Hello, health enthusiasts, and welcome to Rev Up Health, your go-to podcast for all things wellness. I'm Dr. Mark Hechler, and I'm Tandi Hechler. Together we're here to fuel your health journey with the best of functional medicine and holistic well-being. Each episode, we'll dive deep into topics that matter to your health, bringing you the latest insights, research, and inspiring stories. Whether you're on a quest for vibrant health or just looking for daily health tips, we've got you covered. So let's embark on this journey together and transform the way you live. So, Tandi, what's on our wellness radar for today?
Hello, and welcome to the Rev Up Health Podcast. Today we're going to fill you in on our most recent weekend of continuing education. We're just getting back from the Academy of Preventive and Innovative Medicine's annual academic summit. This year's title was "Powerhouse for Optimal Health."
This meeting has always been very informative. It's a yearly meeting — there are a lot of other meetings they have throughout the year — but this one is a little more appropriate, you could say, for a lot of the things that we do at Revelation Health and Wellbeing. It's not just about optimizing hormone health; it's more about optimizing metabolic health and things you can do to optimize your overall health and well-being. WorldLink Medical is also where Mark got his certification in advanced bioidentical hormone replacement therapy. This topic has continued to grow and expand, and there's a lot more interest now, so we thought we'd catch you up to speed with some of the topics that came out. A lot of the speakers were very well-versed, knowledgeable, well-published, and heavily followed in the social media space.
Evidence-Based Medicine and the Danger of Group-Think
What's really great about these meetings is that you get to see the evidence behind the thought. Oddly enough — well, not oddly, I guess it's pretty expected — as we were traveling, we were also listening to a great new book that's out called Blind Spots by Dr. Marty Makary. In his new book, he talks about blind spots in medicine, group-think, and cognitive bias, or cognitive dissonance.
That's one of the things that's so great about these offerings — it really does make you think about not doing things just because "that's the way we've always done it." Confirmation bias, cognitive dissonance — basically, trying to create opinions and recommendations based on scientific information. You have to be very aware, even from a scientific standpoint. In healthcare, as well as any scientific space, you have to ask: what kind of study is this? Is it an insurance-based study, just an observational study, or a causative study? There are a lot of details you have to read through in each of these studies to see what they're trying to prove or disprove — because you can take a meta-analysis of any study and make it say anything you want it to say. So you have to be very aware and look at the overall outcome.
Knowing the way Western medicine has been presented to you in the past, it may be someone's opinion, so you have to be careful how that opinion is perceived: is it a scientifically based opinion, or is it somebody's observation? I think that's where the faults have been overlooked, from cognitive dissonance and confirmation bias. We get a lot of opinions, and we get taught this in medical school or residency — "this is just the way you need to do things: you've got belly pain, you've got appendicitis, you need your appendix out." We can go down that path another time; that's part of another podcast, but that's part of that Blind Spots book by Dr. Makary, which was really important.
We've had the benefit of some really good speakers at this meeting, because they may not just be MDs or DOs — they're PhDs, or they have the specialty interest and the bioscience background to present these topics, and that was really enlightening to see.
The Power of Exercise
One of the other great things about this meeting is that we actually started talking about exercise in the first few sessions, which I really loved. "The physiologic basis of exercise for health benefits" was literally the topic of the first meeting. It emphasizes and reiterates a lot that we already know: there is certainly a role for exercise and health, no question about it. Cardiorespiratory fitness level is such a marker for overall health and longevity — good health is going to lead to longevity, so it goes hand in hand.
One of the great takeaways from this first session was "exercise snacks," which is a term I've heard before, but when you're sitting in a meeting, it becomes very evident how important it is to just get up and move your body for a second. What we mean by exercise snacks is literally getting up and doing 10 air squats. I was telling Tandi that when I get back to the office next week, I'm going to implement a program and have a sign on the break room door that to enter, you have to do some type of exercise snack. That might be kind of fun — I don't know how long that'll last, or who's going to police it — but it's certainly something that makes you think, because that muscle movement is a metabolic improver for mitochondrial health and fitness. And it's not only good for your body to move, it's good for your mind, because it gets you away from your screen or desk and gives you a little mental break.
Throughout the first couple of talks, it really emphasized the overall benefit of muscle fitness — the development of muscle fitness and hypertrophy with resistance exercise. It's unequivocally the number one thing for overall metabolic health, hands down. It goes beyond just having bigger or active muscles; it leads to a lot of metabolic benefits, like lowering insulin resistance, which is the driver of a lot of inflammatory processes and chronic disease.
They also talked about HIIT — high-intensity interval training — in the first couple of meetings. There are a lot of opinions about that, but elevating and raising your VO2 max — which is the body's ability to deliver oxygen to the cells — is very important for longevity and health. There's a lot of evidence that shows if, rather than just going for a sustained walk, you were to add some high intensity — and that may be as simple as hill work — going for a walk knowing you're going to hit this hill takes your intensity up a little. So it doesn't have to be what most people think of as high intensity.
They really drove the point home that everybody is at a different level in their health. For an elite athlete, high-intensity interval training versus somebody who's completely sedentary is different. High-intensity interval training for someone who's sedentary may be going up a flight of steps, and that's all they can do, whereas it may take extended one-mile hills to bring an elite person up to a high-intensity level. So it really is good for everyone — you can do this with any fitness level. They showed a significant benefit — I don't remember exactly off the top of my head, but when you do these short bursts, they talked about "five by ones" and "two by twos" — in other words, a group of five one-minute sessions of HIIT, or something as simple as two two-minute groups of HIIT, just a couple of times a week, two or three times a week — doing something like that will reduce your cardiac risk by 30-something percent. It's just incredible that even these small little bursts are so important.
That's something I think we can all work into our walk — don't just go out for a leisurely walk; hit it hard, walk as fast as you can, or walk up hills. I tell Tandi that's kind of what my HIIT is for running — my HIIT is basically hills. I like running hills because that's high-intensity interval training, and then I get the rest break coming down the hills. It's a way to build that in so you don't even think about it.
Motivational Interviewing
They also talked about how supporting a person's behavior during an exercise program is very important. A lot of people may have intentions of starting programs, but it's really hard to stick with them sometimes. As a trainer or healthcare provider, you have to provide options and choices for them on what they can do to start — you have to meet them where they are.
That is such a great thing that most providers don't get. If we're going to write a prescription for exercise, nutrition, or sleep, we have to really think about how to make this doable for the patient. So motivational interviewing was the topic, and it's so important. Providers — nursing doesn't get this in standard school, and you don't get it in personal training either, at least beyond a mention. It's all individualized, so it really depends on the individual and how sympathetic or empathetic you are toward the patient, and what the patient's capabilities even are. Some folks may have a hip or knee problem, so you can't expect them to do those exercises, and people aren't trained to do certain things correctly. It really is a collaboration that needs to happen in healthcare.
Deprescribing Medications
Then there was discussion about deprescribing medications. There are a lot of medications out there — SSRIs (antidepressants), PPIs (for gastric acid reduction) — and some of these can be harmful in the long term. They're helpful, yes, and a lot of folks need them; we have some great medications. But it's just like antibiotics — good for an acute situation, but something you can't chronically take. They talked about the different effects of the medications, the SSRIs, even the diabetic medications, and what's called HCTZ (hydrochlorothiazide), a diuretic. Some of these medications may not be very helpful in the long run, but they're what's prescribed and what's out there. The goal was to talk about trying to get folks away from prescription medications and onto a metabolic pathway for health.
It's very important to reiterate that there is a place for medications, and we need them, so use them as we need to — and then work on getting to a place where we don't need them, and knowing how to navigate that. I have an example coming to mind of a patient who was on a GLP-1 and losing a lot of weight, but wasn't followed as well as maybe they needed to be. Because they were losing so much weight, their blood pressure was coming down, and no one was watching to tell them they needed to come off their blood pressure medicine — now that they've lowered their weight, they don't need that medication anymore. So that causes a whole new line of issues.
There are a lot of folks on statins, on sleep medications — benzodiazepines and the Z-drugs — even osteoporosis prevention medications, the bisphosphonates. Those things may not necessarily be ideal long term. There's a lot we can do from a functional metabolic standpoint, but also from a hormone-support standpoint. There was a point about cognitive therapy for depression being 80 to 90% effective — more effective for controlling depression than the medications themselves, I believe. That's certainly important — knowing that sometimes it's too easy to give a pill to somebody.
The Critical Role of Sleep
There was a lot of discussion about melatonin and its importance, which was a very important topic with sleep, because they talk about how necessary sleep is — more necessary than we give it appreciation for. There was more than one session on sleep — multiple sessions. Melatonin is an option, and there's magnesium, L-theanine, GABA — a lot of different things that can be used for sleep. But some of the side effects of the medications we prescribe for sleep can be general cognitive decline, and more of an addictive issue — it's hard to come off some of those medications. There is also cognitive behavioral therapy for sleep.
A good seven to nine hours of sleep is going to do a lot of people a lot of good. If you're the person I used to be, who thought "I don't need much sleep, I can get by without it, go to bed late and get up early and keep going" — that's not true. Your brain needs the sleep. There's a complex array of repairs that happens in the central nervous system when we sleep; your brain just needs that reset. It's a reboot — like when your computer doesn't work well, the first thing you do is turn it off and turn it back on again. That's what happens with the brain and sleep.
Society has kind of ingrained it in us that you don't need sleep, or that you look more productive when you don't get as much sleep, but the truth is — let this be your permission to sleep. Get the sleep. A lot of us have this idea of "Oh, I'm lazy" — don't think that. Take the sleep, take the rest, you've got to do it.
Methylation and MTHFR
There was some new information about methylation issues — the MTHFR (methylenetetrahydrofolate reductase) enzymes. These are genetic mutations that cause us to not be able to methylate very well, or reduce our absorption abilities, and you'll have elevations of homocysteine, which is one of the labs we check in our panel. You're going to see low B12 and folate levels with these. These types of things can lead to inflammation, which leads to chronic disease — you can have some bone mineral density issues. There was also some talk about migraines and folks with other types of pain disorders that can be as simple as a methylation issue. That's something we all have to look at from an inflammatory standpoint.
Optimizing Nutrition
Then, nutrition — boy, they really drove home nutritional support for improving our metabolic health. We are literally in an unseen, quiet epidemic of overweight and obesity, and that is driving 90% of the chronic diseases we see — and these things are preventable. Insulin resistance and elevated glucose levels — our daily diet consists of about 70% carbohydrates, and a lot of that is in overly processed starches and sugars. This heavily processed stuff really weighs on our metabolic system.
It was a really good talk. Dr. Ben Bikman was there and presented a couple of different sessions for us, and Dr. Reynolds, his colleague, was also there and talked about glycation. Lots of great information on nutrition and how to help offset diabetes and elevated A1c (hemoglobin A1c). Just to realize that at least 90% of the adult population is metabolically unhealthy, and that translates into chronic disease.
The Pros and Cons of GLP-1 Medications
Of course, there were discussions about GLP-1, which we touched on earlier. The consequences of that can be decreased GI motility — it does put some people at risk for constipation or absorption issues. If you get too high in some of these concentrations of the GLP-1 agonist, you start having GI issues and symptoms. It promotes satiety, but the problem is that it may not be well regulated, monitored, or followed. We know the medications work, but we've got to watch to make sure we don't lose too much muscle mass, because 40% of the amount of weight loss people experience on these GLP-1 agonists is lean mass. So it's really important — just like any medication, there's a place for it, but being aware of all the details so you make it most effective overall.
They mentioned that you can't stay on this forever; it's not something you want to be on forever. I think it was about 70% of the people, if I'm not mistaken — I should check my notes — about 70% of people in two years weren't on the GLP-1 agonists anymore. But there are some people who are on a maintenance low dose, because there are some anti-inflammatory benefits from it, and insulin resistance gets improved. But there are things we can do — we have to educate ourselves and each other about what can be done to help maintain this long term. That may be something as simple as fats, fiber, and protein — those things will increase GLP-1 also — but also good gut health, having a good, appropriate microbiome with the Akkermansia bacterium, which can elevate our GLP-1 production and help us out.
Menopause and Hormone Health
Last but not least, the last day was about menopause and menopausal hormone therapy. I won't go into all the details about the WHI trial — the Women's Health Initiative — from 2002, but it just needs to be said that menopause is basically an estrogen reduction, and that's going to lead to cardiovascular disease, bone loss, sarcopenia, sexual dysfunction, UTIs, and cognitive decline, and may even increase your risk for certain types of cancers by having estrogen deficits. So for a female — and for men too, but for females specifically — hormone replacement therapy is a good thing.
What we really wanted to point out is that there's a difference between estrogens, and a difference between progestins — they're not all created the same. There are the bioidentical hormone replacements, which we've talked about before, and then there are the synthetic forms. The bioidentical hormone replacement forms are the ones that have the better track record, and there's no reason to be scared of those. They are going to improve the quality of life for a female going forward into the adult years, period. There's absolutely no reason to be scared of these things. If a person wants to be on them, they can; if they don't want to be on them, they don't have to — it depends on what quality of life you want.
We're hearing more about that all the time, and I know we're going to continue to hear more and more, and they're going to be doing more studies. There was a recent paper one of the speakers had just published, where she talked about the differences and what the original study said, and how it just got snowballed into the media and scared people away. As a result, literally hundreds of thousands of women are going to lose their life and have issues from a lack of hormone therapy going forward. That may sound like an exaggeration, but I don't think it is — when you start thinking about the osteoporosis fractures, the cognitive decline, and the cardiovascular risks that go with a lack of estrogen into the later years of life, it makes a huge difference.
Wrapping Up
So that kind of sums it up — that's our two-and-a-half-day education event in a nutshell. We just wanted to give you a peek inside the things we're learning and excited about and open to hearing more about. And think about it — we talk about this all the time — this is a process, an ongoing process. If you get into the idea of cognitive dissonance or confirmation bias, that "this is the way you've been taught, this is the way it is, and this is the way it's going to be," it's hard to get out of that. So you really need an open mind, and you need to be aware that going forward, this process is going to have updates. All the information we gain now — in 10 years, who knows if it's going to be more important or less important. But that's why we do this stuff, and we hope we can provide a little information and insight on how people can improve their metabolic health. Thanks for tuning in, we'll see you next time. Bye-bye.
Thank you for tuning in to another episode of Rev Up Health. We hope you're leaving with some valuable insights to supercharge your health journey. Don't forget to follow or subscribe to Rev Up Health wherever you listen to your podcasts, and if you enjoyed today's episode, please leave us a rating and review. Have a topic you want us to explore? Reach out to us on our social media channels — we love hearing from our wellness community. Until next time, keep thriving, and remember: your journey to health is a journey to a better you. Stay well, and we'll connect with you again soon. This is Tandi, and this is Dr. Mark, signing off from Rev Up Health. Take care.
The information provided in this podcast is for educational purposes only and is not intended as medical advice. The content is designed to support, not replace, the relationship that exists between a patient and their healthcare provider. Always consult with a qualified healthcare professional before making any changes to your healthcare regimen, including diet, exercise, or treatment plans. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official policy or position of Revelation Health and Wellbeing.