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What really helps prevent injuries—and what should you do when one inevitably strikes? In this episode, I use my friend Tim’s pickleball injury as a jumping-off point to explore what the evidence actually says about ice, rest, NSAIDs, stretching, and more.

When Tim skipped his warm-up and pulled a calf muscle, it raised a question many of us face: was it avoidable? While ancient wisdom and modern influencers often shout conflicting advice, this episode sorts through the noise to uncover what’s evidence-backed, what’s outdated, and what might actually delay healing. For pain, yes, ice works—cooling slows nerve conduction and can help with comfort, as seen in this study of ankle injuries. But does it reduce inflammation in a helpful way? Possibly not. Some research suggests that vasoconstriction may hinder the delivery of reparative cells and removal of waste, as noted in this trial.

The evolution from RICE to PEACE to MEAT and even PEACE & LOVE reflects our shifting understanding. A meta-analysis of 22 randomized trials found no conclusive benefit of ice when added to compression or elevation. As for NSAIDs like ibuprofen, the Cochrane Review revealed no significant advantage over acetaminophen in pain relief or swelling reduction—and no clear evidence they speed up recovery.

What about rest? Surprisingly, prolonged rest may do more harm than good. The Deyo study and later NEJM data show that continued normal activity (within pain tolerance) results in faster recovery than either bed rest or structured exercises, at least for acute low back pain—offering insights that might extend to other strains or sprains.

Can you prevent injuries altogether? Static stretching (think toe touches) doesn’t show strong support in RCT reviews, and while a recent meta-analysis found a small reduction in muscle injuries, the impact was modest. Dynamic stretching remains inconclusive according to current evidence.

The takeaway? When treatments or prevention strategies are studied over and over yet results remain ambiguous, it likely means any real benefit is small—a principle I call “Dr. Bobby’s Law of Many Studies.” Compare that with fall prevention in older adults: 66 RCTs involving 47,000 people showed strength and balance training significantly reduces falls by 20–30%. When something works, it tends to show up clearly and consistently.

Takeaways:
If you’re injured, ice and NSAIDs can ease discomfort—but don’t count on them to speed up healing. Resting too much may slow recovery; try gentle movement instead. Stretching might help a bit with prevention, but don’t expect miracles. Evidence

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We all want to live long and well—but how do we determine how many good years we have ahead?

In this episode of Live Long and Well with Dr. Bobby, we explore how to estimate both our total lifespan and the number of years we can expect to remain active and pain-free. Dr. Bobby reflects on personal experiences, emerging science, and time-tested frameworks to help you reframe your health trajectory with clarity and motivation. While we may not find exact answers, the tools and thought experiments shared in this conversation can shape the way we live now—and influence how we plan for the future.

We begin with why this topic matters, touching on personal stories of loss, aging milestones, and medical advancements. Then we move into three frameworks: how many years you might live (using tools from actuarial tables to cardiovascular risk calculators), how many of those years might be "good," and the wildcard of unpredictable events.

The simplest predictor comes from actuarial life tables, which estimate life expectancy by age and sex. A 55-year-old man today might expect to live to 79; a woman to 82. More advanced tools include the Framingham Risk Score, which factors in cholesterol, blood pressure, smoking status, and diabetes to estimate 10-year cardiovascular risk. Research suggests that sharing these risk scores can lead to behavior changes, as shown in this meta-analysis of 28 studies and preliminary evidence of outcome improvements.

On the genetics side, polygenic risk scores offer a glimpse into inherited risks, though they remain research tools for now (Nature study). More accessible are tests for specific genes like APOE4, which increases the risk of dementia (PubMed).

Beyond numbers, simple physical tests can offer insight. The Brazilian sit-stand test links mobility with mortality risk: fewer than 8 points doubles your six-year mortality risk. Grip strength, too, is a strong predictor of all-cause mortality across 17 countries (PubMed).

While biologic clocks based on DNA methylation are generating buzz, their utility remains limited due to variability between samples and testing methods (Nature Communications).

When it comes to estimating “good” years—those lived free from major pain or disability—the data are sparse. Some disease-specific tools (e.g., for MS or dementia progression) exist, but there’s no universal actuarial equivalent. However, we know muscle mass and aerobic capacity decline predictably with age—1–2% muscle loss per year and a 10% drop in aerobic fitness per decade (OUP Journal). Predicting your future function can begin with assessing how far you can walk, whether stairs leave you breathless, or how your weight and strength compare to a decade ago.

Finally, we can’t forget unpredictable events: the odds of a serious fall increase significantly after 65, and vision or hearing loss multiplies that risk (NCOA). Building physical resilience now can reduce these odds—see

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In this episode, I revisit the most powerful tool for longevity—exercise—and unpack fresh research that changes how we should think about its timing, type, and impact.

We begin with a quick recap of the foundational elements covered in Episode 2, emphasizing that aerobic activity can lower the risk of mortality, heart attack, stroke, cancer, and dementia by 20–30%, even when started later in life.

Then we explore compelling new studies that show how exercise affects everything from blood pressure to brain volume. A meta-analysis of 14,000 participants shows even 15–20 minutes of moderate exercise daily lowers blood pressure. A review of 19 trials links physical activity to better sleep efficiency and reduced wake time. In terms of weight management, a meta-analysis of 116 randomized trials finds that even 30 minutes of exercise weekly leads to measurable weight loss, with a dose-response up to 300 minutes per week.

Exercise also appears to influence mood. A review of 33 observational studies involving nearly 100,000 adults suggests that 5,000–7,000 steps daily correlate with reduced depressive symptoms. While causality remains uncertain, the association is intriguing. Beyond mental health, strength training may reduce inflammation: 19 trials show CRP levels dropped in adults who engaged in resistance training. Perhaps most excitingly, a smaller study found higher cardiorespiratory fitness linked to greater hippocampal volume and better memory in older adults.

To optimize these benefits, we explore emerging science around exercise timing and routine structure. A large study of 14,000 users wearing devices found that intense workouts within two hours of bedtime delayed sleep onset by 36 minutes. Perhaps finish workouts at least four hours before sleep for better rest. Interestingly, data from over 400,000 adults reveals that women gain more longevity benefit from exercise than men—and with less time invested.

We also cover weekend warriors. A UK Biobank study showed no difference in health outcomes based on when exercise occurred, debunking the belief that daily consistency is essential—what matters is that you do it. If you're sleep-deprived, caffeine might restore performance, as shown in a 10K time trial study. Lastly, a novel study using post-workout cold exposure showed that cold immersion reduced blood flow and amino acid uptake for up to 3 hours.

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In this episode of Live Long and Well, I'm joined by Dr. Anthony Pearson, a board-certified cardiologist known for his evidence-based yet refreshingly skeptical take on mainstream cardiac care. Together, we explore the nuanced science behind heart health and how you can make smarter decisions to protect your cardiovascular system—starting today.

We open by recognizing that heart disease remains the leading cause of death for both men and women. While many of the six pillars of longevity—from exercise to stress reduction—play protective roles, today’s episode zooms in on two powerful, sometimes polarizing topics: the role of diet in heart health and the value of coronary artery calcium (CAC) scans.

Dr. Pearson shares how a personal brunch conversation with his wife challenged decades of low-fat dietary dogma, prompting his transformation into the "Skeptical Cardiologist." Here is a summary showing that dairy won't increase risk of cardiovascular disease. He recounts the

We dive into the broader saturated fat debate, highlighting how different fat sources have varied effects on cholesterol and cardiovascular risk. While dairy fats may be benign or even beneficial, others—particularly those consumed in excess on paleo or keto diets—can raise LDL cholesterol substantially. Dr. Pearson discusses the Keto-CAD Study, which found that even lean, low-risk keto followers may build up arterial plaque if their LDL levels skyrocket.

The conversation then shifts to the calcium heart or CAC scan, a non-invasive $100 screening test that quantifies calcified coronary artery plaque via CT imaging. While traditional risk calculators like the pooled cohort equations often fall short, CAC scoring offers a personalized look at actual plaque burden—critical since many heart attacks occur in people not flagged as high-risk. As Dr. Pearson explains, a high score doesn’t mean you will need surgery. Instead, it’s typically a cue for lifestyle and medication adjustments, not invasive procedures. He references the ISCHEMIA Trial, which found no benefit from stenting stable, asymptomatic patients over optimized medical therapy.

We close with practical advice: talk to your doctor, especially if you have a family history or fall in that “borderline risk” zone where a CAC score might influence your care plan. And yes, it should be okay to keep enjoying that butter—as long as you’re informed and mindful and don't overdue it.

Takeaways: Full-fat dairy is not the enemy—it may even be heart-protective. If your LDL skyrockets on keto, that’s a red flag worth addressing. CAC scans can personalize your prevention plan and offer peace of mind or a critical nudge toward action. Want more clarity on your own heart health journey? Talk with your doctor about whether a calcium scan makes sense for you and explore Dr. Pearson’s writings on The Skeptical Cardiologist and MedPage Today.

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The microbiome receives lots of attention, but what do we really know? In this episode, Dr. Bobby unpacks whether your gut bacteria are truly the key to preventing disease—or if the science still needs to catch up.

Microbiome buzz is everywhere—from promises of inflammation relief and weight loss to claims about mental health and longevity. But what does the research actually say? Dr. Bobby begins with four essential questions: Is the microbiome important? Does it change based on our habits? Do those changes cause disease? And can restoring it improve our health?

Using his open-minded skeptic lens, Dr. Bobby explains that while mouse studies offer compelling clues—like the famous “fat mouse, skinny poop” experiments showing weight gain linked to microbiome transplants—the same effects haven’t translated reliably in humans. A rare exception is C. difficile colitis. Here, fecal transplants have up to a 90% success rate, with medical societies endorsing this approach (source).

For other conditions like diabetes, rheumatoid arthritis, and Crohn’s disease, microbiome disruptions are well-documented. Still, whether these disruptions cause the illness—or are just innocent bystanders—is unclear. In diabetes, for instance, small studies and reviews show possible improvement in insulin sensitivity after fecal transplants (source) and mixed outcomes with probiotics (source), but nothing rivals the proven power of standard therapies like metformin.

Dr. Bobby also explores whether lifestyle choices—such as eating more fermented foods, fiber, and taking probiotics—can truly “reset” your microbiome and keep us healthy. The answer? These may enhance diversity and gut health, but current data doesn’t yet confirm long-term disease prevention. He references findings from the NIH Human Microbiome Project (source) and other studies showing how gut bacteria influence immune development, vitamin production, and digestion (source).

He also touches on terminology: probiotics are live bacteria (think yogurt and kombucha), prebiotics are their food (found in beans and whole grains), and postbiotics are beneficial byproducts. Each plays a role, but their direct impact on human disease remains uncertain.

Dr. Bobby closes with this: he enjoys homemade yogurt and sauerkraut, but doesn’t chase expensive probiotic supplements. “It can’t hurt and might help,” he says—but don’t expect probiotics to fully replace conventional treatment. As research evolves, he’ll continue to watch the space closely—and encourages listeners to let him know if this type of deep-dive, still-unsettled topic resonates.

Takeaways:

1. Fecal transplants are a proven, effective microbiome treatment—for C. difficile, not for general wellness.
2. Most microbiome buzz comes from animal studies, and evidence in humans is still preliminary and inconsistent.
3. Eating more fiber and fermented foods likely supports gut health, but won’t replace proven medical treatments.

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Can a simple habit like flossing really reduce your risk of stroke? In this episode, Dr. Bobby unpacks the headlines sparked by a recent presentation at the American Stroke Association’s International Conference that claimed regular flossing could reduce stroke risk by 20–50%.

Dr. Bobby begins with a refresher on the importance of stroke prevention. From there, he explores the biological plausibility of a connection between oral health and cardiovascular events. While Americans are fairly diligent about brushing (with 90% brushing once daily and 60% brushing twice a day per YouGov data), flossing habits lag significantly (NIH Oral Health Study—highlighting a clear opportunity if the flossing-stroke link is real.

Dr. Bobby dives into the study behind the headlines, a new analysis from the long-running Atherosclerosis Risk in Communities (ARIC) study, which tracked over 6,000 individuals for 25 years. The preliminary finding: regular flossers had significantly lower risk of ischemic and cardioembolic strokes (Study Abstract). Surprisingly, brushing and dental visits showed no significant benefit in this analysis.

So why isn’t this flossing-stroke connection headline a "five-alarm fire" in medicine? Dr. Bobby explains the limitations: the results were shared via a conference abstract, not a peer-reviewed journal article. Without full access to the data or understanding how many other hypotheses were tested from this large dataset (which has already generated over 2,300 publications), we risk falling into the trap of correlation being mistaken for causation.

To further evaluate the credibility of this association, Dr. Bobby introduces the Bradford Hill criteria—nine principles to assess causality in observational studies. While the biological plausibility is strong and the effect size notable, the study fails on criteria like replication, dose-response, and publication rigor (Bradford Hill Overview).

In closing, Dr. Bobby affirms the benefits of flossing—not necessarily for stroke prevention, but for better oral health, which is valuable in its own right. He shares his personal oral care routine, including flossing nightly and using a water jet, while reminding listeners to stay evidence-informed in their health decisions.

Takeaways
Flossing likely improves oral health, but its role in stroke prevention remains unproven.

Be cautious with headlines drawn from unpublished conference abstracts—they’re a starting point for inquiry, not a reason to change behavior just yet.

"How to Live Long and Well" at DrBobbyLiveLongAndWell.com.

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Resilience is crucial as we age, especially when it comes to maintaining muscle, joint, and bone health. In this episode, Dr. Bobby DuBois discusses how building physical reserves early on can help withstand inevitable changes and setbacks as we get older. Just like investing in an IRA, the earlier you start building your physical resilience, the better prepared you’ll be for the challenges of aging.

Dr. Bobby shares insights from his interview with Karen, who experienced a rapid decline in strength after a period of inactivity. Despite previous success with weight loss and fitness, Karen found herself struggling to lift groceries after weeks of illness and time away from the gym. Her story highlights the importance of maintaining muscle mass and staying active, even after setbacks.

Key Points:

1. The Impact of Inactivity: As we age, muscle loss accelerates. We can lose 1–2% of muscle mass per year after age 30, and inactivity can drastically speed up this decline. Strength exercises, even when started later in life, can still yield significant gains (study).
2. Muscle Memory and Recovery: Muscle memory helps regain lost strength more rapidly than building it from scratch, but the recovery time lengthens with age. Karen’s experience reinforces the importance of staying consistent, even when life gets in the way.
3. Protecting Joints: Joint cartilage thins with age, increasing the risk of osteoarthritis. Contrary to popular belief, regular running does not inherently damage joints. However, previous injuries significantly raise the risk of osteoarthritis (study).
4. Bone Health Maintenance: Bone density peaks around age 25 and gradually declines, especially after age 50. Engaging in weight-bearing and high-impact exercises can help preserve bone density. Heavy resistance training is especially beneficial for maintaining bone strength (study).
5. Supplementing won't solve the problem: Calcium/Vitamin D supplements don't seem to solve the problem.
6. Practical Tips for Resilience:
   • Keep your protein intake between 0.5 to 0.75 grams per pound of body weight to support muscle maintenance.
   • Incorporate cross-training activities during periods of injury or illness to maintain fitness.
   • Focus on exercises that build both muscle and bone density, such as resistance training and weight-bearing movements.

Takeaways:

• Aging is inevitable, but weakness isn’t. Building resilience through consistent exercise and strength training is crucial to maintaining independence and quality of life.
• Don’t give up after setbacks—muscle memory and consistent effort can help you regain lost strength.
• Prioritize activities that strengthen both muscles and bones to minimize the impact of inactivity and age-related decline.

Live long and well by staying resilient and proactive. Remember to keep moving, invest in your muscle and bone health, and stay committed to your fitness journey. If you found this episode helpful, please share it with others and rate the show!

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Summary:
What happens when you need a brain MRI—but the results leave you with more questions than answers? In this episode, I take you through my personal journey of facing unexpected MRI findings, the emotional and medical challenges that followed, and the valuable lessons I learned along the way. If you've ever dealt with medical uncertainty, this episode is for you.

Key Topics & Takeaways:

• The Decision to Get an MRI – Why my persistent vertigo symptoms led me to pursue brain imaging.
• The MRI Experience – What to expect, including the impact of claustrophobia and tips for managing anxiety during the scan.
• The Immediate Shock of Results – Understanding what “chronic microhemorrhage” means and how I navigated the initial fear.
• Seeking Answers – The process of finding a neurologist quickly versus waiting for a super-specialist.
• The Power of Medical Conversations – How reviewing my MRI images in detail helped clarify what was truly concerning (and what wasn’t).
• Lessons for Everyone – How to approach unexpected medical findings, manage anxiety, and make informed decisions about your health.
• Practical Next Steps – From tracking symptoms to preparing questions for doctors, how to take control of your health journey.

🔹 Take Action:

• If you've ever faced an unexpected medical result, take a step back, ask the right questions, and seek out the right specialists.
• Interested in the six pillars of longevity and wellness? Download my free eBook "How to Live Long and Well" at DrBobbyLiveLongAndWell.com.