellness practice is, is really into what's called motivational interviewing. That I would like to get better at. The whole concept of that is not, rather than just harping on them and telling them what you should be doing. You try to. You try to build up, build up a rapport over times to make it their idea. So the point that they're finally saying, okay, you know what do I need to do, rather than you telling them.

Dr. Patrick Hogan : 32:19

Because so often when you tell someone that they should be doing it, there's a natural resistance for the natural tendency for them to resist and so, but if we can build the, the knowledge and the trust to build them towards that, that goal of having them say, okay, no, I'm ready, what do I need to do to get healthier? And. But I agree, it is. It takes time and what? And most, most practitioners don't do that. So that's why there's this whole movement to try to change that, to get people to be more fit, to try to stop smoking, to eat right. But there's a big gap there from what we tell people to do and what they actually do.

Tom Butler: 32:59

And even in the face of real life and death or the potential of limited function, it seems like there's the consequences of not making change can be really significant, and yet that's not enough to produce change.

Dr. Patrick Hogan : 33:13

That's right. I mean, it's an obvious example of smoking. You know, people know obviously it's pretty, you know it's a every person knows that this is, this has potentially fatal what they're doing. But yet you know that addiction drives them on or to be uncomfortable. To exercise is such a barrier that they don't. You know, they just never make that step. But even despite just what you're saying, knowing that this could make a huge difference in their, in their lifestyle, you know that whole, that whole idea that you know we could talk about in a minute what you know what, how the American medicine would be better if people were more fit.

Tom Butler: 33:50

Because I think that's a great segue to this question, which is how big of a difference do you think an active lifestyle makes for the patients that you treat?

Dr. Patrick Hogan : 33:59

Yes, and we know it certainly does. You know there's a, it's a good statistic that that they feel that there should be about a 40% less Alzheimer's incidence if people will maintain an adequate exercise and adequate lifestyle. So it'd be about 45% less people with Alzheimer's if the American public were, in general, more active and falling in that. And that's huge. That's millions of people, countless dollars. You know, in our, in our society that could be prevented or reversed if people were in a positive lifestyle. So it's a. It's a huge factor, and not just for the brain but for, obviously, for other metabolic diseases and heart diseases.

Dr. Patrick Hogan : 34:44

I kind of use an analogy sometime or metaphor. Metaphor sometime about aging is that it's like we're paddling down, paddling in a river, and in that river there's going to be some small, small waterfalls along the way and now they're just inevitable. That's just aging. But if we paddle upstream and keep active and we can we can prevent those from happening. Eventually there's going to be a huge waterfall that's going to take us out, but eventually we can. We can prevent that from happening by by paddling upstream, but it but for most people though, they just kind of follow the stream over the waterfalls.

Dr. Patrick Hogan : 35:18

Once you go over one, you can't get back again, and that's the whole idea. You, for exercise, you know, for example, once you stop it's really hard to get back to it. It's it's just something about human nature. So you can. You know the whole key is never to stop and just maintain. But you know there's something that we call in American medicine the sedentary death syndrome, and that's really, it's really essentially a slow suicide by people being in a sedentary lifestyle, because it's, you know, it leads to deterioration of our body and all aspects of our body will deteriorate if we're not in, you know, an active lifestyle and in eating or not, not doing things that are negative to our system, with the wrong foods and and wrong metabolism, we just there's things that you can do, but you have to take the effort to do it.

Tom Butler: 36:07

I really like that image of paddling in a stream and, you know, if you're willing to paddle against the current, which is a lot of times what it really feels like, then you can delay some of these events. I like the perspective of paddling and paddling and paddling. I'm going to be taking out sometime, but I would rather it be a big event that just takes me out rather than a bunch of little events that limit, limit, limit, limit and take my capacity away slowly over time. And then there's also the perspective of paddling with the stream. It just seems like there's an awful lot of things that are in the grocery store that we can partake of. That is paddling with the stream.

Dr. Patrick Hogan : 36:50

Yeah, exactly that kind of brings to the whole aspect of. You know, besides our exercise aspect of how do you maintain the? You know, besides our motor, we need to have that internal structure to maintain our muscles and health and we have to have metabolic health too. You have brought that up. You know there's a lot of problems in our society with people having, you know, internal organ dysfunction even if they're exercising, if they're not doing other things correctly. There's Peter Tia. Dr Peter Tia has a really good site that deals a lot with metabolic health. He has a book called Out to Live and outlines some of that.

Dr. Patrick Hogan : 37:30

For example, like there's a lot of people in our society that have fatty livers even though they're maybe otherwise reasonably healthy because they're eating you know, too much fruit toast in their system and you know pretty drinks.

Dr. Patrick Hogan : 37:43

You know, even though fruit toast is good in some in a limitation, with some fruits that could be poison at a certain point, like carbonated beverages and excessive carbs. You know, especially as athletes, we need carbs but the excessive glucose levels are harmful to our system. I've been wearing a continuous glucose monitor for the past couple of years and a lot of athletes are doing that now. You don't have to have diabetes to be monitoring your glucose levels, because we know that these glucose spikes and elevated glucose levels produce oxidative stress that damages blood vessels and again increases in instance of dementia. We have to be aware of what's going on internally to avoid overwhelming our ability to metabolize glucose, because if you do, if you overwhelm your system with too much glucose in the system, you start getting insulin resistance and elevated levels and that leads to type 2 diabetes and that leads to oxidative stress that damages the blood vessels and leads to other problems. So we have to be aware of all these metabolic problems, besides the importance of exercise alone.

Tom Butler: 38:56

This is my journey. I started cycling. You know I wanted to reverse. Some of the things that I was seeing was never diagnosis diabetic. I really think I should have been. You know, I was right, bouncing right up against that level to be diagnosis diabetic. I decided to get a continuous glucose monitor that I've been wearing for a little over two months now and wow, I mean it was an eye opener.

Dr. Patrick Hogan : 39:22

It opens your eyes. It definitely does.

Tom Butler: 39:24

And I wish my doctor would have had that data because I think I would have been diagnosed as diabetic a while ago and I'm sure it's been 20 years that my insulin levels, you know, which I've learned now to kind of go upstream from my blood glucose levels and say, okay, this is an insulin issue, and then going from an insulin issue to this is a liver fat, liver function, organ function issue, and so that continuous glucose monitor has really opened my eyes to trying to get upstream, you know, from the issue of how my blood glucose spikes are.

Dr. Patrick Hogan : 40:05

That's great, I mean. I think it's important for athletes, even without blood sugar abnormalities, because so often people are so aware that they need to eat a lot of carbs. You know to exercise, but you should be doing that without avoiding the spikes you know, because those spikes, you know they can really can cause damage and then eventually lead to more glucose intolerance. It's pretty eye opening what you know, what stress will do, what your glucose levels are at different times of the day. As you probably noticed, you know you can handle more carbs in the morning than you can later in the day. The sequencing of foods to eat your salads and your rubbish first before your proteins, before your carbs All these things can produce long term health and prevent the development of glucose intolerance.

Tom Butler: 40:52

For me, now that will be my lifelong journey, is monitoring food not from a glucose perspective but from that fat storage and overwhelming like you mentioned earlier, kind of overwhelming my system with the amount of glucose that I put into it.

Dr. Patrick Hogan : 41:08

Right yeah, just what you need, and not too much.

Tom Butler: 41:11

Right, when you look at utilization of your in your practice and you gave this number of 40%, which is just a dramatic number, you know, because you're talking about more than a more than a third of people, that things could be dramatically changed for them. And so if we could somehow do this dramatic increase in the percentage of fit Americans, do you see your practice changing quite? I mean, like, what do you think would be the impact in in your practice as far as maybe of age, of onset, of when you would see people, or just conditions that you wouldn't see? I don't know if you've ever thought about this, but but what do you think would be the impact if, again, one day, there was just dramatic increase in the number of fit Americans?

Dr. Patrick Hogan : 41:59

Well, in my particular practice I don't I don't deal with Alzheimer's disease directly, but it's. But that would that's a major one that would be decreased. But also the same for Parkinson's disease, you know they'd be there's, that's again a neuro protective by people being adequately fit. But again, all the other aspects of stroke you know again we're dealing with a neurological aspect here is can be dramatically improved if we could, if people are better fit and avoiding blood vessel damage, but just general things that are that are triggered by stress. You know people have a lot of people with migraine there when they're major triggers or developments to some of the chronic headaches or can be ready to stress disorders. And you can ameliorate that by a good, good lifestyle with, with, with exercise and outlets and meditation and yoga.

Dr. Patrick Hogan : 42:48

So there's, there's so many, you know so many examples throughout the entire body, including joint health. You know people think, oh, you're gonna wear out your joints. You know, by exercising. No, it's just the opposite, people, that the people that are that are active do not wear out those joints. Our joints are biomechanical. It means they regenerate with exercise rather than a mechanical like the car joint that wears down with exercise. So it just throughout the entire body. Lifestyle changes would would make a dramatic difference in our whole health expenditure throughout the world.

Tom Butler: 43:22

And we talked about compliance and I'm wondering, you know, it seems like mental health that plays a big role in compliance and I'm wondering kind of the interface between what you see professionally and mental health and kind of the impact of being physically active in that realm.

Dr. Patrick Hogan : 43:37

Right, yeah, for instance, depression, you know they've shown that exercise, getting into an exercise program, has as much positive effect in relieving depression as as medicine, antidepressant medication, and that has been shown in studies for the same thing for anxiety and same thing for sleep disorders. All these things that make a difference, including avoiding inflammation in the body with the right, the right diet, since that diet. So it's, yeah, it's, it carries on a lot in the mental health factors, because if people are depressed or have a lot of anxiety, it's another barrier in itself. It's a kind of a contradiction that the exercise would in maintaining a good lifestyle, would would help their depression anxiety, but their depression anxiety sometimes a barrier for them to get motivated to do it. So it's somehow where the human brain doesn't correlate there well, but but I totally agree with you that that is a big part of our, of our problem because of all the stress we have in our country.

Tom Butler: 44:41

The thing that I think about when I'm riding and cycling is my big form of activity until I get dancing, but I think about the risk of a crash and hitting my head, and so I'm wondering if you have some thoughts about the risk of biking and bringing in tree and and even kind of that risk as we get older.

Dr. Patrick Hogan : 45:07

Right it's. It comes up pretty often, you know. The people are just worried, especially traffic, you know, and we and I agree with you, I worry about it too we're out there just hoping that this is not going to be the day that, because I've had some pretty good bike accidents over time and that could have been really serious, but, you know, fortunately recovered. Yeah, there's always that, that problem, although, you know, relative to the, to the number of people biking and the number of hours that we're all biking, it's probably really pretty unusual. So I think the it's all a risk versus benefit, like any medicine, you know, is a risk versus benefit and I think our benefits are far away. The risks, even though there is, those are all they are, those potential risks. It really requires us to be to be that extra careful and look for the right bank paths and, of course, obviously the helmet.

Tom Butler: 46:03

You think that the that it is more important as we get older, and even from a transportation planning perspective, if we want older people to be cycling, older people be active Do you think that's one of the things that needs to be taken into account, that the risk of brain injury does increase when we get older, or is that not? Is there not that much of an increase in risk?

Dr. Patrick Hogan : 46:28

Well, there probably is some increase in risk because with every one of us there is some decreased reaction time. That just happens, and so it's. I think what you said is the transmission planning. We need more bike paths that people can exercise on without the worry about traffic. So often now we're just hoping that the people pay attention, but that doesn't always happen. We hear about these bad stories every once in a while. I'm just glad it's. You know it's. More of us are benefiting from biking than those that are injured. I think it's a risk versus benefit situation, but I think yeah, I totally agree with you Transportation planning would be huge for us, maintaining a ability to continue biking throughout our whole life.

Tom Butler: 47:16

One of the things I hear over and over on the podcast from professionals is that it's never too late to start getting active. It's also never too early to get active, but it's never too late to get active. What are your thoughts on that?

Dr. Patrick Hogan : 47:31

Yeah, there's an old adage that I tell people that it's never too late to start and always too early to stop. So in fact there's been some pretty good studies of people in their bedridden in their 90s that are started on a weight training program that show that even at that point you can get development of their muscle strength and increase their function. So we have these sarcomeres, which are elements in our muscles that contract, that you know, that can weather and be lost over time, but they're always still there and just needs the right activation to get them going. You know the aging effects are inevitable, but the negative effects of aging can be ameliorated by lifestyle. But to maintain our function and our enjoyment in life, we have that option, like, as you were saying earlier, even though we know that's the case, often people don't do it. But we have a fountain of youth, in a sense, people.

Dr. Patrick Hogan : 48:34

I was searching for that fountain of youth. Well, staying active is important. I think biking is a big part of it. I think biking is a lifelong remedy to maintain vitality. Biking is a lifelong medicine to maintain the vitality of living, whenever too old to start and always too early to stop. So the goal now, along that ageing. We hear another adage the goal. I can't remember who said this, but the goal is to die young, but as old as possible. So to die young at 100 is our goal, and whether it is just to maintain our ability to get down the floor and get up off the floor and to lift luggage overhead and to play with grandchildren. There's all kinds of positive aspects of this, but that aren't going to happen if you let our bodies continue to deteriorate.

Tom Butler: 49:34

You had mentioned neuroplasticity before, and I think neuroplasticity is a relatively modern concept. What do you think about maintaining neuroplasticity as you get older? Is that something that a healthy lifestyle contributes to?

Dr. Patrick Hogan : 49:50

Exactly as we mentioned earlier, there is no other way that we can develop new neurons and a new synaptic connection is in our brain other than stimulating them with the brain drive neuroplastic factor. You cannot get that in any other way other than an exercise program. So even as people are getting older and they're losing some neurological function, like we all do to some degree, you can millerate that by just by maintaining that medicine to your brain, which is exercise. It's never too late At all levels, no matter what their current level of conditioning is. There's always a level that people can do. They don't have to be major athletes, but there's always a level that they can do.

Tom Butler: 50:38

To the next step so you're one of those young, older, active people. So when you look at your own challenges for staying active and your own opportunities for staying active, how do you think of those personally, about the things that you'll encounter as you get older?

Dr. Patrick Hogan : 50:59

Right, and I agree, I always am concerned about the natural and aging factors. But, as I mentioned earlier, I think a goal is really important. We need goals to make at least I do and then I think it's an important part of human nature to have a goal to project towards. So right now we're out of the triathlon season, but I have ski seasons coming up with downhill skiing and cross-country skiing that I have to maintain conditioning for, otherwise I'll be injured. If I'm injured then I lose functions. So that's what drives me on, and there's going to be a time when I have more and more difficulty doing that because of natural aging effects.

Dr. Patrick Hogan : 51:40

But the idea is to stay at your potential, whatever that potential is at that point of time, and not to let it erode anymore than it needs to erode. But then toward the summer we'll get back to triathlons. My wife is also turning, is going into her 70s this summer. So as a celebration we're going to do an extended gravel bike trip that we're planning. So it's all idea of having something down the road I could carry it down the road that brings you forward, whether it's travel or an exercise event something that pulls you along to the next phase and not allowing yourself to deteriorate.

Tom Butler: 52:21

Is it fair to say that consistency is even more important as you get older?

Dr. Patrick Hogan : 52:26

That is really important. I remember there was a quote from a man that finished a marathon in his 90s and he says how can you do this at 90? And he said you just never stop. Because that's one of the things that happened when people stop for whatever reason, there's something about human nature. You lose your routine and you stop functioning that people just don't get back to it. So the idea is consistency, because I could make it routine, be consistent and realize that if you're going to say, well, I'm going to take a month or two off, you may not get back to it again. So it's like stopping your medicine for your blood pressure or whatever. You can't do that because it might kill you, and so you exercise as the medicine of life.

Tom Butler: 53:17

You mentioned the gravel bike trip and I'm wondering if you have any other adventures planned in the near future.

Dr. Patrick Hogan : 53:23

Well, I think, yeah, everything we do, whether it's ski trips coming up or a bike trip. We're going to be doing our first ever river cruise that's going to be involved biking on land in between stops next September. So again, that's me another goal. We need goals like that.

Tom Butler: 53:46

Where's your cruise going to be?

Dr. Patrick Hogan : 53:49

It's on the Danube.

Tom Butler: 53:49

Okay, okay.

Dr. Patrick Hogan : 53:52

It's going to be fun. They have little biking trips to stops along the way, so that's going to be fun.

Tom Butler: 53:59

That sounds awesome.

Dr. Patrick Hogan : 54:01

We did Glacier National Park this past spring, biking up to Logan Pass. My wife had some limitations at time because of the illness that she recovered from, so you had to use an e-bike at the time. But now we have the goal of us going to do it again, but let's do it with a regular bike. So all these things are goals that pull you forward to the next step Nice.

Tom Butler: 54:22

Well, Dr Hogan, I'm so thankful that you came on. I know you're busy and take the time to have. This conversation has been wonderful. I am so admiring of the approach you take to your practice and the personal example that you are. I just love all the things that you're talking about, that you're involved in all the things that you're providing for your patients that can help them make really positive lifestyle changes. So thanks for joining me.

Dr. Patrick Hogan : 54:52

Thank you very much. It's a great pleasure. Thank you, Dom.

Tom Butler: 54:54

Take care. Dr Hogan mentioned to mix up exercise so that we're not just focused on one activity over and over and over. I didn't think to ask, but I would like to get some additional feedback on that perspective. Is it possible to mix up my cycling enough to produce that dynamic If I'm climbing one day and then going for a long ride another day? Is that kind of variety enough? Maybe I need to mix in some mountain biking? I am wondering if I truly need to get off the bike to get the kind of variety he is thinking about. Of course, as I mentioned, I think dancing would definitely bring in a different activity for me and I do like the atmosphere around contra dancing.

Tom Butler: 55:44

I would love to hear what you do to complement cycling. I would also like to hear from people who struggle with maintaining flexibility. I need to stay inspired in that realm. I hope everyone out there is acclimated to the change of seasons and you are enjoying some different scenery. They temporarily closed my bike trail so I am discovering new routes. So, like me, keep focusing on how to work in more engaging rides and remember age is just a gear change.