Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand. blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name is Dr. Warwick and welcome to my podcast and videocast station. I'm particularly excited today. I'm speaking with someone from the other side of the world. I've got Dr. David Newman, who's clinical director. at the NY Sports Care Center in Manhattan. David, thank you for joining me. So happy to be here from across the world. It's all good. Nice to see you, Art. I love the technology. This is just such an amazing thing. So to be able to reach out, connect, communicate, and it feels like we're in the same room, but literally the other side of the world. It's awesome. I like it a lot. for those uh listening and tuning in i really do appreciate you taking the time to listen there's so much content out there so if you are taking the time to listen to this i appreciate it and i don't take where you allocate your time lightly so every time i want to give you something that's worthwhile interesting informative hopefully enjoyable as well david um in fact is a an orthopedic surgeon so he would be the first orthopedic surgeon i think i've had on the podcast I'm very much looking forward to that. But David in recent time has become slightly more entrepreneurial focused, more business focused, and also more holistically lifestyle focused. So one of the things that we've communicated about in the past, David, is sort of the eight pillars of healthy lifespan as something that you're really sort of working with, formulating and discussing with people. Would you like to just... Give us some insight into that. Yeah, absolutely. So here in America, and I don't know if it's international or not, but there's the American College of Lifestyle Medicine. And it took a step back from the standard practice of American medicine to kind of really look at who we are as humans and what things drive us and what things bother us. Cause, let's say, slowing down cognitively or physically. let's say other comorbidities such as high blood pressure, diabetes, obesity, high cholesterol. These are things that many Americans suffer from, and really all over the world. But when you take a step back, if someone comes into my office with knee pain, it's not only about their knee, as I've discovered over time, but it's really about their whole body, what they have access to, how they live their lives. some genetic component, but there's a few lifestyle components that need to be taken into account if somebody's going to, let's say, overcome their knee pain. And in my new life, not as an orthopedic surgeon, but really as a health and wellness entrepreneur, is kind of helping people on their journey to age gracefully and to make the most out of their lives. I think that's an important component of being here on the earth. not burdening yourself or others with things that, let's say, make you more dependent. So let's take that example of knee pain. It's common. Walk me through how an individual may present. What are the key things that you're looking for? How that dovetails with your eight pillars approach? How do you... Sure. Thank you. So I am sports medicine trained, which means I took care of athletes, semi-elite athletes in their 20s and 30s. But I also took care of injured workers and those people who suffer accidents at home or by car accidents. So it's very similar pathology inside your knee. Let's say if you get hit by a car or you have a soccer injury and you twist or. You have an injury at work where you fall downstairs while carrying things. So the pathology inside the knee is really the same. I'm not really going to focus on that, though, because it's more about what happens the year or three after that injury, whether you've had surgery or just therapy or just injections or, you know, you recover to mostly recover. And what I say mostly is when people have an acute injury or one that makes them stop what they're doing. this thing called inflammation kicks in and inflammation is a it's like a four or five pronged little symptoms of like swelling and heat and stiffness and warmth and overall leads to a loss of function if you don't control that inflammation so people are some people young and healthy uh they can recover nicely after inflammation but that knee pain But the damage to the very delicate structure of your knee doesn't always recover 100%. You might have some tearing to the cartilage inside the knee, which is the soft tissue cushions. You might have some reactive scar tissue that builds or grows inside your knee, like a scab on the inside of your knee. And that can irritate these things called nerves. And nerves are the wires that transmit signals from our brain down to our toes and back and forth. So if we put our finger on a hot stove, we pull it away because of the nerves. So the nerves give us coordination. They also give us feelings of sensation. They help us coordinate our body. And even with the knee injury, it becomes chronic, which means it goes on for more than three months. And you're like, what is going on with my knee? You do all you can to get better. But there are other aspects of your life that might determine how well you do ultimately. So that to me is the cornerstone of, okay, how does your lifestyle fit in to how your knee is going to behave or how it's going to treat you as you age? And I mean, one year, two years, five years, 10 years from now. So that's kind of my basis, my philosophy of helping people like understand their bodies and then do the right things so they can live this thing called health span. Health span is living at a high level of function. until the very end of your life, whether it's 70, 80, 90, or 100, but you live very high level at a good health span and all of a sudden things end. It's different than your lifespan, different than your lifespan, which is how long you are on the earth, but it doesn't mean that you're happy, doesn't mean that you are active, doesn't mean that you don't need like four to six pills every day to survive, or a cane, or a crutch, or a wheelchair, or some home health. aid to take care of you that means you've lost some of your independence and now you're more dependent still alive still living on this earth but i don't know you know when people have let's say cognitive decline they're still alive but they can't communicate with you and maybe they're not as happy or as fulfilled as they were before this happened there's no question david that there's a huge difference between health span and lifespan i'm sure those listening would be tuning in partly because they're aware of that. And I think we all want to conceptually believe that we will live as well as possible for as long as possible. That's my tagline, actually, helping people live as well as possible for as long as possible. I love it. You almost figuratively want to live and function well and then just fall off a cliff suddenly and that'll be the end. But it is so true that many people just fade away over time. Really appreciate you raising Healthspan. When you're talking about this knee injury, if we, I'm trying to drill down a little bit on specifics. So is your management of these sort of issues, are they very specific to that individual patient or do you have a more generalised approach? How do you sort of, how do you see that, David? Yeah, yeah, that's, I appreciate that. I think I like to take a nice history from anybody I'm seeing as far as like going to give some advice to see what other things might be going on in their lives. Like I said, I think a lot of the pathology inside the knee is very similar, which means the alteration from normal. There might be a surface of the bone. like a split or a flap of tissue that's kind of rubbing around and irritating, let's say in the knee. You can have some of this stuff called scar tissue or it's a band of tissue, like a rubber band or a spider web that grows after trauma. And that can pull on the nerves. Then the nerves live in the sac that holds the knee bones together. And then there's these things called meniscus tissues. And those are like small washers inside the knee. There's two of them, one on the inside, one on the outside. They have a lot of nerves in them. So sometimes they get bruised and sometimes they get torn. So feeling the pain when your nerves are stimulated from scar tissue, inflammation, torn structures inside your knee, they all manifest in a very similar fashion, although everybody perceives pain differently. When I focus on knees, I'm like, okay, guys, people, it's really important to control the inflammation. different modalities and different things like pills, like ice, like compression, like topical ointments, but also stretching and exercise. So that's my big thing is corrective exercise to really kind of help people regain what's called full motion of their knee. And full motion is different for everybody because some people have more muscle tone, some people have more flexible soft tissues. Some people might have just a bigger pain tolerance. But full motion is whatever your non-injured knee can do as far as getting your heel close to your buttocks. If you're standing up and you kind of pull one heel up to your buttocks by holding onto the counter and using your other hand to grab your ankle, that's full motion for somebody. And if you can get that back after an injury, I think you're doing better than a lot of people. But when I think of full motion, it means that your muscles that are involved with... moving your knee around in the world, they can get as long as they can in a normal fashion. If they can get to as long as they can to allow your heel to get very close to your buttocks or to let your knee get perfectly flat on the ground when you're sitting down or laying on a carpet or something, that means you got good motion, okay? So good motion means your muscles can get as long and as short as they need to get in order for them to really optimize their function. So that's emotion. The other one, yeah. As I'm listening, David, I'm getting the sense that your application or your care for individual people and what you do for different people really boils down to what's gone on for that person, whether they've got meniscal tears, whether they've got cartilaginous injury, whether they've got tendon injury. And so you may vary your approach, maybe offer different exercises. based on what you think will help that individual. But are there overarching things? For example, if someone were to twist their knee and hurt it, are there certain things you would be recommending that those people do from the absolute get-go before they even come and see yourself or someone in a position? Yeah. Thanks, Mark. I appreciate that. So I live in Manhattan, and it's a really busy place. And if you call up somebody to try and get an orthopedic appointment, sometimes it's two to four weeks from now. So it's not always easy to get into the office. However, the inflammation starts really the minute you get an injury, right? So even like before that, the second you like land and bruise your knee on the ground, you automatically, your small blood vessels get crushed, your muscles, your skin gets crushed. Inflammation starts within a few seconds. The cells in your body start grouping together, bringing this to help that it needs. And that's the swelling and the redness that people get. So calming that inflammation down in the first two weeks after injury is really, I think, very important. And it's a lost art amongst people because they don't always know, oh, what did I do? What's going to happen? What do I do to, like, nip it in the bud? Don't let it become a full-blown flower. Like, nip it down there and just get that weed, pull it out early. So I started a company called popdoc.com, and it's P-O-P-D-O-C.com. is my really take on before you're active, be pre-active. So it's basically say you have a pain or injury before you're active, be pre-active. Pre-active is an acronym I came up with a long time ago. And so it's on the website, but the P, so each letter stands for something different as far as like helping you overcome the acute or the just happened now. pain and inflammation. Yeah. Okay. Look, I've, in fact, you've also covered this on a TED stage. A little bit. Yeah. And for those who are listening and do want more detail, please check it out. David's presentation, the TEDx presentation. I'm not sure if I saw that on the pop doc website, but I certainly saw your TEDx. Is it on your website, David? Yeah. if you go under joint pain or joint education there's one of the one of the headers on the header side uh hang on one second i'm gonna so i'm like outside hang on one second i can still hear you okay oh you can good thank you but you know city life and i'm I'm outside and I apologize. I wanted to be in an office and I wasn't able to do that. But that was an ambulance going by and that happens way too often here in Manhattan because there's a lot of people. So I apologize if there was some rings on your ears during that whole thing. That's fine. Anyway, PREACTIVE is an awesome acronym because it's a stepwise progression of what you can do. And the P stands for positivity. So even if you get hurt. I think inherently staying positive is, first of all, that's one of the eight pillars is having that positive mindset. But that is also part of preactive, meaning maintain that positivity and the optimism that you will overcome and you will feel less pain and inflammation with the right knowledge, with the right action. Then I think you will succeed at overcoming it, whatever it is. And so I don't know if I'm going to run through all. you know, seven or eight letters of Preactive, but I really hope to, that any of your listeners, Andrew, you can, can be around to explore the website and to like really get to know what Preactive is. Cause it's, to me, it's, I was an athlete as a kid. And then I always like, when I twisted my ankle, it was always kind of doing Preactive in a way where I, you know, would, would actually not only the rest and the ice and the compression and the elevation, that's all part of Preactive. but also like some topical stuff and gently moving the joint or moving the knee around is okay as long as there's no broken bone. And you can tell if it's a broken bone because it hurts like the dickens. And in the first six hours, it only gets worse, worse, worse. So I'm not saying that you do this instead of seeking medical attention, but it's like for a lot of little bumps and bruises, you can certainly at least, you know, approach recovery. by being preactive. So, look, I'm going to invite the people who are listening or watching us to check out your website because there's obviously good information there, pop underscore doc dot com. It's pop hyphen. Hyphen. Pop hyphen doc. Or look up David Newman, N-E-U-M-A-N, Ted. talk uh where he covers preactive and that's that's where i i saw it and uh check it out yeah now look we're just in the interest of time david i want to come back to the eight pillars do you want to just touch on those yeah absolutely absolutely yeah and they're not in any specific order but they're really just about okay And I'm an aging gentleman. I'm an aging man. I've had some surgery, some orthopedic surgery in my life, and I don't like pain. And I, therefore, have been kind of altering a few aspects of my lifestyle so I can try and age gracefully. I got a couple of kids. I want to see them grow. It makes me so fulfilled to watch them grow. And I got some aging parents. I like to hang out with them as well and give them some tips and suggestions so they can live as long as they can. David, you're not alone. I'm pretty keen to age gracefully myself. I know. I heard what you're doing with OsteoStrong and how you're being there. You're trying to make a difference in your local community, Warwick, and I think it's kudos to you on that. It's important to give them access to something like OsteoStrong, people. I think that's very powerful. motivating people is not easy, but if you get them into the right scenario in the right environment, they might just see other people and want to do better for themselves. So if I think of like the lifestyle pillars, you know, and like I said, not in any order, but one of them is exercise. And it doesn't have to be huge exercise where you're spending an hour a day doing very heavy weightlifting and putting your body at risk. I'm talking about just body weight exercise. to maintain your flexibility, which is your ability to move in a full range of motion, your balance, which is very important. That means the small muscles of your feet all the way up the chain, all the way up into your upper body, they're all connected nicely if you can balance well. So flexibility, balance, and the most important one is strength. So you've got to maintain those muscle power of your muscles. But it doesn't have to be, it has to be through resistive exercise, but it doesn't have to be more than your body weight, meaning dips, pull-ups. push-ups, chin-ups, planks, those kind of things that you're just using your own body, but you do it over time. So your endurance muscles, your postural muscles get to be strong and able to support you all day long, whether you're sitting at a desk or whether you want to go gardening or whether you want to do cooking or whether you want to play pickleball. So that's... I'll jump in there super quick, David. It's getting touched on OsteoStrong, so I may as well mention it. We actually... try and deliver a one maximal rep stimulus. So we actually do get people through the machines, the equipment that we've got, we get people really measurably stronger. And so my own, and I'm sure you know more about muscle training than I do, but my recent understanding of it is that that one maximal stimulus, Max rep allows you to just gradually push up someone's strength, and it's really in quite a controlled environment. I like that. Great. I completely agree that strength is important, but for anyone listening, OsteoStrong do it in a slightly different way, in a way that you probably wouldn't imagine, and it's just really worth checking out. Yeah, I don't disagree. It's certainly worth checking out. The thing is about strength, right? There are good studies that even the octogenarians, even the 80-year-old plus people can still build muscle if they're doing the right resistive exercise. A lot of these joints at 80 years old are not what they were at 20. So they have to be very mindful and do it like in an altered style, but still successfully get resistive exercise to build muscles by stimulating growth hormone from just like causing your muscles to work hard and they will stimulate growth, even at 80. So I keep telling my patients, even if I see them two years after injury, I'm like, guys, you can still build up this muscle around your injured joint. So that's, I'm a huge advocate of exercise and that's part of my pillars of lifestyle, but there are four or five or six others that if you want to talk to them briefly. Yeah, just to speak to the age quickly, we've had a number of members over 90 years of age who we've improved the strength measurably. And the impact of improved strength is... quality of life and independence. Because if you're strong enough, you can carry your groceries up the stairs. If you're not strong enough, you need institutionalized care. 100%. So true. Yeah, yeah, let's do that. Let's do that. Let's do that. Let's just do those last pillars because we probably run over. Yeah, yeah. So thinking about just like the exercise. It allows you, it sets you up for sleep, and that's one of the pillars, right? So you get good sleep, and you find yourself sleeping more than six hours a night fairly thoroughly. And then, you know, six is minimal. I'd like to think seven, seven and a half, especially when you age a little bit. But even if you're not totally sleeping, even if you're at rest on the inside of your brain in a dark room that's fairly cold and quiet, you will still regenerate your brain and your body. through just being inactive for six to eight hours. And you will get into your REMS, which is the time when you dream. You'll get there, and some people get there more often than others. But I think getting adequate sleep consistently, like if you have a two-hour night's sleep and you're really bumming, you can't make it up by having 10 the next day. It's about just staying routine, building that routine where you are setting yourself up for success in the bedroom, your sleep at least. All right, so that's one. And hydration's another one. I think now these days, Water in itself is getting a little bit of a bad look, even though it's very important to drink enough water. I think water plus some electrolytes, and that does not include sugar. That just means water plus some electrolytes to keep your cells working nicely, keep your organs working well. I liken it to the oil in your car, right? So when you don't have enough water, it's not the gas. It's not the food. It's the water. It's the lubrication of your blood vessels almost. and your joints and your organs. Nehydrated people are just setting themselves up for failure on so many levels. Hydration is another one. So it's sleep hydration. It's exercise. It's mindfulness being like, have that mind. No one's positively up all day long, 24, 7, 365. They normally will dip down into a lower mood. But you're going to just tell yourself, find that silver lining to get out of that mood to keep your mindfulness and say, all right. Yes, I had a tough day. I had something happen with my friends, family. You can still get out of it if you have the right mindset. I think that's an important part. Being social is another huge thing. So it's even more, almost one of the most important things is sociability. If social people live a longer life because they have people to talk with, to see, to interact with. But I think that's important as you age is to stay social. Well, not to be like a ton of people, but there should be a couple. Nice confidants. Don't be afraid to go out and socialize with some random people. I think that's important to keep your brain active and everything like that. Vices is another one, just kind of like minimizing your vices. Vices is drugs and alcohol and tobacco, smoke and all that stuff. Caffeine is not really a vice because there's so many good properties, whether it's decaffeinated or decaffeinated coffee. Those polyphenols and those antioxidants in there are very important as far as like... not being a vice that yes people can get addicted to caffeine but that's like i don't know that's almost like the benefits still outweigh the risk when it comes to that but the other vice is like like tobacco to a day for me david i'm a huge fan of me too me too warren for sure But tobacco and alcohol, so alcohol is like the new tobacco in the world. And so even the metabolites of alcohol, first of all, goes right into your brain, goes right through the blood-brain barrier. It gets broken down. One of those metabolites are toxic to nerve cells in your brain. So no matter what. So I don't care if it's in wine, beer, liquor, alcohol, whatever. So I've greatly cut down my alcohol after listening to a Andrew Huberman podcast. He's based in Stanford. Smart guy who likes to talk a lot, but he talks about very important things. So that's one of them too. Learning your vices. And then I think, and then diet's probably one of the bigger ones because that's part of the lifestyle. We have some very bad feet here in America. This ultra-processed food has finally gotten, the ultra-processed and the word ultra-processing has finally become more mainstream than ever because capitalism here in America, companies want to make the cheapest type of food possible to make the most income. or most gain in their value but it doesn't mean that they have the humans at heart so a lot of ultra processed food and the most simple way i like to describe it is if you read an ingredient list and you don't have that ingredient in your kitchen it is ultra processed if you have the ingredients in your kitchen it's not and i know it's a lot cheaper and i know a lot of people in this in this country and the world can't always afford the high quality food so Just being mindful of the stuff you put in your body when it comes to the food. And even like the oatmeal bar or the protein bar or the chips, they are mostly ultra processed. So that's another lifestyle pillar. If you can go with the whole food, plant-based foods, the fruits, the veggies, the grains, the high quality proteins as opposed to the protein proteins. And I think of proteins, I'm like, I'm a big animal protein guy. That's just me. But it's like the hormones, the antibiotics, the pesticides and the herbicides that are in our foods here in America are really just silently killing us. And that to me is leading to inflammation. And inflammation is a silent killer that transcends all organs and most comorbidities. Most things like high blood pressure, diabetes, obesity, high cholesterol, those are based in inflammation. I'm not even talking about cancer. autoimmune diseases or neurodegenerative those are all based in inflammation also meaning the people who have these are very inflamed on the inside even though they might not have pain which is a part of inflammation they still are quite inflamed so it's part of my mission these days is to is to like be aligned with companies that are bringing new technology to the world that offer lower inflammation without opioids let's say or without like hardcore uh fda prescribed drugs. So let's say low-level light therapy, ultrasound therapy, cold therapy, hot therapy, massage, vibration, let's say nutraceuticals like Ayurvedic compounds. Those are all to me very low. They help lower your inflammation in your body no matter what condition you have. So let me jump on there just very quickly. I completely... I tried to just run right through it for you. Completely concur with the importance of diet. But for those listening, your comment, if it's got ingredients in it that are not in your pantry, it's probably ultra processed. The other way you might think of it is if you unwrap it and leave it on the counter and it doesn't deteriorate, it doesn't break down. and it's the same in a year's time, then you can't possibly think your body can break it down naturally either. So I'm down to seven pillars. Do you remember the last one, David? What was the last? It's funny. So I was reading an article about the eight essential pillars of life, and it's kind of either seven or eight. I'm just trying to think. You know, and I think when I say sleep, That means going to bed and getting sleep. The other one is probably rest and recovery, meaning if you work out a lot, you have to give your body time to rest and recover. I think that means that you never work out your arms two days in a row because that's going to negatively impact the muscles in your arms. So having the ability to recover after, let's say, people who are avid runners. I'm not a huge advocate of running more than three times a week because there's got to be this thing called cross training. So getting a rest to allow your body to recover after physical exertion is one of the pillars as well. I completely agree with that, David. There's no question. Thank you. You can even over-train the heart. For those listening, we do see conditions of the heart from excess training, believe it or not. Although we love people to exercise, you can have too much of a good thing. That's right. That's right. I'm just going to say that that was very... for me to like spit it out so quickly the pillars and because i think that there's no one magic bullet in the world right so it takes it takes a it takes a what do they say it takes a neighborhood or it takes a village to like achieve it and it's the same thing in your own body like i think that the stuff you put in your body you got to be so mindful you only have one of them you might as well try and make the most of it if it's something you aspire to which is reaching gracefully staying independent which means flexibility, strong, having great balance so you don't fall over, but also thinking about the other facets of life because those are important because it's not just one thing. It's a group of things that help you achieve your goals in life. Often, David, I try and relate to my patients that it's a bit like a car journey, and there's multiple factors coming to that. Part of that... safe car journey is making sure the engine is running well your mechanics looked at it the brakes are sorted and that's the sort of stuff you and i do we're the mechanics for people but they have to drive the car and that's that's You know, that's many of those pillars. You have to wear your seatbelt. You have to keep within the speed limit. You have to follow the road rules. You have to drive to the conditions. You have to drive to your experience. You have to give way. You have to do all these things. And you have to stay awake and be very mindful about it. 100%. It's a great analogy. It's a great analogy, Warwick. Thank you. And I really hope that the people who are listening, they really kind of like take a deep dive within themselves. and see if it's like little things they can change. It's not a monumental thing. It's small changes over time, building a new habit, maybe getting rid of a few vices, being more mindful of the amount of alcohol you take into your body or the portion size of the food you take in. Even if it's fairly healthy, if you take in twice the amount, you can still have some negative impacts on your body. These are very much small investments with big returns. Look, David, in the interest of time, I'm going to have to wrap up. I actually sensed that you and I could talk for hours. No doubt. We are completely aligned on our desire to see individuals embrace really simple change on a daily basis to make a big difference. For those listening, thank you so much. The wrap up is this was David Newman. NY Sports Care Orthopaedic Surgeon Manhattan. Please look up his website, pop-doc.com, and please check out his TED Talk on Preactive. These are really well worth doing. David shared... seven or eight pillars of real common sense living to help you improve your health span, including exercise, sleep and recovery, hydration, mindfulness, social connection, cutting down those vices and being really aware of your diet. It all makes perfect sense. And the literature even supports that, David. So the longevity, Harvard longevity study supports. socialization. We know that sleep is probably foundational to those other pillars. They sound like motherhood statements, but please, if you can put them in place, they will make a difference. David, I'd like to thank you once more for joining me from the other side of the world. Awesome, man. I love your energy, Mark, and thank you so much for summarizing things so nicely. That's very helpful. Best of luck to you. And, you know, one day, I will make my way to your land and we will meet. Come and knock on the door if you do come. Awesome, man. Thank you. Next time I'm in New York, I might come and say good day to you. Please. That would be great. Keep up your passion. I appreciate it. Thank you. For those listening, thank you so much for listening this far. I am sure you've found this valuable. I know that it really resonates with sensible decisions. good things that we can do as individuals to look after ourselves. Last thank you to David. If you've got any queries or questions, drop us a note at info at drwarwickbishop.online. And if you like this podcast, please share it. Get it out there. Share it with some people so that they benefit as well. Till next time, I hope you live as well as possible. For as long as possible, take care and bye for now. Hi, ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States. Nine million deaths globally per annum. 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