THANK YOU ALL FOR BEING HERE TODAY AND TAKING TIME OUT OF YOUR DAY TO COME TO THE PRESENTATION ON MEN'S HEALTH. I WANT THIS TO BE KIND OF INFORMAL SO IF YOU HAVE ANY QUESTIONS AS WE GO ALONG, STOP ME THERE. THE APPROACH I TOOK ON THIS WAS ACTUALLY TO SEND SOME NUMBERS OF MY TEAM OUT AND CAME UP WITH A LIST OF QUESTIONS I THOUGHT WERE RELEVANT QUESTIONS FOR -- THAT MEN MIGHT HAVE AND I SENT MY TEAM OUT AND SAID GO AND TALK TO MEN AT NIH AND AT LUNCHTIME STOP THEM IN THE HALLS AND FIND OUT DO THEY LIKE THE QUESTIONS, WHAT IS REALLY ON THEIR MIND, IF THEY WANTED TO LEARN MORE ABOUT MEN'S HEALTH OR THE HEALTH, THEIR OWN HEALTH. SO THE -- THERE IS NOT REALLY A FULL PRESENTATION HERE OF COHESIVE THEME BUT QUESTION-AND-ANSWER FORMAT SO FEEL FREE TO RAISE YOUR HAND AND ASK ME QUESTIONS AS WE GO ALONG. THERE WE GO. SO A LITTLE BIT ABOUT ME, I HAVE A PH.D. IN PHYSIOLOGY AND WENT FROM BASIC SCIENCE TO NIH AND BEEN HERE FOR SIX YEARS AND THE PAST TWO YEARS I'M THE DIRECTOR OF FITNESS AND WELLNESS PROGRAMS FOR RN W AND FOR THE LAST FIVE YEARS I HELPED IN A VARIETY OF PLACES TO LEAD WELLNESS ACTIVITIES AT NIH AND A TRI ATHLETE AND CYCLIST AND SOCCER REFEREE AND A PERSONAL TRAINER AND DONE NUTRITIONAL CONSULTING OVER THE YEARS. AND I SEE SOME PEOPLE WRITING THINGS DOWN. THESE SLIDES WILL BE AVAILABLE AFTERWARDS SO YOU DON'T HAVE TO GET WRITERS CRAMP WRITING EVERYTHING DOWN. BEFORE WE DIVE INTO THINGS, I WANT TO JUST TALK ABOUT THE DEFINITION OF HEALTH. A LOT OF PEOPLE THINK OF THE PHYSICAL HEALTH, RIGHT, AND I HOPE THAT PEOPLE ARE EMBRACING THE MORE WHOLISTIC DEFINITION OF HEALTH NOW. THE WORLD HEALTH ORGANIZATION DEFINES HEALTH AS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING. AND NOT MERELY THE ABSENCE OF DISEASE AND/OR INFIRMITY AND HERE IS JUST A MODEL THAT ENCOMPASS THEM ALL AND THEY ARE MORE PREVALENT RATHER THAN FOCUSING ON EITHER DISEASE OR JUST PHYSICAL HEALTH. AND SO WHY FOCUS ON MEN'S HEALTH? ONE REASON IS THIS IS MEN'S HEALTH WEEK. BEYOND THAT, ARE YOU GOING TO ADVANCE, MOST MEN PAY MORE ATTENTION TO THEIR HEATH. COMPARED TO WOMEN, MEN ARE MORE LIKELY TO BE LESS THAN KNOWLEDGEABLE ABOUT THE PERSONAL HEALTH. THEY ARE MORE LIKELY TO PUT OFF REGULAR CHECK UPS AND MEDICAL CARE AND MORE LIKELY TO OR LESS LIKELY TO SEEK HELP FROM HEALTH PRACTITIONERS. AND THEY ARE MORE LIKELY TO TAKE HEALTH RISKS BOTH PHYSICAL AND LIFESTYLE, PHYSICAL RISKS BEING THINGS LIKE TYPICALLY MORE DANGEROUS JOBS, WHEN YOU WALK DOWN THE STREET AND THOSE YOU SEMEN GENERALLY AND IN TREES CUTTING LIMBS AND I SAW THAT ON MY WAY TO WORK TODAY AND DRIVING AT HIGHER SPEEDS AND MORE LIKELY TO SMOKE AND DRINK AND ACCESS AND A LESS HEALTHY DIET. SO THE TOPICS THAT WE WILL COVER DURING THIS TIME BAR ARE STAYING HEALTHY AND PREVENTING DISEASE. THIS REMOTE IS A LITTLE DODGE, SMOKING AND DRINKING AND AGING AND BLOOD PRESSURE, INJURIES, AND NUTRITION. AND I COULD TALK ABOUT EACH OF THESE ALL DAY BUT WE ARE JUST GOING TO SKIM THE SURFACE OF THEM AND IF YOU HAVE OTHER QUESTIONS, I'D BE HAPPY TO TALK ABOUT THEM. SO STAYING HEALTHY AND PREVENTING DISEASE, WHAT ARE THE MOST IMPORTANT THINGS YOU CAN DO TO STAY HEALTHY? THAT WAS A COMMON QUESTION THAT CAME UP WHEN WE POLLED MEN IN THE HALLWAYS AND MAINTAINING A HEALTHY WEIGHT. THIS IS PROBABLY THAT PEOPLE KNOW BUT IT'S REALLY, REALLY IMPORTANT. I REALLY LIKE AND CHOSE THIS CHART BECAUSE WHAT IS OFTEN USED WHEN YOU GO TO THE DOCTOR, THEY SAY WE ARE GOING TO TAKE YOUR HEIGHT AND YOUR WEIGHT, RIGHT, AND THEY USE THAT FOR SIMPLICITY AND CALCULATE YOUR BMI. FOR ME I AM LESS MUSCULAR THAN I HAVE EVER BEEN NOW, BUT I'M NO LEANER. AND MY BODY MASS INDEX HAS CHANGED DRAMATICALLY. I WAS IN THE VERY OVERWEIGHT BEFORE BECAUSE I WAS LIFTING WEIGHTS MORE AND DIDN'T PLACE ME AT A HIGHER RISK OF ANY DISEASES. BUT ON THE BMI CHART IT WAS NOT EXACTLY REFLECTING MY HEALTH STATUS. AND THIS RECOGNIZES THAT THERE ARE DIFFERENT FRAME SIZES, RIGHT. AND YOU KNOW I'M MORE OF A MEDIUM FRAME. BUT SOMEONE ON THE LARGER FRAME SIZE, I'M 6 FOOT AND RIGHT ABOUT 178 BUT IF YOU ARE A LARGER FRAME IT'S REASONABLE THAT YOU HAVE MORE MASS AS WELL. SO BUT MAINTAINING A HEALTHY WEIGHT IS REALLY IMPORTANT. EATING A VARIETY OF HEALTHY FOODS AND LIMITING CALORIES AND SATURATED FAT AND BEING PHYSICALLY ACTIVE, AND I CHOSE THESE FIVE BECAUSE IT OUTLINES SEVERAL WAYS YOU CAN BE ACTIVE AND DON'T NEED TO BE A RUNNER, GOLFING AND WALKING THE COURSE IS CERTAINLY A WAY TO BE ACTIVE. AND THE GENTLEMAN DOWN HERE DANCING, YOU KNOW, WHATEVER YOU LIKE TO DO TO MOVE. YES, SIR? >> I JUST WANTED TO HAVE A QUESTION ABOUT WEIGHT AND PARTICULARLY FOR GUYS THE WEIGHT AROUND THE MIDDLE AND MAYBE NOT OVERWEIGHT ANYWHERE ELSE BUT THE MIDDLE AND DO YOU BRING THAT UP? >> I WILL TOUCH ON THAT. THE QUESTION WAS ABOUT WAIST SIZE AND WEIGHT SO THAT IS A GREAT QUESTION. I THINK I WILL DIVE INTO THAT. AND THEN DON'T -- SMOKING IS OBVIOUSLY VERY IMPORTANT. ALSO SEEING A DOCTOR FOR REGULAR SCREENINGS IS ONE THING THAT MANY MEN DO NOT DO. WOMEN ARE MUCH BETTER AT THAT. NOT JUST WHEN YOU ARE SICK. CONTROLLING BLOOD PRESSURE AND CHOLESTEROL. PROTECTING YOURSELF FROM TOO MUCH SUN, WHETHER IT'S WITH SUN BLOCK OR STAYING OUT OF THE SUN. NOT DRINKING TOO MUCH ALCOHOL, TAKING CARE OF YOUR TEETH. THAT IS SOMETHING THAT WE KNOW TO BRUSH AND FLOSS BUT HOW MANY OF US DO IT EVERY NIGHT? I WAS TALKING TO A DENTIST ONCE AND HE SAID NOT FLOSSING EVERY NIGHT AND JUST BRUSHES IS LIKE TAKING A SHOWER AND NOT USING SOAP AND IT STUCK WITH ME AND DON'T FLOSS EVERY NIGHT AS I SHOULD AND MANAGING STRESS AND THAT COULD BE A TALK IN AND OF ITSELF AND MAYBE I'LL GIVE ANOTHER ONE ON THAT. THE LEADING CAUSE OF DEATH FOR MEN. THIS IS THE MOST RESENT DATA OUT -- FROM C.D.C. FROM THE NATIONAL VITAL STATISTICS SYSTEM. AS YOU SEE HEART DISEASE, CANCER, ARE TOP FOR BOTH GENDERS. BUT IT'S PARTICULARLY HIGHER IN MEN. I MEAN, IF YOU REALLY DUG INTO THAT IT'S DEFINITELY STATISTICALLY SIGNIFICANT AND HIGHER IN MEN. I LIKE THIS. IT REALLY TYPIFIES WHAT WE ARE TALKING ABOUT HERE AND YOU CAN PROBABLY PICK IT OUT, BUT NOT THE CAROT AND MEN DIE EARLIER WITH -- FROM HEART DISEASE AS I SAID AND ABOUT 25% DEATHS RELATED TO HEART DISEASE OCCUR BETWEEN THE AGES OF 35-65. AND THAT'S A STATISTICS THAT HITS HOME FOR ME, APPROACHING 35, I DON'T THINK I'M AT RISK OF A HEART ATTACK BUT I KNOW THAT MY YOUNGER BROTHER, EIGHT YEARS YOUNGER THAN ME ACTUALLY HAS HIGH BLOOD PRESSURE. AND HE IS 25. SO ACCORDING TO NHLBI, HEART LUNG AND BLOOD INSTITUTE 3% OF AMERICANS PRACTICE 3% OF AMERICANS PRACTICE THE BIG FOUR HABITS THAT PREVENT HEART DISEASE. WHAT DO YOU THINK THE BIG FOUR ARE? DO WE KNOW? DIET AND EXERCISE. HEALTHY DIET, REGULAR EXERCISE. MAINTAIN A HEALTHY WEIGHT. AND SMOKING. AND SMOKING. SO KNOWING YOUR NUMBERS AND THERE IS SEVERAL NUMBERS TO KNOW, THEY ARE ALL REALLY IMPORTANT. THE FIRST IS BLOOD PRESSURE. AND WEspy KNOW NORMAL IS 120 -- LESS THAN 120/80, RIGHT, AND THEN IT'S THE PREHYPERTENSION AND HYPERTENSION THAT YOU OFTEN YOU MIGHT FIND BY STOPPING BY ONE OF THE LITTLE KIOSKS IN THE HALLWAY BUT THAT IS WHERE YOU ARE GOING TO FIND OUT IF YOUR BLOOD PRESSURE IS A BIT ELEVATED IF YOU ARE GOING TO THE DOCTOR JUST FOR PREVENTATIVE SCREENINGS AND ANNUAL PHYSICALS AND THAT KIND OF THING. SORRY ABOUT THAT, GUYS. SO CHOLESTEROL, LDL OBVIOUSLY THERE ARE TWO TYPES OF CHOLESTEROL, LDL AND HDL. LDL IS HERE AND LESS THAN 100 IS OPTIMAL. SO MOST PEOPLE KNOW 120/80 BUT I DON'T KNOW IF MOST PEOPLE KNOW LESS THAN 100. SO IT'S OPTIMAL FOR LDL. AND THEN BETWEEN 70-100 IS NORMAL FOR FASTING GLUCOSE AS WELL, SO REMEMBER 100 AGAIN. AND THEN WEIGHT BMI AND WAIST SIZE AND THIS IS ONE OF THE TIMES THAT I CAN ADDRESS YOUR QUESTION. AND I WAS ACTUALLY AT THE AMERICAN COLLEGE OF SPORTS MEDICINE MEETINGS TWO WEEKS AGO AND THEY WERE TALKING ABOUT WAIST SIZE AND USING WAIST SIZE INSTEAD OF BMI BECAUSE YOUR WEIGHT MAY NOT CHANGE AS YOU LOSE BODY FAT, RIGHT, BUT YOUR WAIST SIZE OFTEN WILL. WHEN I WAS WORKING WITH NUTRITION CLIENTS SEVERAL OF MY CLIENTS SAID I CAN TELL THAT EVEN THOUGH THE NUMBER ON THE SCALE IS NOT CHANGING, I CAN TELL I'M MAKING PROGRESS BECAUSE MY CLOTHES ARE FITTING DIFFERENTLY. AND IF WE JUST FOCUS ON THE BMI OR JUST FOCUS ON THE NUMBER WHICH IS REFLECTED ON THE SCALE, WE ARE MISSING POTENTIALLY SOMETHING THAT THEY CAN SHOW IMPROVEMENT AND PEOPLE GET DISCOURAGED IF THEY DON'T SEE THE NUMBER CHANGE BUT IF YOU GO FROM THE RIGHT TO THE MIDDLE, AND YOU ARE GAINING MORE UPPER BODY MASS OR SOMETHING YOU MAY NOT DECREASE IN WEIGHT. BUT IT'S STILL A SIGNIFICANT, IMPORTANT CHANGE. SO HOW OFTEN SHOULD I VISIT THE DOCTOR? THE RECOMMENDATION IS EVERY TWO YEARS. UP UNTIL THE AGE OF 50. AND THESE ANIMATIONS REALLY DIDN'T WORK. AFTER AGE 50 ANNUALLY AND THEN IF YOU DO HAVE HIGH BLOOD PRESSURE GET IT CHECKED EVERY YEAR JUST TO TRACK THE PROGRESS IN IT. ANOTHER GREAT QUESTION, WHAT CAN I DO TO PREVENT SKIN CANCER? WE ALL KNOW TO APPLY SUN BLOCK. SOMETIMES WE DON'T DO WHAT WE KNOW WE SHOULD DO. BUT THEN REAPPLY REGULARLY. THIS IS SOMETHING THAT IS DIFFICULT FOR ME BECAUSE I LOVE BEING OUTSIDE. I LOVE REFEREEING SOCCER GAMES AND BEING OUTSIDE ALL DAY. BUT IF YOU CAN AVOID DIRECT SUNLIGHT DURING THOSE HOURS, IF YOU ARE A CYCLIST OR IN DOING ACTIVE THINGS AND GARDENING AND THINGS LIKE THAT IF YOU CAN GET OUT EARLIER IN THE MORNING OR LATER IN THE AFTERNOON, YOU WILL REDUCE YOUR -- REDUCE THE TIME THAT YOU ARE OUT WHEN THE RAYS ARE THE STRONGEST. AND THEN GETTING SUN BURN. THIS IS A GREAT STATISTICS THAT FIVE OR MORE SUN BURNS DOUBLES YOUR LIFETIME RISK OF DEVELOPING MELANOMA. LET ALONE IT'S OBVIOUSLY VERY UNCOMFORTABLE TO LOOK LIKE THIS GUY. BUT IT DEFINITELY DOES INCREASE YOUR RISK OF DEVELOPING SKIN CANCER. AND THEN CONDUCTING AN EXAMINATION HEAD TO TOE SO THAT YOU CAN NOTICE CHANGES PARTICULARLY IN YOU KNOW IN AREAS THAT ARE NOT EXPOSED TO SKIN. OR EXPOSED TO SUN. AND THEN GETTING A YEARLY SKIN CHECK UP FROM THE DOCTOR. YES, SIR. >> I HAVE A QUESTION ABOUT THE SUN BURN. IS IT MORE OR LESS A LINEAR RELATIONSHIP BETWEEN THE NUMBER OF SUN BURNS AND THE PROBABILITY OF SKIN CANCER? >> THAT IS A GREAT QUESTION. I AM NOT QUALIFIED TO ANSWER THAT "YES" OR "NO." I WOULD -- YOU KNOW, THE RISK FACTORS FOR ANY TYPE OF CANCER IS SO DIFFICULT TO PINPOINT EXACTLY, BUT I THINK, THIS IS PROBABLY AN EPIDEMIOLOGICAL STUDY THAT ASKS PEOPLE HOW MANY TIMES THEY GET SUN BURNED AND FOUND A TIPPING POINT AT THAT POINT. OBVIOUSLY YOU ARE NOT NECESSARILY COMPLETELY SAFE AT FOUR, YOU KNOW. JUST KEEP A CHECK AND, YEAH, I ONLY GOT FOUR SO I'M GOOD AND NOT DEVELOP SKIN CANCER. ONE OF CANCER IS A FUNNY DISEASE. ONE OF THE -- WHEN WE WERE MEETING PEOPLE AGAIN AT THE AMERICAN COLLEGE OF SPORTS MEDICINE CONFERENCE A COUPLE WEEKS AGO ONE OF THE LEADING RESEARCHERS IN PHYSICAL ACTIVITY RECENTLY PASSED AWAY THIS YEAR FROM LUNG DISEASE AND SHE HAD NEVER SMOKED AT ALL IN HER LIFE. AND SO YOU KNOW SOME PEOPLE DEVELOP MELANOMA THAT SPEND MOST OF THE TIME INSIDE SO THERE IS NO GUARANTY. THIS WAS ANOTHER QUESTION THAT CAME UP A LOT AND ESPECIALLY IN THE OLDER POPULATION HERE AT NIH, WHAT CAN I DO TO AVOID DEVELOPING DEMENTIA AND MY PARENTS ASKED ME THIS AS WELL. GO TO THE TALKS HELD ON ALZHEIMER'S DISEASE AND DEMENTIA AND TELL ME WHAT I CAN DO TO STAY ENGAGED LONGER. SO THERE IS NO SURE FIRE WAY AGAIN TO PREVENT ANY DISEASE. BUT IT MAY BE BENEFICIAL TO DO THE FOLLOWING. SO ONE IS TO KEEP YOUR MIND ACTIVE. AND THERE WAS A GREAT TALK RECENTLY AT NIH ON MUSIC AND THE BRAIN AND HOW MUSICIANS, THE BRAIN IS WIRED IN VERY COMPLEX WAYS AND DIFFERENT FROM PEOPLE THAT DO NOT PLAY MUSIC. AND SO PLAYING A MUSICAL INSTRUMENT, I DON'T THINK THAT THE EXPERTS IN THE FIELD DIDN'T THINK THAT NECESSARILY LISTENING TO MUSIC HAD THE SAME EFFECT, BUT REALLY ENGAGING YOUR BRAIN PROBABLY WATCHING SOMEONE PLAY CHESS WOULD NOT HAVE THE SAME EFFECT AS PLAYING CHESS BUT PLAYING GAMES OR PUZZLES, CROSS WORD PUZZLES AND PLAYING INSTRUMENTS AND MEMORY TRAINING AND SUDUKO AND BEING PHYSICALLY AND SOCIALLY ACTIVE, SO IT INCREASES BLOOD FLOW TO THE BRAIN AND HERE IS A GREAT SLIDE THAT I FOUND FROM THE UNIVERSITY OF ILLINOIS. AND THE RED, YOU KNOW, IS OBVIOUSLY THE HIGHER ACTIVATION AREA. AND THIS WAS TAKING A TEST AND THERE WAS MORE BLOOD FLOW TO THE PARTS OF THE BRAIN THAT WERE OBVIOUSLY ENGAGED HERE. BUT THEY WERE SITTING QUIETLY PRIOR AND THEN THEY TOOK A 20-MINUTE WALK PRIOR TO TAKING A TEST. SO THE PROOF IS IN THE COLOR THERE. QUIT SMOKING. OBVIOUSLY THERE ARE A FEW THEMES THAT COME UP HERE. I COULD PUT THEM IN BUCKETS BUT BECAUSE THEY ARE SO CROSS CUTTING I DIDN'T MIND THE REPETITION HERE. I DON'T THINK THAT YOU KNOW IT'S A SURPRISE THAT QUITTING SMOKING IS GOOD FOR YOU BUT ACROSS ALL OF THESE THINGS SMOKING HAS BEEN LINKED TO DEMENTIA. AND LOWERING YOUR BLOOD PRESSURE, AGAIN, IS ALSO LINKED TO AVOIDING DEMENTIA. PURSUING EDUCATION. NOW, THIS IS KIND OF ONE OF THOSE, AGAIN, CORELATIVE THINGS BUT GOES BACK TO KEEPING YOUR MIND ACTIVE. AND THEN MAINTAINING A HEALTHY DIET. AND YOU PROBABLY HEARD THE VALUE OF OMEGA 3 FATTY ACIDS AND THE REASON IS THAT IS WHAT ACTUALLY MAKES UP YOUR BRAIN. THAT IS THE FATTY TISSUE THAT MAKES UP YOUR BRAIN AND SATURATED FATS IMPAIR THE DEPOSITION OF THE HEALTHY FATS IN YOUR BRAIN. SO IF YOU ARE NOT EATING THINGS THAT CONTAIN OMEGA 3S AND TOO MANY OMEGA 6 AND THEY ARE GENERALLY IN RED MEATS AND SATURATED FAT OILS, OMEGA 3 ARE IN FISH AND NUTS AND OTHER THINGS LIKE Q!rxTHAT, CONSIDER THAT IF YOU ARE WORRIED ABOUT DEVELOPING DEMENTIA. SO THIS IS AN INTERESTING QUESTION. PROBABLY NOT ONE THAT WOULD BE INCLUDED IN THE WOMEN'S HEALTH TALK, RIGHT, I DON'T KNOW A LOT OF WOMEN THAT SMOKE CIGARS BUT THERE IS KIND OF A COMMON PERCEPTION OUT THERE I THINK, AT LEAST IN CIGAR SMOKERS I HAVE TALKED TO THAT THEY ARE NOT AS HARMFUL AS CIGARETTES AND THERE IS CROSS OVER BETWEEN THE SMOKERS, THEY REPUTATION IS PROBABLY BASED ON THE FACT THAT THEY ARE NOT SMOKING CIGARS EVERYDAY. YOU ARE NOT SMOKING A PACK OF CIGARS AS YOU WOULD MAYBE SMOKE A PACK OF CIGARETTES AND YOU ARE ALSO NOT INHALING AS MUCH, BUT AS WE KNOW SECONDARY SMOKE IS OBVIOUSLY AN ISSUE. AND THEY ARE ACTUALLY WORSE THAN CIGARETTES. ONE REASON IS THEY CONTAIN MORE CARCINOGENIC TARS AND MORE NICOTINE AND IT'S ABSORBED THROUGH THE MOUTH BECAUSE YOU HOLD THE SMOKE IN YOUR MOUTH A BIT MORE. AND BECAUSE THE CIGAR WRAPPERS ARE LESS PORUS THEY DO NOT BURN COMPLETELY AND MORE OF THE TOXINS ARE RELEASED. SO, YES. >> WITH REGARDS TO BURNING LESS, IF IT BURNS MORE. >> THEY DON'T BURN AS COMPLETELY AND JUST BURN -- I THINK BECAUSE THEY HOLD ON TO THE TOXINS MORE AND THEN YOU INHALE MORE RATHER THAN BURNING AND JUST FALLING INTO ASH. SO IT STAYS THERE IN YOUR MOUTH, READY TO BE SUCKED IN LONGER. DOES THAT MAKE SENSE? THAT'S WHAT THEY FOUND. SO CAN DRINKING PERMANENTLY AFFECT YOUR MEMORY? YES, DRINKING CAN AFFECT YOUR MEMORY BOTH SHORT AND LONG-TERM. I REMEMBER BACK IN COLLEGE THEY GAVE A PRESENTATION DURING OR ORIENTATION THAT SAID, THIS WAS OVER TEN YEARS AGO THAT SAID, YOU KNOW, THAT THEY FOUND THERE WERE STUDIES THEN TO FIND DRINKING THE WEEKEND BEFORE WOULD IMPAIR TEST PERFORMANCE AND THINGS AFTER THAT, THE WEEK AFTER IT. AND HEAVY TO MODERATE DRINKING CAN CAUSE SLIPS OF MEMORY. AND STUDIES HAVE SHOWN THAT SIGNIFICANT BRAIN SHRINKAGE IN ALCOHOLIC MEN AND WOMEN COMPARED TO CONTROL GROUPS AND I ACTUALLY HAVE A PICTURE OF THIS. AND THAT IS SIGNIFICANT. AND, NO, REALLY. HERE IS -- YOU CAN ACTUALLY SEE HERE, THESE ARE EQUAL AGE WOMEN OR MEN AND YOU CAN SEE THAT THE BRAIN ACTUALLY HAS SHRUNK. DEHYDRATION IS ACTUALLY WHAT CAN CAUSE JUST FROM PHYSICAL ACTIVITY THEY FOUND THAT CAN SHRINK THE BRAIN AS WELL. BUT YOU ARE ASSUMING THESE PEOPLE ARE AT EQUAL HYDRATION STATUS AND IF THAT IS NOT A PICTURE THAT WILL STICK WITH YOU AT THE BAR NEXT TIME I DON'T KNOW WHAT WILL. SO WHAT CHANGES IN BEHAVIOR ARE ADVISED AS YOU AGE? EAT A HEALTHY DIET SEEMS TO BE A REOCCURRING THEME. EXERCISE YOUR BODY OR CONTINUE OR BEGIN AEROBIC EXERCISE AND HERE ARE THE AFFECTS OF EXERCISE ON AGING. FAVORABLE AFFECTS AND INCREASE CARDIO OUT PUT AND BURN DENSITY, THAT IS ONE THING THAT GETS OVERLOOKED IN MEN MANY TIMES AND THINK OF OSTEOPOROSIS AFFECTING WOMEN MOSTLY BUT MEN ARE JUST AS SUSCEPTIBLE IF NOT EATING A HEALTHY DIET AND NOT GETTING THE THINGS THEY NEED. AND STRENGTH TRAINING IS SOMETHING THAT CAN DEFINITELY HELP BONE DENSITY AS WELL. EXERCISE YOUR MIND. AND CONTROL STRESS. AND I PUT THIS SLIDE UP HERE BECAUSE WE THINK OF STRESS AS BAD. RIGHT. AND STRESS IS ALL AROUND US ALL THE TIME. AND IT'S REALLY A RESPONSE TO THE STRESS THAT WE NEED TO CONTROL. RIGHT? THERE IS A LOT OF THINGS THROUGHOUT OUR DAY THAT WE DON'T HAVE CONTROL OVER. AND MYSELF BEING A CONTROL FREAK, THAT SOMETIMES STRESSES ME OUT. BUT WE CAN CONTROL A RESPONSE TO THINGS. AND SO YOU KNOW, I THINK THE LEFT SIDE OF THE FIGURE, IF YOU WERE THERE ALL OF THE TIME, YOU WOULD PROBABLY BE A VERY BORING PERSON. AND YOU WOULD BE BOARD AND YOU WOULDN'T BE ENGAGED AND IN YOUR PERFORMANCE WOULD REFLECT THAT. SO WE WANT TO BE IN THE MIDDLE BECAUSE ONCE WE REACH THE OTHER SIDE AS IT SAYS FATIGUE AND EXHAUSTION AND WE BURN OUT. BUT WHEN WE TALK ABOUT CONTROLLING STRESS, IT'S REALLY CONTROLLING A RESPONSE TO THE STRESS AND NOT TRYING TO CONTROL THE SITUATION AS MUCH AS WE MIGHT. AND JUST CONTROLLING WHAT WE CAN CONTROL AND LETTING GO OF WHAT WE CAN'T. AGAIN, LIMITING ALCOHOL CONSUMPTION AND NOT SMOKING. AND FOCUSING ON PREVENTION, COMMUNICATING WITH YOUR PHYSICIAN, THERE IS SOME GREAT VIDEOS ACTUALLY ON THE A HR Q WEBSITE ABOUT ASKING QUESTIONS OF YOUR DOCTOR AND THEN GETTING A FLU VACCINE ANNUALLY BEFORE COMMANDER-IN-CHIEF CAN GO AND GET A FLU VACCINE, IF IT'S GOOD ENOUGH FOR HIM, IT'S GOOD ENOUGH FOR ME. AND THEN CANCER SCREENINGS AND CHOLESTEROL CHECKS EVERY FIVE YEARS. SO THIS IS ONE OF MY FAVORITE SLIDES ACTUALLY AND YOU WILL FIND OUT WHY IN A MOMENT. BUT WHAT CHANGES IN HEALTH ARE NORMAL AS YOU AGE? RIGHT? AND I UNDER LINED NORMAL BECAUSE THE NEXT LINE REALLY SAYS IT, RIGHT, MOST INDIVIDUALS ARE LESS ACTIVE AS THEY AGE. SO WHAT IS NORMAL? IS NORMAL WHAT SOCIETY DICTATES AS NORMAL OR IS NORMAL WHAT PHYSIOLOGICALLY WE COULD DO? RIGHT? AND BECAUSE MOST INDIVIDUALS ARE LESS ACTIVE AS THEY AGE, THEY EXPERIENCE DECREASED ENVIRONMENTAL DENSITY AND OSTEOPOROSIS, BRITTLE BONES AND LESS STABLE JOINTS AND LEAD TO WEAKER HIPS, KNEES, SHOULDERS AND MAYBE FALLING BECAUSE OF THIS, REDUCED EYESIGHT AND DEGENERATION AND HEARING LOSS, LOSS OF BLADDER CONTROL, AND GI ISSUES MAY INCREASE. BUT WHAT IF WE DIDN'T GET LESS ACTIVE? WHAT IF WE WERE LIKE THIS, THIS GUY IN THE UK WHO JUST FINISHED A TRIATHLON AT 91 YEARS OLD? I WAS AT A TRIATHLON THIS PAST WEEKEND AND THERE WAS A 65-69 CATEGORY. AND THERE WERE THREE PEOPLE PLACING IN IT. AND THERE WAS A 70-74 CATEGORY. AND THERE WERE PLACERS IN THAT AS WELL. >> AND WHAT TRAGICALLY HAPPENED IN BOSTON BUT A GUY WAS 72 AND HE WAS LIKE AT THE FRONT OF THE PACK. >> THAT IS RIGHT. >> THAT WAS AWESOME. >> SHE WAS MENTIONING THE GENTLEMAN THAT WAS FINISHING JUST AS THE BOMBING AND THE BOSTON MARATHON WAS 72 YEARS OLD. I SAW AN INTERVIEW WITH HIM RIGHT AFTERWARDS AND THEY SAID SO IS THIS GOING TO CHANGE YOUR MINDSET TOWARDS RACING? AND HE SAID, NO. I'M GOING TO KEEP DOING IT. AND SO I THINK THIS REALLY, THIS IS A GENTLEMAN THAT IS ALMOST 60 YEARS OLD AND I THINK IT REALLY IS TRUE, THAT WE TONIGHT STOP EXERCISING BECAUSE WE GET OLD. WE GROW OLD BECAUSE WE DON'T -- WE GROW OLD BECAUSE WE STOP EXERCISING. SO SPEAKING OF EXERCISE AND GROWING OLDER, WHEN DO MEN BEGIN LOSING LEVELS OF HUMAN GROWTH HORMONE AND THAT WAS A QUESTION THAT CAME UP AGAIN AS WE WERE POLLING PEOPLE IN THE HALLWAY. AND JUST AS VERY BRIEF BACKGROUND, GROWTH HORMONE IS PRODUCED BY THE PITUTIARY GLAND AND THE PEA-SIZED ORGAN WITHIN THE BRAIN AND IT FUELS CHILDHOOD GROWTH AND HELPS MAINTAIN TISSUES AND ORGANS THROUGHOUT YOUR LIFE. AND BEGINNING AROUND THE AGE OF 30 THE PITUITARY GLAND SLOWLY REDUCES THE GROWTH HORMONE THAT IT PRODUCES. AND OFTEN THE SYMPTOMS BECAUSE OF THE CASCADE, THE PATHWAYS THAT ARE INVOLVED IN THESE PROCESSES OF MAINTENANCE OF MUSCLE MASS AND TISSUE AS IN ORGANS, THE SYMPTOMS OF LOW TEST -- TESTOSTERONE ARE CONFUSED AND PEOPLE CONSIDER SUPPLEMENTS FOR BOTH AND IT'S NOT CLEAR WHETHER THOSE ARE EFFECTIVE ACROSS THE BOARD. I WAS LOOKING INTO THE STUDIES IN THESE AND THERE IS NO STRONG RECOMMENDATION THAT MEN SHOULD TAKE SUPPLEMENTS OR GET INJECTIONS OF THESE. THIS IS SOMETHING THAT IS A NATURAL PROGRESSION AS WE AGE. ANY QUESTIONS ON ANYTHING SO FAR? SURE. >> ON THE TESTOSTERONE, YOU -- THERE ARE STATEMENTS THAT AGE AND THE GROWTH AND MOST MALES DON'T GET TESTED FOR IT BUT IF YOU GET TESTED AND ARE BELOW SOME RANGE -- [TOO LOW TO HEAR] . >> I'M GOING TO REPEAT THE QUESTION BECAUSE WE ARE BEING VIDEOTAPED. THAT IF YOU ARE OUT OF THE MEDICAL RANGE, I MEAN, THERE IS A LIMIT WHERE IF YOU ARE OUT OF THE RANGE, IF YOUR TESTOSTERONE IS LOW YOU SHOULD RECEIVE INJECTIONS OR SOMETHING LIKE THAT, SUPPLEMENTAL TESTOSTERONE AND YOU ARE RIGHT ABOUT THAT. I'M SAYING THERE IS A PRETTY LARGE NORMAL RANGE AND SOME OF THE SYMPTOMS OF JUST THAT ARE NOT NECESSARILY ASSOCIATED WITH THAT ARE THE CONFUSION AND IT'S ATTRIBUTED TO LOW TESTOSTERONE LIKE NOT EATING BREAKFAST OR FATIGUE AND IT'S NOT THAT. IF YOU ARE TESTED FOR IT AND FOUND TO BE LOW, THEN THAT IS IN THE DOCTOR'S. >> I WOULD SAY THERE IS AND BECAUSE IF YOU ARE SAYING THAT [TOO LOW TO HEAR] CALCULATING AVERAGES. >> SURE. >> YOU BASICALLY HAVE. >> A SKEWED, THAT IS RIGHT. >> A RANGE OF TESTOSTERONE. >> THAT IS A GREAT POINT. >> SO I DON'T KNOW. >> THANK YOU. DID YOU HAVE A QUESTION? OKAY. ALL RIGHT. MOVING ON TO BLOOD PRESSURE. ANOTHER QUESTION THAT CAME UP IS HOW CAN I LOWER MY BLOOD PRESSURE WITHOUT MEDICATIONS? AGAIN, LIFESTYLE PLAYS AN IMPORTANT ROLE IN TREATING HIGH BLOOD PRESSURE. SOME PART OF IT IS GENETIC. I KNOW IF CHOLESTEROL AND BLOOD PRESSURE AND I KNOW MANY PEOPLE THAT ARE VERY ACTIVE AND HAVE HIGH OF BOTH. AND SO THERE IS DEFINITELY A GENETIC COMPONENT AND VARIES BY RACE AND GENDER, BUT DEFINITELY THINGS LIKE STRESS, BODY WEIGHT, AND ACTIVITY, THE AMOUNT OF SALT YOU INTAKE IN YOUR DIET, ALCOHOL USE AND AGE ALL AFFECT BLOOD PRESSURE. BUT IF YOU ARE ABLE TO SUCCESSFULLY CONTROL YOUR BLOOD PRESSURE WITH A HEALTHY LIFESTYLE YOU COULD AVOID DELAY OR REDUCE THE NEED FOR MEDICATION AND I'VE SEEN THAT IN SOME OF THE PEOPLE THAT I'VE WORKED WITH RIGHT JUST HERE AT NIH. SO THERE IS TEN LIFESTYLE CHANGES AND I'LL BRING THOSE UP QUICKLY. LOSE EXTRA POUNDS AND WATCH YOUR WAIST LINE IS THE BODY WEIGHT AND EXERCISE REGULARLY, EAT A HEALTHY DIET. LOTS OF REOCCURRING THEMES. REDUCE SODIUM IN THE DIET, LIMIT THE AMOUNT OF COLUMN YOU DRINK, TOBACCO AND CUTBACK ON CAFFEINE AND REDUCE YOUR STRESS, MONITORING YOUR BLOOD PRESSURE AT HOME, MAKING REGULAR DOCTOR'S VISITS ESPECIALLY IF YOU HAVE HIGH BLOOD PRESSURE AND THEN GETTING SUPPORT FROM FRIENDS AND FAMILY CAN EASE THAT EMOTIONAL COMPONENT TO HIGH BLOOD PRESSURE. INJURIES. ESPECIALLY WHEN YOU ARE WORKING WITH ATHLETES AND THE FITNESS SIDE OF THINGS AS I DO MANY TIMES, PEOPLE ALWAYS ASK WHAT IS THE BEST WAY TO CARE FOR THIS NAGGING INJURY THAT I'VE HAD FOR THE LAST TEN YEARS, RIGHT. ESPECIALLY LIGAMENT AND CARTILAGE ISSUES, ONE OF THE FIRST THINGS IS STOP IF IT HURTS. THAT IS THE HARDEST THING FOR ME TO DO. ESPECIALLY WHEN I WORK WITH RUNNERS AND THEY ARE USED TO RUNNING EVERY SINGLE DAY TO TAKE TIME OFF. THEY FEEL LIKE THEY ARE LOSING GROUND AND THEY WILL GET OUT OF SHAPE RIGHT AWAY. AND IT'S DIFFICULT TO OVERCOME A NAGGING INJURY WHEN YOU JUST KEEP GOING AND KEEP GOING BECAUSE IT'S PROBABLY THE ACTIVITY THAT CAUSED THE INJURY INITIALLY AND CROSS TRAININGLY IS A GREAT THING HERE. SO I SAY NO PAIN, ALL GAIN. SO INITIALLY FOLLOWING IF THERE IS -- IF IT'S AN ACUTE INJURY, YOU CAN SEEK MEDICAL CARE. IF IT'S SEVERE ENOUGH OR IF YOU ARE ABLE TO#G TREAT IT AT HOME, RICE IS THE ACRONYM, REST, ICE, COMPRESSION, AND ELEVATION. AND PEOPLE ARE USING COMPRESSION MORE AND MORE NOT JUST FOR INJURIES BUT JUST TO REDUCE INFLAMMATION AND THINGS LIKE THAT. THERE IS MANY PRODUCTS OUT ON THE MARKET NOW THAT ARE COMPRESSION SLEEVES FOR THE CALVES AND THINGS THAT PROFESSIONALS ARE USING AND NOT JUST DURING RACES BUT FOR RECOVERY AND THE EVIDENCE IS SHOWING THAT IT IS NOT JUST THE PLACEBO EFFECT. AND THEN REHABILITATION IS SO IMPORTANT. I'VE KNOWN MANY PEOPLE WHO HAVE NOT DONE THE REHABILITATION THAT THEY SHOULD HAVE DONE AND YEARS LATER, ALTHOUGH THEY DON'T HAVE THE PAIN ANYMORE STIFFNESS IS NOT NECESSARILY AS MUCH OF AN ISSUE. THEIR RANGE OF MOTION IS LIMITED BECAUSE IMMEDIATELY AFTER THE INJURY THEY DIDN'T DO THE PROPER REHABILITATION. SO WHEN YOU GO TO THE PHYSICAL THERAPIST AFTER THE INJURY AND THEY GIVE YOU EXERCISES DO THEM. THAT IS THE TAKE AWAY. AND THEN TO REDUCE STIFFNESS AND DUE TO SCAR TISSUE, STRETCH THE MUSCLES AND WARM UP AFTER EXERCISING. THAT IS A BIG ONE. JUST TO GET THE JOINTS LUBRICATED, GET THE BLOOD FLOWING AND THE MUSCLES WARMED UP. A PROPER EXERCISE ROUTINE AND WARMING UP IS NOT JUST STRETCHING BUT REALLY GETTING YOUR HEART RATE UP AND CORE TEMPERATURE UP TO PREVENT FURTHER DAMAGE TO THOSE. SO I'VE BEEN AT IT FOR 40 MINUTES AND I'M GOING TO THROW IN A CARTOON HERE, WHAT DOESN'T KILL YOU, MAKES YOU STRONGER. AND I LOVE THIS. I FOUND THIS, SOMEONE POSTED THIS ON FACEBOOK. EXERCISE ONCE BUT FOUND THAT I WAS ALERGIC AND GOT SHORTNESS OF BREATH AND SWEATY, AND IT WAS VERY DANGEROUS SO BE AWARE WHEN YOU ARE EXERCISING YOU MAY EXPERIENCE THOSE SYMPTOMS. IF YOU DO CONTINUE. SO HOW CAN WE REDUCE JOINT INFLAMMATION DUE TO EXERCISE? IT DEPENDS ON THE CAUSE OF INFLAMMATION, RIGHT? DUE TO AN ACUTE INJURY AGAIN JUST AS THE PREVIOUS SLIDE SEEK MEDICAL ATTENTION OR REST, ICE, COMPRESSION AND ELEVATION AT HOME. IF IT'S CAUSED BY ARTHRITIS, RIGHT, WHICH IS A COMMON THING THAT PEOPLE ARE COMING INTO THE FITNESS CENTERS AT NIH SAYING, YOU KNOW, SOMEONE CAME IN YESTERDAY AND SAID I NEED TO USE THE ELIPITICAL BECAUSE I CAN'T RUN ON THE TREADMILL BECAUSE OF MY ARTHRITIS. SO GENERALLY YOU ARE NOT GOING TO BE ABLE TO CURE THAT UNDERLYING CONDITION. BUT PHYSICAL THERAPY, ORTHOTICS AND SPLINTS TO SUPPORT THE JOINTS AND MESSAGE AND WATER THERAPY, DOING EXERCISES IN A POOL WILL OFTEN ALLEVIATE SOME OF THOSE SYMPTOMS AND EVEN PREVENT THEM. SOME OTHER RECOMMENDATIONS ON DECREASING INFLAMMATION. RECOVERY AND THAT YOU KNOW JUST GETTING ENOUGH SLEEP IS WHEN YOUR BODY REPAIRS. A LOT OF PEOPLE THINK IF I WANT TO GET STRONGER, I WANT TO GET FASTER I NEED TO WORKOUT MORE AND IT'S REALLY THE INCORPORATION, RIGHT, OF THE EFFECTS YOU ARE DOING, THE STIMULATION YOU ARE DOING DURING YOUR EXERCISE WHEN YOU ARE RESTING AND RECOVERY. SO GETTING EIGHT HOURS A NIGHT, I DON'T SLEEP EIGHT HOURS A NIGHT BUT THAT IS THE RECOMMENDATION. AND JUST RECOVERING. MOVE. I DON'T HAVE -- I'M NOT CLOSE TO HAVING ARTHRITIS BUT I GET STIFF IF I SIT FOR TOO LONG. AVOID SITTING IN ONE POSITION FOR TOO LONG. AVOID PAIN. IF THERE ARE THINGS AND I WAS -- AS I WAS THINKING ABOUT THIS ONE, THERE ARE THINGS YOU DO ROUTINELY IN YOUR HOUSE, YOU KNOW, LIFTING OR REACHING AND THINGS LIKE THAT THAT ARE PAINFUL, CONSIDER REARRANGING WHERE THE HEAVY PLATES ARE IN YOUR CABINET OR SOMETHING LIKE THAT SO YOU ARE NOT PUTTING STRESS ON YOUR SHOULDERS OR YOUR ELBOWS OR SOMETHING LIKE THAT BY PUTTING TOO MUCH WEIGHT IN AN AWKWARD POSITION. AND THEN DESTRESSING. NOT JUST JOINT INFLAMMATION IN THIS, BUT THERE IS MANY, MANY STUDIES OUT THERE THAT HAVE LOOKED AT, YOU KNOW, STRESS AND INFLAMMATION, THAT IS PROBABLY IF YOU --@ IF YOU GO ON GOOGLE AND DO INFLAMMATION AND ANY DISEASE AND INFLAMMATION IS RIGHT UP THERE. THE LINK IS VERY, VERY STRONG WITH EVERYTHING NOW. SO DESTRESSING CAN DEFINITELY HELP THAT. OTHER RECOMMENDATIONS, AGAIN, EATING LOTS OF FRUITS AND VEGETABLES. I RECENTLY JUST THIS WEEK SAW A STUDY ON SHOULD YOU OR SHOULD YOU NOT TAKE A MULTI VITAMIN AND IT WAS, YOU KNOW, THAT HAS BEEN THE RECOMMENDATION FOREVER, RIGHT, TAKE A MULTI VITAMIN ESPECIALLY IF YOU ARE NOT GETTING WHAT YOU NEED FROM FOOD. I DON'T THINK THAT IS NECESSARILY CHANGING, IF YOU DON'T GET WHAT YOU NEED YOU DON'T WANT TO BE DEFICIENT IN ANYTHING BUT EATING FRUITS AND VEGETABLES AND GETTING IT IN ITS NATURAL, WHOLE FOOD FORM IS DEFINITELY BETTER THAN TAKING A SUPPLEMENT. AGAIN, OMEGA 3, HERE ARE MORE EXAMPLES. MENTIONED BEFORE THE FISH, ALSO FLAX SEEDS ARE SUPER HIGH IN OMEGA 3 AND SOME OILS AND PUMPKIN SEEDS AND NUTS AND WEIGHT LOSS. AND THEN MEDICATIONS. I DON'T LIKE TO ADVISE PEOPLE73 TO TAKE, YOU KNOW, IBUPROFEN IF YOU HAVE PAIN. BUT I WAS SUFFERING PERSONALLY SEVERAL YEARS BACK FROM SOME INFLAMMATION THAT I THOUGHT WAS RIGHT ACROSS MY GLUTE AREA AND THOUGHT THIS WAS JUST GOING TO GO AWAY. I'LL JUST WAIT IT OUT AND WON'T TAKE ANYTHING. AND I ACTUALLY WENT TO AN ORTHOPEDIST AND HE SAID HAVE YOU EVER HAD ANY GI INFLAMMATION AND I SAID AS A MATTER OF FACT I HAVE. THIS WAS LIKE THE THIRD OR FOURTH DOCTOR I WENT TO. AND HE SAID YOU KNOW, I THINK THAT THE INFLAMMATION FROM YOUR GUT MAY HAVE ACTUALLY SPREAD INTO YOUR SI JOINT, YOUR SACROILIAC JOINT WHICH IS A FUSED JOINT IN THAT AREA. AND SO IT ALIGNED EXACTLY WITH WHERE THE PAIN WAS. IT WAS STRAIGHT DIAGONALLY FORM IN AND I WAS STRETCHING LIKE CRAZY AND IT JUST WASN'T IMPROVING AND I SAID WHAT CAN I DO? HE SAID JUST TAKE SOME IBUPROFEN AND IT WORKED AND ANY OTHER PERSON WOULD HAVE DONE IT RIGHT AWAY BUT ME RESISTING MEDICATION AND DIDN'T NEED TO TAKE IT CHRONICALLY AND I TOOK IT A FEW DAYS AND IT REDUCED THE INFLAMMATION AND IT WENT AWAY AND A STORY THERE IS USE IN TAKING AN ANTIINFLAMMATORY DRUGS, I PUT THEM BOTH UP HERE BECAUSE IBUPROFIN AND NAPROXIN ARE ANTIINFLAMMATORY DRUGS AND ACETAMINOPHEN AND THIS IS NOT AN ANTIINFLAMMATORY DRUG AND WORKS BY A DIFFERENT MECHANISM AND WILL REDUCE PAIN BUT DOESN'T TREAT INFLAMMATION AND IF I TOOK TYLENOL IT WOULD NOT HAVE DONE ANYTHING, IT WOULD HAVE TAKEN THE PAIN AWAY BUT IT WOULD NOT HAVE TREATED THE INFLAMMATION SO KNOW WHAT YOU ARE TAKING THERE. ALL RIGHT, NUTRITION, AGAIN I CAN TALK ABOUT THIS ALL DAY. THIS IS WHAT MY PH.D. WAS THIS NUTRITIONAL PHYSIOLOGY BUT I BROKE IT DOWN INTO THREE PARTS HERE SO THEY ARE ALL ON ONE SLIDE. EAT LOTS OF FRUITS AND VEGETABLES AND MODERATE AMOUNT OF HEALTHY FATS, PROTEIN AND LEGUMES AND DAIRY IS ALWAYS ON WHAT THEY, YOU KNOW, THE GOVERNMENT PUTS OUT. THERE IS A LOT OF PEOPLE THAT DAIRY DOESN'T WORK FOR AND WHETHER YOU ARE LACTOSE INTOLERANT AND WHY IT'S IN ITALICS AND IF IT DOESN'T WORK FOR YOU THERE ARE OTHER SOURCES OF CALCIUM SO KNOW THAT IT'S OFF TO THE SIDE THERE I THINK IN A GLASS BECAUSE THAT IS THE WAY THEY WANT TO REPRESENT IT. BUT FOCUS ON THE OTHERS AND UNLESS YOU ARE REALLY LACKING IN VITAMIN D OR CALCIUM, YOU ARE ABLE TO GET IT FROM OTHER SOURCES. AND THEN REDUCE STARCH AND PROCESSED FOODS AND MEATS AND FRIED FOODS AND RED MEAT AND SOME PEOPLE MIGHT DISAGREE WITH ME ON THE LAST ONE BUT THERE ARE A LOT OF STUDIES THAT HAVE LINKED HIGH RED MEAT CONSUMPTION WITH THINGS THAT ARE NOT GOOD LIKE HEART DISEASE AND CANCERS AND THINGS LIKE THAT. AND SOMETHING I THOUGHT WAS INTERESTING WHEN I DID A FACT SHEET ON IT WITH THE NATIONAL CANCER INSTITUTE WHEN I WAS WORKING WITH THEM FIVE YEARS AGO ABOUT THE NATURAL CARCINOGENIC COMPOUNDS THAT ARE FORMED IN CHARRED RED MEAT AND IT'S NOT FORMED IN CHARRED ZUCINNI SO IF YOU ARE GRILLING BE CAREFUL AND SOME PEOPLE LIKE IT REALLY WELL DONE BUT THERE IS A HEALTH RISK AND I MENTIONED THIS BECAUSE WE ARE GOING INTO SUMMER TIME AND PEOPLE WILL PROBABLY GRILL MORE AND SO IF THERE IS SOMETHING REALLY CHARRED DON'T THINK, YOU KNOW, I DON'T WANT TO WASTE THIS GOOD FOOD, IT'S DELICIOUS AND PROBABLY NOT WORTH THE RISK WHEN IT'S CHARRED ON THE OUTSIDE. YOU CAN SCRAPE IT AWAY, BUT THERE ARE COMPOUNDS IN IT THAT ARE NATURALLY OCCURRING WHEN IT'S COOKED AT A HIGH TEMPERATURE. SO IN SUMMARY MOVE YOUR BODY. EAT HEALTHY FOODS. GET REGULAR CHECK UPS. AND LIMIT SMOKING AND DRINKING AND THOSE ARE THE REOCCURRING THEMES, RIGHT? AND THERE IS A TREMENDOUS NUMBER OF RESOURCES ON GOVERNMENT WEBSITES THIS ONE IS A GREAT ONE, THIS WAS THE MEN'S HEALTH PAGE THERE AND NIH HAS A GREAT MEN'S HEALTH PAGE, MEDLINE PLUS WHICH IS A SERVICE OF THE NATIONAL LIBRARY OF MEDICINE AND NIH, OTHER GREAT INFORMATION THERE. AND MY FINAL THOUGHTS ARE I REALLY LIKE THIS QUOTE THAT I MAY NOT BE THERE YET BUT I'M CLOSER THAN I WAS YESTERDAY. RIGHT, SO IF ANY OF THE BEHAVIORS HERE ARE THINGS YOU ARE NOT DOING RIGHT NOW DON'T DESPAIR. IT'S JUST GETTING ONE STEP CLOSER TODAY THAN YOU WERE YESTERDAY. SO STRIDE FOR PROGRESS, NOT FOR PERFECTION. SO WITH THAT I'LL OPEN IT UP TO ANY QUESTIONS THAT YOU MAY HAVE BEEN HOLDING ON TO. YES, SIR. >> WHAT WOULD BE AN EXAMPLE OF REFINED GRAIN? >> I MEAN, THE STEREOTYPICAL EXAMPLE IS WHITE RICE AND BROWN IS UNREFINED AND WHITE IS REFINED AND A LOT OF PEOPLE SUGGEST EATING OATMEAL FOR BREAKFAST AND FOR CONVENIENCE YOU CAN GRAB THE LITTLE PACKS OF INSTANT OATMEAL, BUT THAT IS REFINED MORE THAN THE QUICK -- THE QUICK OATS IS MORE THAN THE WHOLE ROLLED OATS. AND I FOUND THAT I EAT OATMEAL IN THE MORNING AND FOUND IF YOU BOIL WATER AND POUR IT OVER THE ROLLED OATS IT'S THE SAME AS BOILING IT AND IT TAKES NO TIME. AND SO IT REALLY DOES MAKE A DIFFERENCE. THE ADDED FIBER HAS SHOWN IN STUDIES WHERE THEY LOOKED AT PEOPLE'S GLYCEMIC RESPONSE THE BLOOD SUGAR SPIKE AFTER EATING WHITE RICE VERSUS BROWN RICE ANDXL IT'S SIGNIFICANTLY LESS. OTHER EXAMPLES ARE THINGS THAT I THREW UP THERE LIKE YOU KNOW REALLY ANY -- ANYTHING THAT IS PROCESSED AND ANY GRAIN THAT IS PROCESSED. YEP. >> I JUST WANTED TO SHARE THAT I DID ONE MAJOR ELEMENT OF THE STORY WHICH WAS PEANUT BUTTER SANDWICH FOR BREAKFAST AND PEANUT BUTTER AND HONEY AND USE NON-WHEAT, NO GLUTEN-TYPE OF BREAD AND THEN I MEAN IT COSTS A LITTLE MORE BUT ORGANIC PEANUT BUTTER. >> UH-HUH. >> REFINED THAT. >> THERE YOU GO. AND FINDING WHAT WORKS FOR YOU IS IMPORTANT, YEAH. AND MY MOTHER EATS THE SAME THING EVERY MORNING FOR BREAKFAST. SIMPLICITY IS REALLY IMPORTANT ESPECIALLY FIRST THING IN THE MORNING WHEN YOU ARE RUSHING OUT THE DOOR. EATING BREAKFAST AND VERSUS NOT EATING BREAKFAST IS REALLY IT'S IMPORTANT TO EAT SOMETHING. FOR A VARIETY OF REASONS, TO GET YOUR METABOLISM GOING SO YOU'RE NOT HUNGRY LATER ON, THERE IS A VARIETY OF REASONS TO DO IT. AND I THINK WHATEVER YOU CAN DO TO SIMPLIFY THAT PROCESS WHEN YOU ARE HALF AWAKE AND STILL HALF ASLEEP IN THE MORNING IS IMPORTANT. SO FOR YEARS AND YEARS AND YEARS I SAID MOM DON'T YOU GET BORED WITH WHAT YOU ARE EATING BUT SHE HAS FRESH FRUIT AND COTTAGE CHEESE AND A BANANA AND A PIECE OF TOAST WITH ALMOND BUTTER AND IT'S A BIG BREAKFAST FOR A PETITE LADY BUT IT KEEPS HER FULL ALL MORNING AND THAT IS WHAT SHE FOUND WORKS FOR HER, JUST THE BALANCE. ANY OTHER QUESTIONS? YES? >> YOU SAID THE SLIDES WILL BE AVAILABLE. >> THEY WILL BE POSTED WITH THE VIDEO WHEN IT'S POSTED AND ARCHIVED NEXT WEEK. I CAN ALSO, IF YOU GIVE ME YOUR E-MAIL I WOULD BE HAPPY TO E-MAIL IT TO YOU. GREAT, IF THERE IS NOTHING ELSE THANK YOU VERY MUCH FOR COMING. [APPLAUSE]