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"An ounce of prevention is worth a pound of cure." The old adage is sound advice, but too often we take a reactive approach to our health instead of a proactive one. What can we do to better monitor our overall well-being and stay ahead of chronic health issues? In this episode, we discuss the health metrics everyone should know and get tips for course correcting if one or more of those numbers is trending in a concerning direction.
Expert: Dr. Joshua Septimus, Primary Care Physician
Interviewer: Katie McCallum
Notable topics covered:
- The number most predictive of future health might surprise you
- Several additional metrics that are important to monitor
- More than numbers — why trends over time matter
- Why your primary care doctor should be your go-to health resource
- The most common chronic conditions you should aim to prevent
- Don't forget about cancer screenings, even if your numbers look good
- The "how to" of keeping tabs on your health, including check-up frequency
- Lifestyle habits that you can also track to help improve your health
- Why the relationship with your primary care doctor is like a marriage
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Episode Transcript
ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.
KATIE MCCALLUM: I’m Katie McCallum, former researcher, turned health writer, mostly writing for our blogs.
ZACH: And Katie, when I say “health numbers,” what are some of the first health numbers that come to mind for you?
KATIE: If I’m thinking about myself, I think they’re actually, like, the pretty normal health numbers. But I think it can really vary based on, like, who you’re talking to.
ZACH: True. It’s kind of, a personal thing, right? Yeah.
KATIE: For me, blood pressure is the one I think of. I always think of when people, kind of, like, go straight into the really nitty gritty, like, “Oh, I hit these macro numbers perfectly every time.” Or like, “I lift three times a week” kind of thing. Like, I don’t know, I think a lot of people think of health numbers in, like, a wellness standpoint, maybe.
ZACH: Yeah, I mean calorie intake. That’s -- I mean, that’s where my mind goes, that sort of thing. So, it is different for everybody.
KATIE: Daily calorie intake, that’s a really good one.
ZACH: Step goals is another one.
KATIE: Step goals, another really good one. So yeah, I think blood pressure, just because, like, in my mind, that’s the one that I always, like, when I go to the doctor’s office, I do always write that one down on my phone.
ZACH: I should do that ‘cause I always forget. They usually tell me I’m pretty good. I’m like, “Okay, great, X over Y. Sounds great.”
KATIE: I think that’s kinda all we need if it’s good. I’d never look at it again, which is what makes this fun about it.
ZACH: Yeah. It’s like, you know.
KATIE: I write it down and I don’t look at it again.
ZACH: If it’s good…
KATIE: Yeah.
ZACH: You’re not paying attention to it. That’s our nature, right?
KATIE: Well, that’s where you wanna be.
ZACH: That is where you wanna be, so. But there are a lot of health numbers out there. Like, there’s cholesterol, BMI, et cetera.
KATIE: Yeah. We’ve talked about BMI before. And in fact, kind of, like we shouldn’t really be thinking about that one a ton. So, maybe what should we be thinking about? I think that’s the hard part. Now, do you go to the doctor? The primary care doctor?
ZACH: I mean, regularly?
KATIE: Yeah. Putting you on the spot.
[Laughter]
‘Cause they give you a lot of numbers, in your annual physical.
ZACH: Yes. When they hand you that sheet, I’m like, “So, which one of these do I need to be paying attention to?”
KATIE: This is how I know you haven’t gone recently because it’s not a sheet, it’s online.
ZACH: Well, you know, back in 1998, the last time I went, they printed something out on a Dot Matrix printer, which no one knows what that is anymore, I don’t think.
KATIE: No. But no, to your point. They report out, you do your blood draw every year at your annual physical…
ZACH: Mhmm.
KATIE: And they report back on a lot of stuff. Like, you can get a metabolic panel, you get, like, platelet counts. You get all sorts of stuff. And it can be a little overwhelming in the sense of what on this list do I need to be worried about. Now, they give -- they give you the values and they tell you if you’re over or under.
ZACH: Yeah.
KATIE: But it’s just a lot of stuff. And I think one thing that would be nice to know is which of these various numbers actually matter for me.
ZACH: Right, well that’s the one point where I do get, like -- when they say something like, “Well, these are okay. You wanna keep an eye on it though.” I’m like, “What does that mean?” That gets me nervous. But -- and to your point, we wanna figure out which ones should we be keeping an eye on.
KATIE: Or, like, the top ones. Like, give me the top five list, or the top four list, or top ten. I don’t know, what is it? So, that’s what we wanna talk about today. What are those numbers that we need to know, and keep our eye on, and sort of regularly be checking. And are they things we can check at home? Or are they things we need to go to the doctor to find out? And so, we wanna figure that out today.
ZACH: And who did we talk to about this, Katie?
KATIE: We talked to Dr. Joshua Septimus. He is a primary care physician here at Houston Methodist. And we, kind of, just opened the door for him to advise us on which numbers matter. And I’m gonna be honest, the first number that he calls out was not what I was expecting.
[Sound effect plays to signal beginning of interview]
KATIE: I find it interesting, and I’m excited to talk to you about this today because when I talk to my friends about, like, our wellbeing and wellness, like, numbers come up. We talk about numbers. Well, one friend will be like, “I, you know, I got my hundred grams of protein today.” Or another friend will be like, “Oh, I’m adding, you know, a calcium supplement, and I need to think about, like, what -- how many milligrams do I need per day?” So, we’re thinking about our health in numbers, or we think we are. But my guess is, and this is an assumption, I’m curious to get your take, is that we’re missing out on probably some really important numbers about our health that are pretty easy to collect if we just talk to our doctor now and then.
DR. JOSHUA SEPTIMUS: Well, even sometimes without talking to your doctor, what I would say first is that one of the problems with the wellness industry is that everyone’s looking for an easy number. Oh, it’s just my number of grams of protein, is a good example actually. But the most important number that you can know about your health is actually something that I will bet you 95% of your listeners have never had a doctor do in their office, and that’s their waist circumference. If I had no stethoscope, no blood pressure monitor, no lab tests, and you asked me what is the one measure that would be most predictive of future health? It would be waist circumference. And the reason for that is that if you have a big waist circumference, then you have an increased risk for everything under the sun. From type 2 diabetes to heart disease to dementia to adenocarcinomas, which are many of the deadliest cancers. And so, that’s the thing that I think patients should know more than anything. There are certain numbers that can be diagnostic if things like metabolic syndrome. And that’s, in a white person, for example having waist circumference of over 40 inches, but I think that’s less useful because it’s very dependent on your gender. And by the way, that was the male waist circumference measurement for that. It depends on your gender, it depends on your race, it depends on how tall you are.
KATIE: Mhm.
DR. SEPTIMUS: So, you could have, for example, someone from the Indian subcontinent who has a waist circumference of 35, but in that individual, that’s very abnormal. Whereas a tall football player who’s white, it might be normal. So, it’s more important for you to know on your body what, quote unquote, normal is. And so, you’re follow up question is gonna be, “Well, why aren’t the doctors measuring it?” And you can imagine, how would you feel, especially as a woman…
KATIE: Yeah.
DR. SEPTIMUS: If your male doctor said, “Let me just -- let me just take a tape measure and measure around your belly button.”
KATIE: “Let me just talk about the one thing you never wanna talk about with you right off the bat. Here we go.”
DR. SEPTIMUS: So, I think we -- we have all these other tools in the doctor’s office. And when I talk, at least, about health, and wellness, and see patients in follow up who are working on improving their health, I’ll talk to them about, “Hey, how are your clothes fitting around your waist? And have you dropped your belt size?” But I don’t know that I wanna go measuring everyone because it’s a really sensitive issue. But you can know your own number yourself.
KATIE: Yeah. And I like that too because I also, kinda, know probably when my waist size is changing. Because like you just said, my clothes are feeling tighter. This happened to me a couple months ago. You know, you start to notice it. You’re like, “Okay, pants that I, you know, have had for five years, are like, getting a little tight.” And I don’t even need to measure my waist, my pants are measuring my waist for me. And I can step on the scale and immediately be like, “Yup, I’m up. My weight’s up.”
DR. SEPTIMUS: Well, and that happened a lot during Covid, right?
KATIE: Oh yeah.
DR. SEPTIMUS: People were out of the office and wearing sweatpants for a year. And then “Oops, I can’t get my jeans on anymore.” But I will say this, if patients are doing one of the things that I recommend more than anything, which is to make sure that they’re doing strength training. Sometimes the scale does not tell the story.
KATIE: We did an episode on BMI, is that where you’re headed?
DR. SEPTIMUS: Well, I don’t even talk about BMI. It’s about the waist circumference. So, I actually saw a patient this morning who, he was probably about 170-180 pounds, and he gained 10 pounds year to year, but he looked super fit. And I asked him, “Hey, what’s changed in this year?” And he said, “Oh, I’ve been doing this workout.” I don’t remember if it was F45 or Orange Theory or something. And I said, “What’s going on with your waist?” And he said, “My pants are loose.” So, this guy gained ten pounds, and his waist circumference went down.
KATIE: That’s the dream
DR. SEPTIMUS: It is. I mean that’s -- you want -- that is a measure of health.
KATIE: Yeah. I think it’s great. I mean, when we’re talking about the opposite patient, the patient who, maybe is trending up on the waistline. What’s your, kind of, initial pep talk for -- I know we can’t get into all the specifics on weight loss, ‘cause, you know, that’s probably 20,000 -- we could have a whole podcast series about weight loss and how to get it done. But what’s your, kind of, pep talk in the sense of, “Look, here’s a health number you need to keep your eye on. And here’s a way to start getting headed in the right direction.”
DR. SEPTIMUS: I mean, welcome to my life, right? I’m a primary care physician and this is what I deal with all day every day, over and over again. And unfortunately, it’s often a losing battle. So, you have to keep giving yourself a pep talk to as a provider. What I try to give people is something simple to focus on. And that’s part of why waist size is so good, right? You don’t have to weigh yourself every day, you don’t have to count carbohydrates, you don’t have to count your grams of protein. You focus on the bigger picture. And what I tell folks is okay, what’s gonna drive waist circumference? The very simple answer is insulin resistance.
KATIE: Hmm.
DR. SEPTIMUS: So, I try to tell folks who are struggling with this that that’s the one thing you should focus on. What is this activity that I’m choosing, be that watching Netflix versus going for a walk. Or what is this food, be it an apple versus a Snickers bar. What is that gonna do to my insulin resistance? Because if it’s gonna raise my insulin resistance, my belly fat’s gonna go up, and if I lower my insulin resistance, it’s gonna go down. And from that, like, thinking about things in a more simple way, you can drive positive change with healthier food choices and healthier lifestyle choices. And it doesn’t mean you can’t choose the unhealthy choice, right? It just means that you’re acknowledging that choice in a mindful way.
KATIE: Yeah, yeah. That makes sense. Something else you touched on that I wanna hit on too, checking your waistline and comparing it to something it was before. This idea of these numbers matter in the context of your own, sort of, trend and timeline. In that, like you said, somebody from a different continent, a waistline number for them is not gonna apply to somebody from here. So, what is the importance of keeping trends, and kinda, keeping track of that stuff?
DR. SEPTIMUS: I think it’s critical. There’s a more sophisticated way to look at it would be your waist to hip ratio, which I don’t like because then it makes it more complicated. But that also is very predictive. It’s not something that I pay much attention to again because it just overcomplicates things. But there are a couple of ways to simplify it. One is to say that your waist should be no more than your inseam. If your inseam is a 30, your waist should be about a 30. Doesn’t have to be exact, but that’s a good rule of thumb. Now, there are some people who have really long legs, but that’s a good rule of thumb. The other thing, and patients hate when I say this, but you really ought to be about the same size you were when you graduated from college.
KATIE: Woah.
DR. SEPTIMUS: And that’s tough…
KATIE: Yeah.
DR. SEPTIMUS: And again, there’s always exclusions to that. There are some people who really don’t come into their own until they’re a little bit older. And it applies more to women than men because women reach their peak in terms of bone density and muscles mass when they’re in their early to mid-20’s, whereas men, it’s more their mid to late 20’s. So, sometimes men will stay healthy but still get a little bit more in the waist than women will in their mid-20’s. That’s a frustrating thing for people to hear because unfortunately, we are so unhealthy as a society. There are very few people who are still in the same pants size that they were. And I know there’s a -- there’s all these people who will -- like, my aunt for example, she’d kill me for telling you this. But she used to always be able to get into her cheerleading outfit from high school on Halloween, for years and years and years she could. And, you know, I have a friend who his dad is a veteran. And on the Houston Astros Veterans Day, he was one of the honorees, and this veteran is in his 70s, and he was able to put on his dress uniform from when he was in his, like, 20s or 30 years old. That’s really a marker that they’ve taken good care of themselves.
KATIE: As much as it, kind of, overwhelms me to hear it when you first say it, I do like to think of it in that way. Because it puts a -- it paints an actual picture of what your health should, kind of look like. I think a lot of times we -- I know I do this. I’m like, “Okay, if I feel okay, I must be okay.” I think that’s a -- until something feels wrong, everything must be okay.
DR. SEPTIMUS: That’s something we wanna fight against because we wanna -- we wanna promote proactive, preventative healthcare, which is really starting at home. And you have to also remember that when you’re in your 20s, especially your early 20s, that’s when your body is the most resilient. Once we get older, our resilience goes down, and that’s when we start coming into problems.
KATIE: That sounds right. ‘Cause I feel like most of my health problems started, like, late 20s. As we get into the next metrics, I think one thing I wanted to dispel, and you, kind of, have is that this, “If I feel okay, I’m okay. If I don’t feel okay, I’ll go to the doctor. But until then, I’m okay.” Why is that a problem? And can you feel okay, but your health be trending in, like, a pretty concerning direction.
DR. SEPTIMUS: A hundred percent. And I’ll oversimplify this to say let’s just look at colon cancer, right? Colon cancer is completely asymptomatic, and nearly 100% preventable if you catch it early. So, I have a patient that I saw this week who she is 47, I talk about her all the time. I actually told her I talk about you all the time. Not by name, you know, but she’s in her late 40s, and when she had her baseline colonoscopy at 45 like we’re supposed to, she had colon cancer. But because she got that colonoscopy, even though she felt great, they were able to take it out with a simple polypectomy, meaning they -- during the colonoscopy, they just took it out. But if she had not been proactive, if she had not been focused on wellness, by the time she was symptomatic from that colon cancer, she would have, best case scenario, needed a huge surgery and chemotherapy. So, that’s the best example of that.
KATIE: Yeah, it’s a good one. So, to that end, what are these other health metrics aside from waistline, that people should be keeping tabs on generally, no matter their age, really.
DR. SEPTIMUS: Well, regardless of age, you can’t really say that because there is a point when you’re a teenager, for example, where you really don’t need to pay attention to much else, right? If your waistline is good and you’re following a healthy diet, you’re active, there really is no other metric. You don’t need to measure your blood pressure, you don’t need to have labs done, none of that. But once you reach adulthood, particularly, you picked the age 30, that’s a good age to really start focusing on your health. You should know your blood pressure. Again, you don’t even need to go to the doctor for that, but you should know your blood pressure because high blood pressure is very tightly linked with heart attack and stroke. You should know your cholesterol, and that’s a whole can of worms in part because that’s my area of expertise. You know, which cholesterol number should you know. I have patients all the time say, “Well, my cholesterol is 190. So, I’m good.” Well no, you don’t look at total cholesterol anymore. You have to know your LDL and you’re non-HDL. And so, a full what we call lipid panel is really important to know. And then, it’s related to that waist circumference. I think knowing your hemoglobin A1c, which is a three-month sugar average, for the vast majority of people is a really critical number for you to know. I will give a caveat to that, and that is that if you have a chronic anemia, for example, sickle cell anemia or if you have conditions like sleep apnea, if your blood counts are off, like sleep apnea gives you a high blood count, it skews the numbers. But for the vast majority of us that hemoglobin A1c’s gonna give us a good marker of blood sugar. The reason, though, I would caution people who have an increased waist circumference but a normal hemoglobin A1c. So, those folks are gonna say, “Oh, I’m good.”
KATIE: Yeah.
DR. SEPTIMUS: No. Because it takes years. And I’m not exaggerating. Years to go from insulin resistance as reflected by your waist circumference to an abnormal blood sugar. And then another several years before you develop diabetes. And if we’re talking about health and wellness, that’s why that waist circumference is even more valid.
KATIE: Yeah. But that’s actually -- that’s a really positive message ‘cause that means as soon as you catch the waist circumference out of whack, like, you can start -- It’s a long time for you to make actions and, kinda, work against something that might be coming down the road if you don’t take action. So, I love that.
DR. SEPTIMUS: A hundred percent.
KATIE: Yeah. That’s really cool. I think sometimes, it’s easy to think, “Oh, I’m not gonna -- I don’t need to worry about diabetes until I have prediabetes.” Or, you know, these sorts of things.
DR. SEPTIMUS: That is a great point because by the time you develop diabetes, you have been insulin resistant for over a decade.
KATIE: Wow.
DR. SEPTIMUS: And if you look at -- you know, there’s two main problems with diabetes. One is the small blood vessel disease problems, the other is the large one. So, the large blood vessel diseases are heart attack and stroke. But the small blood vessel diseases, which are the kidney failure, the blindness, the amputations that unfortunately we see way too often in diabetics, if you wait until you’re diabetic, at least 10% of type 2 diabetics already have those small blood vessel diseases by the time they’re diagnosed. Why? Because it’s not like when you go from hemoglobin A1c of 6.4% to 6.5%, something magic happens. It’s insulin resistance overall. So, addressing things when you first have the issue, like an increased waist circumference like a colon polyp, and the colonoscopy example is so powerful. And I try to frame it that way for my patients that this knowledge should be empowering. Like, don’t be afraid of the fact that your waist is a little bit thicker. It’s empowering. There is something you can do about it.
KATIE: Yeah, absolutely. And to me, it’s empowering because instead of just worrying about my health all the time, if you can’t tell from that, I’m a bit anxiety prone. And so, you know, when I think about keeping tabs on my health, I can get in that worrisome kind of spiral. But, and correct me if I’m wrong, but it sounds like as long as I’m keeping tabs on these metrics, if they are okay, I’m in good shape. And if I keep doing what I’m doing, you know, I’m okay too. And I can, kinda, check that off in my mind of, like, “Okay, my waist circumference is at a good place. If my A1c is a good place, great. It’s that peace of mind, too, I think. And if it is maybe not in a good place, at least you know, and you know that, “Okay maybe I need to be a little worried. But I have information to work with it.”
DR. SEPTIMUS: I don’t wanna give people a license not to worry about their health at all.
KATIE: Yeah, that’s fair.
DR. SEPTIMUS: What I would say is if you have a normal waist circumference, you have a normal blood pressure, your cholesterol is normal, your hemoglobin A1c is okay. Those are really positive things. But all of those address only part of your healthcare experience. I’m really bursting your bubble here.
KATIE: No, no, it’s fine. I think this is a lot of people’s bubbles, so this is helpful.
DR. SEPTIMUS: There is -- you know, there’s a guy, I think I’ve referenced him on a previous podcast, named Peter Attia. Who he has thought about longevity and health span in a way that has just really clicked for me. And he talks about the four horsemen of what’s gonna determine your lifespan and your health span, and cardiovascular disease is number one. That’s what you’re addressing with blood pressure and cholesterol, and you know, we haven’t talked about lifestyle ‘cause that’s not a number for you to know. But lifestyle and metabolic disease is another one of his, you’re gonna address that with the waist circumference and with the hemoglobin A1c. But the reason I’m being cautious in endorsing your worry-free approach is that you’ve still got cancer.
KATIE: Right.
DR. SEPTIMUS: And you cannot forget that that is the second leading cause of death in the United States. And there’s no number to know for that, right? So, I would never want people to blow off cancer screening because the rest of their numbers looked okay. The fourth horseman is neurodegenerative diseases. And that’s things like Alzheimer’s disease and Parkinson’s disease. But I wanna make sure that listeners know, you gotta get your cancer screening.
KATIE: No, this is great though. So, we have -- we’ve talked about the numbers, and I do think this is an apt time to also talk about screenings. So, do you wanna run through quick -- like, very quicky since it’s not a number, and that’s what we’re trying to do here today. But I get your point. It’s very important. It can’t be another thing that we brush off. ‘Cause we do tend to brush things off. So, in your mind, what are the cancer screenings you want listeners to walk away from and make sure that they’re staying on top of?
DR. SEPTIMUS: So, first I just have to say, this totally fits with a typical internist. Like, if you ask an internist a question, they never give you a simple answer, and I’m just laughing at myself because my father is a physician also, and he’s an infectious diseases doctor. And listening to him talk to residents from when I was a kid, I always remember there was never a simple yes or no. When I was in med school, there’s never a simple yes or no. And even now when I call him with questions, there’s never a simple yes or no. So, it just cracks me up that now I’m following in his footsteps, but -- So, if you look at cancer screening, it is really not that complicated actually. So, for women, cervical cancer screening is critically important. In women, mammography is critically important. For both men and women, colonoscopy screening for colon cancer is critical, and in men prostate cancer screening is critical.
KATIE: Okay.
DR. SEPTIMUS: In smokers, depending on their risk factor, you can -- their risk factors, and it’s, kind of a, milieu of questions you have to go through with them, and you have to do shared decision making ‘cause it’s not a simple answer. But there is lung cancer screening now for high-risk individuals. Unfortunately, we don’t have screening for all of the common cancers, but I will point out that, you know, the top three cancers, in terms of death in both men and women, number two is colon cancer. We got a great screening test for that. And in both men and women, leading is lung cancer. We got a screening test for that. And then in women, breast cancer, men prostate cancer screening. We’ve got screenings for that. So, at least for the most common things, or the most deadly, we have ways to be proactive about our health.
KATIE: I like that, that’s nice to hear.
[Music to signal a brief interjection in the interview]
ZACH: Unsure whether you’re due for a cancer screening? The general recommendations are for women to begin cervical cancer screening around age 21 and breast cancer screening at age 40. For men and women to begin colorectal cancer screening at age 45. For men to begin prostate cancer screening at age 50. And for men and women who are former or current heavy smokers to begin lung cancer screening at age 50. That said, your doctor may recommend earlier screenings if your risk for developing one of these cancers is higher than usual. Your risk level may also affect how frequently you need to be screened. And your primary care doctor can help you understand what your individualized screening plan should look like.
ANNOUNCER: From annual checkups to managing chronic conditions, your health care should be personalized to you. At Houston Methodist, our primary care doctors provide customized care for you and your family with more than 40 convenient locations across greater Houston. We offer a variety of ways to get care, from in-person and virtual appointments to same day visits when you're sick. Choose your doctor and schedule online at houstonmethodist.org/stayhealthy. Houston Methodist, leading medicine.
[Sound effect signals return to the interview]
KATIE: So, at this point, I hope you have convinced listeners to, you know, care about these numbers and screenings, ‘cause you’ve convinced me. So, I wanna get through the specifics now of someone’s who’s kinda like, “Well, I don’t even have a primary care doctor right now.” Where do you want someone to start? What does it take to learn this information?
DR. SEPTIMUS: So, the first is I would encourage you to go to houstonmethodist.org/pcg. We have great primary care doctors, many of whom are my partners and start a relationship. Because I actually tell patients that a primary care relationship is like a marriage. You have to feel comfortable with one another, you have to be willing to compromise with one another, you have to be willing to go back and forth with them. And sometimes, it takes a couple different relationships before you find one to marry, so be proactive about it. In terms of your actual numbers, you can’t get your hemoglobin A1c without seeing a physician. So, that’s the place to start there. Measuring your waist circumference, you measure around your belly at the belly button. You can do it yourself. And like we talked about earlier, if your waist size is more than an inch or two more than your inseam, you might have something to worry about. In terms of blood pressure, you can measure it yourself. There is a right way to measure your blood pressure. I will tell you if you’ve been to the doctor and you’re hearing me say this, you’re gonna tell your radio or your iPhone, “Wait, that’s not how my doctor does it.” Because we tend not to. The right way to measure blood pressure is to be seated calmly in a quiet room. You should have an empty bladder. Your feet should be flat on the floor, your back should be supported, and your arm should be resting on a table so that your upper arm, and I would encourage you use an arm cuff, not a wrist cuff, is at about heart level. And you wanna put the cuff on your bare skin. And then you know what you do next?
KATIE: No, I don’t know.
DR. SEPTIMUS: Nothing.
KATIE: Nothing, okay.
DR. SEPTIMUS: You wait for at least a few minutes before you press the button.
KATIE: Give it some time.
DR. SEPTIMUS: Because everyone will have some degree of what we tend white coat hypertension.
KATIE: Yeah.
DR. SEPTIMUS: So, you wanna wait. And it’s been found that home blood pressure measurements are actually very accurate compared to what you get in the doctor’s office. So, I check my blood pressure a few times a week, I keep a diary. And I show it to my doctor when I go for my annual wellness exams. And I would encourage people to, “Okay, I’m gonna make an appointment with a primary care doctor, but I need to start doing this first.”
KATIE: Yeah, I love that.
DR. SEPTIMUS: Other things that you can do, you know, not necessarily a number per se, but you can start tracking your fitness, right? So, you can track your resting heart rate. And if your resting heart rate is high, that’s a marker of poor fitness. And once you start exercising, it should come down. You can, you know, clock how many miles I can walk without having to rest. You can track all kinds of things in terms of measuring your progress. So, instead of being, kind of, focused on the failures, focus on your successes.
KATIE: Yeah. Or the 30, you know, the 30 grams of protein in your protein bar that apparently is gonna make you healthy forever.
DR. SEPTIMUS: I would encourage people not to -- I always tell patients to follow Michael Pollan’s metrics of food, which are to eat real food, mostly plants and not too much. And it sounds overly simplistic, but real food is not a protein bar. And it’s anything that your great, great grandmother would recognize. So…
[Laughter]
KATIE: Not recognize a protein bar.
DR. SEPTIMUS: I mean, and so that’s -- I know you’re kidding, but it’s actually something that’s really good to focus on is that, “Wow, if my diet consists of a bunch of things that have 12 ingredients in them that I can’t even pronounce, it’s probably fake food.”
KATIE: Yeah. It’s interesting ‘cause it’s -- you think you’re doing something healthy, and it’s quote unquote, “health food,” but yeah, to your point, the ingredient list is longer than a bag of chips sometimes. You know, a bag of tortilla chips. You can get some with just three ingredients and that protein bar probably has like 15.
DR. SEPTIMUS: And the more TikTok influencers, and Instagram influencers that are peddling a product, the less healthy it probably is.
KATIE: Yeah. Okay, so, I wanted to mention too, as far as where to start with these health numbers. Because I have a primary care doctor now, and I like going every year because we do the blood tests, and then I get, like, a bunch of data about myself. ‘Cause I like having this information. I think a lot of us do. We’re all very data centric. We have our watches, it’s got tons of information. I have learned that, like, one of my favorite things of the year is like getting my -- all my numbers back and just be like, “Ooh, are they up or down?” How important is it to, kind of, like look at those every year, or can you just, like, if your doctor doesn’t say anything, you’re good? Is this a very complex answer?
DR. SEPTIMUS: It really depends. There are some folks like, you know, your listeners can’t see you, but you’re young, you look fit, you’re healthy. There’s some folks who that’s really, “Oh okay, my doctor didn’t say anything.” I’m grimacing a little bit because what I always tell patients is doctors make mistakes, guys. I have to be transparent about that. And it’s really good if you ask questions. Now, that doesn’t mean you have to obsess over everything on the panel. And in fact, one of the detriments of us releasing every bit of information in the chart to the patients is that there’s too much data. But I would encourage you, if you see something on your lab results that you have a question about, to collect it into one message, not send fifteen messages, but collect it into a message and ask. Because there’s only one of you, and a busy primary care doctor will have thousands of you.
KATIE: Mhm.
DR. SEPTIMUS: And so, sometimes doctors miss things.
KATIE: Yeah. I like that because as you mentioned, it’s a relationship too. It doesn’t need to be one sided. I do -- it’s an interesting point. I think my initial, sort of, thoughts about healthcare coming in is like my doctor is gonna tell me what to do and I’m gonna do it. Whereas now that I’ve kinda been going to my primary care doctor for a while now, I guess like a decade, maybe less. It is a conversation, and it is a back and forth, and it is a dialogue. And yeah, I think that’s interesting in the sense of it does -- it shouldn’t be this one way relationship. As we wrap up, is there anything else you wanna leave people with from as far as either health numbers or the pep talk you give people when -- like you said, sometimes it is news they need to act on, and it’s hard work. But I think you said it all pretty eloquently. But I just wanted to give you one last little bit of time to, sort of, it’s your pep talk to get people to, when they finish listening to this episode say, like, “Yeah, I think I do wanna go figure that out and maybe take some action.”
DR. SEPTIMUS: So, the question is okay, now I know my numbers, what am I gonna do about it? Right? And so, that’s what I would leave people with is that there are concrete changes that we can all make to our lifestyle to improve weight circumference, improve hemoglobin A1c, improve cholesterol, improve blood pressure. And they are all the same things for the most part. So, I would advocate that people not forget about their muscles because your muscles are the, you know, drivers of your metabolism. So, one of the things that very commonly happens is as people get older, they lose lean muscle mass, and as they lose lean muscle mass, they accumulate belly fat. So, I would encourage you, especially as you age, don’t forget to pick up heavy things. Doesn’t have to be that you do CrossFit, it doesn’t have to be that you do F45, it doesn’t have to be anything extreme. But pick up heavy things, use resistance bands, even do some kind of body weight training. The second is that you don’t want to fall prey to fad diets and extremes. You wanna only implement things that are sustainable. That means, you know, don’t go on a liquid diet, it means don’t, you know follow, in my opinion, a Keto diet, don’t follow – Just don’t follow extremes. Do things that are sustainable. And I will mention here, because one of our key metrics was cholesterol, first of all, that the cholesterol hypothesis is proven to be real, so don’t believe any of these social media hacks that say that LDL doesn’t cause heart disease, because it does. And the implication, if you do go on, ‘cause I know some of our listeners will go ahead and go on a, you know, a Keto diet or a low carb diet. If you do, go to your doctor and get your cholesterol tested afterwards because there are some people for whom those high fat diets are fine for, but there is a percentage of patients who will develop a reaction to a high saturated fat diet, akin to familial hyperlipidemia and that is life threatening. And so, you need to know that you’ve had that reaction so that you can change course. In addition to just your standard cholesterol, one thing that you may have to ask your physician to do because it has not become widespread practice in the United States, is to have your doctor check your Lp (a). This is something that most of your listeners have probably not heard of. Cholesterol is carried around in our blood in a substance called lipoproteins. And on the surface of those lipoproteins are different apolipoproteins. You don’t have to know those details, but one of those apolipoproteins is called a little a, like a lowercase “a.” This is a test that’s widely available. It’s available from Houston Methodist, it’s available from every major lab in the country. It is something that you measure once as an adult, and if you’re a woman, once when you’re post-menopausal you should do it as well because it changes after menopause. It is genetic, we do not have FDA approved medications for it. So, you say, “Why in the world are you telling me that that’s one of the numbers I need to know?” Because it increases your risk of heart attack, it increases your risk of stroke, and it increases your risk of aortic stenosis. So, patients who have an increased Lp (a) need to be monitored more closely for cardiovascular disease and aortic stenosis. And when we treat folks, for example, for high cholesterol, we may do it more aggressively in someone who has an elevated Lp (a). There are Lp (a) lowering therapies on the horizon...
KATIE: Okay.
DR. SEPTIMUS: But for now, it’s just important to know you have that condition.
KATIE: Mhm. Got ya. Okay. Well, this has been really great. I think you left us with a ton of information, a lot to think about. I gotta go check my waist circumference when I get home, just to make sure I’m on the safe side there, but really enjoyed this talk today. I think it gave us a lot of actionable, what I would say, are easy tips, even if they’re hard to act on later, but actionable tips for us to better our health, so, thank you. We’ve done a lot of blogs together, this is our first podcast. So, I had a great time talking to you in person about this, and thanks for joining.
DR. SEPTIMUS: It was awesome. Thank you.
[Sound effect signaling end of interview]
ZACH: Well, great to have Dr. Septimus on the podcast again. He’s always full of great…
KATIE: Yes.
ZACH: Knowledge for us. Now, I like that you were talking about, “Well, you know, my waist size, you go into a doctor.” Like, I don’t know, like if you go into a medical environment, I don’t mind, like, tell it to me straight. Right? I was like give me all these stats and you know, I’m not really self-conscious about it at that point. But as far as like – ‘Cause I want to know those numbers, you know?
KATIE: Yeah, I agree. But I could see how the waistline thing would be a bit sensitive. It’s – for some reason seems even more personal than, like, your overall weight. I don’t know why. But it’s funny. You don’t think of that as -- I probably wouldn’t have thought of that as a health number to be honest. I really wouldn’t.
ZACH: I think of it as, like, a getting a new suit number, right?
KATIE: Yeah. And we’ve done – We’ve tried doing these blogs before that’s like, how much should I weigh? And then the doctors are always like, “Well, it depends.” Whereas the waistline number, I thought it was really interesting ‘cause it is – There a bit some more standards there and things you can track. It resonated with me because the times that I start to focus the most on like, well I know I’m kinda, like, gaining weight. It is more about my waistline ‘cause I’m always – it’s when my pants don’t fit right, which is the natural measure for your waist.
ZACH: I think you’re just leaving your pants in the dryer too long, Katie.
KATIE: Ah yeah, that’s true. Thank you.
[Laughter]
Thanks for looking out, Zach. You’re totally right. No more drying my pants. Air dry only. Another thing about the waist circumference that I liked was it’s a super early number too, in the sense of, you know, if your waist circumference is, kind of, trending upwards, you know, now’s the time to take action. Because as he mentioned, the next, kind of, thing that can happen to you is insulin resistance, and then the next thing that happens is prediabetes, and then type 2 diabetes. But there’s, like, a ten-year gap there where, you know, your waist size might be trending up. But like, if you can take steps now, and you have time to work on it. It’s not like – it’s not like you’re doomed to have a health problem now ‘cause you’ve let your waist, kinda, like get out of control. I really liked that part of it, because it just shows – it, kind of, displays the preventive side of this that’s interesting with the numbers where if you’re waiting until your blood pressure is high, you’re waiting too long. You know, if you’re waiting ten years to do something about your waist circumference, you’re waiting too long. But it’s a long time to do something about it.
ZACH: Something that he said stuck out to me. He said blood pressure – Dr. Septimus mentioned he gets his blood pressure checked very frequently.
KATIE: I think he says he checks it at home and keeps a log, which like I guess I need to be doing that too. Him and I, sort of, bonded over the fact that we like to like collect all these health metrics about ourselves, so. I’ve always, kind of, thought that the blood pressure checking at home was really only once you have a problem maybe you should be doing that. But I don’t know, he might have convinced me. That or maybe I, like, buy one for the family and we can, kinda, like pass it around or something.
ZACH: Yeah, I mean it’s just another metric to see where you are, right? And that makes sense to me, if you would truly wanna track, you know, what might be coming, what you might be going through, that’s a good stat.
KATIE: Yeah, and that’s a good point. I think another big thing too that came out of this for me is it’s not just, you know, I checked this number and I’m done, it’s the trend, right?
ZACH: Mhm.
KATIE: Like okay, maybe my waist is getting a little higher right now, or maybe it’s fine right now, but you do need to be checking it. And, like, blood pressure, you know, it’s the trend there. And not just saying like, “Oh, went to the doctor and all my numbers are okay. I’ll be okay forever.” I, I think as you’ve probably recognized, and maybe some of our listeners have, I like to either hyper fixate or oversimplify. And I think he caught me on that today of hyper fixating on some things but then oversimplifying others. So, I did like his, sort of, simple way of, kinda, bringing it back to home base in these numbers that are, you know, blood pressure, waist circumference, cholesterol, your A1c values. Like, those are, kinda, just some numbers that if those are okay, you know, your health is on the right track, but that doesn’t mean you can just stop thinking about it completely. It’s something you have to work at over time.
ZACH: Right, right. I think he even said, like, “I don’t wanna dissuade anyone from…
[Laughing]
KATIE: Yeah, the cancer screenings is the other piece there so I’m glad he brought that up because that is a really important point. Especially as we see things like colorectal cancer rates are rising and, you know, people our age, now is not a time to think, “Oh, I’m young, I’m healthy, I’m fine.” You still gotta be keeping up with all this.
ZACH: Yeah. And you know, we mentioned the recommended ages that you start to get screened for cancers. And if a certain kind of cancer kind of runs in your family, then you know you gotta back that up by like five or ten years even when you start getting screened, right?
KATIE: Yeah. Like you did that prostate cancer episode and, you know, family history of prostate cancer, what does that mean for me? Does that mean I need to go get screened early? I mean, I don’t know if you’ve had any conversations with your doctor yet about what screening looks like for you. I know you’re not into your 40s yet, but I think you’re creeping up.
ZACH: As soon as I turn 40, I’m like, “Well, that’s step one,” right? You know, I turned 40, the next day go get a prostate cancer exam. That’s my plan. But no, really, I mean you have to keep an eye on that sort of thing. And you know, some of us have those things that run in our family, and that’s why it’s wise to be aware of your family health history as well.
KATIE: Mhm. And I like this thing of not waiting to start this care until it’s time for a screening or until now you’ve got some symptoms that are bothering you, you know, in your 30s. He even said early 30s is a good time. I mean, maybe even late 20s if you’re someone like me who hyper fixates on things. Like, get a primary care doctor and start finding one that you like and you can talk to and you can look at these numbers with and things like that. I really enjoyed it I know.
ZACH: Enjoyed it, huh?
KATIE: Well, it’s nice. It’s a nice peace of mind for me at least. Like, I go to my annual physical every year, I pretty much don’t see my doctor the rest of the year, but each year we check in, we check up, and we talk about things, and we do my blood test, I think every now on then I’ve gone on, like, a vitamin D supplement, ‘cause I have low vitamin D levels. But otherwise, it’s a pretty painless, easy process that I have enjoyed keeping up with.
ZACH: If you’re gonna start journaling this kind of stuff, you bring those numbers in to your doctor and say, “Here’s what I’ve been charting the last six, eight months.” Something like that?
KATIE: Yeah. I always go in with, like, really good intentions that I’m gonna journal about things, and then I don’t do – I do it for like two days and I stop, so. I’m not a good example there. No, I just go in and usually my numbers are okay, and we just talk about, “Oh, well did you go get your cervical cancer screening? Like, I see you haven’t done it in a couple years.” And he reminds me and then I go make that appointment and I do it.
ZACH: This shouldn’t be intimidating, right? It’s just – It’s like taking your car in for an annual inspection. That’s what it’s all about, right?
KATIE: Mhm.
ZACH: Think of your body as a car and I think you might be able to maintain it better.
KATIE: That’s not the first time you’ve used that analogy on this podcast.
ZACH: That’s a good one. Yeah.
KATIE: It’s working well for you.
ZACH: All right. That’s gonna do it this time for On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings, so until next time, stay tuned and stay healthy.