Live Long and Well with Bobby DuBois, MD, PhD

How do we separate health hype from medical reality?

In episode #142 of The Art of Medicine, I spoke with Matt Hongoltz-Hetling about the history of "quack" medicine. Today, I’m joined by Dr. Bobby Dubois to discuss how we can protect ourselves from modern snake oil.

About Our Guest:

• Bobby Dubois, MD, PhD: Internal medicine physician and researcher with 180+ published papers.   
• Host: The Live Long and Well with Dr. Bobby podcast.
• Athlete: An active Ironman Triathlete in his 60s.   

We live in an era where "miracle" cures are sold daily by celebrities and self-proclaimed experts. These treatments often prey on desperation and limited health literacy, resulting in physical harm and financial loss. Dr. Bobby shares his insights on how to identify what actually works in healthcare and how he maintains his own peak performance as a ranch owner and triathlete.   

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Transcript

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[Andrew Wilner, MD] (0:08 - 2:28)

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. I've planned a great program for today, but first, a word from our sponsor, locumstory.com.

Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a locums 101 crash course.

Learn about locums and get insights from real life physicians, PAs, and NPs at locumstory.com. And now to my guest. Today I'm pleased to welcome Dr. Bobby Dubois. Bobby is an internal medicine physician, has a PhD in public health policy, and a health researcher with 180 papers to his credit. He's also an Ironman triathlete, a Texas ranch owner, and hosts the Live Long and Well with Dr. Bobby podcasts. He focuses on separating the hype in medicine from what really works.

Welcome, Dr. Bobby. Thank you. It's great to be here.

Dr. Bobby, this is going to be fun because, you know, healthcare, you know, not five minutes goes by that we don't have a healthcare news item. And in fact, I saw one today, ADHD came across my emails, get a lot of healthcare related emails. And apparently there was some treatment with trigeminal nerve stimulation that was approved by the FDA based on, you know, sort of initial minimal testing.

And they went and did much bigger studies. And it turns out the thing doesn't do squat. It is FDA approved, really probably on the basis of safety in that it doesn't do any harm.

But in fact, they did a big study and it's no better than placebo. And you know, I guess by the end of the day, we could use AI, we could probably come up with a thousand instances like that. And we're going to get to that.

But first, tell us a little bit about your background as a physician and what you're doing now.

[Bobby Dubois, MD, PhD] (2:29 - 9:03)

Sure. So I'm a physician, internal medicine trained at Harvard, Hopkins and UCLA, and was always interested in sort of the big picture issues, you know, not just taking care of individual patients, but how do we take care of groups of patients or a whole population of patients? At the end of my internal medicine work, I realized, well, I don't know how to think about that.

I also had an entrepreneurial side to me and I decided, OK, well, I need to get a PhD in health policy so I could begin to understand some of these issues. So my career really has been focused on evidence. What do we know that works and how do you get doctors and patients to do all that?

And what do we know that doesn't work? And then how do we stop doctors and patients and insurance companies from doing those kinds of things or paying for those kinds of things? So my my career really has always focused on that question.

And it just evolved from kind of decade to decade. Initially, I spent about 10 years, helped co-found some companies that worked with managed care. Again, can we use evidence and science to find out what surgery is appropriate for what patients, you know, which patients will benefit from back surgery, which don't, which patients should undergo a tonsillectomy or hysterectomy, which should not.

And then could we intervene to make sure the people that need it get it and the people that don't need it don't get it. And my career then kind of evolved and I worked in the electronic health records world for about a decade and really explored the issue of what can data tell us again about what works and what doesn't work, longitudinal data, data in the hospital, data in the ambulatory environment. And then after that, I worked at a think tank focused on pharmaceutical issues, and my focus shifted a bit towards value.

How do you figure out whether $1,000 rheumatoid arthritis drug is the right way to go with a patient or a $40,000 drug? And if a $40,000 drug might help a patient, how do you justify that it's $40,000, not $1,000? So that was another phase of my career.

As I decided it was time to leave the corporate world, I was really blessed to be able to do really academic work in a non-academic site, so I was able to publish, as you said, 180 or so peer-reviewed publications. So all the work I did wasn't proprietary, it all came out in well-recognized journals. I've also always been interested in health and fitness.

I started out doing marathons in my late 30s and then decided, what the heck, I might as well learn how to swim and bicycle ride. And then I started doing triathlons, the short distance, then the medium distance, and then the full Ironman distance. And I'm 69 years old and I'm still competing, or I should say I'm still participating.

I don't know how competitive I am at this age, but I'm still doing it. And as I was listening to lots of podcasts, over and over again, I was struck by how much opinion was being shared and how little evidence that opinion was based upon. And so I decided a couple of years ago I was going to put together my own podcast.

Now there's lots of health and wellness podcasts, so I had to sort of figure out, okay, so what's my angle at this? And my angle is a couple of things. One is everything I talk about is, I don't have a dog in the race.

I don't care if red light therapy works or it doesn't work. I don't care whether detox cleanses work or don't work. I just want to look at the evidence and say, you know, this is what I found.

And on the one hand, this is what we know. On the other hand, this is what we don't know. And so that really has been the focus.

The other piece of the puzzle is so much of what is talked about by experts are things that they make money off of, which was like, hmm, I don't need to make money doing this, so I'm not going to have sponsors. I'm not going to have subscriptions that people might pay for. I don't own companies that are in this space whatsoever.

Really it's, I don't have any financial bias one way or the other. Look, we all have biases, and I try to be as upfront about those biases. I call myself an open-minded skeptic.

So if somebody comes to me and says, you know, Tylenol in pregnancy causes autism, my first reaction is going to be, I don't think that makes sense. I can't figure out the biological problem associated with that. But if you bring me evidence and you can show me that, yes, Tylenol really is deeply connected to autism, then I'll say, yes, okay, I buy into that.

Parenthetically, of course, I'm not impressed by the evidence on this. I think it's been really debunked, and I'm actually quite disappointed that the FDA pushed as strongly as they have in this area. So whatever I do in my Dr. Bobby podcast, I try to explore these from a very balanced way. And then I have a lot of fun. So I published, we had a podcast episode recently on the five-second food rule. You know, you drop food on the floor.

If you get it within five seconds, is that safe and okay? So that was a fun one. You know, I've done them on microplastics.

I've done them on, is your morning coffee a good idea or a bad idea? And then I have a core of six, what I call pillars, and I have lots of podcasts that relate to those, but it's exercise, sleep, nutrition, mind, body, harmony, exposure to heat and cold, and social relationships. And I basically review each of these as ways for us to live long and well, but they're all grounded in evidence.

Every one of those areas tells us something that actually works, not in a test tube, not in, you know, rats, but people who tried approach A or approach B and who did better. So those six pillars, there's actually quite good evidence to support them. So that's a kind of a lengthy background, but that's who I am and that's how I sort of got here.

[Andrew Wilner, MD] (9:04 - 11:44)

Well, I love your six pillars because it's basically what your mother would say, right? You get enough sleep, you eat well, make some nice friends. You know, I mean, if you think about it, the things that are really, really important in that work have kind of been time tested.

And we're talking about thousands of years of civilization, and those things make sense. And I want to get back to a couple of things that you said that I think are red flags. You know, when something new comes up, you know, there's a new treatment for this, or you mentioned red light therapy.

So the first thing is, who's telling you are they making money because of what they're telling you, right? Is it sponsored? Is it the manufacturer that's telling you how great it is, right?

You have to be a little suspect when somebody, as you say, has a dog in the race. And it's very hard to find someone like you, who is a neutral party, an informed party, not just neutral, but you're a scientist so that, you know, you know what literature to look at, you know how to weigh the evidence, and you're willing to put the time in to sort of give your own verdict. Well, you know, based on what I've looked at, this is what I think.

So I think one red flag is, who's behind it? And the other one is, does it make any sense at all? You know, is there a comprehensible physiologic basis that this actually works?

For example, you gave the example of Tylenol causing autism. Well, you know, it's a real stretch. First of all, we don't know what causes autism in the first place.

And then second of all, Tylenol is pretty well understood how it works. And there's no obvious way that that chemical would get into the brain and mess things up. So there might be some yet undiscovered mechanism.

That's possible. But it's a lot easier to understand a side effect or a beneficial effect if there's a plausible, like steroids, for example. Steroids, we know, decrease inflammation.

OK. So if you take this steroid cream and you got a big red rash, that cream, that rash probably going to get better. Well, that makes sense because that's what steroids do.

But if it doesn't make any sense at all, or if it's some, you know, really, if it's a real stretch, you got to be a little suspect. So those are two that I rely on. Which other ones do you use that kind of light things up for you?

Like, whoa, I got to be careful here.

[Bobby Dubois, MD, PhD] (11:45 - 14:17)

So I put together an equation, which I think really helps for me to frame the issues. And I think it relates exactly to where you were beginning. So much of the hype and the excitement and people in social media saying, oh, my God, we must all do this and buy my supplement or whatever it is.

The first piece of the puzzle is that there's a cool mechanism or theory. You know, as we get older, we get more tired. And that's because our mitochondria are starting to wear out.

And if we could support the mitochondria, you know, fill in the blanks, this will be wonderful. So you've got a cool mechanism or theory. And it makes sense.

I mean, plausibly, I can see your mitochondria are important for energy. If they're falling apart as we get older, then that's the explanation. OK, so part one, you have a cool theory.

Part two, you have compelling anecdotes. Oh, yes. And I tried that supplement and I feel great.

My sleep is wonderful. My sex life is great. My hair grew back, et cetera, et cetera.

And then not only one anecdote, but then Sally did it and it worked for Sally. And then it's on, you know, a celebrity did it. A celebrity did it.

And then, you know, everybody chimes in and says, this is wonderful. OK, so we've got our cool mechanism. So now we're all jazz.

Then we got these anecdotes. So now we're like convinced. And then you add to it the third piece of the puzzle, which is a credentialed expert.

Dr. So-and-so. Now, Dr. So-and-so may be pushing red light therapy and Dr. So-and-so is a nutritionist or a chiropractor. No training specifically in the area, but they are a credentialed expert.

And when you combine those three. The cool mechanism, the compelling anecdote and the credentialed expert, those three does not equal evidence. So evidence has nothing to do with a beautiful theory, people saying it's great and experts supporting it.

Evidence is really about, as I said earlier, what happens in people.

[Andrew Wilner, MD] (14:17 - 14:26)

So you're going to add one to your equation, please, that it it's a secret and doctors don't want you to know about it.

[Bobby Dubois, MD, PhD] (14:26 - 15:26)

That's a great one, because I that is I can't tell you a number of leads in YouTube videos, what your doctor doesn't want you to know. And I pull I have no hair left. So I pull out all my hair.

I work with the pharmaceutical industry for years and, you know, get this. Oh, they've got cures to all these diseases, but they're locked up. Right.

And they won't give them to you. Having been close to the pharmaceutical industry, they'll charge you a million dollars, but they're thrilled to give you a cure. And in fact, gene therapies like, for example, hemophilia, some subtypes of hemophilia.

I mean, they pay a million dollars. Sounds like a lot of money, but they pay for themselves because they avoid all the blood transfusions these kiddos might need. So there are no there are no cures out there that your drug company or your your doctors won't tell you about.

We all want to help people. And yes, there's ways to make money in that process.

[Andrew Wilner, MD] (15:27 - 15:39)

Did you have a point system like, you know, like you get one point for this and minus two points for that. So what's evidence? You mentioned evidence.

What is evidence?

[Bobby Dubois, MD, PhD] (15:44 - 17:19)

There is a famous Supreme Court justice. I can't remember who it is. It's like, you know, I can't define pornography, but you'll know it when you see it.

I do not believe that applies to evidence. I don't believe that evidence is something that, well, I sort of think this and I think that's evidence. I'll give you Dr. Bobby's view of evidence. I think anything that's done in a lab or in a petri dish or in mice is great for figuring out a theory or a mechanism that we need to test. So as you and I are old enough to remember that one of the first artificial sweeteners, saccharin and cyclamates were just horrendously criticized because they cause bladder cancer in rats or mice, one of those two. And then, of course, later we learned that it probably doesn't do anything in humans, certainly not in the doses we get them at.

So anything in the lab, I don't get excited about. Anything in animals, that's interesting. But, you know, mice and longevity are not the same as humans and longevity.

And dogs and longevity are also not the same. So I don't get excited about that. In the nutrition world where so much of this happens, observational studies by and large are junk.

Oh, people that eat eggs got heart disease and and people who, you know, had this special diet live longer live.

[Andrew Wilner, MD] (17:20 - 17:24)

People in France that drink a lot of wine live, live longer. Right.

[Bobby Dubois, MD, PhD] (17:24 - 21:05)

There's so many confounders. There's so many reasons people don't remember what they had today, let alone yesterday or a week ago. You know, they do these longitudinal studies for 30 years and they'll say, yeah, the people that had fiber in their diet, you know, had less fill in the blanks.

And then you realize that was based on a survey of one day's diet 30 years ago. And they're extrapolating forward that you're a fiber eater and somebody else is not. So I don't get excited about those kinds of studies.

The ideal, the pinnacle is a randomized control trial where you've got a group of people and you randomly say, you know, you're going to get this drug, you're not going to get this drug. And oh, by the way, you'll get a placebo because we know placebo is a very powerful thing as well. And then we'll see how who does better.

That's the kind of evidence we're looking for. Now, you don't always find that. So, for example, smoking, there's never been a randomized trial that says smoking is bad for you, nor are we ever going to see a randomized trial on smoking.

That comes from observational data looking at people who smoked and what happened. They got heart disease, they got cancer. But in addition to just saying we observe this, there's something called the Branford Hill criteria, which are ways to say that even though it was an observational study, I'm actually more convinced.

And it goes back to one of the points you say, which is, you know, there's a biologic plausibility to this. But there's also a dose response that we observe. So, if you smoke one cigarette a day, you didn't do as badly as five cigarettes, and you did worse if you did 10, 20, or 30.

That makes an observational study a bit more convincing when you see this dose response. So, I tend to focus on studies where there has actually been a clinical trial, but I do look at observational studies. And if they're done well, and for some particular things that we observe, that's important data to keep in mind.

For example, saunas. I talk about saunas. And do saunas help us?

And there's data that suggests that saunas reduce your risk of heart disease, reduces the risk of dementia, and overall mortality. Now, there's never been a randomized trial of 30 years of sauna use. But you have an ecological test in Finland.

One of the arguments about sauna is that, yeah, of course, people live longer. Anybody who can do sauna has money to buy one and has time to enjoy it. Well, of course, they're going to live longer because we know wealth is strongly correlated with living longer.

But in Finland, it's very democratic. I don't mean that from a political sense. Saunas are available for everybody.

Every apartment complex has them. You sign up for them. They're free.

Everybody does sauna. So sauna is not something that's only with the rich. And what do they find?

They find that people who did saunas had lower risk of these problems. And they had a dose response. So if you did it once a week, you didn't do as well as if you did twice a week or three times a week.

If you did it for 5 or 10 minutes, you didn't do as well as if you did it for 20 minutes. That's an observational study. In the absence of a clinical trial, it's pretty good information.

And I think it's worth considering a sauna if you have the time and the availability.

[Andrew Wilner, MD] (21:06 - 21:33)

Let's stick with saunas. Did you look into, there are these saunas that use lights, the infrared heating lights, because you can just plug that kind of sauna into an ordinary outlet as opposed to having like hot rocks and all of that. It's a lot easier.

But there's been some suspicion that that may not be healthy, that heating your body up from the inside with infrared maybe. Did you look into that?

[Bobby Dubois, MD, PhD] (21:35 - 23:06)

No. The short answer is I looked but didn't find anything. So infrared saunas are very popular.

In fact, that's what we have down the hall. And they are great. But there's no data to suggest that they're equally as good as a conventional sauna.

No data to say it's worse than that. And absolutely, from a marketing standpoint, and our daughter was the one that got me to like, oh, you need to get the infrared one. It is, you're getting cooked from the inside out, not the outside in.

The conventional just gets the hot air, it bathes your body, you sweat, etc. The infrared does actually soak in like the sun, which is, again, one of the marketing arguments, and you heat from the inside out. I think mechanistically, in terms of why might sauna help us, whether it's heat shock proteins or whatever else, I don't think there's an obvious reason to say that conventional would work but infrared wouldn't.

In the studies that were done in Finland, they traditionally use the conventional approach. So we really don't know. You know, I couldn't argue, I mean, if somebody said, I want to go where only the evidence takes us, then I would say, get a conventional sauna.

And then, of course, there's the whole other thing that the sauna has nothing to do with what's going on in your body. It's the fact that you're relaxed, you're meditated, you may be listening to some music, and you're often in it with a loved one. So, you know, what could be better?

[Andrew Wilner, MD] (23:07 - 24:05)

Let's talk a little bit about why are smart, educated people so susceptible to the hype? I have some neighbors who are wonderful people and very bright, very successful in business, and they, we had this discussion, they were convinced the other night that ivermectin is the way to go. I'm trying to remember what it was for cancer.

Yes, they had a friend who had cancer, they took ivermectin, now they were cured, and we should definitely try that. We have a relative who, unfortunately, is sick with cancer. We should definitely try ivermectin.

And I'm sure if I gave them a business proposition, they would scrutinize it, you know, very carefully for all the pros and cons and debts, and they would know what to look for. But when it comes to medical, people seem to have this gigantic blind spot about what makes sense. Do you have any thoughts about that, or do you agree?

[Bobby Dubois, MD, PhD] (24:06 - 29:15)

I totally agree with you. I do have some thoughts about it. I think it starts with our failure as a medical system, that there's an awful lot of clinical conditions that we can't help people very well.

I mean, there are very few diseases that we cure, you know, certain infections we cure. There are some rare cancers we can cure. Well, we can cure more with surgery if you catch it early.

But most diseases, we can help. We can treat your cholesterol or your diabetes or your heart disease, but we don't cure anything well, very little. So there is a body of folks who are hurting, and they're fatigued, they have headaches, whatever it might be, and the traditional medical system isn't solving the problem for them.

So they are open to alternatives. You know, as they say, if you don't have your health, you don't have anything. So people will try anything to make the problem better.

So that's kind of part one. The traditional medicine leaves a lot of folks who aren't cared for. Unmet need, right?

Unmet need, beautifully put. Second piece of the puzzle. When you are in a difficult situation in life, you know, you broke up with a loved one, you have a health diagnosis, one of the most powerful ways to get back on your feet emotionally is to realize that you have agency.

Yes, I just got dumped by my girlfriend. But you know, I could meet somebody new, and my friend wants to introduce me to Sally, or I could do a dating app. You want to be able to feel like you can do something about the problem.

So now you have this unmet medical need. And now somebody comes to you and say, look, you've suffered for years. I have something you should take.

And then we go back to my equation. And there's all the compelling reasons why you might want to do that. So that's the second piece of the puzzle.

And the third is the kind of financial motives behind a lot of what's being pushed. And it isn't always just money. People like to be famous.

So being on YouTube or elsewhere, people like to have followings. They may not own the supplement company, but people love to come to them for advice. So sometimes it's financial, and sometimes it's, you know, people get other reasons to try to tout some of these things.

And I think in the era of social media, what was a cottage industry of snake oil salesmen? You know, 100 years ago, they would, you know, have their covered wagon. I guess it's probably 150 years ago, they had the covered wagon.

They go from town to town, and they would be peddling a salve or, you know, an elixir. And they would say, it's hard to make it. You know, how do you get oil from a snake?

Of course, 99% of the time, it wasn't oil from a snake. But it sounded good, and it was expensive. And so, you know, so there's always been snake oil salesmen.

But now with the internet, it's so much easier to get the word out and to start up your own little business pushing that. So I think there's a lot of reasons now why there is so much hype in health. It doesn't make me feel any better about it.

But I do have some sympathy for folks. I just recorded an episode that will go live in about two weeks on GLP-1 analogs for weight loss. And I believe that these are remarkable drugs.

And now, they're not miracles. They have side effects. They're expensive.

And I go through all of those kinds of things. But for decades, people have struggled with losing weight. And if somebody came to you and said, you know, I can help you lose weight.

I can help your arthritis get better. I can help your sleep apnea get better. And I think I can help your liver and your brain get better.

We'd think this is snake oil. But Ozempic and Monjara and these others, they actually do that. So people who struggled, who had no agency, all of a sudden, you give them an injection within days, they're like, I'm not thinking about food all the time.

So and now, obviously, millions and millions, one in eight Americans have tried GLP-1s. So it's quite remarkable. I mean, between diabetics and people who are overweight.

So there's a compelling reason why people want something. Now, it turns out that GLP-1s have great data to support them. But you're just as likely to fall for something that doesn't have evidence.

And so I've tried to help people kind of, well, how do you decide what is hype and what isn't? What should they do? So that's another sort of topic we can talk about.

[Andrew Wilner, MD] (29:16 - 32:02)

I want to throw out, we did a program a while back with Matt Holgoats Hetling. I always have to look at his name. He's an independent journalist.

And he wrote a book, If It Sounds Like a Quack. And he investigated several, he kind of highlighted the lives and trajectories of several people who had made it their life's work to be snake oil salesmen. There was one fellow who I think his thing was red light therapy.

And I think he had been a dentist and he became a red light there. And, you know, and that was his whole world. And, you know, there's a suspicion that these people may have actually talked themselves into believing that this stuff works.

But there was one woman who was into leeches for everything. There was another guy, some special water, you know. But these people dedicated their lives to it.

And he followed them around and researched them. And so if you're interested in this topic, it's called If It Sounds Like a Quack. I love it.

Great title. It probably is, right? If It Sounds Like a Quack.

You know, the other point I would make about what you said, and I think it really bears highlighting is not only does the health industry fail to fix everything, although we try, I think health literacy is poor and that people don't understand basic concepts that you're educating people about of evidence. What is evidence? How do you tell if something works or something doesn't work?

You know, your neighbor saying it works is not the same thing as a double blind randomized trial. It just isn't. And that's health literacy.

I work in a county hospital and our health literacy, our literacy rate is very low and our health literacy rate is very low. And that's something that I always keep in mind when I'm explaining something to a patient. You need to take this medication for your blood pressure, or usually for me, it's a seizure disorder or something like that.

And I'll often add, you have to take it every day, whether you need it or not, because it's not obvious that this is something you would take whether you need it or not. In other words, this is a daily medication, not just when you have a seizure. So, you know, I add that little tagline because of the, you know, you and I would understand that, you know, prophylactic medicine for your cholesterol, it's a daily medicine, but that's not a given.

So I think we need to do a lot more work like what you're doing on health literacy.

[Bobby Dubois, MD, PhD] (32:03 - 36:10)

So those are really great points. Let me touch on each one of them. You know, there are the nefarious types that are trying to sell something and then there are the not so nefarious types that actually believe it and they're pushing it because they believe it.

There's a famous saying is if you walk around with a hammer, everything looks like a nail. You know, if you're a surgeon trained to do knee arthroscopy, you're going to find opportunities where you think it will help people, whether randomized trial supported or not is a separate story. So one of the things that on the hierarchy of, OK, you're a charlatan, you're not a charlatan, but you believe in something that doesn't work.

And then there's even higher level of what you might call moral goodness. And that's the medical profession. What people don't realize is that we often get it wrong.

I mean, recent examples, you know, peanuts. Oh, my God, you can't give young kids peanuts because it was one study in pregnant women in England that showed some relationship between that and and allergies. And that came over to the US.

There were no randomized trials. There were no decent trials whatsoever. The Academy of Pediatrics picked it up.

And for years we said, oh, don't give kids in the first six months of life or year of life peanuts. And then, of course, what we learned is we then created a generation of kiddos that were hyper peanut allergic. And now we're, of course, back to expose your kid to to that.

You know, eggs were horrible. Don't eat eggs. Don't eat dairy, you know, fast food.

And the medical profession was all behind this low fat diets. I mean, all this stuff. And now we realize that was one of the dumbest things we ever suggested.

And that gave birth to the obesity epidemic of all this, you know, sugar laden, ultra processed foods. So, you know, I there are charlatans, but we in the medical profession get caught up. I mean, it's been 30 years since the nurses health initiative tested hormone therapy.

And it's only been in the last six months that the FDA finally got around to saying, oops, we had it wrong. It doesn't deserve a black box warning. And in fact, for women who are suffering, it's a really good way to take care of their menopausal symptoms.

So it isn't just these people on late night TV or, you know, on on on Reddit on or X. It's the medical profession. So people will look for these alternatives.

The other thing that you mentioned I want to touch on when you're asking about evidence and how will people kind of know when they see it? There was a whole flurry of activity in news reports about a study that looked at people who were doing intermittent fasting. And lo and behold, the people that were doing intermittent fasting had higher rates of heart attack and death.

So there was this horrible, oh, we can't be doing we can't recommend intermittent fasting because it does these horrible things. But when you dug in and said, OK, well, who did this? What kind of study was this?

You realize that it was not a peer reviewed article. It was an abstract at the American Heart Association's annual meeting. So there was no peer review.

There was no detailed understanding of the methods, the analysis of the results. And it was picked up, sadly, was picked up by the AHA, the American Heart Association, as a press release from them. And so it had all this kind of professional credibility.

And I don't even know if the article has ever actually been published in peer review, but it's been debunked that, you know, that's not the case. So it's very easy to be caught up in this. And and with but hopefully with a little bit of training, and I don't mean you've got to get a PhD.

I mean, you know, things that I talk about, people can begin to separate the hype from the stuff that's promising. And I can walk through some of those if you care.

[Andrew Wilner, MD] (36:11 - 36:41)

You know, I think credibility also comes from, you know, somebody who can walk the talk. There you go. So and you mentioned earlier that you're 69 years old.

You're still competitive with Ironman and stuff like that. So for those of us who want to do Ironman stuff at 69, you have any sort of tips? Healthy aging, healthy aging.

[Bobby Dubois, MD, PhD] (36:42 - 43:18)

Yes, healthy aging. Certainly genetics plays an important role. So pick your parents carefully.

Yeah, choose your parents carefully. I did a podcast episode called Will You Live to be 100? And the bottom line is to live to be 100 is mostly genetics.

Living to 70 is mostly environment. You know, it's what damage we do to our poor bodies. But to really be an outlier, especially as a man to live to be 100, a lot of it is genetics.

So, you know, part of it is genetics for me. But and I did this podcast that just came out on kind of my life and what are the five lessons that I learned and that might be helpful to others called from point A to point B, the life I never planned. So when I was in my 20s, I looked at people who were in their 50s.

And I said, God, they look old. I don't want to look like that. And so I said, OK, what is it about them that makes them look old?

And there were two things that I know. Now, this is very simplistic. This is back in the, you know, the 19 early 1980s.

So I had a very simplistic understanding of health and fitness, even though I was in medical school at the time. But anyhow, I boiled it down to they have a big belly and they have small arms and that I didn't want that. I didn't want to look like that in 30 years later.

So when I was in my early 20s, I started a daily regimen of stomach exercises and pushups and things that would help me with my arms. Now, obviously, there's a lot more to fitness than that, but that was my beginning. And so from that point on, I have always, you know, tried to be physically active.

You know, the guidelines are you want to do 150 to 300 minutes a week of aerobic exercise at a level that it's not easy to talk, but you can get a sentence or so out. That's critically important. Then there's obviously a lot of other things in the fitness space that you need to do in terms of high intensity intervals and strength training and balance training, those kinds of things.

I think being a good weight is critically important because I think we're learning more and more. Not only is it a cosmetic problem, not only does it hurt your heart, but probably the subtle inflammation that comes from a lot of extra fat in your body, especially the visceral fat, affects really pretty much every part of your body. So I think if you can get your weight under control and the GLP-1s are, you know, a route for some people who have struggled, I think that's another one.

You know, I've done a bunch of podcasts on organic food and those kinds of things. I think it's most of it's a waste of money. I think, you know, if you eat a reasonable diet, that's OK.

You don't need to be taking supplements. Yes, you can have a Big Mac hamburger. I love donuts and I certainly eat donuts periodically.

But if you keep your weight under control and you're really eating a roughly reasonable diet, you know, shopping mostly with around the periphery of the market with your fruits and vegetables and meats and not buying too many, you know, canned SpaghettiOs and hamburger helper or, you know, instant whatevers, you know, from a nutrition standpoint, I think that's good enough. I don't think you have to obsess over how many grams of fiber and, you know, are you getting enough of this or that protein is really important. And especially as we get older.

So I think having enough protein is critically important. And I think the unsung hero that I talk about and others do is sleep. I think we're learning more and more that if you don't get enough sleep and sadly, 50% of Americans get less than seven hours a night.

That's a big problem, not just you're going to feel miserably and you're probably going to yell at your spouse more than you should, but it takes a toll on every part of your body, including your brain and dimension and your heart and everything else. So I think sleep is another critical one. You know, meditation is wonderful, but, you know, it's at the margins.

It'll help in some ways and also the sauna. I mean, sauna is helpful, but, you know, I think if you keep your weight under control, you get your exercise and you get your sleep. You're so far up the curve of longevity that you can control that, you know, enjoy your life.

You got to enjoy your life. I mean, one of the things I talk about, I did a podcast episode on alcohol and it was entitled some or none. That's the question.

I mean, nobody would argue that having a bottle of wine day by yourself is a good idea. The question is, do you have to drink none or can you have a drink a day or three or four or five drinks a week? And is it really going to make a difference in cancer and dimension, whatever else?

Now, if you get into two to three to four glasses of whatever a day, yeah, that will cause problems. But when I did the calculations, I realized that, you know, for a woman in the United States, their likelihood of getting breast cancer is like 12%. If you drink a small amount of alcohol, you know, like one glass a night, that 12% could go up to 12.5%. It's not going to double your breast cancer risk. It's not going to mean you're going to get breast cancer. But yes, if you believe the data, and I don't necessarily believe the data, but if you take the worst case scenario, it will boost it by, you know, five to 10%. And now the question is, is that something that you want to do?

You know, we would never drive a car if we maximize living longer. And, you know, having alcohol is a social experience for most people. Do you want to get rid of that?

Well, just understand the risks and the benefits. And I do drink alcohol, but I don't drink a lot. I probably have three, four drinks a week.

I used to drink one to two glasses a day because that's what, you know, we thought was right. But now, you know, I drink modestly and I accept the fact that maybe I'll have a tiny increased risk of something, but I have a lot of enjoyment, which will reduce my stress, which hopefully will reduce my problems. Just my thought about it.

[Andrew Wilner, MD] (43:18 - 45:05)

You know, I've done some work in developing nations. And one of the things I noticed, you know, I was really out far, far away in rural areas where people didn't see doctors, is that the people that I saw for the most part looked very fit. And it's like, this is amazing.

You know, there's 20 people here and they all look great. They look like you. And it's like, they don't, they don't go to the gym, but they did not have easy access to processed food or alcohol.

In other words, they basically ate what they could grow or catch or kill. And that wasn't easy. And they had to spend a lot of time doing it.

So overeating was really not an option for them because it wasn't, those things weren't available. And I think, you know, one thing to tell people, I mean, how is it possible that half of the people in the United States are overweight? I mean, it just seems impossible, but it's true.

It's because the deck is stacked against you. All you have to do is put out your arm and you've got thousands of calories within reach and processed food tastes great. Cookies and donuts taste great.

Why wouldn't you eat them? You know, and that I did the calculation once. I'm sure you've done it.

You know, how long do you have to spend on the treadmill, you know, to equal one cookie? It's like 30 minutes, you know, of really putting in the effort for one cookie. It's like, that's insane.

But, you know, so you can't exercise. Exercise is very important. Don't misunderstand me.

But you cannot exercise your way out of a bad diet. Would you agree with that?

[Bobby Dubois, MD, PhD] (45:05 - 48:02)

I do. And, you know, when you asked about longevity, I said, look, having a good weight is critically important. I think how you get there is less critical to me.

I did a whole thing on ultra-processed foods. And the way I like to think about ultra-processed foods is, is it stuff that's added to the food that's bad for you? Is it the stuff that's taken out of the food that causes you the problem?

Or is the fundamental problem what you said, which is, you know, the Lay's potato commercial, nobody can eat just one. And they're right. So, yes, if you eat mostly all processed foods, it strips away good vitamins and nutrients.

So that's, that's not good for you. I don't believe that, you know, the, the nitrates that are added to bacon, oh, by the way, nitrates come from celery. And celery seems to be something we're supposed to eat.

And, and the uncured and the other things, bacon has actually nitrates from celery. So I don't think it's the stuff that's added that's dangerous. I think ultimately it comes down to you just eat too much and you, you gain weight and you want to eat a lot because it's calorie dense and it's yummy.

I mean, the combination of fat, salt, and carbohydrates is the perfect storm. It's just irresistible. But, you know, you can get into the same mess with healthy food.

I mean, my wife and I play this game with all our friends, whoever we talk to. If you were on a desert island for the rest of your life and you could only eat one food, that's it. One food, like banana.

You can only have bananas all day long. What would the one food be? And I counsel people, it's like, it doesn't matter.

Don't worry about nutrition. Just choose one food. And both my wife and I choose peanut butter.

We love peanut butter. Love it, love it, love it. Look, I eat the Jif because I love the salt and the other stuff.

She eats the more healthy stuff. But eating peanut butter is as bad as ultra processed foods because, you know, a tablespoon has 190 calories and it's real easy to have three or four tablespoons. You know, that's close to 800 calories.

So I believe ultra processed foods are not great. But it's the calorie density that's really the problem. If you sit down with a brick of cheddar cheese made in a wonderful organic farm, you can also overeat.

So overeating is a problem. And peanut butter is, again, it's got that perfect storm of yummy things. So that's that's my belief.

Try to keep your weight under control however you need to do it. And if cutting out ultra processed foods helps you, beautiful. Go for it.

[Andrew Wilner, MD] (48:03 - 48:20)

Dr. Bobby, this is terrific. Before we close, I want you to tell us just a little bit about your, I don't know, is it a ranch or a farm? I know you've got like hundreds of acres out there in Texas with all kinds of exotic creatures.

What's that all about?

[Bobby Dubois, MD, PhD] (48:21 - 50:18)

So, yeah, in in in my podcast where I said, you know, life, I didn't plan. I had no plans to be a rancher or a bed and breakfast owner or owner of kangaroos and antelope and alpacas and all sorts of other crazy animals. But one thing led to another.

We moved to Texas and then was like, well, you know, people like to buy land. So maybe we'll have a weekend getaway. And then we ended up with a much bigger piece of land than we thought.

And then we built stuff and then COVID happened. So we moved there from Austin. We're about an hour from Austin.

And then we built, you know, houses and this, that and the other. And then we looked at each other and say, well, gosh, now what do we do with this place? We've got a whole lodge.

We've got a guest house. Well, maybe we'll make it available to others. And oh, by the way, it's part of the wellness view of the world.

And, you know, we have all the six pillars kind of built into things. So we built a bed and breakfast. So it's it's not your traditional bed and breakfast where you have, you know, eight families, each one has, you know, bedroom number three or bedroom number seven.

Only one family comes at a time. You get the whole 178 acres. You get us to be your guides to meet all the animals and have fun.

And we got seven miles of hiking trails and two thirds of a mile of a creek you can swim in. And it's it's a remarkable place. Kind of our tagline is nurture in nature.

So it's upscale, you know, accommodations. We, of course, have the sauna and the cold plunge and the hot tub and meditation walking and, you know, massages and whatever else. And then I'm the chef.

So I get to if you want, I can I will make you meals. And so it's been a lot of fun along with my podcast and my exercise stuff. It keeps me out of trouble.

As my wife, my dear wife, Gail, says, I didn't retire. I just sort of changed careers. So now I'm very busy with this.

So it's a lot of fun. It's just, you know, kind of our new life. We love it.

[Andrew Wilner, MD] (50:19 - 50:24)

And I'll put the website in the show notes. OK, thank you.

[Bobby Dubois, MD, PhD] (50:24 - 51:17)

Yeah, it's called Madrone Springs Ranch. Just, you know, you look at it. Madrone Springs Ranch.

Anything you'd like to add before we close? Now, if people like what I have to say, I have a podcast, which is Live Long and Well with Dr. Bobby. So just look up Dr. Bobby. You'll find me in the usual place. I have a sub stack where I write articles related to each podcast. So that's I'm Dr. Bobby at Dr. Bobby. So you'll find me there. So yeah, and then I have a website. Just put in Dr. Bobby evidence and dot com and you'll find me. And again, lots of stuff there, too. I'm not selling anything. I'm not, you know, no sponsors.

It's just it's a lot of fun. I really and that matters a lot to me that I don't pull out the rest of my hair and that people can learn, you know, how to look at evidence, what to believe, what not to believe. And and hopefully I'm guiding people along that journey.

[Andrew Wilner, MD] (51:18 - 51:31)

Well, you're a rare find, Dr. Bobby, because very sweet of you to say that an honest guy. I try. I try.

Dr. Bobby Dubois. Thanks for joining me on the art of medicine.

[Bobby Dubois, MD, PhD] (51:32 - 51:33)

Thank you.

[Andrew Wilner, MD] (51:33 - 54:03)

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Andrew Wilner, MD, is a professor of neurology at the university of Tennessee health science center in Memphis, Tennessee. Views, thoughts and opinions expressed on this program belong solely to Dr. Wilner and his guests and not necessarily to their employers, organizations, other group or individual. While this program intends to be informative, it is meant for entertainment purposes only.

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