Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.162 How to Add 15 Healthy Years to Your Life: The Power of Data-Driven Healthcare

• Michele Henning Folan • Episode 162

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What If Your Annual Physical Is Missing the Most Important Clues About Your Future Health?

In this episode of Asking for a Friend, I sit down with Dr. Dave DeMarco—primary care physician and owner of DexaFit Cincinnati—to uncover what most standard medical exams are failing to tell us, especially for adults in their 40s, 50s, and 60s.

Dr. DeMarco is reshaping the landscape of preventative healthcare by using advanced diagnostics to detect early warning signs of metabolic dysfunction, muscle loss, and other hidden health risks—long before they show up in traditional bloodwork or physicals.

We explore:

  • Why DEXA scans are a game-changer for understanding body composition, especially visceral fat and lean muscle
  • How muscle mass acts as your “401k for aging”—and why it’s critical to build and protect it now
  • The role of VO2 max, metabolic rate testing, and continuous glucose monitoring in predicting long-term health and vitality
  • What you need to know about GLP-1 medications like Ozempic—and how to use them without sacrificing muscle

Dr. DeMarco explains how the right data can help you delay or even avoid the “marginal decade”—those final 10 years marked by physical decline, mobility issues, and dependency—and instead create a longer, healthier, more vibrant life.

Whether you're trying to lose weight, maintain your independence, or outsmart a poor family health history, this conversation is packed with insights you can act on now.

Midlife isn’t too late—it’s the perfect time to take charge of your health.

 Don’t forget to subscribe so you never miss an empowering conversation about midlife wellness.

You can find Dr. Dave DeMarco and DexaFit Cincinnati at https://www.cincinnati.dexafit.com/

DexaFit locations are popping up all over the U.S. - go to https://www.dexafit.com/ for more information

Get 10% off your first month of therapy at Better Help. Go to https://betterhelp.com/askingforafriend 

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*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Michele Folan:

Let's be honest, midlife can feel like a lot. Shifting roles, changing bodies, aging parents, and sometimes you just need a safe space to talk it all through. That's where therapy comes in. It's not a sign of weakness, it's an investment in your well-being and with BetterHelp, getting started is easier than ever. Betterhelp is entirely online, so it works with your schedule. You fill out a brief questionnaire and get matched with a licensed therapist in as little as 48 hours and if it's not the right fit, you can switch. No awkward breakup required. Give yourself permission to feel better. Visit BetterHelpcom forward slash. Asking for a friend to get 10% off your first month of therapy. That's BetterHelpcom. Forward slash asking for a friend. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, michelle Follin, and this is Asking for a Friend. What if your annual physical isn't telling you the full story?

Michele Folan:

This week, on Asking for a Friend, we're diving into the power of personalized data-driven healthcare with Dr Dave DeMarco, a primary care physician, on a mission to take prevention to the next level. Dr DeMarco isn't your typical doctor. He's combining advanced testing, meaningful blood work, biometrics and scans like DEXA to give patients real answers and real strategies to support their long-term health. No more guessing, no more band-aid solutions, just evidence-based insights to help you thrive in midlife and beyond. We're going to talk about why traditional medicine often waits for symptoms before it acts, how the right data can completely change your health trajectory, what a DEXA scan reveals and yep, I had one and we're going to talk about that. How he coaches patients using tools like glucose monitors and even GLP-1 therapies, and why it's never too late to get a clear picture of your health and take control. If you've ever felt dismissed, confused or in the dark about your health, this episode will change the way you think about what's possible. Dr Dave DeMarco, welcome to Asking for a Friend.

Dave DeMarco MD:

Well, thanks for having me, it's my pleasure.

Michele Folan:

So I'm going to tell everybody how we met. I drive past his office, his Dexafit office, multiple times a day and when I was interviewing Dr Doug Lucas, who is an osteoporosis and orthopedic specialist, I had told him. I said I've got to run in there, I just I want to see what they're doing. And he's like yeah, do, let me know. You know, I'm super interested. And I immediately walked in. Two of the women that work there in the office listen to the podcast. And we started chatting and I said sign me up, let's do this. So Dr. DeMarco is the doctor that owns the Dexafit practice near my house, and I wanted to get him on the show. Okay, now, enough of me talking. What really inspired you originally to go into medicine in the first place?

Dave DeMarco MD:

Yeah. So I think our personal history really informs just about everything about us. So when I look back at my family origin, lots of cardiometabolic disease runs in my family. My dad grew up in Brooklyn, New York, one of five boys, and my grandfather unfortunately died at age 54 of a massive heart attack. I never got to meet him. Four of the five boys had heart attacks. My dad was the lucky one that didn't have a heart attack but unfortunately he had diabetes, and diabetes that kind of had him yo-yo dieting up and down. Do you remember the cabbage soup diet? Does?

Michele Folan:

that sound yeah.

Dave DeMarco MD:

Our family was doing cabbage soup dieting at times when I was a kid, so this was always front and center, always in my brain and you know I saw some of the things that made it hard for him and ultimately, because of his diabetes, which is so hard on the kidneys, he had a hard time even having a simple knee replacement and that led to decline in health that ultimately took his life earlier than we would have liked.

Dave DeMarco MD:

Meanwhile my mom also developed over time just your normal and this is kind of relevant for your podcast midlife weight gain. It was a combination of stress and perimenopause, I think that led. Looking back I can say that now didn't know it then, but now I know that she was dealing with a lot of the hormonal changes and gaining weight and she too became diabetic. So we look at diabetes in my family and we say, okay, two parents that are diabetic, I have a hundred percent chance of becoming a diabetic. Now you've got my attention, you know. And looking at the cardiovascular risk that goes on my dad's side, it's always been front and center and something I care a lot about.

Michele Folan:

So what was the turning point then in your career when you said I really want to focus more on prevention rather than just treatment of disease?

Dave DeMarco MD:

Right, right. So I think because I was so interested in helping prevent diseases, because I saw it in my family and how it affected just the day in, day out. Even just the annoyance of having to think about dieting every day like it's exhausting. It was exhausting to see them come in with the next fad diet, most of which were not that helpful and ultimately led to more trouble. That made me say I really just I want to help people in a deep, foundational way.

Dave DeMarco MD:

So I've always kind of looked at health care from a how do we crack the code? You know, like there's got to be. I really do believe that. You know, there is no absolute truth. Even gravity is basically a high, high, high probability endeavor. I'm not going to test that, by the way. I'm going to trust that gravity is real. But you know, I think we can get closer and closer to certainty with science, with the probability getting closer and closer to, you know, 100%, but we never quite hit 100%. I think that I'm always looking to crack the code to get a little closer to that. So you know 100%, but we never quite hit 100%. I think that I'm always looking to crack the code to get a little closer to that. So you know we're trained in allopathic. You know that's when you have the MD after your name. We're trained in allopathic medicine to diagnose and treat disease.

Dave DeMarco MD:

And I was a family practice resident when I left med school. I went to Ohio State for med school. It was great training. I went to St Elizabeth's near here, which is a really rigorous family medicine program that had us doing all sorts of really complicated things and threw us in the deep end of the pool, if you will, and it really built me up for being very comfortable dealing with sick people and being able to handle the sickness. But I don't like the sickness, if I'm honest. I don't like working in the hospital. I prefer to catch people with their clothes, their street clothes on, not a hospital gown. So I knew right away when I was in the hospital's training I'm going to be an outpatient doctor and watching people suffer really hit me hard.

Dave DeMarco MD:

I really wanted to prevent that and so I realized, you know, if we can step back more steps, make one step, two steps before disease really manifests. We have a chance of helping people engage with their lifestyle and I started realizing how much lifestyle makes a difference. I got board certified a few years ago in lifestyle medicine, which basically looks at six pillars. It looks at your nutrition, your exercise habits, your sleep patterns, your stress management, how you relate to other people and how you relate to risky substances, whether that's the illicit stuff like drugs, alcohol, which is legal but maybe overused in our society, or even just caffeine, which I'm guilty of big time taking too much caffeine in, or sugar, right, and we see all of this play into impacting our health and chronic disease in a lot of ways is just completely related to our lifestyle. So helping crack this code, as I said, includes learning. How do you help people with lifestyle and how do you start soon enough so that you can actually make the difference when it matters most?

Michele Folan:

In the years that you've been a doctor, are you seeing that we're getting sicker?

Dave DeMarco MD:

I think we are in a lot of ways. Here's the thing I think we are getting we're living longer lives but we're not living better lives, if that makes sense. So I would argue, when I look at most of the demographics that I take care of in my current practice, I'll tell them you know, there's a good chance we're going to keep you alive to age 85. I mean, we can keep people alive. That's not the part I'm concerned about, it's just will you enjoy that? Last 10 years?

Dave DeMarco MD:

Dr Peter Atiyah calls it the marginal decade, which is that last 10 years or 12 years of your life where you're going to kind of start to decline. And first of all I have patients that are starting that decline in their 50s and 60s and then others that start around age 70. But I tend to see somewhere between 70 and 80, a big decline. And I think that with what we're doing at DexaFit and what I'm trying to accomplish in terms of positively disrupting primary care is, let's get a step, maybe two steps, ahead of the problem and see what we can do to delay onset of disease so that maybe what's manifesting at 65 doesn't manifest till 80. So that marginal decade hits well after that. And if we can get that going, we're going to not only help people live better lives and enjoy the ride more, but we're going to save healthcare dollars. We're going to make it so that we're a healthier society and hopefully we won't be sicker as we go.

Michele Folan:

You know, I had a conversation yesterday with a new client and Dr DeMarco knows I'm also a health coach and I wanted to know what her motivation was. What got you to reach out? Dyslipidemia, triglycerides were really high, HDL's low. Her A1C her hemoglobin A1C, which is a glucose marker, is starting to increase year over year and it's like she's on the bubble, right. She knows that and what you're saying is if we can get. And if we can, what you're saying is if we can get before we get to that point. If we can start nipping things in the bud earlier, then we've got a chance, right 100%.

Michele Folan:

Yeah.

Dave DeMarco MD:

And there are tests out there that help us triangulate around your health much better than what our current tools are. And I'm not bashing our current tools. Our current tools are great. I love having my patients in for a deep dive, looking at their blood work, their blood pressure and other vital signs, but what I find is, especially from about age 35 to 60, there's a gap, and the gap is people don't feel that bad and they're busy and they're active, doing other things, and some people genuinely are already on a lifestyle kick, but others are not yet because of whatever reason. But oftentimes it's just the busyness of life and we need to get people's attention. And the best way I have found to get your attention as a patient is to say well, let's look actually at year in year out, what your muscle mass is actually doing. Let's look year in year out at your accumulation of visceral fat and, using those two things on a DEXA scan, for example, we look at those and we can measure them every six to 12 months and tell you how that's changing. And let me you know spoiler alert it's going to change. Just because you're on this earth and living another year, you know you're getting around the sun one more time, and that means there's risk for this going down.

Dave DeMarco MD:

I like to use the 401k analogy a lot because I talk about. You have until about age 40 to build up as much as you can, similar to your 401k plan. You have until retirement to build it up, or at least 59 and a half. When you have to, you can start taking it out then. But how do we get that as big as possible so that when you start spending it down you have enough to last? And we want to keep your muscle mass up so that you have enough to last. You ripe into your nineties and beyond and nobody really wants to live a long life unless that those last 10 years can be valuable and rich and you have a mind that can enjoy the people around you. And I think that's what we learn from connected. You know being connected to other humans. There's a great book I think it's even behind me on that shelf called the Good Life that looks at the Harvard Men's Study, which had more than men in it. It was women, men, children, and it's one of the longest lasting studies that cut to the chase. They realized it wasn't sickness or health, it wasn't wealth or poverty. It wasn't fame or obscurity that made people think they had a good life, it was how connected were they to other people. But that requires a flourishing mind. That requires a mind that remembers who you are and who's important to you. So all of this ties in to our testing and our muscle mass evaluations, our visceral fat, which drives so much of the inflammation and chronic disease that I've already mentioned. We haven't mentioned dementia, but definitely I guess we sort of mentioned dementia there. But it definitely hits all of those areas. And yeah, when you combine that with cardiopulmonary fitness, which is basically a way of saying your VO2 max your VO2 max is a number that tells us how well you can use oxygen when you exercise the higher that number there's great science that shows that it correlates with longevity and it correlates with less risk for cardiovascular disease.

Dave DeMarco MD:

A stress test is only going to be abnormal. We all hear about stress tests. Maybe some of us have had. I've had one myself and you know we get on there and what it's really looking for is is there enough plaque burden in my heart arteries to make that an abnormal test and flip it from normal to abnormal? But what that really means is 70% blockage or more, and I'm sure we've all heard of someone that has had a heart attack and then it's like he just had a stress test six months ago. I can't believe it. And the reality is you're going to have a heart attack with 40, 50, 60% blockage, but it wouldn't be a positive stress test, right?

Dave DeMarco MD:

So how do we know whether your heart's healthy at a stage where we can measure it? Well, there are good tests like a CT angiogram that can look at the arteries. You can even use some 3D modeling to tell exactly the first, third, middle, third, last third of that artery where is the plaque and how much is it. These are great tests but they're quite expensive. There's quite a bit of radiation that goes with it and it's not something you can do every year.

Dave DeMarco MD:

Meanwhile, something like a VO2 max test you can do that two, three times a year.

Dave DeMarco MD:

If you want, you could do it. It's safe to do as many times as you want, but I would argue twice a year if you're trying to make a difference in your health journey makes a lot of sense, because your VO2 max, the higher it is, the more likely you have a good heart. And if you can measure that today and then do some things to change that and then measure it in six or 12 months. Now you know whether you're maintaining or maybe even improving your VO2 max. Now you know whether you're maintaining or maybe even improving your VO2 max. That also goes down as we age, but if we can maintain it enough, man, you will have higher quality of life, and what that directly relates to is what are the little things, the activities of daily living that you're going to enjoy doing as you get older, the more VO2 max, the more chance you are of being able to go hike with your family. Not be the one that's the burden, holding the group back, but the one that maybe even is leading the charge.

Michele Folan:

Absolutely so. I love all this. We are going to take a quick break and when we come back, I want to talk about the process of someone coming into your office and the testing that you do. How many drugstore products are you going to try before you finally decide you deserve better for your skin. Listen, if your skincare drawer is overflowing with half-used bottles that overpromised and under-delivered, it's time for a change. Rimon is the number one skincare line in South Korea for a reason.

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Dave DeMarco MD:

Yeah, that's a great question and just I did listen to your podcast on osteoporosis, which was great. You did a great job with that and I definitely think that there's a difference and we need to make that clear for you guys. We are not interested as much in the bone. When we think body composition, we are looking at three compartments which is bone, yes, fat, and then what's not bone and not fat, which is lean, and so we're going to call three compartments in your body fat mass, lean mass and bone mass. Now we differentiate bone with a body composition scan using DEXA, but mainly just so that we know how much that bucket weighs and I'm going to say it's about two to 3% of the total weight. Then our focus is more or less going to be on your fat mass and your lean mass. Now we will give a T-score for the total body, but a total body T-score is going to give a number for an average for the whole body, so to speak. So your skull, for example, pretty dense bones or other bones in your body that are more dense and going to affect the total T-score.

Dave DeMarco MD:

So I don't want anyone to not get a what we call segmental DEXA looking at the lumbar spine, the hips. Sometimes we look at the forearm when we can't get a good reading in the hip or the spine due to a replacement or arthritis. This is still really important and I think these two scans complement each other really well and, in my opinion, should be done potentially at the same time. I don't think you need an every year segmental DEXA scan, although it doesn't hurt to get one if you're already on the machine to get a body composition and so but at the end of the day, we are really looking at your fat mass and your lean mass, and then a segmental DEXA really looks at how dense are those bones, are they going to support me in a fall and am I going to be at risk for a hip or a spine fracture? Do I need to do more? And you know I refer to your other podcast which was so well-spoken about that side of the equation.

Michele Folan:

Thank you, thank you, yeah, and so, even though I went and got the body scan with Dr DeMarco, I am scheduled for a regular bone scan at the end of July because, as my listeners know, I have osteoporosis and that is of concern. But we'll talk more about kind of my plan forward that I have with Dr DeMarco and it's going to address that too. All right, so when someone comes to your office, what would they expect during their first visit with you?

Dave DeMarco MD:

So, first of all, we've got a beautiful space. It's going to be very welcoming and hopefully, very comfortable for you to walk in. This can be a dicey thing, right Like I'm going to be told what's actually going on in my body, and these are tough topics to talk about. So we want to create a really comfortable environment for you. The staff is fantastic. They're going to welcome you, they're going to laugh with you and it's going to be genuine, it's going to be real. They're just wonderful, wonderful people.

Dave DeMarco MD:

So we'll bring you in, we will take you back, we'll weigh you and get your height and then we'll put you on a DEXA scanner. So a DEXA scanner we didn't really talk about what it looks like or what it really is. A DEXA scanner is a big table that you lay on and it's got a C arm, which is basically this little arm that moves kind of like this across your body, right, and it sounds like a Xerox machine, but it's very it's notvasive, there is no claustrophobia risk and it's about a six to 10 minute test really, depending on your body weight and size. Once you complete that test, we'll get the data right away. We put it up into our DexaFit cloud, and our cloud contains over 250,000 de-identified tests, and all those data points then are used to help you kind of look at your body compared to peer groups. And this is where it gets really interesting, because we take the data and we do more with it than we could otherwise do.

Dave DeMarco MD:

If you got a DEXA scan for body comp somewhere else, the software is available as an app and you can look at your bone mass and your lean mass and your fat mass and the distribution of those, and there's explanations in there to help you take a deeper dive. And then, beyond that, you'll be able to follow it over time in that same app. So it becomes like your source to see where have I been and where am I going with these really important body composition metrics. If you stick around and do more than just our DEXA scan, we have two additional tests that we do. Now. I think you just did the DEXA scan, but that tells us the what right. What is the current state of my body when it comes to two important metrics? Visceral adiposity, which is dangerous fat that's deep in our belly.

Michele Folan:

And mine was relatively low, which I was glad.

Dave DeMarco MD:

That's great. And then number two what is your lean mass? And we like to look at lean mass in the same way that we think about body mass. And I say it that way because we've all heard of the BMI. The BMI is a body mass index where we take your total weight on the scale in kilograms, divided by your height in meters squared, and it gives you a number. And we all know that that's a frustrating number because you would be overweight on the BMI. But you're not really overweight because you've got a lot of muscle, and an NFL star is a perfect example of that person.

Dave DeMarco MD:

They would be clinically obese by all standards of BMI. But they are clearly not what you would think of as an unhealthy specimen. They're the opposite. And then to be fair, a very thin build person might be under muscled, but we would never pick up on that on a BMI. You know that's going to say, oh, you're fine, you're in the normal range, which we'd call 19 to 25. But they might actually have more risk than it shows. So the BMI is a poor tool.

Dave DeMarco MD:

There's something called an ALMI and the appendicular lean mass index is what we like to look at to help see if you're appropriately muscled, do you have enough muscle to age? Well, that's the way to think about it. And if you're in the top quartile, there's some advantages, according to the research, and if you're in the bottom quartile, there's some risks. If you're in the middle, it's opportunity. And if you're below that quartile, that bottom quartile, we really want to at least get you to the 30th, 40th percentile for your gender and age, just to make sure that you're safe and you're not going to have increased health risks as you age. Make sure that you're safe and you're not going to have increased health risks as you age.

Dave DeMarco MD:

So that really looks at your lean mass in your arms and your legs divided by your height in meters squared. So it's the same metrics but different things we're measuring and that really is, in my opinion, going to be helping us guide patients along their journey Because, as I mentioned earlier, age 40 is when we start to see lots of change. Journey because, as I mentioned earlier, age 40 is when we start to see lots of change decreased muscle mass, little by little, to not just about strength and independence, but it's also about metabolism and how your body handles carbohydrates, how your body handles hormones and different things like that. So all of it's affected by your lean mass and having more especially in makes a big difference in aging well.

Michele Folan:

So, so I'm laughing only because I was in the opportunity class in terms of my lean body mass, and even though it was super hard to hear that, because I have been lifting weights and being very conscientious about making sure that I am strong there, I realize now that I've got some work to do, because, as I tell everybody, look, this is not just about my looking good in the dress I'm wearing at the end of the month, which I am but I want to be able to get off the toilet by myself, so that I don't have to be in a nursing home or in a wheelchair. And so I want to know this data, even though it's hard to hear, and I would love to know how you approach conversations with patients who receive surprising or very tough results.

Dave DeMarco MD:

Yeah, it is hard right. So, again I said, the DEXA scan really tells you the what of your body, which is potentially good news, potentially bad news. So we look at everything as either an opportunity, as you said and I said earlier, or an asset. And here's the thing there's very few people I've seen come through the door here that don't have an asset. If you have a lot of fat mass, you know you need to lose some of that to be healthier. We want to know how much of that's dangerous, how much of it is just subcutaneous fat, and we can talk some of that to be healthier. We want to know how much of that's dangerous, how much of it is just subcutaneous fat, and we can talk through all that and that might be an opportunity. But those individuals tend to have stronger bones. They tend to have better muscle mass.

Dave DeMarco MD:

I kind of joke. It's like every day you walk through life like you're doing a farmer's carry. The whole time You're carrying this extra weight everywhere you go. It does have some benefits. Unfortunately, it's hard on the knees, hard on the back, can wear down joints and then, if it's visceral, it definitely can be dangerous from a metabolic perspective as well. So we talk in terms of and I've been doing this for 25 years you have to deliver bad news in medicine.

Dave DeMarco MD:

You have to tell them about an abnormal cancer screening test, you have to tell them about numbers that are not favorable and you learn how to just come down at it. Very matter of fact and yet gentle and I think we're always going to be gentle with things we joke a little bit about the opportunity thing and a lot of people get a kick out of that. But I think at the end of the day, here's what I like to tell people If it's, if you don't know this information, is it any less true? And the answer is no, in fact it's. It's more dangerous not to know than to know, and it'd be much better for us to just kind of say okay, listen, I'm Dr D, I'm your friend and we're going to work through this together.

Dave DeMarco MD:

If it's a bad news, and if we start with what is true and then build from there, you're going to do much better. And the nice thing is everything about both VO2 max and visceral fat and lean mass index modifiable. They're all modifiable. No one is stuck. It's not like just a genetic thing. Where you're stuck with these things you can put effort in and you can put different inputs into your body mostly lifestyle medicine related inputs that will make a big difference and help you maintain, if not make, significant gains, and you're going to be the one that enjoys the results of that your hard work. You'll get the dividends that pay off later on.

Michele Folan:

And you know that's why I love what I do, because my clients, it's their hard work and dedication that moves the needle, and I'm sure you have a patient success story. Can you share one that you've had?

Dave DeMarco MD:

Oh gosh, I mean, there's so many little success stories, right, and we could think about this in multiple ways, right. There are some people that have just found their way into lifestyle medicine and just embraced it, and they're eating much more of a plant-based whole food diet and they're exercising regularly and they're just feeling great. But I also think about some of our patients that are on GLP-1 drugs, and people are now finally aware that your muscle mass might be at risk as you're losing weight, and this again gets into the semantics of are we losing weight or are we losing fat, and really, what a good GLP-1 response would be. We want to see a significant loss of fat mass, not lean mass, and so therefore, if we see 80 to 90% fat loss and maintaining most of your lean mass, that's, in my opinion, an incredible success story.

Michele Folan:

But here's the thing, and I'm not everybody knows I'm not anti-GLP-1, but if you are on a GLP-1 and you are having significant weight loss, how do you know it's not your muscle If you're not getting some kind of a DEXA scan?

Dave DeMarco MD:

You need it.

Michele Folan:

Yeah.

Dave DeMarco MD:

You need the DEXA scan. We look at real closely how different tools that are out there in the community, for example InBody, that's bioimpedance analysis, bia, and so basically it's looking at how electricity flows through the different tissue types and it's trying to predict then, how much muscle mass do you have, how much fat mass do you have. It even tries to make a prediction on visceral fat, and we, luckily, are able to have people get that test and then the same day get our test. And what all the studies are showing, of course, is that sometimes they're accurate, but they're so fickle, they're so dependent on time of day and water, weight and all of these factors that it's not very good at predicting your fat mass especially, and so it under-reports fat mass and it's going to over-report lean mass potentially, and so therefore you need to have a DEXA scan, which is the gold standard test, to know, and I ask every GLP-1 patient to get one while they're on the GLP-1 every three to four months. It'd be preferred to have at a minimum every four months because you would see those changes little by little, and then you can input more protein into your diet, you can add more weight training.

Dave DeMarco MD:

Maybe we want to lower the dose of the GLP-1. Maybe we find out it's really not good for you at all and we want to stop the GLP-1. And there's lots of different outcomes depending on the results we see. But I have had a few people very, very impressively maintaining their lean mass in spite of a big weight loss on a GLP-1, but they all have lifestyle medicine in common. They all are treating the GLP-1 like it's a tool, not a magic pill, and I really recommend people not view it as a magic pill.

Dave DeMarco MD:

It is dangerous that way. It is actually very safe to use it for a time, but the hope would be just like training wheels on your bike. You don't want to ride your bike as a 20-year-old, 30-year-old, 40-year-old with training wheels and you don't want to boast that you're a bike rider if you have training wheels on. So again, with healthy living, we want to do the lifestyle things. Maybe use the drug if needed, especially if you have high risk, like if you are already pre-diabetic, have fatty liver disease, have disease concerns related to blood pressure and cholesterol. By all means, consider using the drug for a short term, but, please, lifestyle medicine is where it's at.

Michele Folan:

Yeah, and so everybody wants the quick fix, and what I often have to remind people is you didn't get to this place overnight.

Dave DeMarco MD:

Correct.

Michele Folan:

And so let's not use that as a crutch to have a quick fix. Now. If you truly have metabolic disease, you're morbidly obese, you've got a myriad of cardiovascular issues, I'm all for it. But if it's to lose 20 pounds for the wedding, I got a problem with that, and so I'm very honest.

Dave DeMarco MD:

Well, and this is where our other tests come into play, because we talked about the what with the DEXA? And then the how comes in with the other two tests. So we use gas testing, meaning we're measuring oxygen consumption and carbon dioxide production. We call this indirect calorimetry, and that is gold standard testing for looking at what is your actual resting metabolism. I would define that as the number of calories you need to keep the lights on, so to speak, the minimum number of calories that you should eat to safely fuel your body. And if you eat at your resting metabolic rate, you will be safe with your weight loss. The amount of weight that you lose will be dependent on how much you eat over that number. So if you eat too many calories over your resting metabolic rate, you will be in a caloric surplus and you will gain weight. If you eat above your resting metabolic rate but in a caloric deficit, you will safely lose weight. And so we talk at Dexafit about using the RMR as the how nutritionally to do what you're saying lose the 20 pounds, do it safely, sustainably, because you never want to eat under that resting metabolic rate. When you do, you can do it one day here, one day there.

Dave DeMarco MD:

But there's a few really important things to know about that. One, your body will stop burning calories and start reserving those calories and holding on to them. Your body will go into scarcity mode if it's not getting what it needs. And then if you think of your body like a factory, what you'll figure is well, the foreman of the factory is going to say, well, we don't have enough fuel to fuel this whole thing. Let's shut the West Wing down and we'll keep the North and the East and the South wings open and ultimately you're not living a very successful life. When part of your body is shut down and people can see you cut your calorie count 30% below that level, you're going to see a 30% reduction in metabolic output and you'll feel tired and ultimately your body will start to fight back, encourage you to eat and you won't be able to say no and you'll yo-yo, you'll gain the weight back and it'll be very unsafe.

Dave DeMarco MD:

So knowing your resting metabolic rate is super important and it's better to know the actual gas exchange data, because the formulas may or may not be right. The formula for me is off by about 400, 500 calories, and so it doesn't take into account your muscle. It doesn't take into account a lot of things that would affect how fast or slow your resting metabolism would be. So it's a very valuable tool to help crack the code. For how do I lose weight safely, sustainably and naturally. And even if you're on a GLP-1, I think you need to know that number so you're eating as safely as possible. Again, starvation diets are not recommended. Medically induced anorexia is not a good solution for long-term weight loss.

Michele Folan:

You know. So this is the comment I get often from women in my age group. I don't understand why I can't lose weight. I'm only eating 900 or 1,000 calories a day, and I'm walking and I'm doing all kinds of cardio and I'm like, well, your body isn't feeling safe, and so I compare us to being cave people. Our bodies are still programmed for famine and when there was scarcity of food or childbirth, and so until your body feels safe. But what you're saying is you actually have a number that can be used to determine if your body is safe, and I love that that can be used to determine if your body is safe, and I love that.

Dave DeMarco MD:

Yeah, absolutely yeah. We want to give handlebars to what you're doing, so you have a way to ride and steer your ship in the right direction. But we can't just say, oh, just eat less and move more. That's very, in some very basic ways, that's correct, and then there's so much more nuance to it.

Michele Folan:

Yeah, it's kind of I would say it's archaic, because it's just not Very much so. What I always think is interesting and this is how I try to get women to really think about weight training versus cardio is that your resting metabolic rate is much higher after lifting weights than it is doing cardio, which, yeah, and I think that's such a great dangling carrot.

Dave DeMarco MD:

Yeah, and the more muscle you have, the more you're going to have to fuel that and you're going to have a higher resting metabolism. And so when we see someone get our DEXA and then move to the next room and get a resting metabolic rate, we'll again get that data right away and we'll be able to see oh, they have a lot of lean mass. We just saw that on their DEXA. No wonder they have a fast metabolism. They need to also make sure they're eating enough to support that muscle, and so everybody, even people that are in a good place, need to know their resting metabolic rate so they don't start to lose muscle at the age that we are all reaching.

Dave DeMarco MD:

So, yeah, and then the third test is the VO2 max, which is, again I mentioned, a marker for longevity and cardiovascular risk, but it's also a tool to look at how do we improve our body from a fitness perspective. Because, as you're doing measurements of gas exchange, what you're seeing is when, at what heart rates am I burning fat? At what heart rates am I burning carbohydrate? What heart rates am I burning a blend? And so low intensity workouts tend to be those that burn more fat, and we can give you a very precise range and say, okay, if you keep your heart rate within this range and kind of the top of that range, we call that zone two training you maybe have heard that term.

Dave DeMarco MD:

And that's really based off of how much you're burning fat at different heart rates, and we're going to define that very clearly for you at DexaFit and we'll also then tell you how to do proper HIIT training because we can tell you what type of heart rate you should be achieving to really experience either sprint intervals, which would be a shorter, 30 to 60 second burst of high intensity, or more of a two to four minute long high intensity interval.

Dave DeMarco MD:

That's how I would define the difference between sprint intervals and high intensity intervals. Both are important or they could be equally swapped out and um, but your heart rate matters for that and I think a lot of people are not understanding enough of that to be able to take advantage and make their exercise efficient. And I hear a lot of people say I'm working out so hard and so often I don't think I can do more. Doc, I don't think I can do more. And I say, well, let's make it more efficient, then let's, let's get the data that you need to make it more efficient, so that now you not only know the what behind your body composition, but you have the hows for nutrition, the hows for exercise, to really make your lifestyle working, for you to maintain a healthy weight and to live a long healthy life.

Michele Folan:

Okay, I want to move on to one other aspect of your practice that I think has been really helpful for some of your patients is using the continuous glucose monitor as a tool to help bring some awareness around how people handle sugar and insulin.

Dave DeMarco MD:

Yeah, I think that's super valuable. It's not just for diabetics. Diabetics who have to prick their finger multiple times a day have found so much freedom in having a continuous glucose monitor because it pushes information to their phone and they can see in real time where their sugars are, and that could be life or death for a diabetic if it's too low or too high. For the rest of us, it's more about training ourselves away from high glycemic foods and towards eating foods that really support a healthy metabolism and allow us to enjoy the things in life we love to eat. I always ask in my questionnaires what are three foods you're never going to give up and I don't expect you to give those foods up right. But at the same time, we should learn how to best eat those foods. If you eat a lot of what we call high glycemic foods, you'll see a big rise like a big rise in your blood sugar and it'll show up on the app that goes with the continuous glucose monitor. But I've had patients tell me if I eat a half a banana, I see this little bump and I eat the other half and it's a little bump, but if I eat the whole banana, it just jumps really high on me and comes back down, and it's about how much the different things are that you're eating. It's about what the foods are made of and a lot of us learn hey, even if it's technically a healthy food, if my body doesn't respond the way I want it to do this, then I think I'm going to need to eat less of it or just time it differently. And, of course, the earlier in the day you eat certain foods, the less of a sugar spike you're going to get. So it's fascinating and it's a great tool for learning how your body responds to healthy foods, unhealthy foods. How much is enough, how much is too much?

Dave DeMarco MD:

And I use it as a deterrent at holidays from having that second or third, you know, fill in the blank. I know it's like boy, that's like Ebenezer Scrooge why are you wearing that thing at Christmas? But it really does help me, say you know what, I am satisfied with what I just consumed in this party setting. I don't need to have any more and the CGM tells me that. So we wear it a few times a year. I think is a good goal, like when you're in a time of really strict dieting. It's good to do that If you're doing any prolonged fasting, it'd be really good to know what your body's doing during that time. When you're on a holiday, you're on a vacation. It wouldn't hurt to know what's happening when you have a little more food and spirit. You just want to know so that you can be aware and be mindful of your eating.

Michele Folan:

Speaking to a client the other day and she was telling me how she goes into this huge slump in the afternoon. You know, just feels terrible, feels awful, and, as we started digging in a little bit, finding what are you eating up until that point during the day and how are you eating it? And one thing that I have noticed is that, even with fruit like the banana, or even a big bowl of berries is, those in themselves are nutritious and wonderful foods, but pairing them with some protein or a little bit of fat, preferably some protein, can do wonders for how you feel. For how you feel, and so what I like about the CGM is I think it gives people a glimpse behind the curtain of, I know, when my blood sugar does this. An hour or two later, I feel like this, so it helps them play it forward to make better food choices.

Dave DeMarco MD:

Absolutely. And the thing that's happening scientifically and biochemically behind the scenes is when you get a big spike in your sugar, that's the body trying to. You know it's got to now break down all that glucose and every time your mitochondria break down energy, there's something called oxidative stress that happens. So the more sugar spikes you have, the more oxidative stress you have, which is just kind of like damage to the system. And then this is why we need berries and antioxidants that come in other forms, because that helps with some of the neutralizing of the oxidative stress.

Dave DeMarco MD:

But oxidative stress leads to aging and part of what we're doing here is trying to slow the aging process down. So when you keep your blood sugar with fine, narrow and in-range little blubs of going up and down, staying within about 15 to 20 milligrams per deciliter from your average, never really getting above or below that, that's the real sweet spot for really minimizing oxidative stress. And we have tools now that you can do this. And the thing I like about it is you do it sometimes. You don't have to wear it all the time. A diabetic might need it all the time for life-saving reasons. We just need it enough to learn and then to apply what we learn to our lifestyle.

Michele Folan:

Yeah, and I love that. I just love having data, because to me that's the name of the game have the data so that you can put a plan in place. And part of that plan for some of your patients is maybe some supplements, and I know I have two things that I'm using now that Dr DeMarco gave me, and the first one was an amino complex. So let's tell the audience why I am taking that Sure.

Dave DeMarco MD:

So there's different ways to get amino acids into your body, and protein is where we get our amino acids in general. So eating protein clean, responsibly raised meat products, plant-based proteins this is going to be a great first choice, and then some whey protein or pea protein, depending on if you're plant-based or not would be another choice to get more amino acids into your system. But sometimes you want to do, say, a longer fast and you want to be able to start your day turning on muscle protein synthesis without having to eat a bunch of calories, and so you can pre-workout or just at the beginning of the day and the end of the day you can keep muscle protein synthesis on simply by putting essential amino acids into your body. So for 25 calories you can just stir it into some water and drink it, and it gets you enough stimulation of the mechanics of turning on muscle protein synthesis without having to load up on protein, which for some people can make them feel more full. I still want you to get protein in as much as possible, of course.

Dave DeMarco MD:

It's a great add-on because a lot of people tell me you know, I know I'm supposed to get like point eight to one gram of protein for every pound of ideal body weight and they start doing the math and they're like I'm so full, I'm not getting that much. This is another way to kind of keep things going in the right direction without having to feel bloated all the time from too much actual protein in your body. So yeah, All right.

Michele Folan:

Well, I'm using it almost every day. So, yeah, I'm using it appropriately, usually right before and during my workout. So hopefully that's okay.

Dave DeMarco MD:

That's great.

Michele Folan:

All right. The other thing that I am using that you gave me was the ReversaCell.

Dave DeMarco MD:

Yeah, that's a Thorne-based product and it's one of their most popular things.

Dave DeMarco MD:

It's associated around longevity and it's really for mitochondrial health mainly, and cell signaling inside the cell has to do with something called sirtuins and we don't have to get into the details of all of that. But ultimately everything in that supplement is oriented around helping your mitochondrial health, supporting sirtuin activation, so that cell signaling internally is what it needs to be to support aging well and appropriate breakdown of the nutrients that you're eating. There's this theory of mitochondrial aging that is related to we age because our mitochondria age and our mitochondria stay healthier when we reduce oxidative stress, when we exercise adequately, when we take in certain antioxidants, of course, and then we really do support the body with things like the nicotinamide riboside which is in there. That's one of the main ingredients and ultimately it enhances the mitochondrial function which hopefully will keep our mitochondria going longer and stronger and we age slower and feel better along the way, because the more our mitochondria are efficient with energy burn, the more like just vitality we feel. We have more energy.

Michele Folan:

And I didn't tell you. I was going to ask you this, but we talked a little about NAD.

Dave DeMarco MD:

Yeah.

Michele Folan:

Will you explain a little bit about NAD and do you ever do NAD injections for patients?

Dave DeMarco MD:

No, yeah. So that's a great. This comes up in my practice, and so here's what I like to say about some of this. I am trained in allopathic medicine and one of the things we talk about is, first, do no harm and then help the patient. And I'm not saying that NAD infusions are harmful, I'm just saying that the science that I have available to me isn't available. So I am very open-minded and I like to think of myself as someone who's willing to be in the middle of the aisle.

Dave DeMarco MD:

I've got some MD doctor colleagues that would be so angry that I'd even have a conversation around NAD infusions, and I think they're wrong. I think they need to open their minds to like, okay, this could be great and we just don't know yet. We need more data. So let's get the data and let's do something with that data as we go. And then there are people that are going to say, well, if some is good, more is even better, and we've learned from other areas of science that that's not always true. Like another good example is more weight loss might mean more muscle loss, and we know that. Therefore, just losing more weight blindly doesn't make sense. So I think I always ask my patients that go get the infusions. How do you feel like? Are you doing OK with it and I don't think anyone's getting harmed by it, but I also don't think I'm ready to start offering that.

Michele Folan:

Okay, yeah, and I it's. It's for longevity, correct, mitochondrial health and longevity? Okay, absolutely.

Dave DeMarco MD:

Yeah, so it's just the question of dose, right, and everything in the world like it's all dose dependent. Too much of a dose like okay when we need to thin the blood with a drug called Coumadin. If we just use enough, we get the blood thin and we avoid blood clots and risk of dying from blood related issues, but if we take too much it's a rat poison and we bleed out and die, and so it's all dose dependent. And I just think we need to continue to learn and grow, and so my hope is to be kind of a voice of reason in the midst of a world where there's some people that are too stodgy and others that are too loose. And how do we block arms and learn and work together to help patients live long, happy, healthy lives?

Michele Folan:

And we do that with data. Data helps, that's for sure. Okay, I am really very interested to know, pursuing this avenue of medicine and healthcare, how has this changed your view on things? Obviously, you've made some significant changes in your own lifestyle. What would those be?

Dave DeMarco MD:

Oh gosh. So I would say that this is spawned out of my own life journey right, and I already mentioned how I know, as I'm getting older, there's so much risk for me in terms of my family history. But I also know that 70% of it, if not more, is related to my lifestyle and not related to my genetics, and so I have been obviously trying to live all six pillars of lifestyle medicine, and it's funny because there's a tension there and I think life is full of tension and I think we need to embrace the tension. You are sort of walking a tightrope everywhere you go when it comes to if I do too much enjoyment of the finer things of life, then I will lose some of my health, but if I'm too strict and I never do anything fun, then I might lose some of my social relationships and that might affect me negatively too, and so we're always constantly walking a tightrope in this area. I think if everyone can focus in, like what I've tried to do for myself personally is I start with sleep, and I think sleep is a linchpin. I used to believe it was one of the pillars. That might be the most important pillar actually, because think about a day when you know you're underslept, and how you respond to your family, how you respond to struggles in life situations. Food I'm much more likely to crave the wrong foods. I'm much more likely to tap out and not work out. But when you're well rested, you wake up feeling ready to make better decisions, and so if I can get seven hours of sleep preferably seven and a half I'm having a better day. So I always strive for that, and having some device for data reasons that'll keep track of that is very telling. None of the trackers are perfect, but directionally they're all great. So an Apple Watch, an Oura Ring, ultrahuman all of these things are moving in the right direction to help us understand what our sleep is helping us do or not helping us.

Dave DeMarco MD:

And if you have sleep apnea or true sleep problems, it's really important to address that. First you need to talk to a sleep doctor or figure out some ways that we can under kind of dig to the deeper levels and figure out why you're not sleeping well. But from there then I really want to always get two days of resistance training in. I want to get zone two training in as many days as I can. What I love about zone two training, which is that low to moderate intensity, endurance or steady state training. I call it exercise, and so it's exercise and listen to a podcast, exercise and call your mom Exercise and whatever you want to do, fill in the blank, because you're not. You're breathing through your nose. You should be able to talk if someone asks you a question.

Dave DeMarco MD:

If you're doing more, where you're breathing through your mouth out or breathing through your mouth in and out, you're at a higher intensity and it's probably not going to be good. So you want to be good for the purpose of fat burn and zone two training, building up mitochondrial health, so that you have more endurance. So I try to get as many days of that in as I can, and then preferably one or more, maybe two days where there's sprint intervals and that's going to train the high end of your aerobic engine, whereas zone two trains the lower gears of your engine, and then strength is so important, though, so progressive overload with feeling sore muscles. That's super important and, to be honest, it's very hard to do all of those things every week, and so we fight the good battles and we do the best we can.

Dave DeMarco MD:

This is where, yeah, we just you learn as you go and grace should be something you should give yourself, but if you do it with other people, it's going to be even more valuable. So it's said, you can do a lot of hard things for a long time, as long as you don't have to do it alone. And I encourage, you know, get in with another person or a group. So group training is fantastic if you can do that. And yeah, those are the things I would say.

Michele Folan:

And it's funny. So Dr DeMarco andI spoke about all this when I was in the office with him and I had been doing some sprint training. I had started doing that prior to seeing him, so that was good. I have added in some inclined walking on a treadmill to get my heart rate up a little bit more, and that has been very interesting, already noticing some body composition changes with that. So I will say that's been a good one. I will say that's been that's been a good one.

Michele Folan:

And I decided that I wasn't getting sore after I worked out. Even though I was progressively lifting heavier weights, I probably still wasn't lifting heavy enough. So I rejoined the gym and I'm doing machines and heavier free weights and I am getting sore, but it's a good sore. It's not a debilitating sore, it's a hey, I worked out yesterday kind of sore, and these are all things that are simple to do. I just needed that push of getting the body scan to say, okay, I want this for my next 20, 30 years. This is what I want for myself, and this has been an incredible motivating experience for me to get me started on this journey, and so I thank you for that.

Dave DeMarco MD:

It's my pleasure.

Michele Folan:

Yeah, and his office really is nice and the ladies are great too. And on that note, just what for women that are listening, because I would say typically my audience is at least 50 plus, maybe even 55 plus what's one test or scan or service that you wish every midlife woman could prioritize this year?

Dave DeMarco MD:

Oh, I would have to say it's the DEXA scan for body composition.

Dave DeMarco MD:

It's going to tell you information that you just can't get from other avenues. The only other tests that can be as precise or more precise are thousands of dollars and cause claustrophobia from MRIs. It's just cost prohibitive and it's not offered and I don't think you need to go through all that. You get great data from a DEXA scan, learn the what, get that baseline and then from there we can build out and we can build precision around the how with nutrition, the how with fitness, and really help you hone in and what we can't do for you. We can connect you with other people who are capable of helping you even further from a nutrition or dietetics perspective or fitness training. We don't want you to get hurt and we want you to do things well, so we're always going to try to put you in the hands of competent professionals that can help you when it goes beyond what we're able to do for you here but there's a whole lot with lifestyle medicine we can do for you here.

Michele Folan:

And just before we wrap up. So Dr DeMarco's office is in Cincinnati, ohio, but there are DEXA-Fit locations around the country, correct?

Dave DeMarco MD:

Correct, we're up to about 60 different sites Now. Every one is different, not all are run by physicians, but every single one is going to be able to give you the same data that I provide through the DEXA scan. And they're all great, and I would say you can find them on East Coast, west Coast, north and South, and they're even in other countries. We're in Singapore, we're in South Africa, we're in Sofia, bulgaria, of all places. So, yes, there's lots of locations and your data follows you of all places. So, yes, there's lots of locations and your data follows you. I've had patients come from an Orlando site and get their second scan from us and the data is all right there. They can compare.

Michele Folan:

Oh, fantastic. Oh, that's great to know. All right, Dr Dave DeMarco, this was such a fun conversation. I am looking forward to seeing you in five months because I'm going to come back at the six-month point and I will report back then and I invite everybody to be on this little journey with me. So thanks for being here today.

Dave DeMarco MD:

It's my pleasure have a great day.

Michele Folan:

You too. Hey, thanks for tuning in. Please rate and review the show where you listen to the podcast. And did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.