The Next Chapter: Does a positive mindset help promote healthier aging?

The Next Chapter

Peter Allison and Peter Bowes – school friends 50 years ago - discuss science-based lifestyle interventions as they pursue the next chapter. 

Peter A. has spent much of his life working as a professor of geology in London.  He is a keen diver and keen to optimize his health and vitality to continue with his physically demanding pastime.

Peter B. is a journalist and broadcaster with a longtime interest in the science of healthy aging and the hacks we can employ to live life to the full, for as long as possible.

In regular conversations they review the latest data that could help us achieve a longer healthspan. 

This episode includes:

- A study from the University of Barcelona that found a Mediterranean diet rich in healthy fats was associated with reduced cognitive decline in older adults.
A Mediterranean Diet-Based Metabolomic Score and Cognitive Decline in Older Adults: A Case–Control Analysis Nested within the Three-City Cohort Study
Molecular Nutrition Food Research journal
Published: 24 October 2023
- The study used biomarkers in blood tests to confirm dietary habits, providing more reliable evidence than self-reported diaries.
- Potential systemic bias in self-declarations of exercise and diet habits.

- The impact of positive mindset on healthy aging, referencing a study that found those with positive beliefs about aging lived longer and had lower blood pressure.
People who think positively about getting older often live longer, healthier lives. Here is how to reconsider your perspective.
Published:  20 September, 2023

- And finally: The centenarian sisters who embrace modern technology and emphasize the importance of movement.
Centenarian sisters celebrate life together
Published: 22 November, 2023

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Fit, Healthy & Happy Podcast
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Transcript

Peter Allison: 0:20

For these self declarations of what people's exercise they're doing or what diet they're eating. I wouldn't be surprised if there is some sort of systemic bias. They want to think about the good things that they do, and I'm thinking they systemically just avoiding the bad things. And I bet we all do it.

Peter Bowes: 0:43

This is the latest in our series of conversations with Peter Allison, my old school friend from 50 years ago in northeast England. Now, looking forward as I am, to the next chapter in life, when we both hope to maximize our health and fitness, to continue enjoying life as best we can for as long as possible. I'm Peter Bowes. Welcome to the Live Long and Master Aging podcast. It's been a little while. How have you been?

Peter Allison: 1:11

I've been fine, thanks. Although I had a minor knee injury. Whether it's one of those older person things, perhaps?

Peter Bowes: 1:19

Yeah. Do you like me? Avoid using that phrase. It's an older person thing or. Oh, it's just my age. There's something in me that just doesn't want to use that phrase.

Peter Allison: 1:29

I'm actually I mean, it was one of those sort of topics that we were going to be discussing later on today, and I'm actually quite comfortable with my age, and I think with getting older, and I think in part, I think of all of the sort of insecurities I had when I was younger, and I don't have those insecurities now. So I've still got some insecurities, but I've lost a lot of them. So I think it's a sort of a trade that maybe my body doesn't quite respond as well to some things as it used to, but then again, I don't really have these stresses, some of these stresses and worries that I used to have. So all in all, I think it's a good trade. I'll accept it.

Peter Bowes: 2:05

Good. Just to recap, Peter is a geology professor. He has spent much of his career in the academic world, writing, reading scientific papers in his own field, and is now reading scientific papers, amongst other things, focusing on human longevity, healthy aging, which is where our interests merge. We went to school together, recently reconnected, and this is our latest conversation. Really just taking a look at the latest scientific literature as it applies to healthy aging. As we both contemplate the next chapter, the next chapter being, well, we're both significantly into our 60s now. The next chapter being the next 2 or 3 decades, I think, to look at this fairly realistically. Peter.

Peter Allison: 2:53

Yeah.

Peter Bowes: 2:54

So let's start with a study that I spotted in the journal Molecular Nutrition Food Research, which looks at the Mediterranean diet and cognitive decline in older adults.

850 French citizens, roughly 50: 3:07

50 men and women over the age of 65, were followed for more than a decade by researchers from the University of Barcelona in Spain. They were all dementia free at the start of the study, and they monitored various biomarkers, carried out neuropsychological evaluations on each participant during the course of the study and the finding; Those who closely followed a plant based diet, a mediterranean diet rich in healthy fats, as shown in blood tests, were less likely to experience cognitive decline as they aged. And I think, Peter, the interesting thing about this study is the way that these people were monitored and that there were tests, there were biomarker tests, there were blood tests to essentially confirm what the scientists were saying, as opposed to anecdotal evidence, which we might have seen in previous studies on this subject.

Peter Allison: 4:08

Yes. I mean, that was one of the interesting things I picked up on because there were commenting that in many studies like this, they the evidence that they have for diet is just some sort of little diary that the people are keeping. And as you say, that's just sort of anecdotal and that sort of pulls me back a little bit to some of these, some articles I've read about dieting and people's ability to deceive themselves about what they've been eating, that they think they've been really eating very, very good, but then they just forget about all the little snacks that they've been having as well, you know, and I'm guilty of that. So whereas in this study they'd gone through and their, the, their diet was, as you say, it was monitored according to a whole host of markers that were present in their blood. So it sort of gets away from that whole self-certifying what I've eaten problems that you can get.

Peter Bowes: 5:04

The other point is you just said diet. I probably referred to it as diet as well. In general terms, it isn't a diet, it is a way of eating. It is following the the general definition of what a mediterranean diet is. So this wasn't oh, I'm going on a diet to try to lose weight. Situation.

Peter Allison: 5:20

Yeah, yeah. I mean, so the other interesting thing about this is when you were when they were. They were able to monitor. So they were looking at various chemicals in the blood, which were indicative of things that they've eaten. They couldn't assess whether some people have been eating red meat or not. So there was no assessment of red meat because they couldn't find a biomarker that they could use for that, because they couldn't differentiate between red meat or, or chicken. And they or whether or not the body's just the body's doing something with protein itself. So either building muscle or, or reshaping it. So they couldn't monitor that. And it reminded me of another paper that we discussed a few months back, if you remember. So there was a paper that we discussed a few months back that was looking at the impact of diet on cardiovascular risk factors. So their conclusion, which seemed to me to be quite interesting, it was the fact if you, if you, if you're eating, it's it's the quality of the healthy foods rather than the negativity of the bad foods. That was their conclusion. And that the people who have unhealthy diets are eating. The problem isn't that they're eating too much of the bad stuff. The problem is that they were eating not enough of the really good stuff. So that was the conclusion, if you remember that. If you can remember.

Peter Bowes: 6:41

Yes, I do, I do. And essentially I think what they were saying, what you're saying is that the fact that you are eating a significant amount of these healthy foods, these plant based diet foods, that is what is promoting the good health, per se, in terms of a protection factor, and that it doesn't necessarily I think this is what you're saying doesn't necessarily mean that if you eat some meat as part of that diet, that you're going to fall unhealthy, that that is going to be okay as long as the, let's say, the bulk of your diet comes into the the healthy group and you're getting these, these good fats, etcetera.

Peter Allison: 7:19

Yeah. I mean, and sort of like and I guess that the background to that is that there's been abundant studies which have been done on a whole variety of sort of plant based chemicals that have beneficial effects on health. And if you eat lots of fresh fruit and vegetables, particularly if you're eating low calorie, fresh fruit and vegetables, which means you have to eat an awful lot of them. If you're doing that, then you're getting all of these healthy phyto phytochemicals which have all of this benevolent impact on your health. And, I mean, I've read some studies which suggest that just taking, you know, if if you are going to be taking vitamin supplements to try and to try and get the same effect that those vitamin supplements, not all of them have the same impact on your health as just eating, as eating all of them, as eating the fresh fruit and vegetables. So with that study, in my mind, I was particularly looking to see what the impact of the red meat was because they had some because they have a negative score for some of the dairy products in this, in this paper. So I was quite disappointed to find that they couldn't find anything for red meat, because that's immediately what I was looking for. So they couldn't pull that out. But I mean, I guess as we both know, I think I think we both quite sympathetic to this notion of everything trying to everything in balance and so. Yeah. So yeah, I was constantly trying to pull that out when I was, when I was reading the paper.

Peter Bowes: 8:41

That's interesting. Something you said at the start that reminded me of a conversation I had with a scientist recently. And that is the use of anecdotal evidence, the use of food diaries or experience diaries as part of a scientific study, which this study that we're talking about does not rely on. It relies on more scientific evidence in terms of biomarkers based on blood tests. But I've been involved in a couple of clinical trials, and it always occurs to me, and I mean, I think it's a significant issue that so much trust is put in participants of many of these studies that we read about, especially in the popular press, that are based on anecdotal evidence, that you've got to be extremely careful what you're you're reading and what you're believing, because we all know that humans are a fallible.

Peter Allison: 9:32

I mean, I was just thinking of an example. I mean, there was a while back my weight had plateaued and I was thinking, well, I'm getting discouraged. I'm, you know, I'm managing my weight. I'm not eating stuff and this, that and the other. And then I sat down and I had to sit down really carefully and think about the things that I'd eaten. And I was just wasn't counting those. That little time when I stuck my hand into the into the almonds, almonds and sunflower seeds. And at that time when I just decided, oh, I'll just have a little extra, I'll just have one of those little pots of yogurt or a couple of apples or and really, I mean, I worked out I'd put on a bunch of weight last calendar year, and when I worked out over the course of the year there, it was the equivalent of me eating an apple a day too much, which led to the weight weight gain. So it was so I can understand why there are problems. I'm sure that for these self declarations of what people's exercise they're doing or what diet they're eating, I wouldn't be surprised if there is some sort of systemic bias. They want to think about the good things that they do, and I'm thinking that they systemically just avoiding the bad things that they do. Right. And I bet we all do it.

Peter Bowes: 10:42

And it's so easy to make mistake. I mean, an apple a day. So what's that about 100 calories? And yeah, that's right. Sometimes just a handful of sunflower seeds, a handful of nuts. On the surface it looks healthy, it feels healthy, but there's a lot of fat in there and there's a lot of calories. And it's so easy, as you say, just to ignore that.

Peter Allison: 11:01

Yeah.

Peter Bowes: 11:01

Let's move on, Peter, to the next. This isn't a well, it is actually based on scientific studies. But what caught my eye was an article in the New York Times, does a positive mindset really help promote healthy or healthier aging? And this is an article that's really a pull together of scientific studies over the years. In fact, one significant study going back to, what, 21 years to 2002, and this is a piece that's been written by Holly Burns in The New York Times. And, well, it says people who think positively about getting older often live longer, healthier lives. Here's how to reconsider your perspective is the way that they frame it. And just going back to that 2002 study, this is a decades long study of 660 people that showed that those with positive beliefs around getting older lived seven and a half years longer than those who felt negatively about it. And since then, the article says, researchers found that a positive mindset towards aging is associated with lower blood pressure, generally longer and healthier lives, and a reduced risk of developing dementia.

Peter Allison: 12:23

I mean, this is interesting because I think when I first read it, I read the words of, you know, stereotyping. And the first thing that comes into my head is I'm thinking about the stereotypes that others have about aging. So my first thing is, you know, you think about people being ageist and assuming that I can't do something because of my age. But the real issue is self stereotyping, I think. And that's what certainly what's discussed in the paper, it's a and that's what's really discussed in the New York Times thing really, isn't it. The self stereotyping. And I was recalling watching something that we had on the TV. There was a television program on about aging in the UK a while back. And one of the things is they got a whole bunch of people who were in their 80s and they put them in a house together. One of the things that they there was no lifts in the house. And so they didn't they were complaining that they couldn't go up the stairs because of their age, and yet because by the time they had been in the house for a week, they were going up and down the stairs. And so they'd walked into this house with this negative self stereotyping about what they can and can't do. And again, I guess the warning is, is that that's quite pervasive and that needs to be guarded against. And I guess that's that's what the article is really talking about and warning us about that really, isn't it.

Peter Bowes: 13:45

Yeah. In terms of self stereotyping, I'm sure it's something we all do without thinking about it. Do you would you is there anything you can put your finger on in terms of your own life that you're perhaps exaggerating the impact of age in your mind, and it's not a reality.

Peter Allison: 14:05

In terms of physical stuff, I guess physical stuff. I am aware that my body will probably recover from injury more slowly. And so there are probably some things I don't do because of that. So I was thinking about going to a some sort of martial arts class really just for stretching exercises or something. And then I realized that there would be lots and lots of throws in it, and I thought, I'm going to end up with my shoulder damaged and that'll be not too clever, so I won't do that. So I think maybe that maybe I'm overreacting on that, because maybe that's something I should engage with and go forward with. I think the idea of never stopping challenging yourself as best you can is always good, because the more you challenge yourself, you challenge yourself on something tomorrow and then in a week's time, it's no longer a challenge. It's easy. So you challenge yourself with something else. And whether that's physical or mental, I mean, I think that's the attitude, isn't it? It's just.

Peter Bowes: 15:14

Yeah, I mean, the first point you made, I think is a realistic acknowledgment of the effects of aging. And one thing I don't do anymore, I used to do a lot of these, you know, Spartan Race type events where you're leaping over obstacles, you know, you're swimming through mud, and they're pretty grueling, pretty tough. They were great fun to do. But the chance of injury is very, very high. And no matter how fit and healthy you are, it's very easy to jump off an 8 to 10 foot wall and hurt your ankle. And like you, I feel as if a sprained ankle is going to take much longer to recover now than it would 20 or 30 years ago, and that's going to limit me in all the other exercise pursuits that I, I do, and just purely from a realistic perspective of my situation now, I'm just a little bit more careful and I don't see anything wrong with that. I think that's probably quite wise.

Peter Allison: 16:10

Yeah, I am, and I think it's that injury thing. I think I'm aware of that. So I mean, as I was having a conversation about this with my, with my wife yesterday and she, we both commented that if we think about how active we might be until our 80s, if we have six months of an injury to sort out, well, that then just that's a significant amount of our health span time. My wife had an eye just just pointed out that my wife had a two years ago. She had a she was knocked off her bicycle by a car. So she ended up having three months, more or less sitting on her back resting her ligament injury. So that's framed that's impacted upon her on on her thinking. Because at her age, she's thinking she doesn't want to do that again.

Peter Bowes: 16:54

Another line I spotted in this piece. Research also shows that people with a more positive perception of aging are more likely to take preventative health measures like exercising, which in turn may help them live longer. That might seem to be fairly obvious, but I think when you're looking at studies and looking at the impact of people's lifestyles, I think that is is a very good and fair point that if you if that is your mindset that you're doing these things anyway because you believe in them, well, inevitably your chances of living longer are much better.

Peter Allison: 18:01

Yeah. I mean, I think, I mean, you've you've been doing sort of fitness related things for, for decades. And for me, I allowed my fitness to slip and slip and slip, I suppose like a lot of people, my exercise for maybe ten years was a three mile walk across the park in London. So one and a half miles each way on my commute into work. That would have been my exercise every day, which is passable exercise for the average Brit, I'm sure, but I was just getting weaker and weaker and getting aches and pains. And in my head, about 3 or 4 years ago, in my head I thought, this is just aging and I'm just getting older. And really, once I started going to the gym and I started doing exercise, all of those aches and pains just went away because those aches and pains were down to muscles have just got smaller and little strains on tendons and ligaments, and once you put more muscle on, they just went away. They're gone.

Peter Bowes: 19:02

Do you feel since we first started talking earlier this year, Peter, that in terms of your exercise regimes and I think you like me there sometimes on and there, sometimes off and sometimes there, you're reaping rewards and other times you feel as if you're going backwards. Do you feel that overall this year you've made progress?

Peter Allison: 19:21

I think I'm probably static and have gone maybe static, and I've put a bit of weight on. I've probably put 3 or 4 pounds on. My cardio. I'm a real creature of habit. Peter. And I need to get a routine, and once I get a routine, then that routine is my life raft. And I've always been like that ever since I was, you know, I was I was the little boy who, when he, when he played with toy cars, put them back into cardboard boxes and put them away tidy. Right? So that was my mindset. And so in that same way I like to I need a routine. In my gym. I had a brand new gym building. It's a social enterprise and they built a brand new building. I started using different machines and some of the machines I can't use, so I'm going to have to I've got to move on to free weights, and I'm finding that transition rather difficult. And I've had to really persuade myself that I don't like that transition. So I've been going to the gym and I've been doing lots and loads of cardio. So my cardiovascular fitness is great, but some of my strength has gone back a bit, although I'm fairly certain once I now I've just started getting back into looking at the backing, back into using some of the different machines, and I'm fairly certain I'll pull that back within a few weeks really, because not I haven't lost too much.

Peter Bowes: 20:41

Do you have? And maybe I just want to sow the seeds for a future. Let's say the next conversation we have here, which I'm thinking will probably be the final one that we have this year, and a kind of look ahead to 2024 and some of your goals and my goals and aspirations in terms of your physical fitness. But just maybe as a teaser, do you have anything in your mind? And every December, these thoughts whiz through my mind repeatedly as to what you would like to try to achieve next year.

Peter Allison: 21:11

I actually have in my head I have the equivalent of an Excel spreadsheet of the things I would like to be able to do, and I'll give them one at a time. So I'll give one and then you give one. How about that?

Peter Bowes: 21:22

Okay. And we'll elaborate next time we'll do a full 30 minutes on what next year is going to look like in the next conversation. Because these thoughts are just ruminating with me at the moment. I'm just mulling it all over. I've got some ideas, but yeah, you go first.

Peter Allison: 21:34

So background is my goals really are they are waypoints on measuring functional strength and fitness. So these are so that's what they are. So they're related to me doing diving and how everything's going to be working well with that and going hiking as well because I want to do some more hiking. So start off I'd like to be able to do somewhere between 20 and 30 proper press ups. At the moment, I probably haven't done any for a while. I can do 30 if I press up off the knee now, I can do 20. If I press up off the knee, I can do probably. If I pushed by Christmas, I could get back up to 8 or 9 proper press ups. But I've never done more than ten in the last year, so I'd like to get that to in the 20s somewhere.

Peter Bowes: 22:20

Okay, using exactly the same exercise then I would like to. And I'm probably pretty similar to you if I do an absolute proper press up on the ground off my feet. I'm probably getting 8 to 10 really good ones with your hands in the proper position, not spread out wide. So making it easier. Absolutely. doing everything properly. I'm probably in the same sort of region, and I'd love to be able to double that, let's say during the course of next year to get up to to 20. I can do many more if I'm raised up, if I'm pushing off a bar, I'm getting 10 or 12 quite easily. But of course the amount of strength needed isn't so great. But yes, in terms of an aspiration, and that's entirely possible. Yeah, I think there's nothing that can stop either us from doing that.

Peter Allison: 23:09

So in similar vein. So the other one. So I've got these things in my head of just like different exercises. So and I would like to be able to do. So it's about pull ups and chin ups and I can at the moment I can do one pull up. I can probably I can probably do two chin ups. I think at best I've already ever been able to do four chin ups, but I would like to get the like us chin ups. I'd like to try and get to ten and I accept what I can do on. So I'd like to be able to do that. And I mean, I mean, you know, if I don't make this, I'm not really going to be terribly bothered. But I would like it's my little, little target that I set myself when I go and try and do exercises to see if I can do that. So that that's one of the things I'd like to do as well.

Peter Bowes: 23:55

So my other number one aspiration for the year is actually to get back into running. I used to run marathons, triathlons. I do a lot of hiking, a lot of walking now, but I don't really run. And I want to and I'm going to do this the sensible way, and that is to start slowly with very short distances. But I'd love and this isn't a huge ambition, but if I could do a 5K or a more ambitiously, a 10K by the end of next year, that would be great. And I've just got out of the habit of that kind of training. And, you know, part of it is because running is quite boring. I've got a lot of other stuff to do at the moment, and it isn't top of my priority, but the feeling of being able to do and especially to do an event, to do it with lots of other people. I would like to get back into doing that.

Peter Allison: 24:45

Yeah, I've never really gone running because I've never really been very good at it. I was terrible at it when I was a kid at school, as you may remember, and I think I've had that sort of the impact of that, of that failure has probably carried through my life. So I've, I don't run now. So but one of the things I think I'd like to be able to do that. So that's one of the things I'd like to do to change. So let's say I would like to be able to do a 5K by mid-June. So I think probably one of the things I'll just notice is because of all of the cardio I did because of diving and Covid, because Covid can cause lung damage and impact on people's fitness. To dive, I had to go through a self certifying sheet, and I had to do so many Mets of activity on an exercise machine just to self certify to say I didn't have to go to a diving medic. And I did that and I got the full score, but and I was pushing myself to do that. But the interesting thing was, is that my heart rate was really high. I did the exercise, but my heart rate was it was my heart that limited me. And since then I've been doing so much cardio. I've been. I upped the ante with the cardio, and now it's my legs that can't do it, and that my breathing rate and pulse rate is I can't. I find it difficult now to get my pulse rate up too high. So now I'm now leg limited, so I now need to do something with my legs, put more muscle on my legs I think or train my legs something.

Peter Bowes: 26:15

What do you just very briefly what do you get your pulse rate up to when you're you feel as if you're working at maximum effort?

Peter Allison: 26:22

Okay, so when I did this about a year ago, I was getting my pulse up to about 172 173, which is higher than the notional maximum. But, you know, at that point I was starting to feel a bit sick, but now I can't really get it past a hundred and.... Right is my legs won't do it. Won't take it. I feel as though I'm not particularly breathing very heavily. And by the time I'm up to 150.

Peter Bowes: 26:51

Interesting. I haven't tried to get it that high, but I notice at the most difficult part of my morning walk, which is the steepest part of the hill I'm getting to and I try to get it to. It doesn't sound very much compared with what you're achieving, but 120 I, I kind of hover around 118, 119 and maybe put in a bit of extra effort to get it over the hill at 120, but that seems to be my maximum effort at the moment. But I think if I did a sort of stress test type exertion on a treadmill and run really, really hard and fast, obviously I could get it much higher. But that seems to be where I, you know, given our age and maximum heart rate for our age, that's still pretty good for a daily achievement, I think.

Peter Allison: 27:39

But I mean, but you're really I mean, you've got a high level of background fitness. I mean, I'm sure that is it not just that that 120 for you is just that maybe your heart's just saying, hey, this is so easy. I don't really have to stress it.

Peter Bowes: 27:51

Quite possibly. Yeah, because I don't know what your resting heart rate is. Mine is pretty low, sort of mid 40s when I'm asleep.

Peter Allison: 27:59

That's fantastic, isn't it? I mean, I'm my. If I'm lying in bed in the morning, mine's about 59, 58 or something like that. So I think I've improved my heart fitness and that's why I find it difficult to push my heart faster anymore, because I just think it's just got better at pumping blood around. But I think now I have to put more because I think the plateau is I've got to put more muscle on my legs really, and start doing stuff. So I think running, I think I quite want to start doing that. I've just got to action it

Peter Bowes: 28:29

Just got to action it. That's what we should call these conversations, shouldn't we? It's all encompassing. Let's wrap this up, Peter. And in fact, what we've just been talking about is a nice segue into this is just a local newspaper article that I spotted, the Cross Timbers Gazette in southern Denton County in Texas, and they did a nice little piece about a couple of centenarian sisters who lived together, Rene Sutton and Opal Simmons. By the end of this month, both will be centenarians. Opal turns 100 on the 31st, Rene hits 102 on December the 10th, and it is one of those typical articles talking to a couple of very, very old people what their tips for a long life are. And says Rene, I tell people, sit in your chair, but when you get out of your chair, be sure to move. Do something besides sitting around, she says she thinks it works. She says her husband was 95 when he died, and she is still going fast and furious. And you know, this is what I hear from so many very, very old people that you just got to get up. And if you can get up and and move.

Peter Allison: 29:41

Yeah. And I actually thought that that attitude that she had is probably reflects an attitude that she's probably had for most of her life now. It means get up and move. It probably meant get up and do an awful lot more stuff. 20, 30 years ago, I imagine.

Peter Bowes: 29:59

And the other snippet of just made me smile. The other thing that they enjoy, would you believe is modern day technology. And they love Alexa. They each have an Alexa device and they ask Alexa all sorts of questions, like in the middle of the night calling out, what time is it? You just ask her any question and she can get you an answer pretty quickly. They are embracing technology and some sensible advice about exercise. What's not to love about that?

Peter Allison: 30:27

Brilliant.

Peter Bowes: 30:28

Peter, really good to talk to you. As I say, let's talk again before the end of the year. Both give a little bit more thought to what we want to try to achieve next year. And as you were talking, this thought whiz through my mind that if you aspire to run A5K and so do I. Maybe on my next trip to the UK, I see you smiling. We get together and we do that.

Peter Allison: 30:53

That sounds brilliant. Yeah.

Peter Bowes: 30:55

Let's do it. Peter, good to talk to you. Take care.

Peter Allison: 30:56

Nice to talk to you as well.

DISCLAIMER: 30:58

This podcast is for informational, educational and entertainment purposes only. We do not offer medical advice. If you have health concerns of any kind or you are considering adopting a new diet or exercise regime, you should first consult your doctor.