How to get rid of asthma that often recur

>> you guys tell mewhen you want me to get started. we good? what time does everybodyhave just a little after one? >> one. >> okay, great. well two hours is a longtime to go, but we're going to go there.

this is a combinationof pitches i sort of put together that wouldusually go about four or five hours, so we're goingto condense them and i'm going to throw a lotinformation at you. and i'm going to talkabout space medicine applications forterrestrial wellness, human performance andlongevity and i'll be coming to you as a flightsurgeon because that's been sort of my day jobhere at nasa for the last

20 years, 20 yearsas of last april. working the clinics,supporting the astronauts as they fly, they do mlbruns, working mission control. i've supported about 26shuttle missions and two long-duration missions andthen i've been basically worked in the clinic thelast couple of years i run the clinic. and so some disclosures,this is the other stuff i

do i'm on the clinicalfaculty at utb and at wright state, departmentsof aerospace and preventative medicine. i've trained in internalmedicine and aerospace medicine and aerospacemedicine is basically taking very healthy peopleand putting them in a very unique environment. i'm presently i'm themedical director for the occupational and flightmedicine clinics.

i'm the lead for thewellness in human performance program andthe iss fatigue management team. hey, come on in. hey, welcome. >> you messed up my introduction. i was gonna introduce you. >> you were goning to introduce me? >> yes i was.

>> oh i didn't know that. i was just going to makeit easy on everybody. >> so i will doit at the end. >> do you want todo it at the end? okay. >> well i have some little known facts that i... >> oh well then lets just wait until the end. i am on the advisory boardfor and i also do the medical standardsfor the astronauts in

international. i'm also on the advisoryfor virgin galactic and i am on the scientificadvisory board for lighting sciences. and i'm on the board ofdirectors for houston hospice andpalliative care. two of the things thatone of my great mentors in residency in med schoolsaid you probably -- he said what are you going toend up doing, i said don't know

he said well you'reprobably going to do the things that kind of getyou upset the most and the things that we don't dowell are end-of-life care and preventative medicine,so those are kind of my passions and that'swhere i'm coming from. that's what this wholetalk's about today or discussing thosesorts of things. i have been a researchconsultant with injury reduction technology.

i'll show you as far assome publications we've done with them. i'm one -- i was onthe oversight advisory committee for nationalscience foundation polar medicine program. and was on the internalmedicine department at the va hospital and was amedical officer at wiley from 91 to 94. so i've beenhere since 1991.

hey, welcome everybody. and i have no financialrelationships than those to disclose as far asmaking any money off those things that have anythingto do with today's talk, so get thatout of the way. so space medicine,applications for terrestrial wellness,human performance and longevity. that's what we'rehere to talk about.

it all comes down tofamily okay, a lot of it. and of course, we've allgot a little, you know, crazy uncle that's alwaysgoing the wrong direction of the family. but you learn a lot inmedicine that's one of the first things we do isask about family and your family history. and so genetics as youknow is becoming more and more important and we knowfrom twin studies that

basically genes are about20 to 30% of us, okay. the rest of it isenvironment and how our genes handle thoseenvironmental stressors. and there's somepopulations that outlive us by 8 to 10 years withonly one year's difference in death rate betweenmales and females and we'll talk about those. so personalized genomicmedicine is really something that i'mjust going to touch on.

this is actually a wholetalk in itself, but i've got a few slides. it's trying toindividualize what your genetic susceptibilitiesare and your strengths are and how you can usethose to target different medical therapies. and everyone isan individual. i've got 14, 15 peoplein the space station and everyone's going to work,you know, is maybe taking

a differentsleep medicine. and you've probablyheard in the paper about astronauts taking allthese sleep medicines and i'm happy todiscuss that also. which is we do use a lotof sleep meds, but we ground test them and wedeveloped a very unique program on how to do that. in other words, you wantthe right medicine at the right dose at the smallestamount of dose you can to

work. every time i've prescribe-- i hurt my arm or leg, you know, what's rightdose of motrin or ibuprofen or tylenolfor somebody. so we're kind of alwayskind of trying titrate that medicine tothe right dose. so let's talk basics,let's talk genetics. very basic, we've gotabout 20,000 genes in us with about 6billion base pairs.

and what is a gene, a geneis simply something in your body that codes andmakes a protein that goes and does something. and may or may not affecthow you end up with a disease or not okayor avoids a disease. and so it's simply -- agenotype is you've got these 6 billion base pairsthat we can now copy and look at and then welook at people that have certain diseases andwe see if there are

associations. it may not because-and-effect, but there's something goingon with this gene that because it gets hitby this environmental stimulus makes a proteinthat may afford us to be susceptible tothis disease. and so those the basicsand that's the 20 to 30% of the equation thatwe'll talk about. now genotype this wouldbe a phenotype of michael

phelps at a very young ageokay, as he is swimming faster than these otherlittle folks trying to get to the golden prize. well we all know theenvironment is huge that if michael phelps smokestoo much pot or doesn't exercise that he is notgoing to make it to the golden prize. i'm trying throw a littlehumor and trying to keep you awake.

and my plane got in at3:30 last night so i'm at about 25 to 30%deficit right now so. i'll be stuttering alot, which i do anyway. the bottom line is houstonis home to one of the genomes, one of thesix genome projects. it took about $3 billionand we sequenced or not we, they sequencedwatson's dna. it took two months anda million dollars to do that.

the good news is that therevolution in technology preliminarychain reaction. you basically splaythat dna open and you photocopy it. and because the technologyhas gotten so incredible what used to take amillion dollars in 2007 we're now doingthe kelly twins. okay we're flyingidentical twins we're going to have scott kellyin orbit and we're going

to have mark kelly on theground and they're going to be controlsfor each other. so now we're going tohopefully get to see a little bit of one of what the space environment and that'swhat we'll talk about. what kind of an effect ithas on at least one pair of twins. so mark will hopefully onthe ground be acting as a control doing similarexperiments, you know,

eating similarfoods, all that. just not being exposed tothe radiation, the carbon dioxide and allthat kind of stuff. the other neat thing wecan do is you don't have to sequence all 6 billionbase pairs, you can actually -- there are hightargeted genetic markers that you can do it'scalled a gene chip. so instead of looking atthe 20,000 genes you can look at around 1,000 genesthat we already know a

great deal about. and you can find out awealth of information on and i'll show you i'mgoing to use myself as an example and in 2013, itwas $350 to go get a gene chip which now you cango for 23andme you can go online, i'll take youonline you can put down $99 they'll sendyou a little box. you spit in the box, yousend the box back with the mailman and four to sixweeks later it comes back

with a wealth ofinformation on gene chips and your traits, yourinherited conditions, things that you can passon that aren't good like cystic fibrosis and thosesorts of things to your kids. it will tell you -- reporton 240 health conditions. it also got squashed bythe fda back in november because it didn't jumpthrough certain hoops and it was revealinginformation that they

didn't think -- was sortof false advertising. like you're going to gointo your people and say you've got this geneand they were kind of freaking out. if you get the geneyou're going to get it. if you got the alzheimer'sgenes you're going to get alzheimer's. no, no, no not at all. and people go well, youknow, why would you want

to know that and certainpeople don't want to know that. well i will explain to youthat you do want to know that because there's alot of stuff you can do to prevent it okay. it's the environment andthat's what we have to -- that's what youhave to understand. you halve your risk ofalzheimer's by walking 30 minutes a day, fivedays a week okay. so you could probably makehuge differences in the

foods you eat and theamount of exercise and the things that you do. so they're working withthe fda and i'm happy to show you my 23andme. you can go in and join23andme for $99 it's a wealth of information. and you'll find out aboutancestry, i think it's starting to try to bea chatroom like i get notifications oh, youknow, 13 of your 4th

cousins just signedup to 23andme. do you want to chat withthem, no i don't, i don't no, no, no. so it's a very goodabout privacy issues. and the problem with someof the stuff is you can't lose your healthinsurance now because of legislation. you could lose yourlife insurance. like the informationi'm going to show you on myself today if my lifeinsurance policy knew

about this and i have lifeinsurance through nasa what am i doing. no, you know, if theywanted to if they were bad people they could getrid of your insurance. and so those laws are inthe works to try to be in place because what weneed to do is we all have strengths and weaknessesand we all need to pool our resources tohelp everybody. there's always going to berationed healthcare and i

am doc of the day, hold onin the clinic and i will probably justturn -- hold on. okay, sorry. i've got a resident overthere so he'll be fine. anyway, so and i'llwalk you through this. bottom line, you know,having some genetic information might tellus who this person's we have no idea of injury, he justlanded in a soyuz okay.

who is and these folkswere on the same mission and one guy's neuralvestibular system is doing pretty well theother's is not. so would help inform us,you know, what genes -- it's not bad that you'vegot very sensitive neural vestibular system theyhelp you in some ways, it's just they don't helpyou be a fighter pilot or an astronaut when you'rereturning from 0g. so my whole deal, i'mgoing to speed it up now

or we'll be all day islooking at the genome, look at the environment,and how does that equate into wellness and then iwant to throw another hook in it, which a lot ofpeople don't do and that's longevity okay. because it's not justabout the astronaut's career or mission,although that's a big deal and i'll give you examplesof that as i talk, it's also now i have the greatpleasure of taking care of

a lot of theretired folks. you know, i sat down withone this morning for about two hours with amedical list like this. and actually those arethe folks that i'd like to talk about and that's whatsince i'm turning 60 here in another month i'm kindof interested in that also. and it's nothing grandmadidn't tell you, you know, it's what you eat, it'swhat you breathe, it's

your fitness, it's yourstrength and it's your psychological well-being. and the number onequestion i ask to see how someone's doingpsychologically is a very simple question, howare you sleeping. okay, it's like myfifth vital sign okay. so that's very importantif you're sleeping well you're probably doing wellokay and we'll talk more about that.

i'm also going to tryto talk about again, go through this, but i'mgoing to try to get you my experience on, you know, what you should be eating,what you shouldn't be eating, you know, what youshould be doing or this and that. or the fact that they're acontinuum they're all four things that work together. if i and i'll use myselfas an example and my

genetics and my medicalconditions, you know, if i haven't slept wellwhich i haven't. if i haven't exercised,which i haven't in the last two days. and if i'm under somestress, i am, then i eat my twigs. you know, i make sure ieat my vegetables i don't eat anything that canpredispose my endothelial wall, the lining of myblood vessels to aging and we'll talk moreabout that.

so what to eat. well, you know timemagazine one day has all these great thingslike, you know, kale and vegetables and fruits andlean meats and the next day they come out and sayeating butte is fine okay. so they're both right andi'm just going to -- the problem is we eat too muchof the damn stuff okay. so it's not that it's badfor you, it's also it's moderation and it's alsohow we cook it okay.

if we overcook it like withour meats and it's also chemicals and i'lltalk about that. you know, we do a reallygood job of blowing up plants and smoking cattle,we eat a lot of smoked beef. so again, it's what we eatand what we breathe and we have really fast horseshere and also the chemicals that areprobably in our food and that's what our mostpreventable diseases are. again, it's smoking andobesity okay, compared to

all these other things andit's kind of eating our lunch. we are living longer, butas a society we're not living healthier, althoughthere's some indicators that we may be sort ofchanging those things and you see how incrediblethe obesity is out there. and so that sets you upfor chronic inflammatory problems and we'lltalk about that. depending on where youlive in in this area you're going to have moreasthma, you're going to

have 2 to 3 timesmore lung cancer. you just saw the wholething on galena park, you know, with the dieseltrucks going through and they're having aspike in cancer. so it matters, you know,depending if you live downtown. i just was in new york afew weeks ago and i just -- it was a warm day andthere is no breeze, there is just high buildings itwas throughout the whole day.

so we know that when theozone layers are higher or the particulate matter isreally, really high you're going to have more heartattacks, you're going to clog yourself up. air pollution will killyou and if you live in northern china you diefive years sooner than if you live in southern chinathat's because that's where theircoal plants are. so that's why this thingthat we've all built in

this room and we shouldfeel very proud of that is just a great environmentbecause it's such a closed-loop environmentand it's such a great laboratory not only foraerospace engineering and, you know, workingtogether, but also as a as a medical platform whichis what a lot of us have spent our livesworking on. and you know it matterswhat you breathe. this is dan basicallycleaning the filters

because dust floats,that's why we use a lot antihistamines, we have alot of chronic congestion up in space. it can be a realproblem for folks. what we eat is soimportant and then exercise. we've been working, ofcourse, with the medical problems in spacewhich we'll talk about. exercise, we've come along way in developing

exercise programsfor our folks. that's dr. mike barrettwho i trained with up at wright state universityin dayton and had the privilege of working withhim as a flight doc and now as astronaut. and the good news is we'regetting smarter, i mean a lot of people, you know,what's going on in the space program are you guysstill doing things and we've never worked harder.

we've got six people inorbit all the time and it's amazing what we'relearning and in here this is just on our problemfloating and osteoporosis losing all that calciumand here is what we've learned from -- this iszero, this is your no loss and this is where mostpeople came back after being up in space for 3to 6 months on their hip, total hip. this was the mir spacestation usually at about

an 8% decrement in totalbone mass on a dexa scan some people down here. then we got the issared interim resistive exercise device. we got better and thenwe got the ared, we got better and thenbisphosphonates. we've used medications,we've gotten really, really good on vitamin dlevels and so now some of our folks are coming backwith normal bone mass.

so that's areally good thing. so what am i going to dotoday is talk about the role of genetics,environment, nutrition, fitness, psychologicalwell-being and astronaut health and wellness. and explain all the thingsthat we've done in space medicine pre-flight,screening in-flight countermeasures,post-flight longitudinal occupation surveillanceprograms which i think we

need more and more of. and how that's going tocontribute to astronaut and cosmonaut health. and then i'm going to tryto apply all these things to our day-to-day lives,what are we learning from these folks. and it's kind of fun stuff andwe're going to have a good time too because you neverknow what's going to pass by. i was sitting in the lineat a grocery store and dan

called me on the cellphone going what is this, i didn't know this and itwas the lovejoy comet and i didn't know what it waseither, but it just shot by. okay, so what do i get todo, i get to take some of the healthiest peoplein the world because we screen them and put them-- that's original mercury 7 of course and put themin some of the funkiest environments youcould imagine. and it is, you know, theuniqueness of space, the

fluid shifts areinteresting, things are just different. again, bone loss becauseof disuse osteoporosis, vestibular problems, fluidshifts and radiation and radiation is abig deal okay. and also a high carbondioxide environment okay. and then the other thingthat we've made the news lately is sleep and it canbe a very user unfriendly place to sleep loud, backpain, you're 2 centimeters taller or 3 centimeterstaller, you're 2

centimeters taller or 1 or2 every morning you wake up. and then you stand up andyou squash your spine. you don't do that upin orbit and it takes sometimes weeks and monthsbefore that back pain goes away. some astronauts willtell you they never slept better when they get up inspace, but a majority of them have a tough timebecause of the stresses, of the schedules, and iwill also show you the lack of a day night cyclewhich is really important

and that's one of thespinoffs that we'll talk about. if you're hearing about anastronaut being sick then i'm not doing my job i'vemouthed off too much okay. but astronauts do get sickjust like all of us and these are some of thethings that we fixed kidney stone, prostatecancer, brain tumors, coronary disease, shouldersurgeries, diverticulitis, v-tach. these are things thatwe fixed and flown.

we've had afib, we've hadfive oblations of atrial fibrillation, we didn'tfly all those folks, but there's a lotof stuff there okay. and one of the biggestcomplaints up on the shuttle of medical events,this is a presentation i gave a few years back. space adaptation syndrome,but insomnia and fatigue is again one of the bigthings that we battle with and that's one of the bigthings i'll talk about

here fatigue. and it makes a differenceas far as how you perform and how long you liveand how well you live. and again, having thisplatform, having the international spacestation and living for long periods of time witha lot of folks lo and behold you find outwhat's going on. we've got a visualimpairment, intracranial pressure okay, it'sjust come out in the lay

population now inseveral publications. so what's going on there? well, people are notdraining their brain well, that fluid shift going up. i mean think of if youbasically lived in an 8 degree head downtilt all the time. some astronauts said theyfeel like they've got their head in theirlap a lot of the time. so you lose like rightnow, if you put an

ultrasound probe on myneck right now and looked at my jugular vein it'sdraining my brain you wouldn't find it becausethere would be so little blood flow. if you lie me flat thatvein is going to go like this. now if i sit here strainreal hard because my heart and my lungs are pushingand blocking that flow, whoa i've got mysunglasses on, hold on cool okay.

you wouldn't -- if istrained you would see this thing open up becauseyou would impede the flow of blood from your braindown to your heart. well if you're lying in ahead down tilt it's going uphill. you also lose theback drainage from the vertebral system ofthe back, so you're not draining as well. and so what we're actuallyseeing this part of the

optic nerve and disk areactually getting inflamed, cerebrospinal fluid is inthe blue and we're seeing this thing push forwardand we're seeing visual changes. we also saw visualchanges, just if you're tired you'll see a half adioptre visual change or when you first get up inthe morning if you happen to sleep on your face likethis you've been pushing on your eyeball you'llsee visual changes.

but then we started to seesignificant changes and that's because of theeyeball here is getting flattened. and why is this and we'reactually seeing other things going on in theback of the retina. well, there's the fluidshift you're getting puffy and you're not drainingyour brain as well. we're doing a lot ofresistive exercise, well what does that do?

that increasesyour pressure. there are probably somemetabolic genetic factors which somebody has giventhe grand rounds on scott smith next week. carbon dioxideis a big deal. carbon dioxide seems to bethe bugaboo for the planet and it's alsotough for us too. we have about 5 to 10times the amount of carbon dioxide that we have inthis room right now up in

space station. so carbon dioxideis a potent cerebral vasodilator. it probably upregulatesyour cerebral spinal fluid. and, therefore, you'reupregulating your metabolism and you're alsohaving a problem draining it, so you're making moreof a metabolite and you're having more troubledraining it and that's not

good. being a seclusion if youhappen to have a big neck and yoursternocleidomastoid matches up with yourcarotid and your jugular in just the wrongway or the right way. it's good for you whileyou're here, but if you're up in space those thingsimpede your jugular from draining your brain. and then finally i tellyou that yeah, dr. barter

published using actiwatchthat during docked ops the astronauts average about4.7 hours of sleep a night. and then during regularops around six hours a and all of us at a timewould say hey, that's pretty good six hours. no, it's not and wegot to get over that. we were younger and wecan get away with it. and that's why i quitworking emergency rooms,

you know, i could do the7p to 7a and come in and work and then after i gotto be, you know, around 52 50 i couldn't -- i coulddo it but i couldn't recover it would take 2or 3 days before and i was probably not a happy dador a husband at that time. you know, so that'swhy, you know, sleep is important. it's also and i'll talkabout sleep, that's also where you drain your brainwhen you're sleeping.

you do a lot ofother things. so sleep i think addsto this syndrome too. okay, the other thingi want to talk about is astronauts not only getsick, but astronauts also die. there's only one personin this photo that's still alive okay and that'sjohn glenn he's our oldest astronaut, he's93 years old. so let's look at that.

now we've added four moreto this since this came out in 2012. let's just look at thisfor a second, this is a cap of kapalan-meirsurvival curve from the insurance companies. all right, solet's look at this. at the age of 30 downhere, does every see pretty well, is this okay? okay, the age of 30 andplease if i say something

that's just so ridiculousor you go what, just stop, raise your hand, talk,we're going to take questions and thatat the end of this. but at the age of 30almost 99% of us are still alive. now this is the mortalitycurve, so this black line arenormal males in the us of survival. so at 30 99% of usare alive, at 100 .

.2% of us our alive. there's 63,000 of us outthere over the age of 100 and i'm going to end thetalk talking about those folks. so this is a normal curve,so what does that mean? if you're a male in thiscountry and by the way females are over this waybecause they don't do -- watch this as muchas we do okay. at 80 years of age righthere about 40% of folks if

you're a normal male inthis country are alive. now what are these lines? these lines are if you'venever significantly smoked a cigarette, i mean like,you know, if get over 20 30 pack years that's, youknow, that's significant. but if you've reallysmoked very much it's been over 20 years since youhave, then you move the line over here. and if you're a normalweight person you move the

if you're normal weightand you've never smoked you move the lineway over here okay. so that means if you're 80years old and you've never smoked and are normalweight, well about 80% of the time you're aliveat 80 years of age okay. well how are theastronauts doing, they're not doing really welland that's because of challenger and columbiaand apollo 1 and some airplane accidents.

and they don't really seethe benefits until they get out here in their80's and this is 93. now if you take theflight tragedies out yeah, they're doingexactly where we'd expect them to be okay. we think we've got veryhealthy people that take care of themselves andthat's one of the jobs i'd like to continue to dohere even after i leave is to watch after thisgroup of folks.

and there's probably astandard deviation here that means some folkscould even be out here. i think the record is 122years, there's some lady alive right now. so it's going to be areally good opportunity to follow thesefolks as they get. and i'm going to get olderand i'm going to kind of talk about some thingsthat i think would move this line even higher notonly for them, but for us.

so their job is to keepyou flying, that's john glenn he was 76when he flew. i'm also going to end thetalk looking at boston university schoolof medicine study of centenary. okay, so what have thesefolks that lived past a hundred what do they allhave in common okay and what do they don't have incommon, how did they get there and that'skind of fun.

this is actually i cangive this to you and i'm in the -- yeah, you guyscan e-mail me anytime, i can send you my list of --this is a fun thing, this is actually acentenarian risk model. you can plug in yoursocial history, your family history and yourmedical history and it'll tell you based on thesepeople how long they think you're going to live. and it's fun to go back inthere and play with thins

like daily flossing willgive you six months to three yearsmore like okay. so yeah, it's up toyou, i try to floss. so what i'm trying to dohere today is we're kind of -- my job or our jobas flight docs is mitigate risk throughmedical screening. let's not send anybodyup that has significant disease and if they do,then let's get rid of it so they don't.

if they had a kidneystone, let's get rid of that stone and now wethink we know how that stone formed and we thinkwe can prevent it, we think we've gotten smartenough now that we can fly people that had stones,certain kinds of stones and so we're doing that. or let's find coronarydisease really early, let's fix it, let'sreverse it, which you can do now and let's try tobe able to fly those folks

okay. or it's so bad wegot to go cut it out. we've done that too, wefound people that, you know, had very bad gallbladders and we took them out and we let them flyand those sorts of things. okay and i'm going todo that through diet, exercise, fatigue, stressmanagement, and medical treatment. all right, here we go.

again, genome plusenvironment, wellness, longevity and thoseare our topics. so let's take each one ofthem and i'll give you an expert that says, i don'tcare what you do it's what you eat. no, i don't care what youeat it's your fitness. no you got to beable to sleep. it's all ofthe above okay. and i'm going to do itwith public enemy number

one, i gave this talk atsafety total health day to the astronaut corpsbecause one of my good friends, you know,dr. shaskin over inrussia, one of our flight surgeons, basically hada big heart attack and everybody was kind ofgoing he was supposed to give this talk to theastronaut corps avoiding heat stress and greg wasover in russia and had a heart attack and we didn'tget the defibrillator to

him in time becausehe was out running. so don't run,no i'm kidding. sorry that was trite ididn't mean to take away from this. but great guy and so i wastrying to explain to them what happened here and i'mgoing to try to explain that to you guysas best i know. the bottom line is cardiovascular disease 1 in 3 of us are going to die of it,maybe 1 out of 2 of us if

we keep going the waywe're going and i'll show you that there's no reasonfor anybody in this room to ever need a stent oreven need bypass surgery really, there's no reason okay. unless you're 110 and thenyou wouldn't want any, no i'm kidding. so it's also eating ourlunch with expenses and it's not good. and the good news is thatnew technologies, new

understandings of thedisease process and new treatments andcountermeasures, you can actually stop and reversecoronary disease and that's exciting,that's good stuff. and i'm going to usemyself because i can talk about myself, not that iwant to but in a bad way to show you all my medicalproblems and all the stuff so it'll be fun, i canget away with that not the astronauts and stuff.

so again, there's normthagard and there's uncle phil, i mean there's philstepaniak, looking good isn't he? all right, so again whatwe eat and breath are fuel, exercise, strength,psychological well-being. what do we knowabout foods? we know that trans fats,which are vegetable oils that have been partiallyhydrogenated to give them longer shelf lifeare not good for you.

that they increaseour bad cholesterol. now there are somenaturally occurring trans fats in animal anddairy products. so if you have apredisposition genetically to those diseases, youprobably want to avoid those in moderation ormake sure your numbers are right with exerciseand other things. i'm not saying you don'teat them i'm just saying depending on your genesand i'll show you mine,

you might want to tryto avoid those things. i just got back fromvacation i didn't avoid them, it was fun i gotto lose a little of the weight now. and the other thingssaturated fats again have a little bit of -- i'mgoing to show you that like the butter sequencewith the time magazine again, saturated fats arenot that bad they just have a lot ofcalories in them.

and if you don't burnthose up and you have certain predispositionsthey're not going to be good for you okay. in fact, circulation thisis a really good review article that's pretty old2002, you know, basically said that mediterraneandiet and other diets, with diet you can probablydecrease your risk of having a major coronaryevent by 30% to maybe 50 to 60%.

and their recommendationsback in 2002, don't smoke, use alcohol in moderation,30 minutes exercise, you know, keep your energybalance, don't eat more than 10% of energy fromsaturated fats, less than 2% from trans -- transfats have been outlawed in europe for about 10years, they're about to be outlawed here. you know, they say notrans fats, they still have a little in there,they can still have

saturated fats if they'rejust under a certain amount. so you need to just tryto avoid those things. fish is good and we'lltalk about that, i'll show you how fish isbad in some ways. and eat your veggies, ithink that's the biggest thing. limit salt to 6 grams. if i eat 6 grams worth ofsalt i'm sick, i can't do

it okay, it'sjust too much. but you'd be surprised atjust how much salt is in stuff okay, and youget your taste buds. that's the deal with ourkids everybody gets hooked on high salt, high fat,high sugar and those things are what'skilling us okay. and basically it said backthen that if you did this diet and what i'm going toshow you is people that do much more stringentthan that.

you know, you caneliminate coronary disease in you know anybody lessthan 70 years of age. then the newman journalarticle came out with the mediterranean diet thatbasically monounsaturated oil, olive oil andglycolic acid in walnuts and nuts versus goahead and eat your kind mediterranean, we don'tcare what you eat just kind of eat mediterranean. and they unblinded it at4.8 years because 30% of

folks who were eating themonounsaturated and the nuts were having lesscoronary disease and cardiovascular events. so that was thefirst longitudinal well-controlleddiet study. and now they're coming outall the time it's really kind of fun to seewhat they're learning. i've got a new one ididn't get in this talk, but i'll talk about.

we know that red meatconsumption has been associated withtype 2 diabetes. we don't know if it'sbecause -- it's not probably because of thesaturated fat it's just again because ofthe calories okay. we know that this studyjust came out a month ago that people it's again notthe red meat consumption, but it's the processversus unprocessed. process is nitrosamines,it has preservatives, it

has antibiotics and it'sgot a huge amount of salt in it to keep it packedand keep it preserved. the unprocessed organicmeats, free range, you know, in moderation that'sfine, no problem there i don't think. now, this is of course myfamily, my kid and my wife and myself. we had to go to thevortex and get the triple coronary bypass burger,which is $28.95, four meat

patties, special sauce,three fried eggs, 14 slices of cheese, 10slices of bacon all packaged between twogrilled cheese sandwiches. now, if you just took abit of that that would be fine, but who could justtake a bit of that you know. so that's the problem toomuch, it's just -- give me a break that's why it'scalled a vortex and looks like that, but that'sin atlanta so anyway.

what we're finding is highmeat and refined sugar diets are actuallychanging the gut flora in your gut. there's a different kindof bug that lives in you if that happens. sorry man, i'llcall you back. so that is sort of thenew study, they're finding that our gut, our biomein our gut is probably the biggest endocrineorgan we have in us.

there are more crittersthat live on us than there are us. and so changing that --making sure that your gut flora is the right kindprobably cuts down on the inflammatory process. i mean simple dietchanges help arthritis. they help change -- theydid one study where they took, you know, gut florafrom obese people and put it in white micethey got obese.

they put da-da-da andwent back and forth. and so they're juststarting to study that and so that is somethingthat, you know, will be something that welook at in the future. glucose, your glucoseyou know everybody says i don't care what you eat,i don't care what fats and what meats and all thatyou eat, it's all sugar. and it's not allsugar it's both. if you eat a lot of meatyou're going to have a lot

of ldl and a lotof saturated fat. if you eat a lot of sugarwhat we're finding is what the sugar does is make theldl, the bad cholesterol, low-density lipoprotein,it makes that a tighter, more compact, denser unit. so it's smaller, it's justas dense it's got just as much bad goo on it andthat can get through your endothelial lining, whichi'll show you pictures of. and that can form thisimmunologic good that's in

your deal. also, there haven't been alot of good evidence that, you know, antioxidantsand vitamins and vitamin supplements arethat big a help. you know i take amultivitamin, i take a half one in the morningand a half one at night, it's not going to hurt youall right and it probably will help you. but what you want to dois get those antioxidants

from food okay. because there's so manyco-factors we don't know about and it's hard topack all those things in one little tablet. now the thing's not out onsupplements and cancer, so i'm not saying what you'redoing is bad and this and that, i'm just saying thatthe studies so far haven't shown any real benefitfrom supplements as far as coronary disease go.

all right, let'slook at the anatomy. this is that single cellendothelial cell lining of your artery, this is yourteflon okay of your lining and that's through everyone of our arteries okay, it's there. and it iscross-sectionally, it is one cell living, breathingwall, endothelial wall. in fact, this is whatgets decimated in ebola. in fact, they're startingto treat ebola with

statins. statins lower yourcholesterol, they also are an anti-inflammatoryproperties that probably stabilize thisendothelial wall. they've always known thatstatins decrease the death rates from heart diseasea little more than the amount of theldl they drop. and so they think nowthat it's probably the protection of theendothelial cell wall.

don't know, butthat's out there. so and this is thenew england journal of medicine, this is oneof our most prestigious journals. this isn't smithgoing online and pulling something down okay, offof because i get that from certain people. oh yeah, you've got tohave, you've got to have evidence-based medicinethis is not voodoo.

and i hope i'm not gettingany of this wrong and it could be provenwrong later. so be skepticaland ask questions. but what i know is, whati think i know is that if it's not just the amountof ldl, the more ldl bad goo you have here, i meanwhen you pull blood out of somebody who has a genetichyperlipidemia with high triglycerides or highldls it turns to wax. if you put your steak inthe refrigerator the next

day it's got a waxy gooon it and that's because that's the fat. just like when the frenchflew the french food on peggy's mission and theyopened it up and they thought we've got fungusamong us, you know, it was all bad it was actuallyjust the fat congealed on it. so that's what's going onin your blood system and, therefore, your viscosityof your blood is a little higher, your luminalpressure might be higher,

your coagulation factorsand your immunologic insults your inflammatorystressors and chemicals these could allbe affected. and so what happens isthis ldl gets underneath this lining and it's notsupposed to be there. and forms if you've got aninflammatory process going on from gingivitis, fromdental disease as you were a kid, which is where iprobably got my plaque because i didn't take careof my teeth like i should

have or the fact you don'tsleep for days and days or that kind of stuffor infections. you form an immunologicgoo here okay. now the good news is inthe new england journal that with certain foodsand certain things, such as polyphenols,flavonoids, omegas 3s, 7s, 9s, resveratrol, thankgoodness red wine okay. that you can actuallygo here and break these reactive oxygen speciesup and transport them out.

you can actually remodelsome of this what i call goo okay. and you can also doit with sleep, stress reduction, exercise,and statins. and it's also just notwhat's going on in your heart, everybody thinksabout your heart. well, it's also where yourblood vessels are the most they're probablyin your brain okay. and there actually aresome data coming out now

that we're actuallystarting to make a dent in alzheimer's and dementia. but certain people havethese little lipoprotein carrier moieties thatcarry out the amyloid plaques that your brainmakes, the waste material of your brain is carriedout by these apoe lipoproteins and if youapoe 4s you don't do a very good job oftransporting them, so don't get the goo upthere in the first place.

if you got the apoe 3s youdo the average amount of carrying. so on average everybody'sgot a 7.6 chance of having alzheimer's in this room. if you got apoe 3sthat's what you got. if you got an apoe 4 thenyou just double that. and if you're homozygousfor apoes so you got a 4 and 4, you're now fivetimes that or you're 40% chance of havingalzheimer's okay.

do you want to know that,i do okay because i want to take precautionsto avoid it. you've got a 60% chance ofnot having it and if you exercise, you now have a20% chance of having it. and if you eat the rightfoods you probably have a 5% chance of having it. so those are the thingsyou can make a difference so that when you're 95you're going strong. okay, so john belmont whogave grand rounds here a

month or so ago is atbaylor college of medicine and he's one ofour go-to people. we're having a geneticscreening -- well we're having a well woman summitnext wednesday looking at money's no object howwould you screen people for ovarian cancer,for breast cancer. what would you reallydo, would you do really mammographiesevery year, no? would you domammographies, mris and

ultrasounds? you know, what would youdo if money no object, which is one of thethings we get to do here sometimes when we've gotsuch a small group of folks then if we do thatlong enough and show some benefit then we can spreadthat out to them, to the population. what genetic screeningwould you do if you've got brca1 and 2 genes andyou've got a 65, 75%

chance of having breast orovarian cancer what would you do? would you fly that personon space station, yeah you would, but you would wantto do better surveillance down the road after theyleft the core i think. anyway, those are issueswe're going to talk about. well you can go and for$350 you could go get your 1,300 gene types done. so i did that in 2009before 23andme came out

and found out yeah,i've got a little higher increase of alzheimer'sand a little higher increase of coronarydisease and statins have worked, although i mighthave a problem with muscle pain or myopathywith statins. or this is the probablythe best statin for me or this is my starting dosageof rate poison if i had to get on rat poison which ihope nobody will have to. so these are kind ofthings you can pick up.

all right, let's go backto this endothelial cell once again. it not only i s a barrierto ldl cholesterol or bad cholesterol, it's alsoliving tissue that makes nitric oxide which is apotent vasodilator okay. that's why arginine isan essential amino acid that's why you seebodybuilders eating tons of arginine so they canmake a lot of nitric oxide so they can build theirblood vessels so they can

make these giantfunky looking muscles. and the point is thatif you have a lot of oxidative stress, then youdon't make nitric oxide. and one of the measuresof telling how well you're doing with nitric oxideis how much after you've clamped an artery andyou've ultrasound it and you release it, how muchthat artery overshoots from normal, howmuch it dilates. and so you can do testslike that, i did a test on

myself it's used incardiovascular we do it here at the lab, which is,you know, just go over and find dave martin and sayhey, dave let's run a little experiment. so i got up three hourslater i eat my low-fat 300 calorie breakfast, igot a 12% dilation. three hours later i eat mypiece of american cheese and a piece of bacon and igot my 8% and that doesn't sound like a lot, but thatis a significant amount.

i'm saying that if i'dexercised that morning i probably would havedilated even more. my point being that youcan't get in a rut, you've got to us all these thingsat your disposal to lead a balanced day-to-daybalanced life. and once again, ifyou can't sleep, can't exercise then eat theright foods and try to make a change the nextday like i will tonight. okay, let's look at thecoronary arteries, how am

i doing, doingpretty well. okay, those are the firstyour heart actually pumps blood to its cells. so those are the firstarteries off your coronary, off the aortaokay, right, left coronary artery. and the gold standard andthere you go okay, here they are. and the gold standard forseeing if you have disease

is if you've got blockage. now you're not going tosee blockage unless you have a 70% lesion okay. and this is what wethought happened sort of sludge in the ice machinekind of thing and then you threw a plaque andthat messed you up. so fortunately, newtechnologies like borescopes for looking atit cracks in wings, you can actually put anultrasound probe like you

do a cardiac cath in theartery, pull it back and measure theamount of plaque. so this is an ultrasoundprobe, these are things from steve nissen, he'sthe head of cardiology at cleveland clinic, oneof our consultants. that's another thing ilove about nasa we get to talk to some really,really sharp people when we need them. so this ultrasound probelooking straight at you

and that is thatendothelial wall lining right there okay, that'sthe artery and that's a normal looking artery. that's a normal lookingartery, well that's got a little plaque there okay,and you can see it's sort of starting to narrow. so what we thought used tohappen is you slowly built up this goo and it cloggedit up and got a heart attack or you threw apiece of this and it went

downstream, landed atthe tip, kill this little piece of tissue here andthat upset that piece of tissue and it startsinstead of your electrical system going boom-boom,this now starts to fire and take over and you dothis and then your heart does that. the rest of your heartis fine it's just your electrical system has goneout of whack and that's when you do that and thenhopefully it comes back.

we've had a past centerdirector here who has been shocked multiple times andis doing fine now, so it can happen. and the point being that ican show you a few things today that there's noreason for anybody here to rupture a plaque to havethat happen, there's no reason. okay and here's why. here's the glagovremodeling theory of early

atherosclerosis. remember, you get thatlittle goo forming underneath here and ifyou keep doing what you're doing you keep buildingthis goo out okay. well your artery is fineexcept you're building this goo. so here this cardiac cathwith a completely normal artery and here it'scompletely normal. whatever you're doingyou're great, you've got

great coronaries. well actually you've gota big plaque sitting out here okay. here completely normalcoronary artery with a completely large plaquesitting here, it just hasn't reached criticalmass so that now you have a little segmental lesion. that's about a20 to 30% lesion. half the people in thisroom, probably more than

half the people in thisroom have at least that. in fact, they did withultrasound they looked at 30-year-olds, averageof the 30-year-olds that ended up being hearttransplant donors. before they transplantedthem they did intravascular ultrasoundon them and half the males and half the femaleshad a 30% lesion. okay, so it's out there. a lot of people, you know,i'll show you esselstyn

who is at the clevelandclinic wellness center, you know, he was a traumasurgeon in vietnam and that's where he went holymoly look at all this plaque that's going on. and we see it today youstart forming plaque around 9, 11years of age okay. okay, so in other wordsthis thing has to get so big that it's pushing onhere before you get the angle of attack showingthat you've got an indention.

so what's going on is theldl is getting under here forming this goo andthen what kills you is if you've got a really badinflammatory process going and you can get bloodtests to see what your inflammatory levels are. and this thing ruptures,which you won't get if exercise, youwon't get it. and if this thing rupturesand goes south or goes distal and knocks off thattissue that's what kills

somebody with aclot real fast. the other thing it doesis it forms goo and eventually thatgoo forms calcium. well they developedscanners you can go spend 200 bucks right now and godown the street, the same radiation as a mammographyor less and you can go find out if you've gotcalcium on your heart okay, and that's what wedo with our astronauts. and that's yours trulywith the japanese, the

russians and the europeansbecause we had a cosmonaut right before his missionended up with two stents and had a little heartattack over in mbl. whoa, we got to startscreening these guys a little better becauseonce again, a stress test you've got to have morethan 70% lesion okay. so we decided yours trulygot on here and got his scan. and so what you seelooking down at the heart this is the aorta, you seea little calcium, you see

a lot of calcium. and so for your age youfind out what your calcium score is. there's yours trulygetting his and i had pretty bad cholesterols,you know, doctor heal thyself was about 25, 30 poundsheavier than i am now, wasn't sleeping, wasstressing, you know, was working at nasa,no i'm kidding. i love this place and sohere is my scan and you

see whitecalcium shows up. that's my spine, that's mysternum, those are my ribs and this is my heart,these are my lungs and there's my coronarycalcium right there. so i got a littlecalcium on my lad. so what i got is a scoreof 130, so i'm in the moderate plaqueburden and if you're an astronaut and you'reover a hundred and we've got three who are ahundred you're dinged,

you're done. and then we're going to doa cardiac cath or an angio cath and if you've gotlesions you were done until recently, until wecame up with a reversal model and showed that overfour years we actually took somebody's triplevessel disease and reversed all of its lesionokay and that person is on flight status. so that's the good news.

so here's this okay, sothis is smith super gross simplification modelin progression and regression. you know, calcium won'tkill you, calcium's fine, you can have calciums of9, 10,000 and be in your 90s, which people do. it's the plaque, the goodthat builds up that will slowly cause this to pinchin and that's when they go and put a stent in. but you can get rid ofthis and you can reverse

it and i'll show you that. dr. nissen showed itusing medication, diet and exercise when the ldlwas under 80 and the hdl increased by 15%. you increase your hdl by15% by walking 30 to 40 and 50 minutes a day,five days a week. you get your ldl down byeating the right things or you get on amedication or exercise. and they published this inthe new england journal in

2011, for the first time,although for about 10 years they've been showingreversals that have been going on before this. and again, steve nissen,chrisite ballantyne is here in town he's a great guy to go to. show that statins andmedications they show a regression in folksand they saw actually regression usingcrestor and lipitor. and that's because that's what farma could afford

to pay for these meds todo these studies and pay for the intravascularultrasound. okay, nobody wants togo and get an ultrasound probe down hiscoronary artery. so what you can do iswhat's the next artery really close to there,well it's your carotid and you can feel itright now okay. so you can actually go andmeasure this intima medial thickness of your carotid.

so we have a machine overin our clinic we do it to everybody that comesin every year okay. and what we're looking forthere are little pieces of plaque or thicknessesthat are thicker than they should be okay. and with an ultrasoundprobe and we measure a centimeter's worth of itin the same place and this is actually the softwaretechnology was developed by nasa and here is mycarotid artery and here's

my carotid intimathickness and my measurement on my rightside over here okay. you want it under 1millimeter that's the thickness, so i'm . 7 millimeters and atthe time i was 56. here's the scaleof bad, okay, good. so at 56 i had the arteryof a 52-year-old on my right side, well hey cooli'm all right, doing okay. then i did my left sideand i got a 92%, i got an

80-year-old arteryover here okay, oops. now why is that? well because i'mleft-handed and because i sleep on my stomach andi've slept all my life with my neck overmy arm or my pillow. so a third of my lifei've been in hypertensive crisis with my carotidover here okay. really interesting and iactually found papers that show they do that.

so if you do that what youwant to do is have your pillow, sleep on your sideand have your pressure on your jaw and not on yourneck unless you have the genetics that i do, i meanthen you want to do it if you have the genetics ihave, which are all the stuff that youdon't want to have. i've got people livingto 102, i've got people having heartattacks at 62. okay, so that's okay, i'mall right with that, it's

good to know that becausei think i'm shooting for the 102. all right, so here's thegood news and these are actually astronaut normal. three years later my leftside has gone from 1.03 to .66 and my rightside is down to . 48, so i reversed theseplaques in my neck okay. so i feel pretty goodabout that and that's what you can do and we canfollow that very easily by

doing this. okay, so let's look atsome examples of people who say it's allabout what you eat. and i've had some successwith looking at that, so i'll tell you how far youcan go one way and how far you can go the other andwhat's probably the way to do it. and this is caldwellesselstyn he's pretty famous now, youcan google him.

you can google sanjaygupta's last heart attack. and he's at clevelandclinic, he was a trauma surgeon in vietnam, he wonthe gold medal in rowing in 1956, he's a good guy. and he's at cleveland andhe took people who are friends of his incleveland clinic who basically a small groupof folks in 1985 and 88 before statins that haddistal lesions like a friend of his who's athoracic surgeon who had a

distal lesion that wastoo far to bypass and too distal and too longand torturous to stent. so you had to treat themwith medicine and diet, okay. and that's what he did heput them on a very austere diet and exercise programand he got a total -- this is what all of us shouldbe shooting for in this room if you yourcholesterol numbers, of less than 150 and you wantyour ldl under 80 okay. unless you're one of thosepeople that has an hdl

that, you know, like 95 orsomething like that which is the goodcholesterol okay. but these are the numbersyou want to think about and i'm happy to chatwith anybody in this room offline and just call meover at the clinic okay, if you want to goover your numbers. and so how did he do it,he did it strictly with grains, legumes, lentils,vegetables, fruits, so complete vegan diet,which is hard to do.

but if you do it and geton it and try it for a couple of months, you getyour set-points changed and you find some staplesthat you really, really like and you can't eat thesalt, you can't eat the sweets, you don'twant the fat. i can't eat a salad withsalad dressing on it now, i mean they bring them tothe side or i use balsamic i can't do it,i don't like it. and so that's how you getyour set-points changed so

that's a good deal. you know, i use lean meetsas a condiment, but you know i don't eat thatbecause i have these genes that are not good. i also haveaging, which it's got extra protein in it, itgoes around and it bangs into that endothelial walland is not good for you, so you treat that with thesame thing, you get your numbers right.

so his thing is don'teliminate just get the oil, get the protein, allget it from vegetables okay and avoidthese things. now why wouldyou avoid fish? well because we got a lotof crap out there, excuse me we've got a lot ofmercury out there, we've got a lot of stuff outthere and i'm the example of that. we do have a heavy metalprofile over here in the clinic, so i taskedto check for arsenic,

cadmium, lead,and mercury. that's why they havewarnings on tuna cans for pregnant women okay. so yeah, my mercurylevel is high okay. so i got to watch my fish,i got to slow down on my fish okay. so you want toavoid these things. now these are people -- heused this on people that had disease that wereactually having chest pain.

where most people rightnow if you have a little incidence of chest painor if you get say stand up real fast you get a littledizzy or you get a little short of breath and you goto the emergency room or you get a treadmill andyou have a little abnormal treadmill and you gotmaybe a 70% lesion or a 60% lesion they're goingto put a stent in there or they're goingto bypass you. and i would say you don'tneed that, you can simply

reverse it by doingthese things okay. and that's a new paradigmthat's out there. [ comment from the audience ] what? this is again becausea lot of our fowl is processed has chemicalsin it and these are for people, this is one end ofthe bell shaped curve of life, this isreally strict. these are people who havegotten -- clinton's on

this diet, bill clinton. he got bypass surgery andthen he had issues and then he hadstents and now he's on this. there are people nowgetting on this diet and reversing their diseaseand not having to have surgery. i mean think about it ifyou got cancer and you had to go through chemo, thinkabout what you'd do to do

that versus this killsmore people than cancer, you know, and you're justgoing to get on an austere diet. you can just change a fewthings in your diet to make a big difference okayor you can get on statins. some people can't handlestatins and there are going to be newmedicines out too. and i'll tell you aboutexercise too and here we're going toget to that. and we're doing okay,okay we're doing okay.

they said two hours, sothat's what -- if you got to go you got to go ihave no problems with that everybody. okay, so again, these arefor people having chest pain that don't want togo have bypass surgery. yes? got it, got it, theni'm rolling here we go. okay, so good news is thisis what he did with his patients, with a smallgroup of people okay and

that's documented. his book is reallyworth reading, i have no financial gain from this. he gave a grand roundshere, a couple of folks have been on this diet,i've been on this diet and, you know, we'veseen reversals with it. and it sounds like it'simpossible to do, you got to work at it, you got tocook your own food, you've got to be creativewhen you go out.

but it's something thatwill help you, you'll feel better, your cancerrates will go down, your inflammatory processesgo down, your joint pains will go down, it'sthe thing to do. okay, so that'ssome reversal there. butter, this just came outfrom the american college of nutrition this wasin the chronicle, the chronicle doessome good stuff. let's not forget it's justnot about heart disease

it's also about cancer andthese are things that have been associated don't knowthe cause-and-effects, don't know if it's there. but in looking at dietsthese are their new recommendations that theycome out, the american journal of nutrition herefor prostate cancer, dairy products and calciumsupplements don't seem to help guys. alcohol, processed meatsand read me tend to give

you colorectal cancer andeg junction tumor cancer, the fastest growingcancer we've got because everybody's pushing acidup on the esophagus and what do you see everyother commercial, it's for you know proton pumpinhibitors and, you know, acid blockers and thatkind of stuff okay. and when you look at theveggies that puts you all on the other sideof the curve okay. so what are therecommendations, avoid

dairy products toreduce risk of prostate. avoid alcohol to riskcancer of the mouth, pharynx, larynx,esophagus, colorectal, and breast. avoid red processed meatto reduce the risk of cancer to thecolon and rectum. avoid grilled, friedboiled meats to reduce the risk of cancer to thecolon, rectum, breast, prostate, kidney,pancreas, pancreas.

pancreas is starting toetch up because of our obesity it's starting totake over as the number four cancer we've got. consumption of soyproducts to reduce the risk of breast cancer inadults and reduce the risk of recurrence andmortality later on. emphasized it's eat yourfruits and vegetables just what grandma and me toldyou all right, you know, da-da-da.

so this is the pyramidfor the guy at herman hospital that does theheart disease reversal, i'll send youthat link also. it's all about veggies,get your protein from veggies, get your proteinand your nutrients from vegetables and fruits. these are fine justdon't eat a lot of them. eat whole grains if you'regoing to eat your breads because they'vegot the fiber.

and some people withceliac who can't handle gluten or protein andwheat can't handle it. there's also casein whichare in dairy products, some people can'thandle casein. and then just keep yourfats down because they have high calories, butyou need fats that's how you make a lot of yourestrogen and testosterone are made from cholesterolso you need those. but you can get it fromveggies, just stay away

from animalprocessed products. as i've said, it lookslike saturated fats are not that bad, just youknow get it so they're not chalk full of saltand nitrosamines. as mayo clinic advertises,as we're doing up in orbit, look we're growingcabbages isn't that cool? okay, so eat yourveggies, there's steve. exercise, strengtheverybody knows if you exercise a lot, if youexercise a little you live

longer than if you don'texercise at all period everybody knows that. jack lalanne taught usthat growing up okay. steven blair is somebody we work with and we justpublished with, 30 minutes can change your life. so here's a study 5 meps,i'm at like 1.5 meps because i'm doing, i'mtalking, my brain -- you can burn 30% of yourcalories with your brain.

you all are sittinghere at 1 meps. five meps is walkingbriskly, so walking briskly 5 meps for 30 iswhat we're going to see here now. with a huge amount ofpatients over a long period time out of thecooper clinic and here's what we see. death rates for female whowere sedentary, they die at this rate.

males like i say, we die alittle more because we go, "watch this" okay. if you walk 30 minutes aday 5 days a week you have thirdyour death rate. if you walk an hour or twoa day and the good news on longevity just presentedin the american college of sports medicine is walkingfour miles and running four miles is the samefor longevity's sake. so that's kind of goodnewsy, especially when

we're get older and we'rebanging up our joints or you got bad joints. when you stop being ableto walk 300 yards in a day you're dead in ayear or two okay. it's a stat okay, it'sall this happy news i'm bringing in, you know,sometimes it's full of happiness and joy. i'm going to get there,i'm going to get there it's going to be good.

so again, the more youexercise the better you do as far as cancermortality also. you're flushing the systemout you're keeping things moving. and the older you get themore you exercise the less your death rates areokay, at all ages okay. everybody knows that now. here's a good one. here's a reallyinteresting one that i

like. i don't care if you'reobese i just want you to be fit okay. here is somebody who isnormal weight and someone who's obese and theirdeath rates if they're fit and when we say fit thatmeans they're walking 30 minutes a day5 days a week. if you're skinny or normalweight and you're unfit your death rate is 2 to 3times that an obese person

who's fit. so it's not about carryingthat weight around, it's that it's fitness. although, i will show youin centenarians nobody makes it to a hundredwho's obese okay. so you know you got todecide where you want to go with this. if you look at statins,highly fit people on statins have a 70%reduction in mortality.

highly fit people not onstatins, fitness is better than statins, 50% ofpeople have a lower mortality if they're fit,on statins will give you about 30, 40% reduction. okay, this kind of acool guy, he's worth going to see, i'll sendyou this link too. mike evans, he's canadian,he's a really good guy, these are really goodvideos on stress, on everything what medicine decreasesknee arthritis about 47%,

dementia by 50%, diabetesby 60%, post-menopausal 41, anxiety 48, depression47, death rates of heart rate alumni, cramps inyour leg, hold on, hold on, fatigue, treatment-- number one treatment. what would that medicinebe, exercise and that's steven boyer. in fact, if you look atthese are attributable fractions. so this is how all thesebad things weigh as far as

death rates go. diabetes and highcholesterol are kind of here, obesity's kind ofhere, smoking's really bad, hypertension you knowand hypertension melts away when you loseweight and you go on a plant-based diet. but the most importantthing is again fitness, so low fitness. so all you got to do isget out there and go.

we know that fitness isbetter than stents as far as maintaining patency,that's a big german study that was done. the other we found outthey published this study in 2008, on muscularstrength associated with mortality in men. so muscle strength, wealways though it was anaerobic fitnessand stuff. and again steven boyer,good guy and he published

this one, holy moly musclestrength, disability and mortality. little studies fromscandinavian men saying the stronger you are theless you get injured on the job and theless you die. well, what have we beendoing on our astronauts since 1985, we've beendoing isokinetic testing on them. we've got this incredibledatabase knee, shoulder

and back isokinetictesting okay. and that's what we dothere's peggy two days after she comes back frombeing on space station for six months, we're onan isokinetic machine. an isokinetic machinemeans no matter how strong you are, it's going to goat 60 degrees per second back and forth no matterwhether it's me or arnold schwarzenegger okay. and you develop thesetorque curves and there's

my torque curveon my left knee. and that's what we use tosee objectively when an astronaut comes back toits pre-flight standard of after being up in space. well there are companiesout there, a couple companies who actuallyuse isokinetics to measure knee, shoulder, backstrength and tell you whether or not you shouldbe a baggage handler at united okay.

and when i was in ohiotraining i got to know these folks and i've beeninterested in working with them because we didisokinetics here on looking at preventinginjuries and now so they got three musclegroups here and they do knee, shoulder, back justlike we have isokinetic machines over in our gym,really simple to do this on our folks. every person who has comein as an astronaut on

selection has had theirknee, shoulder, back done. and they put this intoa single score and they compared it against thedifferent department of labor standards sedentary,light, medium, heavy, very heavy and they tell youwhether or not you should be a baggage handler ornot and they decrease injury rates. it's not rocket sciencethe stronger you are the less injured you get.

eighty five percent ofyour injuries are caused by 15% of your people thatare too weak or have bad joints, so this screensthose folks out. this came out and i calledup the guy i knew who ran one of these companies isaid do you have informed consent, yeah to followfolks for injuries and death, yes. do you have socialsecurity numbers, yes? so went to the irb andsaid we'll plug in about 5

or 6,000 of these folks goonline with their social security number and seeif they're dead or not. and then if you paid $6more you can find out what they died of, i didn'thave $6 more so we didn't do that. but these are really wimpypeople, these are really strong people. and so what did we get, wecrunched the numbers here and so ifyou're really strong

you're dead here and ifyou're really weak you're dead here, 10 years later. and that's pretty cool. and so we did it withfemales, we didn't have the spread, we didn'tget the statistical significance onthe cox evaluation. for the kaplan analysiswe did, but we got trends, some very nice trends. so let's look at me, thisis me, i went and too this test.

this is my knee, this ismy shoulder, this is my back. now for some reason myleft leg here and here is really strong and forsome reason my left arm is decently strong. for some reason my rightarm is pathetically weak. and for some reason mycore, which most people's core is patheticallyweak okay. so this is not good. so unfortunately if i wentto united airlines and

tried to be a baggagehandler i didn't make the cut. they would say back thengo and work out a little bit and come back. so i did, i went andtrained doing sit-ups, push-ups, pull-ups, and igot my score up so now i could be a baggage handlerat united airlines. but the cool thing aboutthis is if you put this in a mortality, i now have an18% association with a 20%

increase in 10-yearsurvival just by increasing that. so that would be a reallyfun thing to do with measuring our astronautsas they come back retired is to see with theirevolution of their muscle strength has been and tosee how that correlates with all the otherdifferent parameters we have on them, which wouldbe really kind of cool. and we publish thisat american college --

present it at americancollege for medicine, be stronger, live longer andtalk to you about that. and so even china, youknow, our kids are just not -- this is a swedishstudy looking at a million adolescents and showedthat if they were strong as kids they had a 20 to35% decreased chance of having a premature death. even china'sfitness is down. so fitness is the key,we've got to and it

doesn't take much,it really doesn't. i mean if you just simplywork standing up that's 50 more calories an hourright there, so things like that walkingaround, doing things. we're putting in a programat mission control to actually have them walkwhen the zoes come in and they're off center andthey got to walk around and that wakes them up andwe give them a big boast of blue light.

we've also had astronautsthat we've done cardiac caths on and four yearslater we've proven that they've reversed theirdisease and that's exciting and beenable to qualify. all right finally, i got10 minutes to get through this, this is notgoing to work. all right, i'll be realquick with this okay. and this is fatiguetraining, you know, sleep and fatigue beeninterested in this because

that's whathappens all time. it made the front ofsleep review big deal. all right, light ismedicine presented the sleep 2014 which ishideous and that's the newest, coolest thingthat's going on is life can be physiological. like right now we'reon space station we're getting about 130 looks or40 looks of light it's not and if you're on spacestation and you're not

going to the cupola andgetting 100,000 looks, then you definitely don'twant go to the cupola right before you go tobed or you won't go to bed and so what we're tryingto do is actually outfit the station and outfitrooms that's where we're going, so you're actuallygetting the same sunlight although it'll lookbrighter than this, but you'll get the samesunlight as if you were outside okay andwe'll talk about that.

so it's controllingthe light. and of course, withshuttle the sunrise and sunset are 45 minutes andyou know people looking out the window and hangingout doing spacewalks. you know, sleep cansometimes be really tough and interesting to do. what we deal with inmedicine i have to deal with all these medicalconditions that give you insomnia.

poor sleep hygiene, whatwe're dealing with is a lousy sleep environmentand circadian desynchrony flying to russian,flying to japan. and we know that when youdon't sleep your brain looks like you're onalcohol it's a matter of acute fatigue. so i'm doing pretty wellright now because i have acute fatigue now becausei haven't slept well i'm doing better because thelast week i got a lot of

good sleep because i wason vacation, although i was under stress becauseof family issues with the sister. and circadian this is agood time of day except i'm in theseflorescent lights. if i was outside i'dbe a lot more alert. da-da-da a lot of peoplehave it, people don't tell their physicians whenthey show up, i have sleep problems.

they wait until they gethypertension, congestive heart failure,depression, anxiety. you know, even people withsevere sleep apnea, which means you have to wakeup while you're sleeping because you're notbreathing for 10 seconds and you have to wake upmore than 30 times a night or 7 times an hour youtotally obliterate your sleep architecture. that's why with a headcold you can be in bed for

eight hours, wake up andyou feel like i didn't get any sleep, i didn'tget any sleep. i have that happenbecause of my wife's cats. all right, sostress, stress feeds. stress, insomnia they feedon each other and that's what gives you problems. you need sleep 7 to 9hours of it at least. it's where you defrag yourcomputer, you consolidate your memories and youbasically drain your brain

at night that's the latestthing that's come out. that you've actually gotlymphatics in your brain, the interstitium of theframework, architecture of your brain increases by15% while you're sleeping and that's when youdrain your brain. and that's why i need togo drain my brain more. all right, there's somereally funky models out there with fish and birds. these animals when you're-- like right now my brain

is desynchronized becausethe back here is looking at you guys, soit's firing, i'm smelling stuff, i'm talking, somy whole brain is going. and that's whatdesynchronize looks like here. when you're in deep deltawave sleep sleeping then your whole brain is kindof synced up flowing okay. well dolphins can have ahalf their brain full up and half of it full ofsleep and then they can

switch off. we can't do thatunfortunately, although some people try it withcell phones, but it doesn't work. so this is your sleeparchitecture, trying to get this low deep sleepright in here and it's not very much of it in themiddle of the night. and then you try and getthe rem sleep, which is your dream and that'swhere you're working out

the psychological issues. well if you have troublegetting to sleep, if you wake up in the middle ofthe night, brief arousals you're in bed for eighthours you feel horrible. so these people might haverestless leg or they might have sleep apnea. and what do we have, wehave people flying to moscow, to cologne to japankind of hanging out. they're not just hangingout, you know, they're

doing stuff and theseare our ship workers at mission control. and what you're trying todo here is this is houston time this would go tobaikonur and spend two weeks, get well-adjustedand then you launch. and then you got to takea power nap here and then you launch and then you'reon the soyuz use and then you dock. or you launch here rightwhen you shouldn't be

launching, you launchbut we do anyways. you got to take a powernap here and you dock six hours later okay. or you're doing thiskind of stuff in orbit. so this is when it's hardto sleep and this is -- i'll give you an exampleand this is an entire -- this is peggy's entiremission while we had different operations, thiswas six months in space when she was supposedto be sleeping.

and you can tell when dockops and we're going to have this now when we getour new crafts up there this is going to comeback to haunt us. doing spacewalks, theshuttle docks and you slam shift these people allover the place and with actiwatch data you findout that over the last two months of being up thereshe's sleeping about 4 to 5 hours a night and that'swhy she was free ranging naps and needing to usea lot of medications.

yeah, okay. and so what do welearn from shuttle? hygiene, sleep hygiene isvery, very important and keeping -- i gottoo much here to do. can i get 10 more minutes? yeah. >> well this is the firstpersonal hygiene kit for the ds1, john glenn'smission and these are what i carry with me in mybag because if you travel

you've got to get goodearplugs and you've got to get rid of the sun, you'vegot to get rid of light. and this is what we did in1991 on sts35 we started using lights to help shiftfolks in orbit before they'd launchon the shuttle. and that's chuck, oruse them to shift there. what light does lightkeeps you from making melatonin okay. so if we were outsidenow melatonin our sleep

hormone would -- it wouldbe depressed you wouldn't be making any okay. so about 8 o'clock atnight you start to make melatonin and i'llshow you those slides. and so what happensyou drop your core body temperature about a degreethat's why you want it cool at night, yourmelatonin goes up, your cortisol, your stresshormone goes down, and then it starts to go upwhen you start wake up

that's when most peoplehave their heart attacks in here. your growth hormone goesup and that's where you repair all your musclesyou've kind of messed with from working out the daybefore and you repair your neurotransmittersin your brain. and that's why it is sokey that these little guys, you know, my twoboys, i mean if they didn't get their sleep inmiddle school, i mean they

were just differentlittle creatures. and that's why we need tolet them sleep later, but that's a wholeanother story. shift workers, i mean ifyou don't sleep -- get enough sleep you get morecolds, you get more heart disease. shift workers get at least5 to 7 hours less sleep a week. they have all of theseproblems and who gets

them. they're not healthcareworkers and emergency workers they're 24-hourshift workers in factories. and who gets the mostsleep, the flight crews because we mandateit 6 1/2 hours. truckers four, that's whywe see a lot of this okay. all these things happenyour cancer rates go up, i'm not going there.

and we're the worst docsif you do every third night on call up you make5.6 times more errors, this is whocame up with the stuff on us. you have moreneedle sticks. one in five internsadmitted making a fatal mistake -- a fatiguerelated mistake that caused serious injury and1 in 20 said it led to a death, been there.

accidents, you have oneof our capcom's fell asleep and put the car intheir front yard and that caused us to get on topof things with mission skipper i'm good to gojust a little tired, skipper i'm good to goi'm just a little drunk. you're not goingto let a guy fly. well, if you've beenworking 23 hours straight you're legallyintoxicated as far as your performance.

see how they go down hereand then they start to get better. why is that, that'sbecause of their sleep shift, their circadianrhythm is kicking in. that's like this thismorning even though i got like three or four sleeplast night i'm feeling pretty good rightnow, i'm kicking in. if i kept doing that you'dkeep getting worse and worse and worse. all right, anotherexciting thing light just

doesn't suppress melatoninit also hits the back of your retinol ganglia andmakes this thing called melanopsin, which is analertness pigment okay. which alerts you and it'shotwired to your super ganglion nucleus whichis the pacemaker of your body. each of your cells has itsown intrinsic and each of your organ systems hasits own kind of circadian rhythm.

you know you shifted whenyour gut is back in line. when you go to europe oryou go to japan when you start going to thebathroom the same time then you know you'reshifting, you're feeling better. well here's a spectrumof light, here's a normal spectrum of light. this is the normalspectrum, this is if you were outside right nowthis is what the back of

your retinawould be seeing. this is what we're seeingright now and this is what we see on space station. this is what they weregoing to give us on station with our new ledlights and we talked them into this and we'll tellyou what else we did. so this spectrum of lightis the most powerful suppressor of melatoninand the most powerful maker of melanopsin.

so this this is light in abox and now with leds, you if you plug it in, youknow, this that's like being out in thesunlight right now. okay, so use this about10 or 15 minutes an hour that's like being outside. if you have -- we knowthat if you get sunlight outside you're going tosleep better at night. if you exercise you'regoing to sleep better at night okay.

so now you can carry thesun in a box with you for 89.95, no okay. no, no it's uv and that'sthe spectrum that's a good question. this is uv lights downhere and in fact, if you start to get into here youcan start to get a little damage. but these are safefrequencies right here. but the cool thing here'sthe deal, that's how you

use light to help shiftyou much more efficiently. like we can shiftyou going to moscow. you give me two daysbefore you leave and i'll get you there in a day ortwo, i mean we can shift you 3 to 5 times faster. and here's what'shappening here's 8 o'clock and here's the normalmelatonin curve okay, like this and bang. so if we give you bluelight like you get to

moscow and you're reallytired and it's five in the afternoon and we turn thislight on and your system wants to make thismelatonin, we'll suppress it down here and thenwe'll turn the light off and bang you'll beable to go to sleep. and we'll shift thatcurve a lot faster. so we cause light anddarkness to help shift curves. we can also use melatoninstrategically placed and

we can also get smartpeople from brigham like steve lockley to put that into a chart to help you shiftwhen you go to moscow. and we did this with ourinternational partners and developed managementguidelines and came up with an entireimplementation program where we give an educationsession and then i'll sit down. if any of you guys want togo to tokyo or you want to

go to, you know, it'sgoing to cost you a bottle of wine. no, if you want come overto the clinic and i'll give you one of my olddeals and we'll sit down and do acomprehensive assessment, but i'll ask you to followup with me to see how you did. smart people and we cameup with this clinical practice guideline whichhas been implemented and

we need to carryit on and da-da-da. now the other thing ishypnotics and very quickly on hypnotics andwe're almost there. the only time you want totake a hypnotic is when you've got to sleep,you have a window of opportunity to sleepand you don't feel like sleeping. smith, you got to workorbit 1 tonight, you've got to go work missioncontrol at 11 o'clock

tonight. all right, i'd saysee you all, bye. go to my house, getreal cold, put my goggles on, lock thecats into the part of the house, you know and i'dtake either 5 of ambien or 10 or 20 of zaleplon andi'd go to sleep and i would sleep until 10. i'd wake up, drink somecoffee and i'd go in and i work all night.

and every so often i'dgive myself some blue light that night to keepme alert and i'd stand up and walk around. and we just did that inmission control and it works really well. so that's when o usea sleeper for us. you get to france and youwake up in the middle of the night and you can'tsleep, go ahead and take a small dose ofa sleeper okay.

so to sleep in times likewhen you're just, you know, you're going toperform better if you get that sleep. like here wake up, got totake a nap here, stay up all night andlaunch soyuz. okay, well launching onsoyuz will wake you up i would think. but this is when you wouldtake a nap with a short acting sleeper.

and we have really goodsleepers that have very, very short half-lives thatare out of your system like that. and the good news is --our problem is not only do i have to have a sleeperthat's efficacious to get you to sleep, but i got tohave a sleeper if i give it to an astronaut analarm goes off, which happened a few weeksago when they had the capcom smelling stuffand it woke them up they

didn't see anything andthey went back to bed. and i'm sure one of themtook probably took a sleeping pill and thenthe alarm went off. so i've got to have theright dose at the right person so that they canwake up and function. so here's smith's grosssimplification model of sleep induction. there is some level wherethese medicines -- this is zaloplon and thisis ambien, this is

zaloplon and ambien theones we use the most. they give you sleep andthis is an area where there's impairment okay. and what we want is amedicine to help get you to sleep, but then ifyou have to wake up and perform you'regoing to be okay. and so do the groundtesting and over the last four years we've donethat, we've developed this program in astronaut crewquarters where we do a

battery of testson them pre-flight. we did it of course, withguinea pig flight surgeons which probablyshould have presented it a while back. and so we mock up thespace station, give a placebo or give them amedication and for a group of folks of seven thatwe did this was the performance decrement ona 10 milligram, which is a lot of ambien versusplacebo, it took them three times longer okay.

so that's okay, that'swhat the team did, but this individual did fineso i'm feeling good about i feel good about thisguy or gal being able to perform on that amount ofambien, which is what i did with one of my crewmembers that go up and that's whatwe've been doing. this person no, you needto take five or you need to take a different,shorter acting medicine like zaleplon.

and then finally sleeptraining, we've developed ron moonmeow who givesa talk on sleep here, it's really good. developed a thing calledcognitive able therapy and progressiverelaxation therapy. it's called sleep trainingand we've been using it with our astronauts. it's six 2-hour sessions,now we got it down to about two 1-hoursessions with astronauts.

remember thosehemispheres, well we've got two hemispheres too,we just can't do three complex tasks atthe same time. so why is it that we can'twhen we wake up in the middle of the night andyou've got a talk to give or you've got a sisterthat you got to take to m.d. anderson soon or you gotsomething going on, you know, and you can't sleep. that's because you've gotracing thoughts okay or

you got to do a spacewalk. okay, so the way you getthrough that is you train one of your hemispheresto relax and meditate in a state and you takeone hemisphere and you visualize something andthe other hemisphere you contemplate something,counting sheep a simple illustration. if you're thinking racingthoughts you got to think of the sheep here and thenyou got to count them here

that's get rid ofthe racing thoughts. and if you've done thatthe counting sheep part where you're reallyrelaxed and almost in a sleep state it's calledstate dependent learning you can put yourself outin a dentist chair just like that and that helps. we've done that with someof our astronauts it's worked really well. and then finally i'm goingto skip through all this

and take you to the funstuff with space station. what we're going to dowith our led lights is actually be able tocontrol the light to give you blue orred or no blue. and we're going to have todo that because when you go to mars you're havingto stay up every day 38 minutes later, which wedid with the mars lander program. so we're replacing allthese lights now with led lights at crew quartersand of course, we got the

standards wrong and weshouldn't have had this different colors,but we got it right. so this will be a new facewith a lot of blue light so that'll wake them up. this will be the generalillumination during the day and then this will bethe pre-night with no blue in it, it's got no bluewave light and that's what you should havebefore you go to bed. that's why you wantto stay away from your

computers, go toflooks.com and you can download a program whichwill take the blue light out of your screenstarting about 8 o'clock at night and it'sreally pretty cool. and we got some good pressin scientific america on that and then i'm notgoing to go into the little zeo stuffbecause they went out of business. and we just don't wantthis happen, what's wrong

with that picture? the shoes are onthe wrong feet. that could havebeen a big deal. okay and we're doingit with our flight controllers, we're fixingmission control and we've got some real successstories there with those. got some good press innew york times and i'm not going to tell you aboutcommercialized medicine you all know thattranshab is kind of

fun, there's someinteresting stuff out there. we need to go by marswe're taking pictures of this, we found water onmars, i'm sorry. you know, you learn frombuilding a geodesic dome so i want you to goback to the moon. you learn that if youbuild it -- put a frisbee on the beach and you comeback over here you're going to be diggingyourself out, which is

what we do and that's whythe south pole now is on stilts and it can goup-and-down and what we what have you. let's go back to thisand we're ending. the other cool thing thatwe're going to do with the kelly brothers there'sthese things on the ends of chromosomes calledtelomeres on the tips of your chromosomes out here. and they only shorten andnow you can access

them for about 85 bucks,it won the nobel prize in 2009 on this. so we're going tostart doing that. we know in animals andin humans, athletes who exercise a decent amountand after about two hours of exercise you are reallyprobably doing yourself more harm than good. that the telomeres shortenat a slower rate okay. and so not only can wetest and see how much dna

damage you had, but now wecan see how much of your life force of yourself dnais actually burned up and how well you aged overthat year and we're going to do that on thekelly brothers. and that's susan baileyfrom colorado state we're working with on that. finally, centenarians,last three slides. what do theyhave in common? centenarians, not allcentenarians are alike

they vary widely inyears of education, socioeconomic status,religion in a super religious, super atheistpatterns of diet, strictly vegetarian, they'reextremely rich in saturated fats okay. but what do they all havein common, nobody's fat, especially in men obese. nobody has a substantialsmoking history. remember, you know, 30%of people get lung cancer

never smoked okay. so our environment isimportant what we breathe. centenarians are able tohandle stress okay and so if you can't handle stresswell or you don't handle it well, there are tons oftechniques out there to go and figure out howto handle stress. you know, 10% of thestress, i mean it's how we -- 90% of the stress ishow we actually view the information we gotand react on it versus

thinking about it andexercise is probably the number one thing tohelp you with stress. the other neat thing is15% of people who make it 100 don't have anydemonstrable disease. forty three percent at theage of 80, you know, have disease after 80 andthey make it to 100 like hypertension or somethinglike that or arthritis or something. forty two before 80 andthey make it to a hundred.

so instead of the olderyou get the sicker you get, it's more the olderyou get the healthier you've been so take care,don't eat the yellow snow, take time to look out thewindow, get the light, get out and exercise, youknow, play your guitar with dan on orbit andjames taylor in the corner up there in the mixer andparty and rock with james and questionsand comments. and only in texas i loveit here and that's my

e-mail here and this is nolonger valid, that's it. >> thank you. [ applause ] >> that was excellent thank youall, and the little knownfacts that i have. so you went through thestuff earlier about your credentials and where youwent to school and all of >> have you got a parkingticket on me up there? >> no iwon't tell that part.

but how many people knewthat dr. johnston won the bob hope talent search? >> you are, where didyou get that girl? [ multiple speakers ] i played guitar, i had areally talented partner, he was really good yeah. >> and he is a. >> oh you're pullingthat stuff out. >> musician, he's asinger, a songwriter, he

plays piano, he plays theguitar, and he claims to have written flyme to the moon but. >> no [laughter], we'recutting you off now. >> he claims that, buti wanted you all -- everybody in order to getthe credit for the class since i'm now hellen laneand i've taken over janice hall. >> right. >> and i have takenover human systems academy lead and my

secretary who isrucilia guerera is the person who will physically beputting your information into the system and shewill be sending you the -- oh well we got timeif they want to stay. we've got the surveys ifyou're willing to fill them out and if you'renot we'll send that out to you, but i really wouldlike if you all would fill that out and leavethem here with us. and our next lecture isseptember 30th and it's

the human risk of spacelight and it's jen fogarty. >> oh cool. >> and she'll be doingthat on september 30th and ruby is the person who haseverybody's records and so if you want to knowhow close am i to getting my roi she has gonethrough exhaustively and now can tell you whereyou stand as far as your required class, whereyou stand as far as your

elective classes, whereyou stand as far as the tools. so everybody in order toget their roi is required to do five requiredclasses, nine electives and two of the tools. and so bottom line we'velined up between now and november, i just gave youthe thing for september. but we lined up two toursthat we're going to post all the is on the humansystem academy calendar so

you can see where it isand i hope you all will join us and you're welcometo come to all of these. and thank you again, thankyou, thank you when i contacted him he verygraciously agreed to do this and so i appreciate. >> it was fun. >> yeah. we thank you. you have anyquestions, yes?

>> i have two questions. is regardingthe gene test? >> is there a way todo that anonymously? >> you can that'sa good question. in fact, let me just goonline here because i was trying to do that. this is -- you go onlineand you google 23andme and this is a spinoff from oneof the owners of google. and you can go and do thekit and they will give you

your ancestry stuff likelet me just -- i'm online here let me, let's seeand it says that so let me sign in. and i go to 23andmeagain i have no financial connection withthese folks. it's just i've talked tothe medical director, the lead and it tells you, youknow, your ancestry, it tells you how muchneanderthal you got in you, you know.

i've got a little morethan i should, but actually that's good. i was hanging out withwild and crazy people that could get acrossthe ice you know. but it tells you yourhealth risks and you can go there and it tellsyou your strengths, your weaknesses. and i've alreadytold you mine. but you're not going toget this until the fda

unbridles it. so i don't have the brcas,which if you have a brca and you're a male you havea higher risk of prostate. i do have this alzheimer'srisk that i mentioned to you. i have a little highercolorectal cancer risk than the 5.6. you can go and look at allthe traits that you have some mild elevations in,you know, like what does

it mean to have, you know,the normal is 1.6% for parkinson's i'm 1.9. you know, nobodyknows what that means. the alzheimer's and thecolorectal that makes me instead of every 10years i'm going to get my colonoscopy every 8 yearsor i'm going to be more careful about it. and i'm going to eat myveggies and i can prevent most of this stuff.

basal cell is a littlehigher, have had one taken off, i go see mydermatologist. so you can go and thenit has decreased risks. you know, diabetes, ishouldn't get diabetes if i do that. melanomas are lower. and you get to find out,you know, really fun stuff like your health traitslike, you know, if you have, you know, what yourtypical risks are for

afib, for coronarydisease, bipolar disorder, i'm doing okay there,although i'm a little bipolar. and, you know you can alsoif you want you can find out who your relativesare and share information. so you can -- right nowthe fda is making them and let me just going into oneof them and show you like here's alzheimer's. it's really good and ittells you it's got a video

on it, it tells you whatyou want to know or don't want to know, you don'thave to find out if you've got it. you know, it tells theaverage risk, it does the thing on apoe gene types,it tells you what you can do to fix it. you know, definitely idon't want to be playing football like i did as akid, you know, or repeated head trauma of beingknocked unconscious for

more than 30minutes is not good. family history, i don'thave a family history for it. eat the right foods,plant-based diet, stay busy. and then it gives you thecitations, it gives you when they're basing allthis information on, which is simply regression onthe amino analysis of phenotype associatedwith the genes.

so you can go read allthese things here and then they constantly areupdating it and the more people that do this thatactually put in their information, then thebigger the pot and the bigger theycan figure out. like i have every femaleon my mother's side of the family has hadbreast cancer okay. and they're all brca1 and2 negative, so there's another gene out there.

and so that's how byhaving, you know, it's very expensive to do thesegene tests and now it's not. and so the more peoplethat can do that the more information we get. and as soon as we getlegislation that protects you from the, you know,the other insurance companies from it i thinkthe better off we'll all be more informed...

no, they have firewallsand all that, just don't know if they get hacked. you know, we don't know. so it's actuallythey do a good job. so you could just go to23andme and google it and for $99 you can go tobelmont to the genome group and get a genechip for 350 at baylor. just go to baylor genomicsdepartment and gene chip or i can get john belmont to let me know.

and you can get allthis information. i would go on and dothis and i would -- it's fascinating what you'llfind out and then as far as the genetic informationas soon as they jump through the hurdles ofthe fda i think that'll be available to you probablya month or a year or something else. >> you gotanother question. >> yeah, yeah.

>> early on you weretalking about insomnia and fatigue and gavetwo numbers four and a half versus six hours andwhether it was misaligned or aligned. >> what's that mean? >> yeah, great question. when you're misalignedthat's when you're doing those docked ops. in other words, the timeswhere they got into real

trouble is we alwaysprotected the shuttle crew because they had to go upthere and, you know, it's just nonstop and it'sspacewalks and that kind of stuff. so what we would do is wecould shift them on the ground very effectivelyand it was harder because we didn't have the lightsand all to shift people in orbit like the folks. so when you are -- comeon now where is it?

>> that makes sense to me. >> yeah, so it'smisaligned is when you got docked ops, shuttlescoming up and you're slamming the crew on orbitto meet up with them and to do the spacewalkswith them. and that's where wegot into trouble. now remember the otherthing that we could have done on that mission is dodescending and ascending shuttle landings intokennedy and that makes a

big difference. if we'd shifted peggy'sstuff we wouldn't have had that problem. why can't i -- ohhere it is yeah. so what we should've donehere is this was for an ascending landinginto kennedy this way. if you go over the countrywhich we didn't like to do after columbia, but if youcame in descending then this shift they wouldhave gone this way.

so we would have slammedthem here and then they would've shifted later andlater and then synced up. what we did here wasslammed them to here and right about here they'redoing okay and then here they're starting todecompensate and then we slammed back and they'rejust and then we packed in this two weekswith scheduling. so that's justthe way it worked. and that's when you needthese meds and you need to

have timeouts, you know,you need to be safe. and we did that on my longduration missions we had a couple incidents we saidstop, you got to stop, stop, stop okayand it worked. but it's being able to saythat sometimes that's kind of hard. >> i have anadditional question. you talked about veggies,but do you include starches when you'resaying veggies?

>> no, what i'm sayingwith veggies -- complex carbohydrates, you know,there's carbohydrates which are simple sugarsokay and those are breads and potato chips andthose sorts of things. they're simple sugarsthey're just sugar, i mean there's nothing differentin a piece of white bread than going and givingyou a little sugar except they've added somenutrients to it. you need fiber.

what sugar does is ifyou're given a bowl of, you know, simplesugars it's going to quickly raise your bloodglucose level, you know, your sugar level is goingto go up and then you make insulin and then you'reliving like this. and that drives theinsulin goes up and then your sugar drives. you know, it's better toeat a lot of little meals, eat complex carbohydrates.

the glycemicindex is a meal or a protein, a little bitof fat, a little bit of protein, a little bit orcomplex carbo which is i'm sorry, a complex carbo issomething that's going to feed into your systemslower like a piece of broccoli okay,it's got fat in it. a tomato has 6%, 8% fatyou can squeeze a tomato and that's what i cook withokay or i use diced tomatoes andthat's my oil.

so there's fat it'svegetable oil okay, it's just natural it's there. and it's like orangejuice is about as bad as a coca-cola unless you'regetting the pulp and the rest of the orange withit because you're getting 120, you know, caloriesworth of pretty good sugar that's why we get orangejuice to people who have taken too much insulinand they've dropped their sugar so low okay becauseit's rapidly absorbed.

it's the quick bolus ofsugar, whereas if you eat the orange you're goingto get the same amount of sugar, but you're alsogoing to get fiber and protein and even a teenybit of fat in that. and so that feeds intoyour system slower, so you're living more likethis instead of doing this so when i say complexcarbos are vegetables that have proteins, fats andsugars in them, but they just feed better.

did that make sense? >> i've being seeingheadlines about sedentary lifestyle such assitting at your desk all day and they keep callingthat the new heart disease or whatnot. and that even exercising aftersitting at your desk for eight hours isn't going to offset the damage that we do. what are yourthoughts on that? >> i think well the datahere with the cooper

clinic stuff was, youknow, if you just get off your duff 30 minutes a dayand walk at a brisk pace that does negatesome of the factors. and if you're, you know,at a smart desk where you sit there anddo stuff and it's fine. calories are calories, youknow, if somebody went and ate at mcdonald's and theydid fine, but they just ate littlepieces you know. fat has almost twice theamount of calories in it

-- a gram of fat is 9calories per gram as a sugar that's a gram,you know, is 4 calories, protein's 4 calories. so if you look at theglycemic index, you know, for diabetics those arefoods that are relatively slow metabolizing thatdon't give you boluses of sugar. how did i get backon that one you asked me about exercise.

i think, you know, it'sthe key is moderation it's worse for your back andbutt and your posture and everything else if you'resitting at your desk all day, it's just not good. you just have to get upand walk around every so often. you know, we're notprogrammed we didn't evolved to be all that weare, you know, to be you know couch potatoes, weneed to be outside and

that's the next thingthat's going to happen with your light. you can now buy led lightsthey cost a buck a year in power, they cost $69 rightnow though going down in price. you can buy led lightsthat have 1/25th of the power rating of thesepuppies, well not fluorescents, but of thecandescents that you now will be able to controlthe blue frequency, red

frequency. so your room you canprogram your house to be a day night cycle andactually you can control the hue of it so it's notas bright looking, but you're still gettingblue out of it. although, that'sharder to it. so in other words, you'llget a physiologic day. if you get more sunlightlike i work at a window, i'm getting good sunlight.

well we also look atwhat we've done with our schools and ourengineering down here especially. we've engineered thingswith low ceilings and windows far out because acis so important, power is so important so you'renot getting the light in. and so now we can fixthat with led lights and control that. so that's a kindof fun thing.

i mean go to verizon rightnow you can buy little phillips lights that youcan program with your iphone and turndifferent colors. the next step they'recoming out is to be able to program lights thatgive you physiologic blue and no blue and red andplant growth which gives you a lot of blue anda lot of red okay. so they growplants better. i hear they'rebig in colorado.

good question, keep it up. >> i was just wonderingwhen you were talking about the light and themelatonin what about blind people, how does thelight affect their physiological? >> yeah, that'sa good point. they just came out with a-- steve lockley is coming out with a melatonin --they've come out with melatonin preparation, youjust take oral melatonin

that helps them. that you don't have lightsensors on the back of your leg like peoplehave said, you know. although, some people thatdon't have rods and cones what you didn't see inthat photo is there are certain people that areborn without rods and cones that still havemelanopsin ganglion. they filmed -- this wasnasa research that they found this out fromlooking at frogs and

reptiles -- here. so these are your rods andcones, this is what takes light and turns them intoa picture in the back of your brain back here okay. so people that don'thave those still make melanopsin, they stillhave retinol ganglia that make melanopsinand they do fine. it's just the people thatdon't have intact retinas, then what they're doingis giving them melatonin.

and they just comeout with a new 24-hour preparation of melatonin. the israelis havecircadian which is what i like to use with my guysand gals that travel it mimics the same curve asthe melatonin curve that you see versus just givinga big bolus of melatonin it actually givesyou that long curve. so here's that long curveyou just flew to moscow so you're trying to go tosleep here okay and it

takes you nine days toslowly get that melatonin curve here unless you uselight and melatonin then you can get it here inabout three days okay. so you're trying to go tobed here and there's no melatonin on board youcan take melatonin and it gives it to you. >> so dr. johnstonour time is up. >> okay. >> but yougave your information at

the end. >> yes. >> if they wanted tocontact you with other questions and or comments. >> yeah, i meansmith.l.johnston@nasa.gov. >> okay, so you'rein the global. >> yeah, that's thecoronary disease we do. let's see. yeah right here --smith.l@nasa.gov, that's

my mobile and i don't havemy, you know, i'm in the global you guyscan find me. >> thank you, thank you. >> thank you again andthank you all.