Men’s Health Matters – with Dr. Robert Sallis

Why is walking one of the most powerful prescriptions in medicine? Dr. Robert Sallis, team physician for the LA Clippers and clinical professor at Kaiser Permanente, joins Erin Brinker to break down what men really need to know about exercise, sleep, diet, diabetes prevention, and aging well. From fitness wearables to fighting chronic disease, Dr. Sallis shares realistic, research-backed insights on how men can take control of their health at any age—no CrossFit required.

🎧 Listen now and learn how a walk around the block (or the mall!) could save your life.

Transcript

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Erin Brinker: 0:00

Erin, welcome everyone. I'm Erin Brinker, this is the making hope happen radio show and podcast. So glad to have you with me on this beautiful day. I hope you are enjoying it. I know that I am before we get started. Have a great guest for you today, but before we get started, I wanted to talk about, as I often do, what I'm grateful for. And I probably talked about this before, but I'm pretty grateful for it, so I'm going to say it again. I'm grateful for community. I'm grateful for the people I work with. I'm grateful for the people on my street. I'm grateful for the people I see at the grocery store or at the post office, not that I go there very often, or at whatever place I'm I'm visiting. When I'm visiting, you know, there's a lot of craziness in the world, right? And we hear that people are at each other's throats, essentially, that if I'm on this side, I don't like you on that side, and vice versa. But I gotta tell you, when you're out in the community, when you're out with people, they still smile, they still say hello, they still say How you doing, or, if you're from the south, how y'all doing. And yeah, reminds me that that we're all okay, let's focus on the good stuff. Let's Be kind to one another, and I'm grateful for that kindness. All right, it's time to get started on our All right. With that, it's time for our guest Well, I am very pleased to welcome to the show. Dr Robert Salas, clinical professor of family medicine at Kaiser Permanente Bernard J Tyson School of Medicine. He is also the chief medical officer for the Los Angeles Football Club. He's a team physician for the LA Clippers and Program Director Emeritus of sports medicine fellowship at Kaiser Permanente Fontana Medical Center. He is joining us today to talk about all things men's health. We've talked about women's health and the show a couple of times, and now it's time to talk about men's health. Dr Salas, welcome to the show.

Dr. Robert Sallis: 1:59

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

Erin Brinker: 2:01

So So tell me about, you know, going way back, what led you to go to medical school, and then why did you decide to specialize in sports medicine?

Dr. Robert Sallis: 2:15

Yeah, well, I did my undergraduate work at the at the US Air Force Academy, where I was recruited to play basketball, and I played four years of basketball there, and during that time, I was struggling a bit my first year, and the coaches actually got me a tutor in my chemistry class who turned up, turned out to be the pre med advisor, and an off chance, mentioned to him that I always thought I wanted to go to medical school. He would not let go, and just kept encouraging me, pushing me. He happened to be in charge of pre med at the Air Force Academy, and the next thing you know, I'm applying for medical school, and was accepted, and ended up coming to Kaiser to do my residency, and I never left. So did my residency in family medicine, but with my sports background, I was very much interested in sports medicine as well, and helped start one of the, you know, our sports medicine program at Kaiser, which is one of the first in the country.

Erin Brinker: 3:10

Oh, my goodness, I didn't know that. That's great. So did you pass that chemistry class?

Dr. Robert Sallis: 3:16

I did. I actually did quite well. And he kept encouraging me, and really it was I always thought I'd be a basketball coach, and kind of took a sidetrack into medicine, but it was kind of amazing for me doing my training in family medicine. I really did not enjoy being in the operating room, so I really was not interested in surgery. I loved Family Medicine, diversity of it, the breadth of knowledge that you had to have, but then combining it with sports for me, sports medicine is really just doing family medicine on athletes. And I've been taking care of teams my whole career, so it's been quite a fun run. So I love the breadth of it. I really in my sports medicine training. Became fascinated with the effect of exercise on health. And the more I learned, the more I had to question, why is this all about pills and procedures health care? You know? Why isn't about getting people to do, to adopt a healthy lifestyle? And at the centerpiece of that, in my opinion, should be regular physical activity, you know, obviously diet and sleep, and there's other things that are important, but I think they all pale in comparison to just being physically active and getting 30 minutes of moderate to vigorous physical activity each

Erin Brinker: 4:27

day. Now, you know, we think about physical activity, especially, you know, I have two brothers who are CrossFit like they're they do the Spartan Races. They do all of those. And for them, when you talk about being active, this is not taking a walk or parking extra far from Costco or whatever. This is hardcore eat nails for breakfast kind of exercise. But it doesn't have to be that, right?

Unknown: 4:51

Absolutely. And what we're finding is there's sort of a sweet spot for how much exercise you need. Really a brisk walk is perfect. Doing it for 30 minutes, you know where you get a little bit winded, and I like to say you should walk at a pace fast enough that you can't sing, but not so fast you can't talk. Doing that for 30 minutes today really gets the majority of the benefits. Now, to be sure, if you do, you know, Spartan Races, intense physical activity, you get a little more benefit, but the curve really starts to flatten out. And what's interesting, what we have seen in studying extreme endurance athletes, you know, those that are doing marathons and Iron Man distance triathlons, there may actually be a little loss of that protective effect. It may actually be a little more harmful. And I'm not saying it's dangerously harmful, but you know the old adage, everything in moderation, you know, if, if a glass of red wine a day is good, the whole bottle isn't better, you know, so why are we surprised that doing extreme amounts of exercise may actually be a little detrimental to your health?

Erin Brinker: 5:53

Yes, and if, I mean, there are people who are athletes and that are, that's, that's man, that what keeps them going, but you don't have to be that. And if that's not, if you're not wired that way, it's it's nothing to be sad about. It's nothing to be ashamed of.

Dr. Robert Sallis: 6:08

Well, you're not getting extra health benefit. Don't kid yourself that. You know, if walking 30 minutes a day, doing an hour and a half a day, you're not getting a lot more benefit. You know, anything, anything beyond about 100 minutes a day of exercise. You're doing it for reasons other than health. It's it's done more because you just, you like doing it. You didn't even become addicted to it. There are lots of reasons people do these extreme amounts of exercise, but you're kind of kidding yourself if you think that's just going to protect you and be so much better for your health. And just doing the small amounts, like any I like to compare exercise to a medication. Like any medication, there's an optimal dose, you know, there's a sub therapeutic, which doesn't really help, and then there's a toxic dose, which, taking too much of a medicine can actually cause harm, where, when you take the right amount, that's when you get the benefit.

Erin Brinker: 6:59

So let's talk about men's health. There's a lot of stuff in the in the news. We hear about women's health and women's women's mental health all the time. That's a topic that people talk about or the mental health for youth. But really it's it's focused on women and girls. You don't hear a lot about men, because they typically are not the ones to go seek out help when they when they're not feeling good, they suck it up and move ahead. But, and I think that's reaching anecdotally, my opinion is that's reaching a crisis level. What are you seeing in your practice?

Dr. Robert Sallis: 7:30

Yeah, I think the biggest concern for me is sort of an exploding epidemic of diabetes and pre starting with pre diabetes, the type two diabetes that is entirely preventable by appropriate lifestyle interventions, being regularly active and eating a proper diet, keeping your weight down. And the problem with with prediabetes and type two diabetes, they start out asymptomatic, essentially, and it takes its toll, very insidiously, affecting all your major organs, from, you know, your eyes to your kidneys to your heart. And then eventually the blood sugar begins to rise so much that we can't even control with medications. And so that, to me, is one of the scary, you know, silent killers that sort of exploding these days. Is this seems like everybody these days is pre diabetic, and it could be entirely fixed by appropriate lifestyle modifications. And then stemming from that is cardiovascular disease, the major killer, both men and women, but in particular men, is is atherosclerosis of the arteries all around the body, but particularly the coronary arteries that can lead to early myocardial infarctions and sudden death, and the number one killer is is heart disease. And so those two sort of go hand in hand, in my mind, that men really need to pay attention to, because if started early, you know, managing the risk factors, being regularly active, keeping your weight down, monitoring your cholesterol and your blood pressure, not smoking, those kind of things, you know, appropriate amounts of rest, sleep and avoiding excessive amounts of stress. All of those are the contributors that we can we have under our control to sort of manage that can help prevent this stuff. So

Erin Brinker: 9:18

you mentioned sleep. What is, you know, what's a good amount of sleep for a grown man and and how do you how does he what kind of habit should he develop to support good sleep hygiene?

Dr. Robert Sallis: 9:31

Yeah, that's a tough question to answer, because I think it varies with each individual. I don't think there's one size fits all. You know that you need to sleep this amount. I think as we go, if you pay close attention, you kind of figure out what amount of sleep is good for you. I mean, I talk to a lot of patients that if I don't get nine or 10 hours, I feel terrible. Others do really well on six seven hours. I mean, the data suggests that you probably ought to be sleeping at least seven, maybe eight. Hours. Maybe that's the sweet spot, but again, I just find so much variability in that. I think it's hard to assign an actual number. You need to pay attention. The way, what makes you feel good? The most energetic, the clearest thinking. When I get this amount of sleep, I think most of us, if we're paying attention, can sort of gage what is the optimal amount of sleep, but the other factor in there that you need to gage is the quality of the sleep Am I getting into REM sleep, the really refreshing, replenishing sleep that that we need to function at our optimum, and that can be interrupted by things like sleep apnea as we get older. That's another big crisis in men's health, is the development of sleep apnea, which really closely correlates with your weight. And the heavier you get, the more likely you are to stop breathing at night that it doesn't allow you to get into that REM sleep. And you wake up feeling unrefreshed from sleep, and you find your stuff falling asleep when you're doing simple tasks. You sit down to watch TV, and you're dozing off. You're in a they turn out the lights in a movie theater, and you're out, in, out, out, and often snoring loudly. And then often a spouse will notice that you suddenly stop breathing and make kind of cough and snort and then start breathing again. That's that's something that we that can interrupt sleep, that is linked to heart disease and diabetes and a bad health outcomes as you age.

Erin Brinker: 11:27

So, you know, I this is all. This is all incredibly important information. And I'm thinking about, you know, somebody he gets older, maybe he was more active, more athletic when he was younger. Maybe he played pickup basketball at his church once a week or whatever. And now he's in his 50s, he's slowing down. He puts on some weight, he starts to snore, he's, you know, all of those things. You know. Maybe he doesn't have that. Maybe his knees aren't as good anymore, you know, how does somebody like that take care of his needs? In his metabolism slowing. What does he do? What? How does he start this whole process? Because it can be daunting. With an information out there is seems contradictive or contradicting, it is just, it's really overwhelming.

Dr. Robert Sallis: 12:15

Yeah, it can be tough. Certainly, all of these things can make physical activity and getting the proper amounts of physical activity more difficult. More difficult, but there are ways to do it. You know, as your knees become more worn, it's harder to get out and certainly run or even walk, but things like a stationary bike, pool, workouts, resistance training, I think, is really the best exercise one can do. As we age, we lose lean muscle mass, and lean muscle mass is really critical to maintaining blood sugar. Insulin sensitivity really depends on that, and it's essentially an organ system, your muscle, that that helps maintain your sugar levels. So that's particularly important. Doing resistance training also strengthens the bones. We always worry as we age the development of osteoporosis, thinning of the bones, and resistance training, lifting weights, even just doing body weight exercises, those are great alternatives to actually getting out and walking. But I think a combination of those, and then things like pool workouts, where you can unload the joints a bit. You know, swimming is a great exercise. It's a little more difficult, obviously, because you have to have access to a pool, especially in the winter. That can be that can be a challenge and and certainly in California when it gets cold, but it's important to figure out how to get that exercise you need. And so I think that's where really connecting individuals, as we age, men and women with opportunities to exercise. That's why I think, you know, getting a personal trainer, or being able to join the YMCA, there's some cost effective options that we can utilize to help our patients get the activity they need to be healthy.

Erin Brinker: 14:04

So is that, if you have muscle loss, you know people, and I've heard that before, that as we age, especially over 50, there's a certain amount of muscle loss that happens every year. Can you get that back? If you started exercising, Could you could you get that

Unknown: 14:17

back? Absolutely, we know that resistance training at any age can restore muscle last retard, muscle loss that comes with aging. We refer to it as sarcopenia. You know, we always worry about osteopenia, and I think we're so worried about osteopenia and osteoporosis because we have drugs for it, and the companies that market those drugs really push those but I think more concerning is sarcopenia, the loss of the muscle sarcomere, you know, the loss of muscle mass that occurs as we age, and particularly if we become very sedentary, and it causes a loss of strength, which affects it is a daily living and. The opportunities to enjoy things that we, a lot of us, to do. If you drank, you do them more prone. So it really then, and as I mentioned, the key really is with muscle maintaining insulin sensitivity and blood glucose, blood sugar control, those go hand in hand, and that's why resistance training as we age is really important.

Erin Brinker: 15:22

So let's talk diet a little bit. Because I have heard, you know, we should all be vegan. I've heard we should all eat keto. I've heard that it's more No, paleo, no. It's this other thing you have to overload on, on on protein. What is, what is the right diet? How do you find the right diet for yourself?

Dr. Robert Sallis: 15:44

Well, you know, that's a tough question, because diet is so tied to your upbringing, your ethnicity, you know, the foods that you kind of grew up loving as a kid, it's hard to get, you know, to change some of those habits. But the interesting if you start looking at different diets, and what is the best diet? I get that question all the time. I think there are lots of healthy diets, and you can look at things like the DASH diet, the Mediterranean diet, plants based diet, all of those virtually identical. If you go from somebody who's eating an extremely poor diet, really high in processed foods, and you change them to strictly fall one of those diets that we often think are just great, that they that does lower the mortality risk, but it lowers it by maybe, you know, 15 to 20, 2015, to 25% or so improve improvements in mortality. You know, if you increase your fiber from somebody who has basically the lowest amount of fiber in their diet, and you make them on a high fiber diet, yeah, it reduce your risk of premature premature mortality about the same, about 25% but it's interesting, if you compare that to exercise, if you compare taking somebody who's not getting any physical activity to those who are doing, you know, meeting or exceeding the regular physical activity guidelines. 150 minutes per week of moderate to vigorous activity, that reduction in the hazards ratio is about 50% as much as 50% Oh, wow. Compare the highest to the lowest exercises. Now I'm not saying that diet is important, you know, certainly food is medicine, but I tell you, exercise is a stronger medicine. And so if you're going to work on one thing, adopting a really aggressive diet, I'm not going to argue with that, but the better thing to focus on is meeting the physical activity guidelines. But you know, again, I would get back to the point that all of those diets work fine. There is no evidence that a plant based diet is better than a Mediterranean diet or a DASH diet that increasing fruits and vegetables, those things all help more fiber in your diet. Whole grains, all of those things, really, though, they pale in comparison to what getting regular physical activity is

Erin Brinker: 18:02

so if a, if a a man comes to you for the first time, he's been a couch potato for, let's make up 20 years, and he's got, he's maybe he's diabetic and he's got high blood pressure, how would you tell him to start his exercise regime?

Unknown: 18:18

Very with a graduated walking program. I think that's the best thing, assuming that he's able to do that. And I would start him off very gradually, because we know even small chunks of exercise 10 minutes a day, and it does. It can be in bounce. It doesn't have to be in bouts 10 longer than 10 minutes, any type of activity during the day is cumulative, and so just achieving, working towards that goal of 30 minutes, and starting out maybe at 10 minutes a day, and at a lower intensity, and slowly ramping up the intensity, that moderate amount, that moderate intensity, which, again, I gage with what I call the sing talk test, you should walk fast enough that you can't Sing, but not so fast. You can't talk, starting off 510 minutes and adding it up each week, and at 30 minutes of moderate to vigor. And then I would throw in some body weight exercises, you know, some some push ups, pull ups, sit ups, maybe some light arm weights to work your biceps and your triceps and overhead presses with those light weights. And I'd like to use lighter weight with higher rep, and just sort of gradually working into it

Erin Brinker: 19:27

so he doesn't jump in and do

Dr. Robert Sallis: 19:28

helpful. If somebody has a I'm sorry now I would go very slowly into that. But then those sort of total body burpees and, you know, squat thrusts and all those kind of things you can throw in based on as needed. But you know, the few resistance body weight exercises combined with just walking, it's pretty simple.

Erin Brinker: 19:50

So let's talk about community. A lot of a lot of men women, I think, connect more easily than men do men. And correct me, if I'm. Wrong because I'm not a man, but men connect over doing things together, whether it's playing a sport or in their club or a hobby or whatever it is. And you know, not a lot of men have time for that, and so they're missing that, that they're missing the friendships that that go with a healthy lifestyle, kind of talk about that side of men's health?

Dr. Robert Sallis: 20:22

Yeah, I would totally agree with your assessment. Assessment there. I think women are much more likely to get together and do activities than men are, and when men get together to do activities, maybe it's going to a bar and having some beers and watching games. It's maybe not quite as healthy on average. I mean, obviously there are exceptions to that rule, but I think in my perception and my patience, i i It feels like the women are are easier to get together and do activity. And, you know, I find it fascinating that, you know, if you ask me, what was my favorite, if you would ask me, when I was in elementary school, what's my favorite subject, I would have probably said PE, you know, closely followed by recess. I mean, that was my favorite thing to do, to go out on the playground, play, run around. How did we get from where that was your favorite part of the day as a kid to now it's it's drudgery. I don't want to do it. I'm trying to talk patients into doing physical activity when it was the favorite thing to do when they were little. How did that happen? And I really think we sort of engineered all the fun out of physical activity. It used to be so true. I was out on the playground with my friends, playing sports, running around, playing tag, tug of wars, whatever it was, climbing trees. You know, we did all this stuff that we enjoyed, and now it's put headphones on, go to the gym, stand on the treadmill or elliptical and for try to sweat for 30 minutes. That sounds totally unappealing. You know? Why Can't We? I think that is the key to solving the physical activity inactivity problem is socializing it. You know, we need a Facebook for exercise. There's how do we get these people connected to doing because there's so many ways to meet the physical activity guidelines, even if we just socialized it so you're accountable to friends. I think that's the optimal way to solve it. The alternative to that, to me, that I have found very helpful for my patients, is it is a pet, particularly a dog, that likes to go out and walk. And I see so many people that they'll, they'll walk the dog, but not for themselves. Before the dog they they tend to care of their pet, do it themselves. And it was interesting. Years ago, CDC put on a meeting that I spoke at that was very fasting. We had a group of group of physicians, and when you heard the veterinarians talk, it was astounding. The same problems they have with their pets are the same problems I'm dealing with in my patient. You know, they eat crappy diet. They eat too much, they don't exercise enough, they don't get enough sleep. It was virtually identical. And you know, I just think when you explain, if, hopefully the vets are telling you need to get your dog out for a walk, because I think a lot of people, men in particular, they'll do it for the dog, but they won't do it from themselves. And so I think that's another great alternative. And we know from studies that that people who have animals have dogs, or, you know, other pets, that particularly ones they can walk. I think they live longer and and maybe, you know, it's all not, it doesn't all have to do, which is being more physically active, because we know that people who have pets are more physically active than those who don't. But there's also a component of companionship and all that stuff that probably plays into why people with with animals live longer.

Erin Brinker: 23:35

You know, it's, it's so interesting. We have engineered the fun out of everything. And, and I think that that Fitbits, and I wear one, and it gives you all the metrics, but then your health becomes a matter of metrics, right? So did I hit all the markers that I'm supposed to meet, meet to hit? Not did I go on a hike? And it was beautiful, and the payoff was this VISTA that was incredible. It was, Did I hit? Did I get enough steps? Did I climb enough elevation, if

Dr. Robert Sallis: 24:05

I exercise and I didn't have my watch on? Did it even, did I even get

Erin Brinker: 24:10

exactly that's crazy, but it's so true, and I do it too, and I'm not a guy, yeah, yeah, you know. And it's

Dr. Robert Sallis: 24:17

but I can also find that very helpful. I mean, I do look at my stuff counts, you know, on my phone. And if I, you know, I'm at, you know, 8500 I'll go out and walk a little bit to get it up to, you know, 10,000 steps a day, because

Erin Brinker: 24:30

you want to meet that well, and that's good, yeah, that's good. I mean, if it's, if it, if you gamify it, that's different than if it's, you know, I have to do this. I have to it becomes, you don't want it to be compulsive. You want it to be

Dr. Robert Sallis: 24:42

fun. Yeah, sure. I think it's a lot easier to maintain that for that reason, that it's fun than it is. I'm just trying to meet this but you know, I'll do it whatever way works. I think is useful.

Erin Brinker: 24:55

So let's talk about things like that that happened to men as they age, like prostate cancer and other kinds of. Answers. You talked a little bit about about snoring and sleep apnea. You know you need to get yourself checked for these things. At what age should you start showing up and saying, Hey, Doc, I need to check this out.

Dr. Robert Sallis: 25:14

Well, I think all along, you ought to be checking in with your physician regularly. You keeping an eye on things like blood pressure, cholesterol, your blood sugar, as we measure through the hemoglobin, a 1c test. These are all things that can start sort of silently early on that begin to set the stage for, you know, problems with insulin sensitivity, pre diabetes and cardiovascular development of cardiovascular disease early on. You know, we ought to be trying to head those risk factors off before it gets to the point where the arteries are clogged. So hopefully that's going to be early on. But as we get older, you know, cancer goes up dramatically as we age. And I tell you, regular physical activity, the effects on cancer prevention both the primary prevention that is, you know, you get that first colon cancer, but secondary prevention. Once I have it, how much longer can I live? Once I've had it removed, it's got a dramatic effect. And if you look at physical activity, it's hard to find a cancer where there isn't data, where it helps. But I tell you, colon cancer, breast cancer, in women, prostate cancer, lung cancer, those all have clear connections to your physical activity. And it just seems that when we exercise, it ramps up our immune system, and it helps not only cancers, but but infections are are lower. And you know, I was involved in one of the first studies during the COVID epidemic that showed people who did regular physical activity were dramatically less likely to be admitted to the hospital if they got COVID and or die from it. And in fact, they were two and a half times those who are meeting the US physical activity guidelines of 150 minutes a week or more were two and a half times less likely to die of COVID when they contracted it, and it took us a long time to convince the CDC to put that on their website. You know, it was all about all of these other harder things, things that you want medicine to control, just simply getting out and walking was probably the best pill we had. Fact, there was no bigger risk factor for dying of COVID than your exercise level. The only bigger one was age. You know, particularly when you got over the age of 60 and a history of an organ transplant, that those were the two things when we looked at, we did a multivariate analysis where we look at different variables, diabetes was not a bigger risk factor, obesity was not a big, bigger risk factor heart disease was not a big, bigger risk factor during the COVID epidemic, the biggest modifiable risk factor for dying from COVID Was your physical activity level. If your gene guidelines, you were two and a half times less likely to die.

Erin Brinker: 27:57

So even if you're a big guy, if you are getting exercise every day,

Dr. Robert Sallis: 28:02

then you're okay, absolutely, even morbid. You know, extreme levels of obesity, significant obesity was not a bigger risk factor than being physically inactive.

Erin Brinker: 28:13

So some of this, you know, as it's really easy to give the community or give the public knowledge about how we've got knowledge coming out our ears, what we don't have, what it's hard to do is change attitudes and to change behavior, because it's so cultural, it's so familial. And you know, it's cultural on a broader perspective, but it's cultural in your family too. You know, how do you change hearts and minds? How do you change your own heart and mind?

Dr. Robert Sallis: 28:40

You know, it starts in the schools, and I've been dismayed the way schools have handled physical education. You know, we used to have mandatory PE, we did regular exercises every day. It was part of the school curriculum, and it's been engineered out of kids as well. I think the activity I knew when I was a kid recess, and PE, you know, we did some intense physical activity, and that's just not happening today like it used to. And I think we know, you know, as if you're active as a kid, you're much more likely to be active in in college and then go on to be active as an adult, so I think it's imperative that we get kids active early and we keep them active.

Erin Brinker: 29:28

And again, that can be anything from riding your bike all day long, and we used to do that as kids. You hop on your bike in the morning and you're gone until the street lights come on absolutely and I know that kids don't do that for a host of different reasons, but they don't do that anymore. There's no, you're not, they're not out all day long. They're playing video games. And I don't think video games are necessarily horrible. They had them when I was a kid too. It was Atari, but, you know, we still played, but it's, it's the absence of anything else that's the problem.

Dr. Robert Sallis: 29:59

Yeah. Sad is, is we have lots of studies to show that the physical activity is getting in school today. Can they can't even count, be counted towards the 60 minutes of recommended physical activity that kids get, because it's so often, just not You're not stressing the body at all with it. It sets light and irrelevant activity. The recommend, recommendations for physical activity that the extra, the guidelines call for, oh my God, that's a sad commentary on the state of physical education in America.

Erin Brinker: 30:36

Oh my gosh, wow. So let's talk about some some statistics. You know, what percentage of men have our hypertension? What percentage would be are classified as obese, etc? Well, I

Dr. Robert Sallis: 30:53

don't have those numbers right in front of me, but if I had to guess, I'm saying it's maybe two thirds depends on the community, depends on the racial, ethnic background, the socioeconomics play a big role there as well. But I would say at least half to two thirds are overweight or obese, and with that, the diabetes probably is. You know, 30% of Americans probably are pre diabetic. Of adults, I would guess maybe even more, maybe up to 50% those are, they're big numbers. It's becoming where it's going to be. The preponderance of people are going to be overweight and diabetic or pre diabetic,

Erin Brinker: 31:30

and even kind of the same, even thin people can have diabetes and be unhealthful. They just happen to look leaner than their obese counterparts,

Dr. Robert Sallis: 31:40

absolutely. And there's this whole, you know, kind of, you know, thin and unfit, you know, metabolically, you know you're thin, but you're actually, from a metabolic standpoint, you're not healthy and and I it's much more than what your BMI shows. And for the same token, it's interesting. If you can look at what BMI our body mass index, for those of you that know, it's the ratio of your height to your weight. So obviously, the taller you are, the more you would likely weigh. So the idea is that the lower the BMI you're tall, that's the numerator and the denominator, then is your weight. So the and so the the more the BMI goes up, the more concerned we are about that. But the interesting the BMI, typically, we say is normal, is between 18.5 and and 25 is considered normal weight overweight would be a BMI between 25 and 30, and then obesity. Class One, obesity would be 30 to 35 and then 35 to 40. Class Two, we start talking about morbidly obese when you're over 40. But the BMI that's associated with the longest lifespan is a is in the overweight range 25 to 30. That doesn't get talked about a lot. Actually, the most dangerous BMI is between 15 and 20, and particularly as you age, people who are really skinny as they age, don't do as well. Who's people who who weigh a little more, and we don't really know, we're pretty astounded to see the correlations between being skinny and bad health outcomes as we age. They refer to it as the obesity paradox, that it's sort of counter to what we've always thought, that I want to be real skinny, but there are times when that's not healthy. And so I think, you know, kind of, as we age, looking at what's my best weight, it's often, you know, in that slightly overweight range is probably the one that's associated with the best longevity, huh?

Erin Brinker: 33:49

I had no idea that seems counterintuitive,

Dr. Robert Sallis: 33:53

yeah. Now, when you start getting but what's interesting, you know, you start getting up into class, class two, obesity, morbid obesity, you know, then the risks start to ramp up, but they still aren't better than much, you know. It's probably more concerning to have those really skinny, you know, less than 18 BMI. So as we get older, that's a risk

Erin Brinker: 34:18

interesting. I that is that surprising to me? I've not heard that before. So, looking ahead, you know, kind of what innovations, you know, sort of talking about research that not everybody has heard. What are some interesting things going on in men's men's health? And what are you excited about right now?

Dr. Robert Sallis: 34:39

You know, I am kind of excited about the devices, you know, the Apple Watch that can show so many measures. You know, not only just your physical activity, but your sleep, your you know things your like, your blood pressure, your heart rhythm. You know it can detect heart rhythms. I've had a number of patients come in because their Apple Watch told them they were in an abnormal. Heart rhythm. And sure enough, they were, they were in atrial fibrillation in the watch really saved them by causing them to come in because of what they were seeing there. So I think that there's some tremendous opportunities there for monitoring folks and encourage them when they should be going in, reminding of that and picking up things that they might not have noticed. And so I think that's probably of all the innovations, I think that's that's a big one. Some of the things that I think are over hyped, I really think, like supplements and vitamins, those are way overdone. I you know, you the best way to get what's in a supplement and what's in a vitamin is by eating the foods that contain it, healthy portions of the foods that contain it, not taking a pill. And I think that's way over, hyped and overdone. And hopefully, you know, people will work on just a healthy diet to get all the the vitamins, minerals and things that they need, and not take supplements to do it. It's interesting as we age, prostate health in men is always one of the first things we pick up. But what's really interesting is we've more and more gone away from testing for PSA. What we have found is that doing regular screening of the prostate specific antigen, the blood test for an enlarging prostate, and for prostate cancer, will cause the PSA to go up over. Doing that for a good you know, 30 years, what we have found is we're not really changing the outcomes of people we screen catching a high PSA most of the time is the cancer is not aggressive, and you don't die from it. You tend to die with it. And in fact, if you look at the prostates of most men over 80, the vast majority will have prostate cancer. In there will have cells of prostate cancer. And again, they don't die from it. They die with it. So I think we've got a little bit over aggressive thinking that early detection of prostate cancer saves lives, when in fact, it may cause more problems than it helps, because a lot of the things we do when the PSA is high and our patient has prostate cancer, you know, taking the prostate out, you know, treating with radiation or, you know, medications to shrink it, that they can cause more problems than the than the than solving the issue that the original prostate cancer would have been. So I think we have to approach that very carefully with how we use PSA testing and how aggressively we treat when it's elevated and the patient has prostate cancer.

Erin Brinker: 37:33

So I know that most prostate cancers are slow growing, but I have heard of some that have metastasized into the bone or some of the other organs you know are, is that rare and absolutely

Dr. Robert Sallis: 37:45

well, no. I mean, you know prostate cancer, you certainly is a leading killer of men. The question is is, can we do anything to alter that course? And sometimes, when you have very aggressive prostate cancer, you catch it early, you treat it with a prostatectomy, you radiate, you do all these things, and it's you still die from it. It seems that there are some forms that are just so aggressive, no matter what we do, or catching it early doesn't change the outcome in a lot of cases, and that's why the US Preventive Services Task Force has now changed the recommendation to only screen for prostate cancer. It's supposed to be a shared decision with the patient, knowing that we often don't change the outcome. They've looked at groups of men who get regular PSA testing compared with groups who don't, and the ones who don't get it are really no more likely to die from prostate cancer, the cancer, than the ones who get it, which is really distressing when that came out. But I think we have to be really careful, because there are complications that can occur when we aggressively treat prostate cancer well,

Erin Brinker: 38:47

and it's and it it can dramatically impact somebody's intimate life in a very negative

Dr. Robert Sallis: 38:53

way. Absolutely from, you know, difficult with with sexual with erection, and certainly continents and things like that are big issues in people who are aggressively treated for prostate cancer,

Erin Brinker: 39:05

and that's something that you just you have to work with your physician. Yeah,

Dr. Robert Sallis: 39:10

you know, that takes a lot of thought and discussion, what we call shared decision making, where it's not just the physician telling you we're screening your for your PSA and it's elevated, and we're going to biopsy, and then we're going to do this, you know? Do this, you know, because there are a lot of nuances in there where, in a lot of cases, the better choice is just to monitor it. I think intuitively, everybody thinks I have cancer. The earlier I cut it out, the better off I'll be. That's not always the case, particularly with prostate cancer.

Erin Brinker: 39:41

So, you know the discussion about people who realized that they were having an irregular heartbeat and came into to see you, if you, if you, if your tracker is saying that you have an irregular heartbeat, do you go to the ER? Do you make an appointment with your

Dr. Robert Sallis: 39:56

GP? I think it depends on how you're feeling. If you're feeling. Light headed, you're feeling suddenly out of breath, and it says you're in an abnormal rhythm. Yeah, you should go to the the emergency room, or at least an urgent care to be seen quickly. If it's something that's picking up and you're having no no feeling, you don't feel bad at all, then I think it's reasonable to I wouldn't want to wait too long, but especially if it says things like atrial fibrillation, I wouldn't want to miss that so. But I think you gotta couple that with how you're feeling, what symptoms you're

Erin Brinker: 40:26

having, because an atrial fibrillation could could cause a blood clot, which could cause a stroke or heart attack, right?

Unknown: 40:32

Exactly, that's the concern, and we typically need to put those patients on a anticoagulant, you know, to thin the blood to reduce the risk of a stroke.

Erin Brinker: 40:44

So do you recommend that all your patients wear some sort of fitness device?

Dr. Robert Sallis: 40:51

You know, I think they're helpful. I don't think it's the end all be all, but I think for certain people who respond well to getting all that information. And like having that, it's, it's a great option, you know, at the end of the day, though, I just want to, I want to do whatever gets them out, moving, you know. And I think the focus more on, on finding something you enjoy that you'll repeat and doing it again, like you mentioned, because you enjoy it and it makes you feel good, not because you're, you know, Activity Monitor says you need more exercise. I think you got to look at each patient and see what will optimally motivate them. And

Erin Brinker: 41:28

sometimes it'll tell me, get up and do so many more steps for this hour to meet your goal. And in my mind, I'm internalizing, hey, fat, so get off, off your butt. Get moving

Dr. Robert Sallis: 41:37

well, you know, I think everybody's different. You got that's, that's the art of medicine, trying to figure trying to figure out what motivates people and what's likely to get them to do the right thing and the things they they need to do. That's not always easy.

Erin Brinker: 41:51

So, so let's talk about some cultural and racial disparities. Because if you're from a low income community, which typically impacts people of color in this nation, if you're in a low income community, you may not have a safe place to take a walk. What are some things? What are some things that you're seeing in your practice for people who maybe live in an area where that's not getting out and getting active in their neighborhood is not possible?

Dr. Robert Sallis: 42:16

Yeah, those are tough questions. And you know, if you distill down the social determinants of health, you know, which you know, your your ethnicity and income and those types of things, you distill them down. Really, to me, it has to do with, you know, access to healthy foods and a place to be physically active. To me, really, that's it. And then you maybe can throw in some, you know, other high risk behaviors like smoking and alcohol, those impact. But really, diet and exercise, to me, are the biggest things, the social determinants, effect and and, you know, those, to me, are things we can we can change. I mean, there's just no excuse for having, you know, these, these nutritional deserts, you know, where the healthy food is just not to be found, and people are having to buy food from a liquor store. That's insane, that we can't fix that. And then places to exercise Absolutely it's difficult in a lot of neighborhoods, particularly in Los Angeles, it's not safe to go out, particularly if you have kids and you're going to take them with to exercise. But there are some things out there that I some examples of things that I've seen work really well. And one of the biggest is walking in the mall or shopping centers where it's safer, and especially I visited a mall on the east coast where it was an incredible group of elderly people that walked every Saturday in the mall. And then, actually, three days a week, the mall would open early for these walkers, and it was good for the mall. It brought people in there, and as they walked, they often then shopped after they were finished with their walk. But that was an example in sort of a lower socioeconomic neighborhood where the it wasn't safe to walk outside, but they could do it in the mall. You know, those are examples. And I think it's imperative that we we have lights and parks and guards if we need them to make it safe for people to get out in these neighborhoods. Those are things I think that are really fixable, that I wish we would put more focus on.

Erin Brinker: 44:20

You know, I know that here in San Bernardino, where the making hope happen foundation is the mall that's here, the inland Center Mall, they do open up early, and especially seniors, get out there and walk for the exact reason that you're talking about is they feel safe. They can, they their friends are there. So they congregate when the mall is open, they can grab a cup of coffee and, you know, buy something in the stores. And so there's that real social connection as well as the physical connection. And I think those things go hand in hand,

Dr. Robert Sallis: 44:47

absolutely.

Erin Brinker: 44:49

So I think it's important you talked about the social determinants of health, and in in in many places in the country, in San Bernardino and Riverside counties, i. Are no different. There's this vital conditions. And there are seven vital conditions, and one of them is civic belonging. You know, if there's something that's not happening in your neighborhood that you want, like, you want the schools to be open so you can use the basketball courts. You want the lights to work so you're not playing in the dark, etc, it's completely you have the power to go to your school board or to your city council or to wherever to ask for those things to happen for you, because it's they serve you. And I think it's important that people hear that and know that that they can impact those things in their community to create what they need to be successful and healthy.

Dr. Robert Sallis: 45:37

Wow, those are great points. And yeah, we, we certainly these are problems that are not even close to being insurmountable. You know, we're never going to solve income distribution and things like that, but we could solve this. We could make sure that there are access to healthy foods everywhere in the US, in every big city, there's no excuse for not having access to foods, no exercise, yes, that ought to be the minimum that we get for our tax money, that that is guaranteed that every neighborhood has access to healthy food and a place to exercise. How could we say we couldn't achieve that

Erin Brinker: 46:14

in the in the most the wealthiest country in the history of the world?

Dr. Robert Sallis: 46:19

Yes, with what I see us spend money on why would we not go for that? That is, that's low hanging fruit,

Erin Brinker: 46:24

indeed. And so, you know, it's interesting, because now we're getting into the into the area of purpose. And I think purpose dramatically impacts health and wellness and well being. I think everybody needs to have to feel a purpose. And if your purpose is creating a community that meets the needs of the people who live there. So, you know, I live in San Bernardino, and it, for me, it's important that this community meets the needs of the people who live here. They're my neighbors, they're they're my family, and that, and that has given me purpose. And I know that. You know, if you're if, if you're used to sitting on the couch and not doing anything, having a reason to get up off that couch can make a huge difference, absolutely. So what are some we have about about nine minutes left for people who might be interested in going into sports medicine, and maybe they're thinking about, they want to work for a team, or they're just, you know, thinking about maybe doing physical therapy or athletic training or that sort of thing. What would you tell that student about how to do that job or how to get to that place? Yeah,

Dr. Robert Sallis: 47:23

there's, there's so many ways to get into the sports medicine field. You know, so many different angles, not just as a physician, obviously, in medicine, as physicians generally, you would come about as a primary care physician with additional training in sports medicine, or an orthopedic surgeon with additional training in sports medicine. Now, obviously the orthopedic surgeons are their surgeons, and they're primarily in the operating room, operating on those sports injuries, whereas the primary care sports medicine physicians are more often on the sidelines, early on, making the diagnosis, putting the patient in and collaborating with a physical therapist, often for appropriate rehab for their sports injury. So that's another way to come to the field, is through physical therapy. And then, you know, one of the if you think about what is besides the musculoskeletal system, exercise also stresses the heart, and there's a huge component of cardiac disease. You know, cardiovascular sports, cardiology is another area to kind of work with athletes to help optimize performance and health. Those are sort of the ways that you could get into it. And then, you know, I've always loved being a team physician. I always thought I'd be a basketball coach, and I love being on the sidelines, being able to take care of the athletes, watch the games and and so it's been exciting to me. I actually taking care of the LA Clippers, being on the being at the games, taking care of the players. I take care of mostly their medical needs. I have a partner who's orthopedic surgeon that takes care of most of the orthopedic injuries. And so it's a combination of those, you know, it's a, you know, it's, it's everything you would see in the general population these athletes get Now, obviously they put a lot of stress on their ankles and knees. So we see a lot of ankle injuries. That's the most common reason for a player to miss a game. But you know, knee knee injuries as well. There's a lot of stress on the lower extremities and then upper as well. You know, when they're rebounding and, you know, going up to block a shot or shooting with overhead activity, they can have shoulder issues. The soccer players is mostly lower extremity, you know that I see in them. And we get a lot of soft tissue in soccer. We see a lot of hamstring quad muscle, not only strains, but contusions from getting hit. And so kind of knowing what you're likely to see in each and what you have to prepare for. The other big thing is concussion. That's that's the hot topic now in sports medicine, particularly in our soccer players and our football players. What is the effect of these head injuries? That's an area that's a little concerning.

Erin Brinker: 49:49

Yeah, and how much do you want to give up yourself, of yourself, to be able to play that game that you love? And yes, you get paid really well, but is the cost too high? Yeah. Know, and that's, that's a question. I think the NFL especially needs to have that discussion that I'm sure they're already having it, but they need to continue Absolutely.

Dr. Robert Sallis: 50:07

Yeah, we deal with this in our soccer players as well. We have pretty high rates of concussion, and I have players that have had multiple How many is too many? We don't really have the answer to that question. I don't think any of them are good. And the more you have, the more concerning I get. And then, especially when you have persistent symptoms, how do I convince a player, you know, at 35 now it's time to give it up and and you know, you've got the rest of your life ahead of you, but at the same time, I'm asking them to give up their livelihood, right? How they've made a living? So it's, it's a really difficult decision and discussion to have with a player trying to convince us something I've been through numerous times, trying to convince them, I think, in your own self interest, you really need to quit. That's a really hard discussion.

Erin Brinker: 50:50

Oh, I bet it is. You know, I and you went to the Air Force Academy, so obviously you are, you are disciplined. And one of the things that we see in in our youth is that when things are hard, they think, Oh, I can't do this. It's too hard for me. But anybody who's been in the military, or anybody who's been a an elite level athlete or or having a job, like a physician, you know that you got to push through the hard because you can. You can do it. You can get there if you work. And I want young people to hear that message, that the payoff is worth it. And can you kind of talk about your experience in that?

Dr. Robert Sallis: 51:27

Yeah, you know, I It's nice with the elite level athletes, they're pretty self motivated. You know, I don't have trouble. It's often I'm holding them back. But the longer I've practiced and especially doing sports medicine, I have found that I treat every patient like an athlete. I use the same principles of of that I use for managing injuries and illness that I do in my athletes. I use it on my regular patients. Obviously, the goal in the athletes is getting back to competition, and in my regular patient is getting them back to that physical activity that they need to do to stay healthy, and if they aren't doing it, encouraging them to start doing that activity they need to do. So I always think of them as an athlete, helping them pick out the best sport for them, helping optimize their training. You know how to start it? How? What kind of things can you add? And really, if they're ill or injured, taking them out of activity until that illness resolves itself or the injury heals itself, and then I put them into graduated activity. Follow the same protocols that I use in my elite athlete. I use it for my regular patient. I just think it works beautifully. And I really, you know, it's important that we look at every patient as an athlete. In the elite athlete, it's their job. It's even more important in the non elite athlete, because it's what's going to keep them alive, you know. And I've always wanted to get an ad from, you know, someone like Joe Montana, saying, you know, 20 years ago, I was working out every day to try to win a Super Bowl. Today, I work out every day to try to stay alive, to see my grandkids.

Erin Brinker: 53:00

Oh my gosh, that's so great. I think in

Dr. Robert Sallis: 53:03

really saying that now my training is so much more important, the stakes are much higher. You know? I think that we could all agree with that,

Erin Brinker: 53:11

oh, 100% that's a and you push through even when it's hard, it's because, because what you're fighting for is worth it.

Dr. Robert Sallis: 53:19

Yeah, yeah. I think Have you seen that out of the the old man who's goes into his his shed, and he's, he's got some weights, and he's lifting them above his head, you know, he starts out with one small, little weight, and then he slowly adds to it. And then in the next clip, it's at Christmas, and his grandkid is over, and he lifts the grandkid above his head. And it was, he was training to do that. You know, I think that says it all, that we're all athletes. It's just what we want to do, the sport we want to do, that's what we're training for.

Erin Brinker: 53:48

Oh, well. Dr, Bob Salas, this was absolutely fantastic. And I want to end on that, because it's such a high note. How do people, or do you have social media? How do people find and follow you.

Dr. Robert Sallis: 54:01

I don't do a lot on social media. I think, I know I have a have a Facebook and Instagram, I think, but I'm not big on there, but you can probably search me out on different things I've done and and get some if you're interested in some of the studies, the research I've done, you can find it certainly on the internet,

Erin Brinker: 54:20

excellent. Well, and if people want to see the fruits of your labor, they just need to go to a clippers game.

Dr. Robert Sallis: 54:24

That's right. Hopefully we're healthy that and Lef see our le FC season right now. Oh, excellent,

Erin Brinker: 54:33

excellent, excellent. Well, thank you so much for joining us today. Joining me today. It's been a delight, and men and women alike will take a lot from this discussion and hopefully get out there and get moving.

Dr. Robert Sallis: 54:45

Thank you, Erin, I enjoyed the conversation. Thank you.

Erin Brinker: 54:52

Well, that is all we have time for today. Thank you so much for listening. I hope you enjoyed it. I know I did, and always enjoy. Same time with you whenever you are listening. I am Erin Brinker, this is the making hope happen radio show. For more information about the making hope happen Foundation, go to www.makingcope.org, that's www, dot makingcope, dot O, R, G, and I'll see you next week.

Noraly Sainz: 55:22

Hi, my name is Noraly Sainz, and I am Program Coordinator at uplift San Bernardino, a collective impact initiative at the making hope happen Foundation. And this is my story in November of 2017 my husband, our four young sons and I moved away from our families to San Bernardino with the hope of reaching our goal of home ownership in 2018 as our oldest son started kindergarten, I connected with the school district and learned about making hope happens. Kids program with my oldest in kindergarten and my twins at preschool. I had the opportunity to tote my youngest to the kids parenting classes in January of 2020, my husband and our family's breadwinner unexpectedly passed away. I found myself in a pandemic with my sons in an uncertain future. It was then that that oasis that I found at kids turned into my support system, as the staff and friends rallied around me while my sons and I struggled to find our new normal. In October of 2020 after seven years as a homemaker, I joined the making hope happen foundation as a program coordinator for uplift San Bernardino. This career opportunity reignited my family's dream of home ownership in November of 2022 through the mutual support of the uplift San Bernardino Housing Network, my family was able to buy our first home. In my role as program coordinator, and as I connect with other families in our community, I can wholeheartedly attest to the opportunities that the foundation is bringing to our community and truly making hope happen. For

Erin Brinker: 56:53

more information about the making hope happen foundation and to make a donation, please visit www dot making hope.org That's www.makinghope.org your donations make our work possible.

PSA: 57:09

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