Fighting Heart Disease Like Cancer: A Conversation with Dr. Mike McConnell

In this episode of the Bionic Health podcast, Dr. Jared Pelo sits down with cardiologist Dr. Mike McConnell to discuss a revolutionary approach to heart disease prevention. Dr. McConnell, who authored the book "Fight Heart Disease Like Cancer," shares his expertise on early detection, risk assessment, and proactive treatment strategies.

Rethinking Heart Disease

Dr. McConnell challenges the traditional view of heart disease as simply a "plumbing problem" where arteries gradually get clogged. Instead, he frames it as an active biological process more similar to cancer, where growths develop in the arteries that supply blood to the heart. These growths can remain asymptomatic until a blood clot forms, potentially causing a sudden and catastrophic event - as happened with Dr. McConnell's own father-in-law.

"We're in this amazing era of tools, both for prevention from a lifestyle perspective and from a medication perspective that we can really stop this," Dr. McConnell explains. "We shouldn't be having people who have blockages and need stents or bypass surgery or having heart attacks."

Early Detection and Screening

The conversation explores various screening methods for heart disease, including:

1. Risk Assessment Scores - Evaluating factors like age, gender, cholesterol levels, blood pressure, diabetes status, and smoking habits
2. Coronary Calcium Scans - A rapid CAT scan that detects calcified plaques in arteries
3. CT Angiograms - More detailed imaging that shows both calcified and soft plaques
4. Retinal Imaging with AI - An innovative approach using eye scans to detect cardiovascular risk

Dr. McConnell highlights the importance of early screening, especially for those with a family history of heart disease. He also discusses how these imaging tools can help motivate patients to take their risk factors seriously and adhere to treatment plans.

The Essential Eight for Heart Health

The American Heart Association's "Life's Essential Eight" provides a framework for heart disease prevention:

1. Blood sugar management
2. Cholesterol control
3. Blood pressure regulation
4. Regular physical activity
5. Healthy diet
6. Avoiding smoking
7. Maintaining healthy weight
8. Getting adequate sleep

Dr. McConnell adds two more important factors to this list: limiting alcohol consumption and managing stress.

Combining Lifestyle and Medication

While lifestyle modifications are important, Dr. McConnell acknowledges their limitations. He advocates for a combined approach:

"The more you can do with lifestyle, the less you need medication. So that's sort of part of the bargaining or discussion that we have," he explains.

Dr. McConnell notes that only about one in three eligible people in the US are taking cholesterol-lowering medication, even though guidelines would recommend it. He sees tremendous opportunity in increasing awareness and proactive treatment.

Looking to the Future

Dr. McConnell shares exciting developments in heart disease prevention, including using AI to analyze retinal images for cardiovascular risk assessment. His company, Toku, is working to bring this technology to market, which could potentially identify at-risk individuals during routine eye exams.

"Not everybody's day to day, unlike me, most people are not thinking about their heart disease risk every day," he says. "Why not when you're making contact with optometry, ophthalmology, getting an eye exam, that there's an opportunity to say, look, your retina looks like you have some increased risk."

For those interested in learning more, Dr. McConnell's book "Fight Heart Disease Like Cancer" and website (FHDLC.info) provide additional resources and guidance.

As Dr. Pelo notes at the conclusion of their conversation, following Dr. McConnell's advice on screening and prevention could save countless lives - perhaps the greatest impact a physician can have.

Timestamps:

00:00 - Introduction and welcome
00:22 - Dr. McConnell's background and career journey
03:09 - How Dr. McConnell decided to become a physician
05:35 - Framework for understanding heart disease
09:18 - Personal stories motivating heart disease prevention
10:30 - Heart disease screening approaches and risk assessment
14:58 - The "Life's Essential Eight" for heart health
19:11 - Retinal imaging for cardiovascular risk assessment
24:03 - Expanding heart health screening through eye exams
27:08 - Using imaging to motivate patients
30:05 - Balancing lifestyle changes and medication
33:39 - Advanced imaging: CT angiograms and soft plaque detection
40:15 - Where to find more information
41:22 - Closing thoughts

Member Spotlight: Alex Ladan on Finding Personalized Health Support After Competitive Athletics

In this Member Spotlight, we talk with Alex Ladan, former gymnast and current clinical researcher in women's health, about her journey with Bionic Health and how personalized health coaching has transformed her approach to nutrition, stress management, and overall wellness.

From Competitive Athlete to Health Researcher

Alex Ladan's relationship with health and fitness began early. As a former gymnast, she was accustomed to being considered "healthy" simply because she was athletic. "Growing up as an athlete, I was always just considered healthy," Alex explains. "I was never given true information about anything. It was like checking the box—you went to your physical, great job, how's gymnastics going? And that was it."

This experience ultimately led Alex to pursue kinesiology in undergrad, followed by a master's degree in sports science at UNC Chapel Hill. Now working in clinical research focused on women's health, Alex brings a unique perspective to her own health journey.

Why Bionic Health?

When Alex moved to North Carolina for her master's program, she faced challenges many young adults encounter: managing her own healthcare appointments for the first time while balancing a rigorous academic schedule.

"It was my first time moving away from home, which came with making my own doctor's appointments and keeping up with my health," Alex shares. "I really liked the flexibility of Bionic, but I also really liked the advisor portion of it."

What particularly appealed to Alex was Bionic's comprehensive approach that went beyond what traditional providers typically addressed: "It brought in the body composition piece, the exercise piece, all of the things that I feel like my traditional provider was never asking me about or never really understood because I was a gymnast and I was active, so that was good enough."

Evolving Goals and Personalized Support

One of the most valuable aspects of Alex's Bionic Health experience has been working with her advisor, Anna. Their relationship has allowed Alex to address changing priorities over time—from managing nerve pain and anxiety to developing sustainable nutrition practices and preparing for her upcoming wedding.

"I feel like my goals change every time I meet with her," Alex laughs. "I think originally I was experiencing some nerve pain, and I wasn't sure if it was related to physical activity or high anxiety levels."

Through regular check-ins with Anna, Alex gained important insights about stress management. "She helped me a lot with recognizing that from an outsider's perspective, like, 'Yeah, actually, this is not a normal level of stress.'"

Making Nutrition Personal

For Alex, nutrition was a complicated area due to her gymnastics background. "I was hyper-fixated on food for my entire upbringing," she explains. After years of not thinking consciously about nutrition during college, Anna helped her develop practical approaches to meal planning.

"She helped me a lot with understanding the importance of planning my meals before work...things that are maybe so small and mundane but ended up being really impactful for me."

Rather than following a one-size-fits-all approach, Alex and Anna crafted strategies that worked for her specific preferences. For instance, with meal prep, Alex notes: "I don't like to feel like I'm eating the same thing over and over again. I can prep fruits, vegetables, and starches, but I have to prepare my protein each day. Otherwise, mentally, I just don't feel like it's fresh."

Meaningful Progress Beyond Numbers

The true value of Alex's Bionic membership has been in the gradual, sustainable changes that have significantly improved her quality of life:

• Improved Energy Levels: By tracking her sleep and adjusting her alcohol consumption, Alex noticed dramatic improvements in her energy throughout the week. "I used to feel like I'm dragging my feet on Monday and Tuesday. But now I actually look forward to Sundays because I look forward to prepping my meals, and then I feel more energized going into the week."
• Better Work-Life Boundaries: With Anna's guidance, Alex transformed her morning routine. "I would wake up and immediately start mentally clocking into my job. Now I take more time in the morning for restorative activities, listening to a podcast during my commute instead of thinking about work."
• Personalized Approach to Protein: Rather than tracking all macronutrients, Alex focused specifically on protein intake. "It's actually funny that you asked specifically about protein because that is really the only thing that I keep track of each day."

Working Through Barriers, Not Around Them

One of the most valuable aspects of Alex's experience has been identifying and addressing barriers to her goals. For example, when discussing resistance training: "I remember myself being like, 'Well, this is the reason why that's not going to work.' And then we talk through it...recognizing what the barriers are is so, so key."

Alex appreciates the collaborative approach: "It's never just Anna being like, 'You need to do this, and if you don't do it by the next time we meet, then you failed.' It's more fluid and a conversation."

Advice for Health Professionals

As someone with a background in health and fitness, Alex offers valuable insight for other professionals who might think they already know enough:

"It is so hard for me to stay consistent with a routine of exercise and nutrition when I get really busy. This helps to have something consistent. Maybe in the periods where I'm falling through the cracks with my own nutrition and exercise, I have somebody there consistently."

Looking Forward

As Alex approaches her one-year anniversary with Bionic Health, she reflects on how her goals and motivations have evolved: "What I would have said at the beginning and what I would say now is so different—why I'm still a member has changed so much across time."

With her wedding approaching later this year, Alex continues to work with Anna on maintaining a healthy perspective amidst wedding culture pressures. "I told her upfront, 'I feel like this is going to become an issue, and it hasn't yet, but I can feel it starting.' And just having her to talk through that and talk through the things that maybe I'm seeing on the internet and to help get ahead of it has been really helpful."

Interested in learning how Bionic Health can support your health journey? Contact us today to learn more about our personalized approach to optimal health.

Interview Timestamps:

• 0:00 - Introduction
• 0:56 - Why Alex joined Bionic Health
• 3:02 - Initial health goals and expectations
• 5:54 - Meeting frequency with health advisor
• 8:02 - Stress management and physical symptoms
• 11:33 - Perspective changes as a Bionic member
• 15:08 - Insights from lab testing and body composition
• 16:50 - How Alex feels different since starting
• 24:34 - Advice for health professionals
• 34:15 - Conclusion

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The Science of Better Sleep: Inside Bionic Health's Comprehensive Sleep Module

In the latest episode of Medicine 3.0, Bionic Health advisor Kelly Joniak and Dr. Catherine Isaac dive deep into one of our most popular offerings: the Sleep Module. This conversation reveals the multifaceted approach Bionic Health takes to help members optimize their sleep quality and understand the factors affecting their rest.

A Comprehensive Approach to Sleep Health

Dr. Isaac explains that Bionic's Sleep Module stands out for its thoroughness, combining multiple data sources to create a complete picture of a member's sleep patterns:

• Sleep diaries: Members record morning and evening sleep habits, providing insights into sleep quality, bedtime routines, and daytime factors affecting sleep
• Wearable data integration: Information from devices like Whoop, Oura, Apple Watch, or Garmin is analyzed alongside self-reported data
• Specialized assessments: Evaluations for stress, depression symptoms, sleep apnea signs, and chronotype (morning/evening preference)
• Laboratory testing: Thyroid function, basic metabolic panel, hormone levels including progesterone for women
• Cortisol measurement: Both serum and salivary cortisol testing to understand stress hormone patterns throughout the day

Key Insights from the Conversation

Understanding Your Chronotype

Dr. Isaac discusses how knowing whether you're naturally a morning person, evening person, or somewhere in between can help you optimize your schedule and understand potential sleep challenges. This is particularly relevant when family members have different chronotypes, requiring thoughtful coordination.

The Truth About Sleep Supplements

The episode covers several popular sleep aids with evidence-based perspectives:

• Melatonin: Most beneficial for elderly populations with naturally declining levels, shift workers, and travelers—not generally recommended for routine insomnia. Dr. Isaac cautions that over-the-counter supplements often contain higher doses than necessary.
• Ashwagandha: May help reduce cortisol levels and has anxiety-reducing properties that can improve sleep onset.
• Magnesium: Dr. Isaac specifically recommends magnesium threonate for sleep as it's the only form that crosses the blood-brain barrier.
• CBD: May reduce core body temperature (potentially facilitating sleep onset), but insufficient research exists on its effects on sleep architecture.

Wearable Data vs. Reality

A fascinating discussion explores the discrepancies between wearable sleep tracking data and self-reported experiences. Dr. Isaac cautions against letting your wearable device "tell you how to feel," citing research showing how suggestible we are about our sleep quality.

Lifestyle Factors Affecting Sleep

The episode covers practical recommendations about:

• Caffeine consumption (ideally limited to 1-2 cups before 1-2pm)
• Pre-bedtime activities (with warm showers or baths recommended over screen time)
• The relationship between exercise, nutrition, and sleep quality

Why Sleep Matters (But Don't Stress About It)

Dr. Isaac strikes a thoughtful balance, emphasizing that while consistent quality sleep is important for health, occasional poor nights aren't cause for alarm. The research on sleep's health impacts primarily concerns chronic patterns over years, not occasional disruptions.

"I find that when I'm actually doing the review of the sleep data, I find that to be really interesting and I think to help provide important insights," Dr. Isaac notes, highlighting how the module helps members understand their unique sleep patterns.

Ready to optimize your sleep? The Bionic Health Sleep Module provides actionable insights for improving this critical aspect of health. Listen to the full episode for more detailed recommendations and reach out to our team to learn how this module might benefit your health journey.

Timestamps:

• 00:05: Introduction to the Sleep Module
• 00:31: Components of the comprehensive sleep assessment
• 05:06: Understanding cortisol patterns and sleep
• 07:17: Lab tests and what they reveal about sleep issues
• 10:13: Chronotypes and how they affect sleep patterns
• 18:07: Discrepancies between wearable data and self-reported sleep
• 24:55: Optimal sleep duration and impacts across life stages
• 30:46: Evidence-based supplement recommendations
• 38:41: Caffeine consumption guidelines for better sleep

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Understanding Brain Aging and the Fight Against Alzheimer's

In the latest episode of Medicine 3.0, Dr. Jared Pelo sits down with Dr. Christin Glorioso, physician, neuroscientist, and founder of NeuroAge, to discuss brain health, Alzheimer's prevention, and the cutting-edge science of measuring brain aging.

A Personal Mission Driven by Family History

Dr. Glorioso's journey into brain health research began with personal experience—her grandmother suffered from Alzheimer's disease, and she recently discovered she carries an APOE4 allele, which increases her own risk. This personal connection has fueled her 20-year career studying brain aging and what can be done to slow it down.

"My life has been dedicated to coming up with better solutions for people who have high risk of Alzheimer's, which if anyone lives long enough, that's really all of us," Dr. Glorioso explains.

The Science of Brain Aging

After completing her MD-PhD at the University of Pittsburgh and Carnegie Mellon, followed by postdoctoral work at MIT, Dr. Glorioso has focused on understanding the molecular changes that happen in the brain as we age. Her research reveals that approximately 2,000 RNA transcripts (about 10% of the genome) change with age in ways that can either protect against or increase the risk of neurodegenerative diseases.

One of the most encouraging findings: people whose brains are biologically five years younger than their chronological age are significantly protected from Alzheimer's disease—even if they carry genetic risk factors like the APOE4 allele.

The 40% We Can Control

While genetics plays a significant role in brain aging, Dr. Glorioso emphasizes that approximately 40% of our risk is determined by lifestyle factors we can control:

1. Exercise - At least 30 minutes daily, with particular benefits from getting your heart rate into zone three, which releases BDNF (brain-derived neurotrophic factor)
2. Diet - Mediterranean diet, coffee, tea, and foods rich in polyphenols (like berries)
3. Social connection - At least an hour of social time daily
4. Stress reduction - Cortisol is particularly harmful to brain cells
5. Mental activity - At least an hour daily of mentally challenging activities
6. Sleep - Quality sleep is essential for brain health

Measuring Brain Age

NeuroAge has developed multiple approaches to measuring brain health:

• RNA biomarkers - Blood tests measuring 52 RNA transcripts
• Cognitive testing - "Neuro games" that assess various cognitive functions
• MRI brain imaging - Measuring volumes of 26 different brain regions
• Genetic testing - Identifying genetic risk factors

While MRI provides the most accurate assessment followed by blood biomarkers and cognitive testing, Dr. Glorioso notes that even simple cognitive tests can help determine whether memory issues are normal for your age or potentially concerning.

The Future of Alzheimer's Prevention

Beyond testing, NeuroAge is working toward developing therapies to reverse brain aging—essentially creating a "statin for Alzheimer's" that could safely prevent the disease. The data collected through their testing program contributes to this research in a privacy-protected way.

"We're creating therapies to reverse brain aging... something that's safe, you know, a pill that people can take that is going to prevent Alzheimer's in the future," Dr. Glorioso shares.

This partnership between Bionic Health and NeuroAge represents an exciting opportunity for members to assess their brain health and take proactive steps toward preventing cognitive decline. As Dr. Pelo notes, even without extensive testing, everyone can benefit from living as though they're at high risk—the lifestyle interventions that protect brain health also enhance overall quality of life.

Timestamps:

• 00:18: Introduction and Dr. Glorioso's background
• 02:11: Dr. Glorioso's path to neuroscience and MD-PhD training
• 07:27: Research at MIT and Pittsburgh on human brain aging
• 15:04: How RNA transcripts relate to brain aging and disease
• 18:22: The six key lifestyle factors affecting brain health
• 24:12: NeuroAge's three main testing approaches
• 27:59: The future goal: creating therapies to reverse brain aging

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The Science of Body Composition: How DXA Scans Help Optimize Your Health Journey

In a recent episode of Medicine 3.0, Bionic Health physician Dr. Catherine Isaac and advisor Kelly Joniak dive deep into the world of body composition analysis, specifically focusing on DXA scans and their importance in health assessment and optimization.

Understanding Body Composition Assessment

The conversation begins with Kelly explaining different methods of body composition assessment. DXA (dual-energy X-ray absorptiometry) scans emerge as the gold standard, providing a three-compartment model that measures:

• Bone mineral density
• Fat mass
• Fat-free mass (including lean soft tissue)

While home bioimpedance scales (BIA) only measure two compartments (fat and fat-free mass), DXA provides a more comprehensive picture with greater precision. Kelly describes BIA scales as "reliably unreliable" - consistent but not always accurate compared to DXA measurements.

Beyond Aesthetics: The Medical Value of Body Composition

Perhaps the most compelling aspect of the discussion is how body composition analysis serves as a powerful preventive healthcare tool. Dr. Isaac shares several examples of how DXA scans help identify health risks that might otherwise go undetected:

• Visceral adipose tissue (VAT): This fat surrounding internal organs is invisible from the outside but strongly correlates with chronic disease risk. DXA can precisely measure VAT, helping identify people at risk for diabetes, cardiovascular disease, and even fatty liver disease.
• Bone health: DXA provides T-scores and Z-scores that can signal early bone density concerns, particularly valuable for perimenopausal women and men with potential testosterone deficiency.

As Dr. Isaac notes, "We're definitely being proactive in a way that you don't normally have the tools to be."

Common Misconceptions and Mindset Shifts

The podcast challenges several fitness myths:

1. "I just want to lose weight": The experts emphasize that body composition matters more than the number on the scale. Someone might maintain the same weight while replacing fat with muscle, drastically improving their health.
2. "Muscle is more metabolically active than fat": Kelly clarifies that both tissues are metabolically active - a surprising correction to a common belief.
3. "Progress is linear": Both experts stress that health improvements rarely follow a straight line. Consistency matters more than perfection.

The Importance of Community and Consistency

Beyond the technical aspects, the conversation highlights the human elements that contribute to success. Kelly emphasizes that having supportive community makes consistency easier, whether it's workout partners, family involvement, or the workplace culture at Bionic Health.

Dr. Isaac shares her personal journey with weight training, including setbacks and the mental training that came with them: "Mindset is really what's going to help you achieve your goal, whatever area of your life."

Finding Your "Why"

The podcast concludes with both experts sharing their personal motivations for maintaining physical health. For Dr. Isaac, it's keeping up with her active son. For Kelly, it's seeing her 60-70 year old mother and aunt living vibrant, active lives - playing pickleball daily or hiking mountains around the world at 70.

These personal stories remind us that the numbers from a DXA scan aren't the end goal - they're tools to help us live fuller, more active lives for decades to come.

Whether you're looking to optimize athletic performance, prevent chronic disease, or simply understand your body better, this conversation provides valuable insights into how modern body composition analysis can guide your health journey with precision and purpose.

Timestamps:

• 00:01: Introduction to the Body Composition Module
• 01:48: Explanation of DXA scan technology
• 06:13: Drawbacks of different body composition methods
• 09:37: Information about skinfold testing
• 13:45: Discussion of visceral adipose tissue (VAT)
• 15:27: How visceral fat relates to chronic disease risk
• 18:33: Exercise recommendations for reducing visceral fat
• 21:05: Bone mineral density assessment
• 24:25: Importance of protein for muscle and bone health
• 27:32: Shifting focus from weight to body composition
• 30:08: Metabolic activity of fat and muscle tissue
• 32:41: Non-linear nature of progress
• 37:04: Dr. Isaac's personal training journey
• 40:26: Discussion of finding your "why"
• 42:34: Kelly shares her personal motivation

Understanding Dietary Fats: The Essential Guide

When it comes to nutrition, few topics have been as controversial as dietary fat. Once vilified as the enemy of health, we now understand that fats play crucial roles in our body's functioning. Let's dive deep into the world of lipids and discover why they're an indispensable part of a healthy diet.

The Fundamentals of Fat

Dietary fat, scientifically known as lipids, is one of the three macronutrients our body needs. At nine calories per gram, it's our most concentrated source of energy, packing more than twice the calories of proteins or carbohydrates. But energy provision is just one of its many vital functions.

Essential Functions of Dietary Fat

• Provides insulation for body temperature regulation
• Supports cell membrane structure and integrity
• Facilitates absorption of fat-soluble vitamins (A, D, E, and K)
• Serves as a precursor for hormone production
• Acts as a protective cushion for vital organs
• Contributes to brain health and function (Fun Fact: The brain is ~60% fat!)

Types of Dietary Fat: Not All Fats Are Created Equal

Understanding the different types of fats is crucial for making informed dietary choices. Each type has unique properties and effects on our health.

1. Saturated Fats

• Solid at room temperature
• Found primarily in animal products and some plant sources
• Stable for cooking at high temperatures

Common Sources: Meat and dairy products, coconut oil, palm oil

While historically demonized, current research suggests the relationship between saturated fat and health is more nuanced than previously thought. The key is moderation and considering the overall dietary pattern. A good goal is to have calories from saturated fat intake account for <10% of daily calories. Saturated fats may contribute to cognitive decline and neuroinflammation so moderation is key.  

2. Unsaturated Fats

These "heart-healthy" fats come in two main varieties:

Monounsaturated Fats

Benefits:

• Lower LDL (bad) cholesterol levels
• Maintain or increase HDL (good) cholesterol
• Provide antioxidants
• Support heart health

Common Sources: Olive oil, avocados, nuts (especially almonds and macadamia nuts), seeds

Polyunsaturated Fats (PUFAs)

These essential fats must come from our diet as our bodies cannot produce them.

Omega-3 Fatty Acids

• Support skin health
• Maintain blood vessel integrity
• Promote organ health
• Reduce inflammation
• Decrease cognitive decline and neuroinflammation

Omega-6 Fatty Acids

• Aid brain development
• Support cognitive function
• Regulate metabolism

The ideal ratio of omega-6 to omega-3 should be around 5-10:1, with approximately 2 grams of omega-3s per day for optimal health.

3. Trans Fats

Trans fats come in two forms:

Natural Trans Fats:

• Found in small amounts in some animal products
• Less concerning from a health perspective

Artificial Trans Fats:

• Created through industrial hydrogenation
• Found in processed foods
• Should be avoided whenever possible

Common Sources to Avoid:

• Processed baked goods
• Microwave popcorn
• Frozen pizzas
• Coffee creamers
• Deep-fried foods

Timing Your Fat Intake

The timing of fat consumption can significantly impact its effects on your body, particularly around exercise:

• Pre-workout: Limit fat intake as it slows digestion and may cause gastrointestinal discomfort
• Post-workout: Include moderate amounts to support recovery and hormone production
• Throughout the day: Space fat intake evenly across meals for steady energy

Practical Guidelines for Fat Consumption

1. Prioritize Quality:
   
   • Choose whole food sources of fat
   • Opt for minimally processed oils
   • Include a variety of fat sources in your diet
2. Balance is Key:
   
   • Include both plant and animal sources
   • Aim for a mix of saturated and unsaturated fats
   • Monitor portion sizes (remember: fats are calorie-dense)
3. Smart Substitutions:
   
   • Replace processed snacks with nuts and seeds
   • Use olive oil instead of butter when appropriate
   • Choose fatty fish over processed meats

Conclusion

Fat is not the dietary villain it was once thought to be. In fact, it's an essential nutrient that plays numerous vital roles in our health. The key is choosing the right types of fats, consuming them in appropriate amounts, and timing them correctly around your activities. By understanding these principles, you can make informed choices about incorporating healthy fats into your diet while supporting your overall health and fitness goals.

Remember: no single nutrient is inherently "good" or "bad" – it's all about context, quantity, and quality. Focus on incorporating a variety of healthy fat sources into a balanced diet that supports your individual needs and goals.

Note: Always consult with a healthcare provider or registered dietitian for personalized nutrition advice, especially if you have specific health conditions or concerns.

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Brain Health: How Music and Lifelong Learning Can Prevent Cognitive Decline

In our latest Bionic Health podcast, Dr. Jared Pelo interviews neurologist-turned-entrepreneur Dr. Josh Turknett about the science of brain health, cognitive decline prevention, and how learning complex skills like music can help maintain brain function as we age.

From Neurologist to Music Education Innovator

Dr. Josh Turknett's journey is anything but conventional. After completing medical school and a four-year neurology residency at the University of Florida, he spent years in private practice treating neurological conditions. But over time, he began to recognize a significant gap between what he could offer patients in clinical practice and what he believed they truly needed.

"I came to realize that a lot of the issues I was seeing as a neurologist were related to lifestyle and preventable types of things," Dr. Turknett explains. Through his own experience with migraines, he discovered that dietary changes had a more profound impact on his condition than conventional treatments—a revelation that would eventually lead him to reconsider his entire approach to neurological health.

While still practicing neurology, Dr. Turknett pursued his passion for music, specifically the banjo. Drawing on his background in cognitive neuroscience, he began integrating principles of neuroplasticity into his musical practice. This eventually evolved into BrainJo, an innovative platform that teaches musical instruments through neuroscience-based approaches.

The "Stimulate and Support" Framework for Brain Health

When it comes to maintaining cognitive health, Dr. Turknett advocates a simple yet powerful framework: stimulate and support.

"There are two things to think about in terms of keeping a healthy brain throughout our life," he says. "We have stimulation on one side and support on the other side."

Stimulation: Fighting Autopilot Mode

Cognitive stimulation is essential for maintaining brain health, but Dr. Turknett points out that many of us, especially in established careers, operate largely on autopilot. "The more you can spend your day on autopilot, the less cognitive stimulation you've provided," he explains.

Real cognitive stimulation comes from activities that trigger plastic reorganization in the brain—essentially, learning new knowledge and skills. This is where complex activities like learning a musical instrument come in.

BrainJo currently offers instruction in multiple instruments:

• Two styles of banjo (claw hammer and fingerstyle)
• Piano
• Ukulele
• Fiddle
• With guitar coming soon

Support: Giving Your Brain What It Needs

Just as important as stimulation is providing your brain with the resources it needs to maintain existing neural connections and build new ones. Dr. Turknett identifies several key pillars of brain support:

1. Physical activity - Particularly activities that combine cardiovascular fitness, strength training, and cognitive demands (like tennis or pickleball)
2. Sleep and rest - Critical for neural recovery and consolidation
3. Nutrition - Including key nutrients like B12, vitamin D, magnesium, zinc, and copper
4. Stress management - Limiting chronic stress that can damage brain tissue
5. Social connection - Perhaps the most underappreciated factor in brain health

On the often-overlooked importance of social interaction, Dr. Turknett notes: "Being around other people, conversing with other people, being in social situations is an enormous cognitive stimulus... one of the reasons that we see [cognitive] deterioration is because of the loss of that stimulus when people are isolated."

Assessing Cognitive Risk and Monitoring Brain Health

Many people, especially those with family histories of dementia or genetic risk factors like APOE4, wonder how to assess their risk for cognitive decline. Dr. Turknett emphasizes that while there's no single test that can definitively predict risk, there are several approaches to monitoring brain health:

• Regular cognitive assessments, whether through formal testing or self-monitoring
• Basic blood work to identify conditions like metabolic syndrome or nutritional deficiencies
• Lifestyle evaluation to identify areas for improvement

He recommends foodforthebrain.org for those interested in comprehensive cognitive evaluation with a nutritional focus.

Rather than viewing cognitive health as predetermined, Dr. Turknett stresses that "we are actively influencing our risk all the time." This empowering perspective frames brain health as something we can continuously improve through our daily choices.

Anyone Can Play Music: The Science of Learning at Any Age

Dr. Turknett's new book, "Anyone Can Play Music: How to Realize Your Musical Potential with the Laws of BrainJo," challenges the common belief that learning complex skills like music becomes impossible as we age.

"The reason we can learn anything at any age is because we have this ability to change the brain at any age," he explains. "Learning complex skills relies on neurological mechanisms that we all share."

The book outlines principles for leveraging these natural mechanisms, often requiring readers to unlearn ineffective approaches taught in traditional education. It's as much about how to learn anything as it is about music specifically.

A Prescription for Brain Health

For someone in their mid-40s concerned about future cognitive health, Dr. Turknett recommends:

1. Evaluate your current cognitive stimulation - Is your work challenging your brain, or are you on autopilot?
2. Incorporate complex real-world skills - Music, dance, or sports that demand coordination and strategy
3. Ensure physical fitness - Combining low-level movement, resistance training, and occasional high-intensity exercise
4. Monitor nutritional status - Particularly for B12, vitamin D, and other brain-essential nutrients
5. Prioritize social connection - Ideally through activities that simultaneously provide cognitive stimulation

The key is finding activities you enjoy that provide both cognitive challenges and social connection—like joining a community of musicians or picking up a sport like pickleball that combines physical activity, strategy, and social interaction.

Beyond the Clinic: Making a Broader Impact

Dr. Turknett's transition from clinical practice to entrepreneurship reflects his desire to have a greater impact on brain health than the constraints of a traditional medical practice would allow.

"To actually fulfill the role that I initially signed up for... I could do a much better job doing what I'm doing now than I could in the clinic," he reflects. Through his online platform, books, and educational content, he's able to reach and help far more people than would be possible seeing patients one at a time.

This sentiment resonates with Dr. Pelo, who made a similar transition from emergency medicine to focusing on preventative health through technology. Both physicians recognize that while there will always be a need for excellent clinicians, there's also tremendous value in creating scalable approaches to health that can benefit millions.

Time Stamps:

00:01 - Introduction and welcome

00:13 - Josh's background and journey from neurologist to entrepreneur

02:59 - Josh's personal experience with migraines and lifestyle changes

03:59 - Discovering neuroplasticity and challenging fixed mindsets about adult learning

06:51 - Transitioning from clinical neurology to broader impact

10:09 - The challenge of leaving clinical practice and finding new ways to help people

11:40 - How BrainJo evolved to address cognitive health

14:33 - Musical instruments you can learn at BrainJo (banjo, piano, ukulele, fiddle)

15:26 - Assessing cognitive decline risk and preventative strategies

17:39 - The importance of monitoring cognitive function

18:37 - Key nutrients for brain health (B12, vitamin D, magnesium, zinc, copper)

20:33 - Why genetics isn't deterministic for cognitive decline

21:29 - The value of cognitive testing and brain games

23:27 - Practical advice for a 45-year-old to prevent cognitive decline

24:03 - The "stimulate and support" framework for brain health

29:19 - What types of physical activity are best for brain health

33:08 - The surprising importance of social connection for brain health

36:46 - Josh's new book "Anyone Can Play Music" and the science of learning

40:31 - Conclusion and where to find more information

Learn More

To discover more about Dr. Turknett's approaches to brain health through music, visit brainjo.academy. His new book "Anyone Can Play Music" is available wherever books are sold.

This blog post is based on a Bionic Health podcast interview. At Bionic Health, we believe in affordable, precision medicine for optimal health, delivered by doctors and AI working together.

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Understanding Your Metabolism: More Than Just Burning Calories

Ever wondered why some people seem to eat whatever they want while others gain weight just looking at food? The answer lies in understanding metabolism - your body's complex system for converting food into energy. Let's break down the science into digestible pieces.

The Building Blocks of Metabolism

Basal Metabolic Rate (BMR)

Think of BMR as your body's pilot light - it's the energy you need just to exist. Even if you spent all day binge-watching your favorite shows without moving, your body would still burn these calories to:

• Keep breathing
• Produce hormones
• Grow and repair cells
• Keep your heart beating

Resting Metabolic Rate (RMR)

RMR is like BMR's close cousin - it measures similar things but under slightly different conditions. The main difference? RMR can be directly or indirectly measured while at rest and is influenced by recent activity and meals. For practical purposes, they're nearly identical (only 10-20% difference).

Your Daily Energy Breakdown

Here's how your body uses energy throughout the day:

BMR: The Heavy Lifter (60-70%)

• The majority of your daily calories go toward basic survival functions
• This is why crash diets that drop below BMR are so dangerous

Thermic Effect of Food (TEF) (10-15%)

• Yes, you burn calories digesting food!
• Different foods require different amounts of energy to process:
  
  • Protein: Burns 20-30% of its calories during digestion
  • Carbs: Burns 5-10%
  • Fats: Burns just 0-3%

Exercise Activity (EAT) (5-10%)

• Calories burned during your workouts
• High-intensity exercise creates a longer "afterburn" effect
• More intense workouts = longer metabolic boost

Non-Exercise Activity (NEAT) (5-10%)

• The fidgeting, thinking, and random movements you do all day
• Can vary significantly between individuals
• Often decreases during dieting (you naturally move less as your body attempts to limit calorie burn, being in a deficit)

Smart Weight Loss: Working With Your Metabolism

Want to lose weight without wrecking your metabolism? Here's the smart approach:

1. Never eat below your BMR - it's like trying to drive a car without enough gas
2. Calculate your target calories:
   Daily Calories = (BMR × Activity Factor) - 250
3. Aim to lose 0.5-1 pounds per week (anything faster usually backfires)

The Calorie Quality Question

Not all calories are created equal. Here's why the type of food matters:

Protein: The Metabolic MVP

• Burns the most calories during digestion
• Increases overall energy expenditure
• Helps preserve muscle during weight loss
• Keeps you feeling fuller, longer

Carbohydrates: Choose Wisely

• Complex carbs require more energy to digest
• Simple sugars are "metabolically lazy" and digest quickly, great for a workout but not at rest
• Quality matters as much as quantity

Fats: Essential but Efficient

• Burn very few calories during digestion
• Important for hormones and health
• A little goes a long way

Practical Takeaways

1. Focus on protein - it's your metabolism's best friend
2. Don't crash diet - it's like putting your metabolism in hibernation and most people gain back all the lost weight and more once they end
3. Stay active - both planned exercise and daily movement matter
4. Choose complex carbs over simple sugars
5. Remember that healthy weight loss is a marathon, not a sprint

Your metabolism isn't just a simple calorie counter - it's a complex system that responds to how you eat and move. By understanding how it works, you can make better choices that support your goals while keeping your body's engine running smoothly.

Remember: The best approach to managing your metabolism is one that you can maintain long-term. Quick fixes might work temporarily, but they often lead to metabolic adaptations that make maintaining weight loss harder in the future.

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Aging Skin & Rejuvenation: Insights from Dr. Jennifer Goldwasser

In a recent Medicine 3.0 episode, Dr. Catherine Isaac welcomed back dermatologist Dr. Jennifer Goldwasser to discuss aging skin and rejuvenation strategies. This informative conversation covered everything from basic skin care to advanced treatments, offering valuable insights for anyone looking to maintain healthy skin as they age.

Understanding Skin Changes with Age

Dr. Goldwasser explains that as we age, our skin undergoes numerous changes:

• Mottled, non-uniform coloration
• Increased laxity
• Development of wrinkles
• Growth of various skin spots

Sun exposure is the primary culprit behind these changes. Dr. Goldwasser suggests comparing protected skin (like the underside of your arm) with frequently exposed areas to see the dramatic difference sun damage causes. Another telling sign of sun damage in elderly individuals is "senile purpura" - red-purple blotches that appear on sun-exposed skin due to deteriorated connective tissue.

The Subtraction-First Approach

Rather than immediately adding products, Dr. Goldwasser advocates for a "subtraction-first" approach to skin care:

1. Eliminate harmful habits:
   • Tobacco use (smoking, vaping)
   • Excessive alcohol consumption
   • Recreational drugs
   • Sun exposure
   • Ultra-processed and animal-based foods
2. Add beneficial practices:
   • Plant-based diet rich in phytonutrients and antioxidants
   • Simple, targeted skin care routine

Essential Skin Care Elements

1. Gentle Cleansing

Dr. Goldwasser recommends gentle cleansers like Dove sensitive skin products or La Roche Posay's hydrating cleanser. She warns against products with strong fragrances, dyes, or exfoliating particles, especially for aging skin which becomes thinner and more sensitive.

2. Proper Moisturizing

• Choose the right vehicle: Creams (oil-based) are better for aging skin than lotions (water-based)
• Look for jar packaging rather than pump tops for richer products
• Recommendations: Vanicream, La Roche-Posay Lipicar, CeraVe or Cetaphil in jars
• For extremely dry areas, Dr. Goldwasser surprisingly recommends Crisco shortening as an effective, non-irritating option

3. Sun Protection

Sun protection remains crucial even as we age, as UV damage continues to accumulate.

Managing Common Skin Conditions

Seborrheic Dermatitis

Often mistaken for dry skin, seborrheic dermatitis (dandruff) requires:

• Regular, vigorous cleansing
• Products containing pyrithione zinc (like Head & Shoulders)
• For facial involvement: washing twice daily, once with anti-dandruff shampoo and once with facial cleanser

Dr. Goldwasser notes that seborrheic dermatitis is common in babies and aging adults, particularly those with neurological conditions like Parkinson's disease or those experiencing immunosuppression.

Anti-Aging Treatments

Over-the-Counter Options

1. Retinols: Derived from vitamin A, these are the most potent OTC anti-aging ingredients
   • Benefits: Reduce fine lines, improve skin texture
   • Limitations: Can be irritating and sun-sensitizing
2. Vitamin C:
   • Benefits: Stimulates collagen production, acts as an antioxidant
   • Limitations: Unstable in formulations, effective products are costly
3. Other Options:
   • Peptides
   • Hyaluronic acid for moisture
   • Niacinamide for inflammation

Prescription Treatments

Tretinoin (prescription retinoid):

• Apply a pea-sized amount at night
• Wait at least 20 minutes after washing
• Avoid sensitive areas (upper eyelids, lips)
• May need to start gradually (every other day) or seasonally
• Most effective for fine lines, less so for deep wrinkles or skin laxity

Professional Procedures

1. Botox:
   • Temporarily paralyzes muscles to reduce expression lines
   • Generally safe with effects lasting 3-4 months
   • Best for forehead lines and "11 lines" between brows
2. Fillers:
   • Typically hyaluronic acid-based (Restylane, Juvederm)
   • Best for deeper lines around the mouth
   • Duration varies based on product
3. Lasers and Energy Devices:
   • Can address pigmentation, visible vessels, and redness
   • Newer technologies like radiofrequency microneedling can stimulate collagen and tighten skin
4. Surgical Options:
   • Most effective for significant laxity
   • Eyelid surgery (blepharoplasty) offers good value and high satisfaction

Emerging Treatments

While Dr. Goldwasser finds radiofrequency microneedling promising, she cautions against jumping on trends without sufficient evidence:

• Red light therapy: Limited scientific support
• Topical estrogen: Insufficient safety and efficacy data

Key Takeaways

1. Protect skin from sun damage at every age
2. Simplify your routine - less is often more
3. Choose products appropriate for your skin's changing needs
4. Adjust skin care seasonally and as you age
5. Consider the risk-benefit ratio before trying trendy treatments

The podcast emphasizes that good skin care requires adapting to our body's changing needs with age, replacing dated routines, and focusing on evidence-based approaches rather than marketing claims.

Timestamps:

‍00:00 - Introduction

‍02:39 - Effects of sun exposure on skin aging

‍05:39 - The subtraction approach to skincare

‍09:01 - Gentle cleansers and proper product selection

‍11:57 - Understanding seborrheic dermatitis

‍16:57 - Menopause and skin changes

‍23:36 - Types of moisturizers and proper application

‍32:21 - Effective skincare ingredients

‍37:14 - Anti-aging ingredients: retinols and vitamin C

‍44:21 - How to properly apply tretinoin

‍53:13 - Benefits of tretinoin for aging skin

‍57:44 - Botox, fillers and other cosmetic procedures

‍1:04:36 - Innovative treatments in dermatology1:12:27 - Conclusion and preview of future episodes