Staying Safe and Strong in the Summer Heat with Dr. Alex McDonald

On this episode of The Hope Table, Erin Brinker welcomes back Dr. Alex McDonald, sports and family medicine physician at Kaiser Permanente and former professional triathlete, for a practical conversation about staying healthy, active, and safe in the summer heat. They break down how to prevent heat exhaustion and heat stroke, why hydration and electrolytes are highly individual, and why everyone—regardless of skin tone—needs sunscreen. Dr. McDonald shares accessible guidance on summer nutrition (including the benefits of plant-forward, Mediterranean-style eating), safe swimming and beach practices for families, smart ways to train for hikes and outdoor adventures without injuring your joints, and how to balance exercise, sleep, stress, and fun. This episode is packed with clear, family-friendly tips to help listeners enjoy the sunshine while protecting their health.

Transcript

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Erin Brinker: 0:04

Welcome to the Hope Table. I'm Erin Brinker. I am thrilled to welcome back to the show Dr. Alex McDonald. He is in sports medicine and family medicine at Kaiser Permanente in Southern California. He is a lifelong athlete, a former former professional triathlete, and a strong advocate for great nutrition and proper sleep, as well as exercise as first-line treatment for many health conditions. He believes that exercise is medicine, nutrition is medicine, and sleep is restorative in ways that we don't fully understand and are always learning. He sees himself as a guide in helping his patients live a long and healthy life. Dr. McDonald, welcome to the show.

Dr. Alex McDonald: 0:47

Thank you so much for having me. I'm excited to be here, and I guess I didn't screw up too much last time since you invited me back. So I'll take that as a win.

Erin Brinker: 0:54

You're always welcome. Always welcome. So right now people are outside and active, and it is it is hot, hot, hot outside, but it's also a great time to be at the beach. It's a fun time to be in the mountains. I mean, all of the things to be outside and in nature. So we have to learn how to keep ourselves and our children healthy. So when it, you know, of course it comes with risk. What do you think are the biggest health concerns you see this time of year?

Dr. Alex McDonald: 1:22

Yeah, it's a great question. I know, obviously, you know, we live in a great climate for outdoor activities, and heat, unfortunately, is you know just a factor we have to keep into account when we're thinking about any activities, whether it be former like like structured activity or whether it's just kind of recreational weekend activity. So I think the biggest things we think about are you know sun exposure, wearing sunscreen, kind of having covering clothing, and then also with that heat, we need to make sure that we are planning appropriately. We're bringing enough water. We're bringing planning into good activities where there might be shade, if necessary, we're thinking about our own kind of health factors that may make people in our family more or less susceptible to heat. Those are the biggest things that I always think about, and then also just sort of kind of planning appropriately and and ensuring that whatever outdoor activity you're doing is appropriate for your your ability. You know, some people can go for a 10 mile hike and that's fine. Some people, you know, have trouble you know walking around the block, and so kind of picking those activities which fit your your your body body's ability and your family's ability also.

Erin Brinker: 2:36

So it's interesting that you say that because I got into a conversation with some people on X. I know it's kind of a cesspool, but I was on X, and somebody was talking about like in the Texas heat, how do you protect yourself in Texas? And and you know people were oh in Phoenix and in Alabama and in Southern California, you know you just have to go early morning or into the evenings when you're out doing your exercise, and somebody chimed in, oh I did the and it wasn't the Badwater 1000 or whatever it is or 100, but it was one of those really intense, you know, heat out in the heat all day long kind of events, and you know anybody can do it, and don't be a wuss essentially. And I thought he's either a troll or he's insane. As a triathlete yourself, what would you say to him?

Dr. Alex McDonald: 3:20

Well, you know, and again, physical activity is often about an individual. It's an individual sport. It's an individual aspect, and so for some people, you know, if you've run like 10 marathons, like running a marathon isn't maybe isn't as a big deal as someone who's never run a 5k before, and so I think we all kind of have to set individual goals about what we want to do and what we want to challenge ourselves with, because you know that's that's what makes the journey worth it. If it was easy, it's not as not as satisfying to get to that finish line or that accomplishment or whatever it is that you want to do. And so I think some of it is psychological to set goals which challenge us, but also set goals which are realistic and don't increase the risk of injury. Be it from you know just a musculoskeletal injury if we're trying to do too much running if we're not ready for that, or a heat injury if we're trying to do something in an extreme temperature. So it's really individualized, and so I challenge everyone out there listening to set goals and to challenge yourself, but but do it in a safe way and do it in partnership with your physician, if you, or with your personal trainer, or with your family, or someone else. And so it, we all can help each other feel accomplished and meet those goals. But set goals which are realistic, and also make sure we achieve those goals in a healthy way without increasing the risk of of heat illness or you know injury to a muscle or a bone or a ligament or or sun exposure you you name it

Erin Brinker: 4:48

right why do we tend to underestimate how quickly heat can affect our bodies I mean we live in an area where it's hot and we think ah no big deal I'll take a little water but I don't need a lot of water or I don't really need to. Any electrolyte powder to my water or whatever, but then we can find quickly find ourselves in trouble.

Dr. Alex McDonald: 5:07

Yes, absolutely, and everyone again, part of it it's very individualized. So people have different sort of sweat rates. We all lose a different amount of fluid through sweat with different levels of activities and in different conditions, not just the heat, but also the humidity and the heat index, which combines both together, is a probably more accurate measure. So we all lose water at different rates. We all lose sweat at different rates, and so we have to replenish that fluid at different rates. It's also harder to replenish those fluids at different rates based on different activity, so if we're going for a walk outside, yeah, we're sweating, but we're we're probably able to replenish some of those fluids or a lot of those fluids, and our body's going to be able to absorb fluid more easily. Versus if we're running an intense race, it's much harder to eat and drink enough fluids while you're running a race, and you know your stomach's jostling, so the amount of fluid someone needs to drink is individualized to their body, plus their activity, plus their sport, based on how much you can actually just put into your body. Because if you if you try to drink and eat too much while you're out there exercising in the heat, you're going to just run into like you know gas gastrointestinal distress, for lack of a better term, you're going to make yourself sick. Yes, yes, exactly. So that's part of it. And then on top of that, to complicate matters more, we all have different amounts of electrolytes in our sweat. Different, you know, salt, sodium, potassium, magnesium, calcium. We all lose electrolytes in our sweat, and those need to be replaced at an individualized rate as well. So this is part of the issue too. Is there's lots of factors involved, and so you can't have a one size fits all approach when it comes to staying hydrated. It depends on the person, it depends on their sweat rate, on their electrolyte concentration in their sweat, the heat and humidity outside, and what activity they're doing. So, again, it really depends on the individual, and I can't give sort of a one size fits all. I think part of the reason why people sort of underestimate the heat, you know, we all here in Southern California, you know, gets to be like 60 degrees, and we start complaining about the cold and putting on sweatshirts compared to you know my friend my friend in Minnesota who doesn't complain about my friend in Minnesota doesn't complain about the cold until it gets to be at least negative zero, so we we all kind of are are used to certain temperatures and so since we're used to sort of quote unquote used to the heat we don't necessarily think of it as a big deal because it's kind of our everyday normal and and bodies can adjust and can acclimatize to heat if you sort of slowly kind of expose yourself to it over time. Your body can adjust to some degree versus kind of going from you know Minnesota in the winter to to you know doing a race at Ecuador in in the equator area. So we can adjust slowly. But also, we I think people don't think about the heat as a big deal because we're just sort of used to it. It's our everyday activity. But that being said, even here in Southern California, most of our days are spent in air conditioning or in the shade and and doing physical activity or doing anything outside. It's always better to bring too much water and not need it than than not bring enough water. Honestly, and so that's what I always tell people is it's it's always overestimating what what you think you're going to need for a hike or a walk or whatever,

Erin Brinker: 8:33

or just being outside in general,

Dr. Alex McDonald: 8:36

or just being outside in general. Yeah, even at the beach, we're sweating. We're losing we're losing fluids just lying on the beach.

Erin Brinker: 8:43

So, what are some symptoms when you've had too much heat? Whether it's you know danger of heat stroke or heat exhaustion, what are some of the things that you're looking for? So, if it's individualized, people need to be able to pay attention to their own bodies.

Dr. Alex McDonald: 8:58

Yeah. So, heat heat illness is a real thing, and there are kind of two sort of two major buckets. I think I break it down into. So the first one is as heat heat like heat fatigue, if you will. So you're outside and you're just really tired and and you're kind of worn out and like you're just like oh I just don't have the same get up and go and you're just kind of like just worn out, and that's this kind of heat heat illness overall. Then then there, sorry, heat exhaustion. I apologize. That that's heat exhaustion, where you're just kind of worn out and tired, and maybe you're a little bit sort of just like lacking energy. Now that's that is an early indication it's time to get to the shade. It's time to drink some water. It's time to cool off. Now there's there's heat stroke, which is which is a medical emergency. Now that is if you're like really dizzy, if you're nauseous, if you're confused, if you're not making any sense. Sometimes people can pass out or have seizures from heat stroke, which is a medical emergency. And if anyone is around or worried about that, just call 911. Put ice packs on their on their neck or their back. Get them inside as quickly as possible. That's the biggest difference. And so you know, heat heat fatigue and heat exhaustion is an early warning sign that you need to take care of your body. But even then, that's even maybe a little bit too late for some folks.

Erin Brinker: 10:19

So let's let's talk about people who are outside because of work. Maybe they're teachers at a or teachers in summer school, and they're outside, or a summer camp, or they just work outside. How do you protect your skin? How do you protect, you know, your staying hydrated and you know just keeping yourself healthy while you're out there doing your job?

Dr. Alex McDonald: 10:40

Yep. So the the number one thing is avoid the hottest hours of the day. You know, like a 10 a 10 a.m. to 4p.m. are kind of the most intense sunrays, the hottest hours of the day. And so trying to avoid those peak hours is is number one. But number two, if you can't, you have to be outside. Let's say you know you're working like you said a summer camp, or you. I have a lot of construction worker patients who are construction workers who work outside during the the peak hours, so wearing a hat, putting on sunscreen, SPF hot 30 or higher every every two hours or so, especially if you've been sweating a lot or if you go swimming. So that's really important to help prevent kind of over overheating or sunburn. That actually allows our body. Some people say,"Well, I don't like putting on sunblock because that'll prevent me from sweating, and that's actually it's actually just the opposite. So sunblock actually helps prevent your your body from overheating, and so it actually can be one layer. Obviously, you know, long protective clothing can be helped. Bring your own shade with you if you have an umbrella or you have something that can kind of cover you to prevent direct sun exposure, and then again frequent breaks. You know, trying not to push yourself too hard or do too too much. And normally, if you can work for half an hour or an hour without a break, you know, try to plan a break every 15 minutes or so, where you can take a break, sit down, cool off, drink some cold water, and then you can kind of get back to it. So again, it depends a lot on the individual, but there's lots of things you can do to kind of plan ahead and not not push yourself too hard in in the heat, because heat is one stress in the body, and if we're adding multiple stresses at the same time, where we're you know we're out there digging a a ditch or we're playing soccer. That's a stress, but also if we're doing that stress in the heat, that's a double stress.

Erin Brinker: 12:28

So I see people out there who are who are working in the heat and construction workers, and they're generally they're wearing very lightweight cotton or linen or other kind of clothing that is that covers them head to toe and hats. So I I know that that they they clearly have to work in that every day. So they're doing whatever they have they can to make sure that it's as comfortable as possible and as safe as possible. Do even people with darker skin need to wear sunscreen?

Dr. Alex McDonald: 12:56

Absolutely, everybody needs to wear sunscreen. It is sort of a fallacy that people who are already tan or who have darker skin, like they have lower risk of of skin cancer for whatever reason, that's just not true. Everybody, regardless of the the tone or color of your skin, needs to wear sunblock and and wear hats and sunglasses and you know cool protective clothing.

Erin Brinker: 13:20

Anybody can get melanoma.

Dr. Alex McDonald: 13:23

Absolutely, anybody can get melanoma. Absolutely, and and again, a lot of sun exposure can cause premature aging. And you know, people who are in their 40s or 50s who've had a lot of sun exposure when they're 20 and 30, you know, they they look older than they are. Their skin is more wrinkly, and and it can cause more issues just in terms of just cosmetic appearance, also, and so I know I know people who are 20 years old think they're invincible and they're never going to age, but but they will. Sometimes the choices we make they they will sometimes sometimes the choices we make in our in our 20s and 30s can impact our health long term, and so regardless of of your skin color, you know you can get skin cancer, and and you can get kind of premature aging from too much sun exposure without without proper sun protection.

Erin Brinker: 14:07

So let's talk about food because I know nutrition is really important. And people generally think you think of the summer, you think salads, you think things that are grilled and not fried. You think of like nobody's pulling out the chicken soup in the summer unless you've got the flu. So what are what are some good things that people should be eating during the summer?

Dr. Alex McDonald: 14:26

Yeah, I mean, so I mean, I I'm a I'm a big fan of kind of what a whole food plant based diet with lots of fruits and vegetables, and the the fewer kind of processed foods, the better. So I tell people if it comes in a box, a bag, or a package, it's probably not the healthiest option. Kind of things which come in sort of in nature's packaging, if you will. And so summer is great for that. Like fresh, fresh produce everywhere. There's there's berries, there's fruit, there's strawberries, there's watermelon. But then we also have lots of lots of vegetables which are available. I think I think we sort of are fooled in this day and age because we are used to having kind of all the the staples available in the grocery store year round, but there are really certain vegetables which are fruits and vegetables which are which are more seasonal. And trying to eat locally sourced fresh fruit is better than something which has been frozen and shipped 1000s of miles. And and summer is a great opportunity to take take advantage of that. Obviously, whenever possible. So really focusing on fresh fruits and vegetables are, you know, in in the in the summer, like we're hot, and actually people sometimes don't get as hungry or don't eat as much in the summertime because it just doesn't. We just don't have that same drive for for whatever reason. In the winter time, we want to eat all the comfort foods and like hunker under a blanket and and add extra few layers of of protection to our bodies with some heavier kind of fattier heavier foods, if you will. But in the summertime, it's actually just the opposite, where we want to be out be outside moving, eating lighter, fresher, fresher fruits and vegetables, and I think really leaning into that can make people. It can help your health overall, and so that way you're eating, you know, healthier in-season, local whenever possible fruits and vegetables, which which taste better, and our body's really craving in many ways. Also,

Erin Brinker: 16:17

so I had the picked up a watermelon earlier this week, and have and cut it up, and it's been in the fridge, and I'm just been eating it down, and it is so refreshing to have watermelon as a sweet treat after dinner, and you feel like you eat a ton of it, and it's got a lot of fiber, from what I understand, so it's a great treat.

Dr. Alex McDonald: 16:37

Yeah, putting and putting in the refrigerator, it's cool. Also, it's making the taste even better sometimes on the on the really hot days, and so that's a great great example of something that's it's good for you, and you like doing it, and it's it just makes you happy also, right?

Erin Brinker: 16:50

Absolutely. So you said you know a plant based diet, so that that could mean a lot of things to to a lot of people. So do you mean that that people should be essentially eating only plant based products or plant-based plant-based foods, or is it okay to eat a little meat with that? What is what is your philosophy?

Dr. Alex McDonald: 17:09

Yeah. So again, the we have the best evidence for what's called the Mediterranean diet, and the Mediterranean diet has been shown to really reduce the risks of strokes and heart attacks and high blood pressure and a lot of the things which we know are kind of the number one drivers of chronic conditions and poor health in this country. So the Mediterranean diet, you can go and Google and look up Mediterranean diet. It's going to give you tons of information. But generally speaking, the Mediterranean diet focuses on you know mostly, like I said, unprocessed fruits and vegetables. You know, lots of nuts and seeds, unsaturated fats like olive oil, as opposed to butter and thing and other kind of things like that to cook cook your food with. And then, lastly, it does it does minimize red meat. It does minimize pork. It even minimizes chicken to some degree, and there's some there's some fish in there. So not that you can't have red meat, can't have chicken, but limiting it and minimizing it. There's more and more evidence showing that getting our protein from from plant-based sources is actually probably higher quality than than than animal-based protein sources. And so my my

quick elevator pitch is: 18:22

I tell my patients, you know, I want you to eat. If you look at your plate, you know, three quarters of it should be, you know, fruits and vegetables, some like minimally processed fresh fruit or vegetable, and then for protein, having a high quality protein source. Now, what that means when I say high quality protein, I mean lots of fiber, lots of nutrients, vitamins and minerals, and then low saturated fat. Now, the the that basically means the the highest quality protein sources are nuts and seeds and lentils and tofu. Essentially, those are probably the best sources of protein for the human body. However, you know everything's in moderation. You know, chicken, eggs, fish are good good protein sources. Although they do have a little more saturated fat in them, so you have to keep keep that in mind. They also have less fiber, which is something you have to worry about and keep that in mind. So, you know, everyone, not everyone, many people, especially in the summertime, love a nice grilled hamburger or a steak, and that's okay. But the problem is when we start doing that every day, that's where we start having increased risk of higher cholesterol and and less less nutrients and fiber in that those protein sources, and so I encourage people to, you know, you can have meatless Monday. You don't have to be go vegetarian, but there's more and more evidence showing that that minimizing animal-based protein sources, particularly red meat, is actually probably better for your health in the short and the long run.

Erin Brinker: 20:00

So, so one of my you bring up the Mediterranean diet. One of my favorite things to make in the summer are Mediterranean salads. Sometimes I'll put chicken on them. Sometimes I don't. But it always has feta, and I like chickpeas for a for a protein source. And then you know the tomatoes and the red onion and you know the Kalamata olives and all of that. But some people have said, well, you have to eat way more chickpeas than you would if you'd had a chicken breast to get the same level of protein, and so you should have the chicken breast instead. But I like the chickpeas. So what do I tell them? Leave me alone. Are they right?

Dr. Alex McDonald: 20:36

Well, so so I guess I will start by saying the that over 95% Americans get more protein than they need. The vast majority of Americans get more protein than they need. I will say that again. We are sort of protein obsessed in this culture, which is there's nothing wrong with that. Protein is good for you. Now I ask you know again I practice sports medicine. I have a lot of athletes who come and see me. Who and legitimately, athletes do need a higher amount of protein than sort of the average person. So, the the the my question for them or my answer for them when they say, "Well, where am I supposed to get my protein from if I don't eat you know chicken or fish or eggs? I say, "Well, where does the where does the chicken get their protein from? Where where does the cow get its protein from? It gets it from grasses and seeds and feed and other sort of plant-based protein sources. And so, plants have gotten a bad rap; they don't have enough protein in them, and that's just not accurate. Plants have plenty of protein in them, and you need to sort of lean towards, like you said, chickpeas, nuts, seeds, seeds, beans, lentils, tofu's-those types of things are are great protein sources. But they also have a lot of fiber in them. They have more nutrients in them. And so, if you look at sort of rating those protein sources on a scale from least healthy to most healthy, you know, the the the far end, the high end of that scale is going to be mostly plant-based protein sources compared to the low end, which is going to be probably red meat. Honestly, so everyone's different. Everyone likes different things. Everyone has different protein needs. So you know, eat what you like, honestly. And you know, people can judge, but that's fine. Let them judge.

Erin Brinker: 22:19

Right, right. And the protein needs of like Erling Holland, who eats like crazy protein and fish and all of that. But he's a professional athlete, and he does that during his training and during the season. But after that, he I think he eats a more normal Norwegian diet. But most people don't need that because he's he's working his body to its nth degree.

Dr. Alex McDonald: 22:43

Yeah. So most people, the average sort of sedentary adult needs about 0.8 grams of of protein per kilogram of body weight, which is again about 2.2 pounds. That's sort of the average person. Now, if you're trying to build muscle, if you're trying to build be more physically activity, then you probably need somewhere between 1.2 to 1.6 grams of protein per kilogram. But then also, if you're a high-level athlete, you may need up to two grams of protein per kilogram of body weight. So it's a really wide window, and it depends a lot on your on you know what you're doing, your age. Older adults tend to need a little bit more protein than than younger adults, but again, the average adult needs about point gram 0.8 grams of protein per kilogram per day, and most Americans get double that, if not more.

Erin Brinker: 23:34

So, when you were training, when when you were a triathlete and a professional triathlete, which is just really impressive, what did your what did your nutrition and your training schedule look like?

Dr. Alex McDonald: 23:46

Ah, that's a great question. So first of all, I was vegetarian when I was racing full time. I was training between cycling and swimming and running and weightlifting. I was training about somewhere between 35 to 45 hours a week, so it was a it was a full time job. I was probably eating about five to 6000 calories per day, all vegetarian. I was eating purely purely vegetarian plant plant based protein sources, and you know I was aiming for about two kilograms excuse me two grams of protein per kilogram per day on average. What I was was aiming for, and I would, you know, it's hard to get that much calories. Also, especially if you're if you're thinking about whole food plant based sources, it's it's less dense, right? There's more fiber. It just fills you up more, so you're not able to eat as much as much calories sometimes. So I was literally just eating all day long, I would literally always have food in my hand. My my my wife and my in-laws always made fun of me because you know now now I'm a little bit a little more seasoned. I'm not training that hard anymore. I eat like a quarter of how much I used to, but they in their mind they still they still think I eat like that. So when I go over my mother-in-law's house, she gives me like a. Plate of food. It's like, well, you eat this much, don't you? And I was like, not anymore. That was like 25 years ago. Anyway, I digress. But I was just-I mean, my kind of my go-to's were I'd have like I often would do a like a pre-workout shake or something with some carbohydrates in it before some some a smoothie or something like that before I go and work out, and then after workout, I would eat during my workouts too. I'd eat you know there's like gels and and you know bars which are designed to be consumed while you're exercising. I'd use those during exercise, and then afterwards I'd have some kind of a protein recovery shake afterwards. Using my favorite was a there's a lot of protein powders out there. A lot of them are whey based, which is a derivative of milk, and I would usually use more of a pea powder based protein source. And then, and then just you know whatever for dinner. But you know my kind of staples were almonds and apples, and I did have eggs, so I wasn't entirely overactive vegetarian. But I did have some eggs for protein sources. So I can't remember exactly all the details, but that was kind of the the short version of what I'd eat on a regular basis.

Erin Brinker: 26:15

Well, I think it's important to hear because you know you were you were an elite athlete and and living what you're saying people should live, and so you know as a testament to that to that diet being healthy for you, it was it you know it really seemed to work.

Dr. Alex McDonald: 26:32

Yeah, and honestly, and and I I still live by that doctrine today in terms of like I would never tell a patient or recommend something to a patient that I would not recommend or do myself or or recommend to a family member, and I think the diet is is one of those biggest pieces up there that I'm constantly talking about. They're like, would would you do this? And I was like, well, yeah, I've done it before.

Erin Brinker: 26:51

Yep. So let's talk about another absolutely fan favorite and family favorite during the summer, and that's swimming. So what is what are some ways, especially with children, to to keep them safe around the pool?

Dr. Alex McDonald: 27:07

Yeah. So, so never swim alone. Never let children swim alone. Even even the best swimmers out there should never be alone when they swim. You always need to have a buddy with you. You need to have a be have a lifeguard. You need to have somebody nearby can because anything can happen to anyone anytime. You know there have been you know Olympic swimmers who've had problems in the pool and weren't able to get out and and drown. So I don't care how good a swimmer you are, you never swim alone. That's my number one rule. And then especially when it comes to kids, you know you need to watch them like a hawk. Family should always be with them, within ideally within an arm's reach. If there's if there's a problem or an issue, or at least you know close by to to spot trouble before while it's brewing before it hits. And then especially for here in Southern California, you have lots of home pools. Make sure you have gates, fences around your pools, especially if it's little kids. Make sure you have gates which lock. You know, childhood drowning is just heartbreaking. We hear about it every every year, and so my number one thing is, you know, safety first. Get your get you make sure that no one has access to a pool, especially if they're a child alone. And then don't overestimate your abilities, regardless of how good a swimmer you are. And then, and then, lastly, making sure that we are we are kind of in this together and keeping an eye on our on our kids and our our children, and teaching them to swim. Swim lessons is a great a great thing to do in the summer, and you can start kids even when they're in diaper. Sometimes you can you can have kids you know get in the pool and get used to swimming and and build their skills. And that way, if they're stronger swimmers, they they are less likely to drown in in an emergency. But again, and

Erin Brinker: 28:57

less likely to body system.

Dr. Alex McDonald: 29:00

Yes, absolutely, absolutely.

Erin Brinker: 29:01

So I was a lifeguard 100 years ago, and I remember one day it was Fourth of July. We'll never forget it. And the pool, because it was a public pool, I worked at one of the regional parks, and people were shoulder to shoulder, like all like it was. The pool was so crowded, and I was on the I was up in the chair, and I'm scanning heads because it was you know, it was really hard to see shoulder to shoulder, and it wasn't a particularly deep pool. At its deepest point, it was five and a half feet, so it wasn't it wasn't a super deep pool. But that didn't matter. I see this guy shoot from behind me, like run into the pool, and he pulls out a toddler. That child looked like he was about two years old, and he comes up and yells at me, "Why weren't you watching my kid? I'm like your kid is significantly smaller than all of the shoulders that are over him. I could not see your child, even if there's a lifeguard. Parents, you are responsible for your child. There was no way I could see that kid. I felt horrible, but you know, and I felt. I mean. The kid was fine. The child was fine, but it was it was just an unnecessary situation. Don't think, especially a toddler. Don't think your child is going to be okay just because there's somebody sitting up in a chair.

Dr. Alex McDonald: 30:13

Yep, absolutely. I'm just that's a great call up. Yep, no, not not that you have a personal experience with that or anything, but absolutely, I think it's important that even even with lifeguards and in the best situations, even in the worst situations, anything can happen. So you're absolutely right. Parents always responsible. Yep.

Erin Brinker: 30:30

Yes. Now, if the if the child had been a little a little bigger, then maybe I would have seen them. But I it was so crowded that, you know, I would see somebody splashing around. I would see if somebody got into a tussle, I would see, you know, if if somebody's there and then they're not, you know, all the things that we would look for. But a toddler under the, you know, when he was so much smaller than everybody else in the pool, when they were shoulder to shoulder, it was very crowded. That just wasn't going to happen. Yep. Yeah. So, so what are some few simple habits people can build into their day to stay safe this summer.

Dr. Alex McDonald: 31:04

Yeah, I mean, I think planning planning your activity around the temperature, around the the hottest hours of the day. So whenever possible, you know, go early in the morning or or late in the afternoon. I think that's the

number one thing: 31:15

is you don't have to worry about heat if you're not exposed to the hottest temperatures of the day. If that's not possible, or if you want to enjoy the beach in the middle of the day, you know, making sure you're bringing more than enough water. Make sure you're planning ahead, bringing enough food, bringing enough water, making sure that you are. If you have specific kind of health conditions, you talk to your doctor about how your medications may may dehydrate you or put you at higher risk of heat-related illnesses based on based on your individual health and your individual health circumstances. I think making sure that you're using the buddy system, especially around water, or even checking on checking on loved ones when it's really hot. Maybe you know inviting somebody over to hang out at your house in the air conditioning if you know that their air conditioning, they don't have air conditioning, or their air conditioning doesn't work, or anything like that. So, so checking on checking on loved ones frequently, and then when you're out there in the heat, taking more frequent breaks than you think you need, drinking more water than you think you need, and then sun sunscreen, sun exposure, wearing you know loose fitting cool thin clothing, wearing a big, wide-brimmed brim hat-all those things can make a big difference to help keep you keep you healthy, enjoy the the beautiful summer weather, but not put your health at risk either.

Erin Brinker: 32:33

You know, I I think about people who like to walk, and in in in the summer, especially older people, and in the summer, maybe it's safer to walk the mall instead of the neighborhood, and then there are movie theaters that that show like matinees from of of older movies, and and that sort of thing. And maybe it is you you go to a cheap movie instead. Let's let's talk about other other bodies of water because the ocean is a totally different ball of wax. We have rip tides, and we've seen the videos of this these professional life lifeguards who are absolutely amazing, who work on our beaches. You know, going out on on various vehicles and pulling people out of these terrible rip tides. How do you keep your family safe at the beach?

Dr. Alex McDonald: 33:18

Yeah, the beach is a whole again, as you mentioned, the beach is a whole other issue, and I think this is where parental supervision is just even more important. And you know, keeping keeping your kids close and at arm's length, I think, especially when you're sort of wading into the water, a kid who's much smaller can be be pulled out by riptide much more easily than than an adult. Although anyone is at risk, and so you know, going to a depending on on your your your comfort level and your kids' age, going to a maybe picking a beach that doesn't have a lot of riptides, or maybe it's more protector, maybe it's enclosed where there's a lagoon or something where you don't have to worry as much about about the the ocean and the currents, so that's that's number one. Going where there's lifeguards, following the lifeguards' instructions. A lot of beaches will have very kind of clear swimming areas, and they'll have sort of markers where they don't recommend swimming, or they do recommend swimming. So following those those guidelines set out by our amazing lifeguards who work on the beach, and then also I think part of it too is if if you do get caught in a rip tide, again not not panicking, and this is where having a little bit more comfort in the water can be helpful, and having your kids have swim lessons. But rather than trying to swim back into shore stray, whereas you swim parallel along the shore and try to swim out of that rip tide, where you can then then kind of swim back to shore afterwards, and so there there's a lot of factors to that happen at the beach and the ocean. Knowing I know it's fun playing in the waves, right? But the waves can harbor a little bit more danger for especially for younger children or people who are not strong swimmers. And so, definitely stay within your ability. Know your ability, and then if you're not sure the best place or the safest place, ask our lifeguards. They'll they'll tell you kind of where it's safer for families to swim versus others.

Erin Brinker: 35:13

Well, and the water is colder in Southern California than you think it should be. You know, I mean, I I grew up swimming in the Gulf of Mexico, so you know, it's it's definitely colder.

Dr. Alex McDonald: 35:25

Yes, yeah. I remember one time I was actually I grew up in the Northeast, and my my my uncle lived in Huntington Beach, and I remember this very clearly. I was in fourth grade, and I went to the Huntington Beach in February because that was like our winter break, and I was like, this is amazing, right? We're used to zero degrees, and I went swimming in the water, and everyone thought I was insane. That I'm like, oh, this is like kind of nice because I'm used to you know zero degree temperature. But there's no ice in it. California, there's no ice in the water, therefore it must be good to swim in. But yeah, since moving here, I'm like, oh yeah, again, see prior comment about it being 60 degrees when we all put on sweatshirts. Like we're we're a little spoiled sometimes. So the water can definitely be you can get a shock to your system if you jump into really cold water. And sometimes when you jump in really cold water, like you can't breathe for a second or two. Like the muscles and the diaphragm kind of spasm for a few seconds. Sometimes when you jump into really cold water, so I definitely recommend easing, smoothing that transition and kind of getting it more slowly versus like just diving headlong.

Erin Brinker: 36:30

Well, and you know you brought up diving. You know we we see images of people cliff diving in Mexico or diving into a deep pool or whatever, but diving is a great way to break your neck if you don't know where you're going.

Dr. Alex McDonald: 36:44

Diving is unfortunately a very good way to break your neck, and you know really you need to have ideally you have at least 10 feet or deeper to safely dive, and even then you need to make sure you're doing it with proper technique and you're not just going straight down. And particularly if you're diving into a natural body for whatever reason, there can be rocks, there can be locks, there logs, there can be kind of other unknown natural obstacles which can sort of float around and aren't even fixed. And so it's really important to make sure you you kind of know where you're where you're diving, what's around, what the risks are, what the obstacles are, and always you know, just again, do it. Dive if swimming with a friend. The buddy system is key here.

Erin Brinker: 37:27

Yep, you know, it just it's true. It's you know, we have such a we've we've we've done as human beings done a great job in controlling our environment, and so we create these environments where we're largely safe, right? So you go to Disneyland, or you know you're going on these these things that that feel scary but they're not really and we forget that in nature all of those guardrails don't exist so we have to have situational awareness we have to know where we're going we have to you know be respectful of the wildlife that could be swimming there or or or running around there i.e. a bison if you're in Yellowstone and you know what the water temperatures are, and what what the how the water is behaving, and there are there are lots of resources to find out where how high the surf is going to be, or what the temperatures are going to be, et cetera. And we have to you know use our heads and pay attention.

Dr. Alex McDonald: 38:17

Yes, absolutely, absolutely. I think that's a really good point. Is we get definitely lulled into this false sense of security.

Erin Brinker: 38:22

Yes. So you did you because you were a triathlete. You did the rough water swims. Did you do those in Hawaii and in La Jolla and other places?

Dr. Alex McDonald: 38:32

I did. I did. Yeah. So it's a little scary sometimes. And and again, I've done lots and lots of swimming, and I've gotten thrown around by waves and kind of into a little, a couple scary situations before. So, you know, I usually when I did these competitive swims, I had a wetsuit on. So one, I would have to worry quite about the shock to the to the to the temperature, the body from the from a cold water. I'd also that also provides a little bit more buoyancy, so you can float a little bit more easy easily. So you're less likely to kind of get get worn out underground. And then also, oftentimes when I was doing training swims, first of all, I always had a buddy with me, and then I actually had a. It's like you know how on the airplane they have like the life jackets, which sort of like self inflate, or you can pull a little CO two cartridge and it would inflate automatically. Yes, they make those for swimmers. Actually, it's like a little belt you wear. It's pretty it's pretty minimal when it's deflated, but it's sort of an emergency life belt. I would just wear around my waist when I was swimming, and then if I ran into trouble, I would just pull the cord and it was it would had a little CO two cartridge which would inflate automatically. So I definitely made sure I was taking kind of safety precautions when I was out there swimming and training with with a buddy and with that that little safety emergency life jacket backup system.

Erin Brinker: 39:51

So you were an elite swimmer and you took that precaution. That's incredible. I that's an example for everybody.

Dr. Alex McDonald: 39:59

Yeah, I mean. Like I said before, you know, you've had Olympic level swimmers who, you know, have an asthma attack in the middle of the pool or when they're out in the ocean and they can't breathe, and then that's it, right? So, I don't care how good a swimmer you are, you always need to take precautions. The oh, I'd wear a bright yellow swim cap also, so people for visibility also. That's another precaution I used to take. Also, because again, like I said, anything can happen to anyone, regardless of how good or how strong swimmer you are.

Erin Brinker: 40:29

So let's let's move into the area of training because you know people go on vacations. I brought up Yellowstone, but it could be Yosemite, it could be anywhere where you maybe you do a little hiking around or walk around where you are, but you're not used to like the serious hikes that you would find in some of these outdoor beautiful mountains that we are so spoiled to have near us. How do you train for that, and so that you don't hurt yourself?

Dr. Alex McDonald: 40:55

Yeah. So starting small, rather than going. If you're if you're training for you know a 10-mile hike. Then you start with you know one one mile, and and you often maybe will start in the cooler portion of the day, or or in the winter. You know, well before whatever the event is, if you will. So I always think about there's a couple factors you can think about when you're training, and there's different stress. So there is time, how long you're going for that hike, intensity, like how hard you're pushing yourself, how much, how fast you're hiking, and then also kind of the kind of environmental factors, how steep is the hill, what's the temperature, things like that. So anytime you're training for an event, whatever it may be, you want to start slow and and gradually build. Like for example, like distance. You know, starting with with one mile and then adding maybe 10% per week. So you don't go from a one mile to a 10 mile hike. You go from a one mile hike one week to a 1.1 mile hike the following week, you know, to a 1.2 or 1.3 mile hike the next week, and so you gradually build about a 10% distance or time or duration every every week, kind of gradually building up to that event, and then also you never want to adjust more than one factor at a time, and so for example, if you're going up in up in duration of your of your hike, as as our example, you don't you don't want to also increase the intensity and the speed and the energy with which you're hiking at the same time. So you you adjust each of those factors independently. Now, let's say you have a you know a two mile hike on your agenda for Saturday, but it's going to be 100 degrees outside. So trying to avoid that heat, so you're not adding that additional intensity, environmental intensity from the heat. So trying to move it, or if you aren't able to move it, then maybe you scale back and you don't go quite as quite as far or quite as long duration as you were planning to, since you also have the heat as a stress on the body at the same time. So there's lots of ways you can think about training and stress, and you you never want to add more than one new stress at a time. And again, those are that's like distance or duration, that's exertional level and how hard you're pushing yourself, and then also that's like environmental factors, how steep the terrain is, how hot it is, and that's that's my my conception that I always try to think about when I'm training and when I'm talking with athletes.

Erin Brinker: 43:28

So that so that you're less much less because if you push too hard, you the likelihood of injuring yourself or the the risk of injuring yourself goes up a lot. Is that correct?

Dr. Alex McDonald: 43:38

Correct. Correct. Yep. If you're if you're if you're adjusting more than one variable at a time, you're putting yourself at increased risk for injury and for for overuse injury or for heat injury or or you name

Erin Brinker: 43:50

it. So, older people tend to have problems with joints, so hips, knees, you know, ankles, etc. So, how do you keep, especially if you've been sedentary and you're and you you're feeling inspired by this conversation and you want to get up off the couch, how do you protect your joints as you're training or getting used to training for this for more exercise?

Dr. Alex McDonald: 44:14

Yeah, it's a great great question, and I hope I inspire somebody. That would that would make my day if just one person is inspired by this. So starting starting small, right? If you're inspired, like I said, part like I talked about initially is setting a goal, but setting a realistic goal. And so you want to challenge yourself, but you you don't want to challenge yourself too far or too hard that you end up causing injury or having to quit and give up, and then and then you feel like a failure for not meeting your goals, and so picking realistic, attainable goals is the first step. And then the second step is is slow, small, steady progress. If you have severe knee arthritis, then maybe starting running is at age 60 is not the best option. Maybe maybe we start with swimming. Swimming. Maybe we start with cycling. We start with something that's a little bit lower impact that is less stress on the body. And so picking picking a physical activity which matches your your abilities and matches any other kind of medical conditions which may impact you, I think is is is is a big is a big piece of it, and kind of setting yourself up for success. And then thirdly, getting a team, getting getting people to help you achieve that goal, whether it be a personal trainer or or talking with your doctor or or joining a you know a swim club or that has a coach or built in resources or support. So you're not just doing it by yourself, but you have a team of people, kind of helping you. Some people go as far as hiring a coach, you know, talking to your talking to your doctor. So you have multiple people who are all helping you, kind of work towards that goal in a in a steady, consistent fashion.

Erin Brinker: 45:53

And it's important, you know, if you do end up tweaking your knee, don't give up, you know, give yourself time to let the knee heal. Maybe there's other things that you can do.

Dr. Alex McDonald: 46:04

Success is not a straight line. You know, there's ups and downs. There's good days. There's bad days. You know, sometimes if if you tweak your knee, then yeah, you want to keep pushing through. But it's really probably better to give yourself, you know, a couple days or or a week even, just to kind of rest and work on some rehab or some stretches. Do some cross training because oftentimes if you if you if you have an injury, if you treat it early, you can often you know kind of you know nip it in the bud, if you will. But if you try to keep pushing through a small injury or a small tweaked knee, can end up being a much bigger problem in the long run.

Erin Brinker: 46:39

Yep, and you don't want to get to the point where you need surgery, if you know. I mean, if if you need it right off the bat, then you need it. But if you don't, don't don't tempt fate.

Dr. Alex McDonald: 46:50

Yeah, exactly.

Erin Brinker: 46:52

So, so what are some final thoughts as we wind down? What are some final thoughts about about taking advantage of the warm summer months and having a great time in the outdoors, but taking making sure that you take care of yourself. What would you tell families?

Dr. Alex McDonald: 47:08

Yeah, I mean, again, have fun. It like we are we are we live in this beautiful climate where there's so many opportunities afforded to us most of the year, where a lot of other people don't have that, so take advantage of that. Enjoy it. Enjoy the time with friends and family, and make it a social activity. And it's it's great to challenge ourselves and to push ourselves. But but at the end of the day, unless you're a professional athlete, you know it's it's probably not the most important thing. And and it's okay to kind of call it quits if you're feeling overwhelmed, or if you're injured yourself, or it's a it's a bad day. I think sometimes people feel like they have to do like all or nothing, and even even 50% is good. Even 70% is good, and so every little bit adds up to being outdoors, to being physically active, to eating healthier foods to to doing everything we can to maintain a a happy, healthy, well-rounded lifestyle. Because as I always tell people, you know, exercise, diet, stress relief, and sleep are the the four foundations to a good health. And everyone's health is different, and everyone needs different pieces of that. So, if we focus too much on any one thing, then we sacrifice another thing. If we're if we're getting up at four in the morning to go exercise, we're probably not getting a good eight hours of sleep. And if we do that a little bit here and there, that's okay. But when we start doing that all the time, that's when when we run into problems. And I think being being outdoors, being active most of the time is really good for us. But if we can't be like perfect, if we can't do everything we want to do, then that's okay. Also, because there's gives and takes, and finding that balance between you know eating well plus having a little ice cream to being physically active, plus lying on the beach, to you know getting eight hours of sleep versus getting up to go for a hike early in the morning, right? Everything's a balance, and if we put too much weight or too much emphasis on any one of those pieces of kind of lifestyle medicine, we end up we end up being out of balance, and ultimately is is worse for us in the long run.

Erin Brinker: 49:20

Indeed, well, with that, thank you so much, Dr. Alex McDonald. It has been a treat to have you as always on the show. How do people find out more about you? You know, KP.org is that the best place to start?

Dr. Alex McDonald: 49:36

Yeah, so KP.org is is a great spot. You can find me there. I practice here in Fontana, I'm I'm I'm very busy. I think my think my patient panel is full at this point. But I'm always happy to to meet new folks and to see how I can help them along their their health journey. I try to post a lot of health information out there on Instagram. My handle is Alex Z McDonald on Instagram, and people can follow me there and. Get tips and tricks on on a healthy lifestyle. So those are those are the main ways people can find me.

Erin Brinker: 50:05

Well, Dr. McDonald, thank you so much for joining me as always, and I I welcome having you back, and I hope I will again this year.

Dr. Alex McDonald: 50:14

Well, thank you so much for having me. I hope I hope I hope this was was informative and educational for your listeners, and I really enjoyed it.

Unknown: 50:21

Thank you.

Erin Brinker: 50:24

Well, that is all we have time for today. Thank you so much for spending this time with me. I'm Erin Brinker. You've been listening to the Hope Table. Have a great week, everyone.