[00:00:00.000] - Dr. Lemanne
Cold water immersion increases plasma norepinephrine and dopamine by 530% and 250%, respectively. And there's also a lot of epinephrine release. This is much, much more than antidepressants, than even things like Adderall, you know, exogenous catecholamine.

[00:00:26.250] - Dr. Gordon
Yeah.

 [00:00:26.700] - Dr. Lemanne
Prescription drugs. So pretty much everyone who goes into a cold water immersion situation emerges in a better mood, no matter how— whether they started off in a bad mood or started off in a good mood, whatever they started at, they're better when they get out, and this lasts 12 to 24 hours. You have found your way to the Lemanne-Gordon Podcast, where docs talk shop.

 [00:00:55.140] - Dr. Gordon
Happy eavesdropping!

 [00:01:02.650] - Dr. Lemanne
I'm Dr. Dawn Lemanne. I treat cancer patients.

 [00:01:05.790] - Dr. Gordon
I'm Dr. Deborah Gordon. I work with aging patients.

 [00:01:09.580] - Dr. Lemanne
We've been in practice a long time.

 [00:01:11.980] - Dr. Gordon
A very long time.

 [00:01:13.590] - Dr. Lemanne
We learn so much talking to each other.

 [00:01:15.620] - Dr. Gordon
We do. What if we let people listen in?

 [00:01:24.210] - Dr. Lemanne
In this episode, Dr. Gordon and I explore what you and your doctor may not know about sauna. We start with the remarkable story of a man with an inherited mutation that gave him an extraordinarily high likelihood of developing early Alzheimer's dementia, yet decades, decades after he should have become ill, He hadn't. One intriguing possibility: his lifelong job in scorching hot engine rooms, an occupation that functioned like decades of sauna therapy. And that takes us to Finland, where people who sauna bathe 4 to 7 times a week have been observed to have a 66% lower risk of dementia. And A dramatically lower risk of sudden cardiac death. We explore the role of heat shock proteins as at least some of the reasons for these benefits. Then we go from very hot to very cold. Cold water immersion can produce astonishing surges in norepinephrine and dopamine, explaining why people come out of a cold plunge in a better mood than when they went in. And somehow, somehow we end up challenging conventional wisdom about meat, cholesterol, ApoE4, and brain health. We veer off again and challenge another piece of conventional wisdom. In one African cohort, replacing just 200 calories a day of plant protein with animal protein was associated with about a 40% reduction in all-cause mortality.

 [00:03:07.300] - Dr. Lemanne
And then Dr. Gordon reveals a ridiculously simple exercise that may help your knees, balance, back, and your prefrontal cortex. And finally, we discuss a provocative frontier: whether rapid, high-temperature heat exposure— sauna, that is— could place special stress on cancer cells, and why, for my cancer patients, I make an important distinction between a traditional high-temperature Finnish sauna and the more gentle infrared sauna. This is not a cancer treatment claim, but it is a fascinating area where physiology, metabolism, and oncology meet. Finally, comfort has its place, but occasional intentional discomfort keeps our bodies, minds, and emotions adaptable, resilient, and healthy. And extreme but safe temperature exposure is part of that prescription.

 [00:04:10.170] - Dr. Gordon
For some reason, it started with tariffs. So I'm blaming it on them. But there's just a global shortage of estrogen patches.

 [00:04:20.850] - Dr. Lemanne
A global shortage of estrogen? Estrogen patches? Yeah.

 [00:04:25.020] - Dr. Gordon
So I've got all these, you You know, one of the fairly well-established but once hidden in the weeds factors that improves brain health for older women is the estrogen patch. We thought for a long time that women got more Alzheimer's than men because they lived longer, but then when they looked at people at similar ages, those women got more Alzheimer's too, a difference that's pretty much eliminated if women replace their estrogen.

 [00:04:54.630] - Dr. Lemanne
Right.

 [00:04:55.180] - Dr. Gordon
After menopause. So I have all these older menopausal women on estrogen because it's a tried and true intervention you can do to improve brain health. And, but it's not the only one. I think there's some others that are lesser known now that are worth looking into.

 [00:05:18.510] - Dr. Lemanne
Well, you had wanted to talk today about, or we both wanted to talk today about About brain health, and I think I sent you an article about something that you already knew about, of course, but it was news to me, and this was about, the title of the article is from New Scientist, it said, Man Destined for Alzheimer's May Have Been Saved, and it says, by accidental therapy, but actually it was his job, and it says, Doug Whitney has a genetic mutation that means he should have developed Alzheimer's disease decades ago, But his long-term work in hot engine rooms may have protected him in a similar way to sauna therapy. I thought, wow, he was paid to take saunas all day long for decades, and it prevented him from getting the disease that apparently many members of his family succumbed to, which was Alzheimer's disease, and I think early Alzheimer's.

 [00:06:16.050] - Dr. Gordon
People familiar with Alzheimer's a little bit know the common genetic risk factor, which is an allele of the APOE gene, the 4 allele. So to have 1 or 2 copies of APOE4, yes, doubles or more your risk. But he had the presenilin gene, which theoretically gives him 100% risk of getting Alzheimer's. Okay, we know it's probably a tiny bit less since genes never work alone, but theoretically, 100% risk.

 [00:06:48.000] - Dr. Lemanne
You know, nature versus nurture is illustrated by this case. So we have a gentleman who has all of the, you know, the biggest risk factors you could possibly have for dementia, and he then is, I don't know, lucky enough to work in a hot engine room for decades, and that prevented his Alzheimer's, we think. I mean, I guess there's, you know, you said 90-plus percent, so there's You know, 5, 10% who, even with all these genes, don't get it. So maybe he's one of those. But I thought that was a really interesting article, and I was curious to hear your thoughts on that. And I, you know, I'm a big sauna fan.

 [00:07:28.110] - Dr. Gordon
I know that you are, and so I thought that was interesting, and that no wonder you're so smart. No, that probably you were smart before you started taking saunas.

 [00:07:37.040] - Dr. Lemanne
Well, I've been taking saunas since I reached my 20s, and I've always been drawn to them,maybe because I have a propensity to dementia or something like that, I don't know. But do you know sauna bathing or hot bathing is common around the world? So there are a lot of cultures with a heat bath tradition. So Finland, of course, is the one we think of when we say the word sauna, which is a Finnish word. I think they say sauna.

 [00:08:05.540] - Dr. Gordon
Sauna.

 [00:08:06.640] - Dr. Lemanne
And then all of the surrounding countries, Estonia, Latvia, Lithuania, Russia, And then getting a little bit further afield, Germany, Austria, Hungary, and then really far afield in the Middle East, Turkey.

 [00:08:19.850] - Dr. Gordon
Oh, I had no idea.

 [00:08:20.420] - Dr. Lemanne
And if you go to, yeah, they call it the hammam, and if you go to Japan, they have onsen and sento traditions. Those are hot communal baths, usually communal, but not necessarily. Korea has a jimjilbang tradition, Bath, hot bath tradition. China, Laos, South and other parts of Southeast Asia. Australian Aboriginal peoples had sweat lodges, sweat-type cleansing rituals, and Sub-Saharan Africa, you know, you think of that as hot, you know, hot climates, but there are mountainous regions there, and tribal sweat huts and steam healing rituals, and North America.

[00:09:05.540] - Dr. Gordon
Yeah.

 [00:09:05.780] - Dr. Lemanne
Aboriginal people, we know about the sweat lodges, and that extended down into Mexico and Central America. It was called temazcal, and it's a type of sweat lodge.

 [00:09:15.980] - Dr. Gordon
That's interesting that you just said temazcal when the lake in the Berkeley Hills or Oakland Hills is called Lake Temescal, but evidently maybe it really was temazcal.

 [00:09:25.850] - Dr. Lemanne
Maybe.

 [00:09:26.500] - Dr. Gordon
Yeah.

 [00:09:27.140] - Dr. Lemanne
And that extends all the way down to the Andes and even the Amazon region. So all over the world, we have these hot, baths. So you wonder, is there some secret to that? Is there some reason humans like that?

 [00:09:41.500] - Dr. Gordon
Yes. Why have humans gravitated towards that? Because, frankly, in a lot of those primitive cultures, people were not living long enough to decide whether or not they got Alzheimer's. And that's an interesting paradigm because do you know one of the countries that has the highest rate of neurodegenerative disease in the world.

[00:10:03.420] - Dr. Lemanne
Is it India?

 [00:10:04.670] - Dr. Gordon
Finland.

 [00:10:05.330] - Dr. Lemanne
Oh, Finland. Okay.

 [00:10:06.690] - Dr. Gordon
Where they had— and so they said, oh, the saunas must not help. And then they said, wait a second, let's look farther at Finland. Finland has an incredible reputation for longevity in general. So in Finland, people do live longer, and people who live longer, there's a higher incidence of dementia. And they have a very high rate of of that common risk gene, APOE4. So when they took Finland— Finnish people and just looked at the ones who sauna bathed 4 to 7 times a week, 4 to 7 times a week, compared to those who didn't, they did have a 66% lower dementia risk compared to the Finns who were not sauna bathing that much. So—

 [00:10:51.600] - Dr. Lemanne
Wow, that's, that's, that's amazing. Well, you know, there's There's a lot of health benefits from sauna bathing that have been defined by Finnish observational studies. Heart disease, sudden cardiac death, a 63% lower risk for regular sauna bathing, and that's 4 to 7 sessions per week, and it's compared to 1 session per week because saunas, so everybody in Finland's having some sauna because they build them into the houses, so when you build a house, You put a sauna in, just like in our houses we put a kitchen and a bathroom, you know, they put a sauna in as well as all those other things. And so everybody has, pretty much everyone has access to sauna bathing. And 1 session a week, you know, compared to 4 to 7 sessions per week, you see a big difference. So there's this dose-response relationship which indicates some kind of causality.

 [00:11:46.490] - Dr. Gordon
Before we go on, may I ask you a quick favor? Hit the subscribe button. Your hitting that subscribe button really, really matters. You're making sure cutting-edge ideas that matter to you move to the center of medical discourse where they belong. Thank you. That's a good association that tells you some of the fact of it. It is— there's a theory about in Certainly in the dementia world about why that is happening. And that's because the sauna elicits in our body heat shock proteins. And that's a kind of protein. And I don't know if it's an alteration of an existing protein. I thought I had that in my brain, which I evidently don't. Maybe I need to go take a sauna. But you have an increased amount of heat shock proteins, which a remarkable ability to go into the brain and untangle some of the beta amyloid P-tau tangles that are there. And further beyond that, the heat shock proteins provide a gentle coating to P-tau molecules or P-tau function so that it can't retangle.

 [00:13:13.440] - Dr. Lemanne
So it's So it's kind of a comb for your intracellular proteins.

 [00:13:18.550] - Dr. Gordon
It's a comb, that's very good, for your intracellular proteins that leaves a gentle conditioner on those proteins so they can't retangle. And it's one of the reasons and one of the benefits for our recommendation that people who have dementia concerns or problems do high-intensity intervals.

 [00:13:44.500] - Dr. Lemanne
Oh, for the same reason to untangle their towels. Well, to elicit heat shock proteins.

 [00:13:48.780] - Dr. Gordon
In general, evidently working in a hot engine room should be another recommendation.

 [00:13:56.060] - Dr. Lemanne
Well, that gets you exercise and heat, and I consider and I recommend sauna bathing, especially for my patients who are wheelchair-bound. Because sauna bathing is in some ways an exercise mimetic, and I think you've touched upon that with the comparison with exercise here. So people who can't exercise can get some, you know, tiny bit of cardiovascular conditioning with sauna bathing. Oh, definitely, yeah. It makes the heart rate go faster, and it expands the blood vessels and improves elasticity. You know, people who sauna bathe regularly, the other diseases that go down, Stroke risk goes down. People who have heart failure can get a little bit better because their hearts will strengthen with sauna bathing, and they just have to sit there. You know, there's no exercise needed. It lowers blood pressure. It prevents high blood pressure if you don't have it, and it improves lung function. So there's been some data that shows that the vital capacity, which is the amount your lungs can take in and breathe out, Is increased with sauna, regular sauna.

 [00:15:07.240] - Dr. Gordon
And, you know, in my world, there are 2 kinds of sauna. There's the sauna you get into and it's hot and, you know, maybe pour some steam on the rocks, whatever, generate a little higher temperature and you sweat. And then there's the far infrared sauna, which is ascribed greater capacity for detoxification than just the sweating sauna. And it's a much lower temperature. The 2 temperatures are, yeah.

00:15:32.920] - Dr. Lemanne
Right, that's the difference between them, yeah. And I'll tell you my thought about that. So for my cancer patients, I insist on the Finnish sauna because of the higher temperature, and the reason for that is that there's some, and this is preclinical evidence and it's weak, but it's important in oncology, I think, to grasp at everything you possibly can, And that is that cancer cells are particularly susceptible to heat damage because they cannot easily make heat shock proteins. They have to turn off their cell division factories and turn their attention to making heat shock protein, and they don't like to do that. Their main goal is to reproduce.

 [00:16:18.540] - Dr. Gordon
Oh.

 [00:16:18.700] - Dr. Lemanne
Make a new cancer cell, so anything that distracts them from that is, is something that they've been programmed to avoid, so they will avoid heat if they can, but if you get into a fast-heating sauna, a situation that's high temperature, and by that I mean 170 degrees Fahrenheit or more.

 [00:16:38.370] - Dr. Gordon
Whereas a far-infrared sauna could be 130 to 140, quite a bit less.

 [00:16:43.080] - Dr. Lemanne
Exactly. It takes a long, it takes 5 to 10 minutes to get up to The core temperature, which is what I like my patients to do. I like them to get up to a core temperature of 101 to 102 degrees, and I have them measure it under their tongue, standing outside the sauna, of course. If you take a thermometer into the sauna, it's gonna immediately go up to 180 degrees or whatever it is in the sauna. So you have to leave the thermometer outside, but when you think you're hot enough, I ask them to get out and immediately stick that thermometer under the tongue. You don't wanna use one of the COVID-era thermometers that points at your forehead or sticks under your armpit or something like that. We wanna look, measure under the tongue.

 [00:17:16.390] - Dr. Gordon
Okay.

 [00:17:17.010] - Dr. Lemanne
And I want them to get up to at least 101, 102 is better, and what you do then when you raise the temperature quickly is you weaken cancer cells, maybe even kill a few, because they cannot make heat shock protein quickly. However, if you heat them up slowly, it takes you 45 minutes, which it can in a 135-degree infrared sauna, to get to a core temperature of 101 or 102.

 [00:17:40.890] - Dr. Gordon
That sounds brilliant. It sounds much more efficient. How long does somebody need to maintain that 101-degree temperature they got from your hot sauna to achieve their full benefit?

 [00:17:53.770] - Dr. Lemanne
They don't need to stay there terribly long, we don't think. We don't know that for sure, but we do know that once you hit 101 or 102, you've really caused a lot of damage. If you take a long time to get there, however, The cancer cells can kind of protect themselves.

 [00:18:11.500] - Dr. Gordon
So it's brilliant. You just get up there, take your temperature, sit there for a little bit, and you've got your heat shock proteins.

 [00:18:22.210] - Dr. Lemanne
That's right. That's right. And you just— the idea is that you want to do it fast. So that's why I don't really like infrared saunas, because they take a long time. By then, sure, the cancer cells have had plenty of time to make heat shock proteins and protect themselves. So for cancer specifically, and I'm not saying that this is a treatment for cancer or a cure for cancer in any way, shape, or form, and nobody should take this as advice to go sauna bathe. You need to check with your own healthcare professional to make sure sauna bathing is healthy and safe for you. But what I do recommend for patients that I've evaluated and determined that this is a good, you know, reasonable option for them, I recommend the Finnish sauna for that reason.

 [00:19:05.930] - Dr. Gordon
Okay.

 [00:19:06.940] - Dr. Lemanne
And I do think that sweating in general, though, is good for removing BPA, heavy metals, all sorts of toxins that we encounter in life, and it's one of the best ways of doing that. And it is, I think, anything that makes you sweat is going to do that. So infrared sauna, certainly, if you stay in long enough, will make you sweat, and the sweat— sweating itself will remove the toxins. But for Heat shock protein effects in cancer specifically, I prefer, for that indication, I prefer the Finnish or hot water.

 [00:19:40.800] - Dr. Gordon
You raise a point of interest to me. I have a few patients and a friend who, quote, I wanna put it in air quotes 'cause it's hard to believe it's absolutely true, I don't sweat, right? People who say they don't sweat. And I know there's different thresholds for sweating, But first of all, I would imagine if sweating is part of what's good for you from— you might generate more heat if you don't sweat. You're not cooling off by the evaporation on your skin. So on one hand, you could say that's intensifying the benefit of your sauna, but you're losing the sweating benefit of your sauna. And is that true, or are people just not good observers, the ones who think they're not sweaters?

 [00:20:26.940] - Dr. Lemanne
So So people have different numbers of sweat glands in their skin, but sweating is, to a certain extent, conditioned, meaning you have to practice it. And being able to tolerate heat is a conditioning process. So being unable to tolerate heat is a lack of a type of physical fitness, in my opinion, and it needs to be exercised. So people do sweat more differ in their ability to sweat, and the number of sweat glands per square inch of skin, for instance, but not that much. But there are, if you're born without the ability to sweat, you will die.

 [00:21:06.870] - Dr. Gordon
Uh-huh.

 [00:21:07.190] - Dr. Lemanne
It's not compatible with life. But there are medications that decrease your ability to sweat. So people who take antidepressants may not sweat well. People who take antihistamines, you know, Benadryl, things like that, may not sweat. People who are diabetic. People who are diabetic have terrible problems with the nerves that innervate the skin and all other organs as well, but you need nerves that innervate the sweat glands. But that can be, again, conditioned to a certain extent. You can reverse those kinds of things with the practice of sauna bathing. It takes a little time. You have to Be smart about it. Start slowly. Don't go in for an hour if you've never done it before in your life. That's just—

 [00:21:51.720] - Dr. Gordon
That's just common sense, and you won't be able to stay in there for very long anyway if you're not used to it. So that's why both of us have moved from milder climates to Southern Oregon, which brings up an interesting point that I was going to make next. Oh, let me say something because that's— but I've worked my way around to it. So In the other climate that I've visited where there is— everybody is hot bathing, in Iceland, they don't have saunas or hot tubs in their house. They're all communal, which is quite fascinating. In the smallest town we went to, the smallest towns we visited in Iceland, there was hot bathing and hot sauna for everybody. But in that same facility, Everyone also afterwards went into a deliberate cold plunge.

 [00:22:44.860] - Dr. Lemanne
Yeah. Well, you know, in Finland, you know, as far as I know, I've never been to Iceland. I know you have.

 [00:22:50.180] - Dr. Gordon
It is.

 [00:22:50.660] - Dr. Lemanne
It sounds fantastic. And as far as communal bathing, there was a bathhouse when I was a medical student in San Francisco. It was called Osento, and it was a Japanese-styled bathhouse, but there were Oh, yeah. No, very few Japanese people around that I recall, but there were a lot of students, and I used to go there as often as I could, a few times a month, and it was communal. There was a hot tub, and then there was a sauna outside, and then there was a cold barrel that you could get in and get cold, and some of those are some of my happiest memories. It was so relaxing and so peaceful, and I always felt so good afterwards, and I think the cold Plunge was part of it, and now we know a little bit more about that. So, you know, cold water immersion increases plasma norepinephrine and dopamine by 530% and 250%, respectively.

 [00:23:46.810] - Dr. Gordon
That's awesome.

 [00:23:47.420] - Dr. Lemanne
And there's also a lot of epinephrine release. This is much, much more than antidepressants, than even things like Adderall. Exogenous catecholamine prescription drugs. So pretty much everyone who goes into a cold water immersion situation emerges in a better mood, no matter how, whether they started off in a bad mood or started off in a good mood, whatever they started at, they're better when they get out, and this lasts 12 to 24 hours. Oh, that is fascinating. And it lowers cortisol. If you alternate this with a sauna, so if you take a sauna first, and then you get in the cold plunge, and then you get out, and you kind of just rest, you actually, after all of that sympathetic stimulation, your body resets with a higher parasympathetic tone, so you shift your balance toward parasympathetic dominance, which is the healing part, the rest and digest, and heal.

 [00:24:49.490] - Dr. Gordon
And the other one being the sympathetic tone. high stress that a lot of people live in. And so can they get the benefit? Can somebody reset their system by just going in a cold plunge, or is it the heat-cold cycling?

 [00:25:07.050] - Dr. Lemanne
You know, I think the cold has its own benefits, and you can do that by yourself. There are the, you know, the polar bear swimmers or whatever they call them that like to jump in the ocean on New Year's Day and things like that. I think they just do it for the newspapers on New Year's Day, but they do it other times too, and those seem to be beneficial, so cold, and cold exposure is somewhat, somewhat habit-forming, I hear, and I wonder if it's because of the large elaborations of catecholamines. That would feel really good. That would be like taking a drug, only much, much safer and better for you.

 [00:25:42.700] - Dr. Gordon
Dr. Lemanne, you moved recently, and so did you, in your backyard, I know that you had 2 very interesting objects, Unlike most people's backyards, you had a sauna that you built yourself, and next to it, you had a livestock watering trough full of cold water.

 [00:26:03.930] - Dr. Lemanne
These are very glamorous items. They are.

 [00:26:06.670] - Dr. Gordon
In my world, they are. But I wonder, you've sold your house recently. I hope you took both of those with you.

 [00:26:14.210] - Dr. Lemanne
I did. I moved them to the new house and use them almost daily. And I think I've been 5 or 6 times this past week. I hate to miss. When I do take my sauna and cold baths in the late afternoon after work, I find that my heart rate variability the next morning is much better than when I skip those activities. So I know that I'm—

 [00:26:40.070] - Dr. Gordon
I measure this, and I know that I'm improving my parasympathetic tone and improving my In terms of the heat exposure portion of it, I would assume that the answer to this question that I think somebody would pose is, you know, what about a good hot tub? But that just never gets you hot enough, right?

 [00:27:03.560] - Dr. Lemanne
You know, it's harder. And one of the things that is different about a hot tub is that your head's not in. So the head needs to be Although the head can get too hot, and I, you know, if you have a hot tub, please, please, please use it.

 [00:27:19.440] - Dr. Gordon
Oh, that's fantastic.

 [00:27:19.920] - Dr. Lemanne
See if you can get your temperature up to 101, and if you can, well, maybe you're getting a lot of benefit from it, and you can tell, and you probably wanna alternate with hot-cold exposure too. I don't think that we've studied hot tubs the way we've studied saunas, and the reason is is because the Finnish people, having an interest in sauna, Bathing being important because they've built it into all of their houses, have done most of the studies on sauna. So if people do start doing some studies on hot tubbing, who knows what we'll find? I think it's an interesting topic and we ought to look into it, and I certainly, you know, I love a good hot tub. What's wrong with a hot tub? You know, oh, that's nice. Is it exactly the same as sauna? Well, we don't know, but if that's what you have— It's a sauna. Or even if you just have a hot shower, for goodness' sakes, use what you have, hot bathtub, try to get your temperature up to 101. That's what you're trying to do with the sauna.

 [00:28:15.620] - Dr. Gordon
That is a wonderful guide or a measure that people can actually always use. And just because I never pass up a good opportunity to mention some supplements, there are 3 supplements that have been studied around the process of heat shock proteins enhancing brain health that co-induce, they act as co-inducers to facilitate heat shock protein release. And they are sulforaphane, the extract from broccoli seed sprouts potentized into a highly bioavailable form, curcumin, which I'm gonna ask you something about. Everything I have today has a question. Green tea extract. What's the third one?

 [00:29:04.000] - Dr. Lemanne
Well, these aren't supplements. These are foods, Dr. Gordon.

 [00:29:07.860] - Dr. Gordon
Uh-huh, but no, but here—

 [00:29:10.280] - Dr. Lemanne
We can just go to the grocery store and get them.

[00:29:12.840] - Dr. Gordon
So if you want to take some sulforaphane, you can either eat 5 abundant handfuls of broccoli seed sprouts or take 1 pill.

 [00:29:22.040] - Dr. Lemanne
Well, if you want a huge dose.

 [00:29:24.300] - Dr. Gordon
No, that's not a huge dose.

 [00:29:25.580] - Dr. Lemanne
But what about normal, small, small doses?

 [00:29:27.020] - Dr. Gordon
I think they're good for you, but You wanna really boost the effect. Boost the effect. And there's an interesting— so I have an apocryphal story I relate, which I want you to either fact— I want you to fact-check for me, busting it or approving it, which is that my understanding of how we became to be such an adorer of curcumin in this country or perhaps worldwide is because it was observed, I don't know where I got this story, that men in India had less prostate cancer And it was linked to their multiple times daily eating turmeric with coconut oil and black pepper, which can only be mimicked by turning turmeric into curcumin. Is that— does that have any basis in reality, oh wise oncologist?

 [00:30:18.780] - Dr. Lemanne
Well, I don't know. I'll look it up, but that's an interesting idea. You know, curcumin is An antioxidant. It's also an anti-inflammatory. It works on the COX-2 pathway, which has to do with a lot of malignancies by way of inflammation. So it's an interesting question, and I don't know specifically.

 [00:30:42.600] - Dr. Gordon
It makes a good myth, don't you think?

 [00:30:44.580] - Dr. Lemanne
Certainly I do. And, you know, one of the things that I, you know, I don't want to sound like a quack. It's one of my great fears. But do you think that— are you of the persuasion that supplements are a major part of healthcare? Are you moving in that direction as opposed to food?

 [00:31:14.130] - Dr. Gordon
I think I would not. If I had to choose between the two, I'd pick food. And if, you know, speaking to my healthy 40-year-old daughter, there's very few supplements I recommend for her, but a couple. But for my cognitive patients who say, can't I get it all through food? You could get curcumin if you put turmeric on your food 2 or 3 times a day and have it with coconut milk, which I don't advise because of what it's going to do to your saturated fat, and take in black pepper, which might irritate your, you know. So I do think that The more challenged you are in your health, the more you need to rely absolutely on both of those solid pillars, a good food diet and good supplements. Where are you in that alignment?

 [00:32:05.890] - Dr. Lemanne
Well, you know, I guess I completely agree. I think that if you have a serious condition, if you have a serious medical condition like cancer or heart disease, You're not aiming for, let's say, you know, balance, work-life balance. You've got to do something dramatic to shift things back to a healthy area. And so sometimes you do have to really maximize intake, and that can't be done with food all the time. So I agree that in certain situations, you really need to— to concentrate whatever it is you're trying to get from food and put it in a pill and take high doses of it. And in that case, I like to work with patients as a physician and try to measure what we're actually going for. 

[00:32:54.150] - Dr. Gordon
Yes.

 [00:32:54.340] - Dr. Lemanne
So, you know, with curcumin, we can measure high-sensitivity C-reactive protein, for instance, and other measures of inflammation. These are not perfect. There's the neutrophil-lymphocyte ratio and a few others. that can change with curcumin, but those are a little fuzzy, and they can change without curcumin, and just because, meaning there's a black box there, and we don't understand it. But I do think that, yes, supplements have their place. I want, I try to emphasize to patients that I think that the bigger levers are sleep.

 [00:33:31.770] - Dr. Gordon
Yes.

 [00:33:33.600] - Dr. Lemanne
Last time we talked about sun exposure. I think that's a really big one that's completely overlooked. Diet and how diet especially affects blood sugar excursions, I think that's really even more important than the little choices of diet. I'm going to have broccoli sprouts versus sweet potato. I think that what's more important in those kinds of choices is what makes my blood sugar stay nice and flat versus what makes it spike in an unhealthy way.

 [00:34:00.980] - Dr. Gordon
Yeah.

 [00:34:02.020] - Dr. Lemanne
So I think that those kinds of things are things I would concentrate on first, and then at the end, as the frosting, oh, I love cake too, I shouldn't talk about this, but as the frosting, the least important part, but important, is the supplement.

 [00:34:21.060] - Dr. Gordon
And I think so, you know, yeah.

 [00:34:25.240] - Dr. Lemanne
But dementia, dementia is a, Life-threatening, it threatens everything. You know, dementia is kind of the end of the line if you don't take care of it. And so that, I think, you know, I would listen to you in terms of what you might recommend for supplement protocols with dementia.

 [00:34:42.710] - Dr. Gordon
I do appreciate the importance of testing. For instance, I think it's, you know, when I'm telling somebody, I want you to take these particular B vitamins, and they go, oh, but I eat well. Then I'll say, okay, but you have not been absorbing any of your B12. It's not been the right type because the effects of the B vitamins in your system. And the one we look at the most pertinent to the brain, because it has a direct inverse relationship with brain health, is homocysteine. And if your homocysteine— and our criteria are different than standard laboratory criteria or standard cardiology criteria. We look at homocysteine, which is an amino acid the body recycles, and it can cause hazards itself if it's too high.

 [00:35:27.400] - Dr. Lemanne
Yeah.

 [00:35:27.930] - Dr. Gordon
And if it's too high, it's suggesting you have lazy B vitamins somehow or none at all in your system if your homocysteine has gone up. And it's more likely that they're lazy and inappropriate because—

 [00:35:42.670] - Dr. Lemanne
Well, what I hear when you're talking is this brilliance about actually measuring what the diet is doing for that patient's system and body and blood. And you're doing that. You know, that's amazing. I think a lot of people, including doctors, hand a patient a brochure or read them the textbook, this is a healthy diet, and whether the patient's actually responding in a healthy way to that particular diet is never addressed, not evaluated, and you're doing that.

[00:36:17.450] - Dr. Gordon
As all the laboratory facilities in the area know me well.

 [00:36:23.470] - Dr. Lemanne
You have a reputation.

 [00:36:24.610] - Dr. Gordon
I do.

 [00:36:26.300] - Dr. Lemanne
But I want to say, do you know, I mean, you're kind of the doctor in town who, you know, in the state, who is known for that. So do you remember how you met me?

 [00:36:38.720] - Dr. Gordon
Yes, kind of. I mean, it was about a patient that I recall us discussing.

 [00:36:44.810] - Dr. Lemanne

It was about a patient whose diagnosis I completely, I wouldn't even say missed it, never It occurred to me, I was treating this patient for cancer, and the patient had itching.

 [00:36:56.570] - Dr. Gordon
I do.

 [00:36:56.990] - Dr. Lemanne
Do you remember that? Pruritus is the medical-ese term for that. So this patient had amazing pruritus. She was really suffering with this, and she was also being treated at the big tertiary care center, and they didn't know what to do. I didn't know what to do, and one day she came in, and she said, I said, how's your itching? She said, oh, that's fixed. And I said, oh, really? And she said, yes, Dr. Gordon did a test and found out that I had a hepatitis virus, and that was the cause of my itching.

 [00:37:32.180] - Dr. Gordon
I do. I do. I know her name.

 [00:37:34.090] - Dr. Lemanne
Do you remember that?

 [00:37:35.050] - Dr. Gordon
Yeah, yeah.

 [00:37:35.680] - Dr. Lemanne
And that was— I had never heard of you before that, but boy, did I remember that. I was like, oh, that's so embarrassing. I can't meet this doc. I'm just going to hang my head. And, but yeah, so you're known for these brilliant diagnoses and picking things up.

 [00:37:49.160] - Dr. Gordon
What I'm known for is having patients in the lab with lots of—

 [00:37:53.110] - Dr. Lemanne
And lots, but that's why. So lots of—

 [00:37:56.540] - Dr. Gordon
But you know, sometimes I wanna get back a little bit to you talking about what, because doctors can hand out a pamphlet about what is a healthy diet, and there's been some attention recently into perhaps, particularly for my patients, so To our listeners, if you have any particular interest in brain health, particularly if you or your loved ones have the APOE4 gene, one of the things you've been counseled to do is eat a plant-heavy, plant-focused diet and kind of go light on the meat and particularly on the red meat, you know. And an observational study in Sweden Which was looking back, so it's observational. So this is the kind of thing, and when you hear about what was done, that you cannot set this up as a clinical trial. So they looked back over many aspects of these Swedish adults' lives, and they started in middle age and followed them for about 15 years. And it was a food frequency questionnaire. Those are notoriously unreliable, but if—

 [00:39:04.850] - Dr. Lemanne
Yeah.

 [00:39:05.690] - Dr. Gordon
Trends emerge, and better yet, if you can come up with a reason why they do, they at least stand looking at. But they found out that those, and you and I will like this finding even though we're not ApoE4, which those with the ApoE4 gene had better cognition if they ate meat on a regular basis, a substantial amount of meat for people who don't normally eat meat, amounting to about a kilogram a week. And you think, oh, a kilogram That's just a couple pounds. But when you say, yeah, that's like almost half a pound a day of meat, there's a lot of people who don't eat that much. So the bottom line is among all the people who were ApoE 3/4 or 4/4, those who did eat that amount of meat had a statistically significant preservation of their brain power for longer and at a higher level than their meat eating cohort, and on the other hand, those who avoided meat completely for whatever reason had a higher rate of dementia.

 [00:40:14.610] - Dr. Lemanne
That's really interesting. You know, there were some statistics about— out of Japan that I recall. So Japan has a— had traditionally a very low intake of dairy. That's just not a thing for them. They don't graze cattle and drink milk. That's just not what they do. And they had one of the longest lifespans in the world, and at the moment, they are the longest-lived population. Japanese people are much healthier than everyone else, and they live longer. But one of the things that they died of a lot there was cardiovascular— cerebrovascular disease.

 [00:40:56.210] - Dr. Gordon
Mm-hmm.

 [00:40:56.370] - Dr. Lemanne
They had a lot of strokes. They had high blood pressure and stroke. And when the dietary guidelines in Japan changed to increase and encourage some dairy fat intake, and that improved. So, and the mechanism was thought to be low serum cholesterol.

 [00:41:19.340] - Dr. Gordon
Okay.

 [00:41:20.050] - Dr. Lemanne
Low cholesterol. So the Japanese diet was, or the Japanese population had too low Cholesterol, the low serum cholesterol because of low saturated fat intake, and that has been consistently associated with intracerebral hemorrhage, especially in the Japanese population, and by increasing the serum cholesterol from, by means of dairy and animal fat intake, this increased the cerebral vessel walls and lowered the stroke death rate.

 [00:41:48.920] - Dr. Gordon
That is, so all these cardiologists who want your cholesterol to be 17, Are they not— I assume our listeners know really that, of course, that's impossible, but, you know, most people's cholesterol as adults are between 150 and 250, higher range being better for women, but cardiologists like your numbers lower than that.

 [00:42:12.650] - Dr. Lemanne
Well, you know, cardiologists are dealing with people who already have—

 [00:42:14.860] - Dr. Gordon
No, they're spreading their wisdom to anybody they can see that has high cholesterol.

 [00:42:20.450] - Dr. Lemanne
Well, I think we can say that the statistics are heavily based on people who've had a first cardiovascular event, and then are treated by cardiologists with statins and various similar drugs, and then how many subsequent events do they have, and I think that's a slightly different population, and also, remember that statins work possibly not by lowering cholesterol, which they do do, but by lowering inflammation.

 [00:42:48.040] - Dr. Gordon
Inflammation.

 [00:42:48.830] - Dr. Lemanne
And there's a lot of heart disease that occurs in relation to inflammation, like after a big smoke event, which we're having here. Days later, the heart attack rate remains high. It goes up immediately when you have a big smoke event like this. Smoke causes heart attacks, and it doesn't go down for a while. And after a viral infection like COVID or influenza, or even just a common cold, the heart attack rate goes up You know, by a lot, and stays up for several weeks. So, you know, infections, pollution events, other things that cause inflammation are really, in my opinion, where we need to be directing our attention for heart events.

 [00:43:32.380] - Dr. Gordon
Mm-hmm.

 [00:43:32.930] - Dr. Lemanne
You know, it's basically an inflammation event, not a cholesterol event, but the part about Plant-based diets being superior. No, there was— it depends on who you look at too. So there was an interesting study looking at sub-Saharan Africans and, you know, the Blue Zone, you know, plant-forward diet, as vegetarian as you can get pretty much, is better. But in Africa, in sub-Saharan Africa, higher animal protein intake was independently associated with decreased all-cause mortality. And substituting 200 calories per day of plant protein with animal protein reduced all-cause mortality by around 40%. And this was a study of about 2,000 African men and women who were followed for 13 years. And this really contradicts the recommendations that we see made around here.

 [00:44:34.980] - Dr. Gordon
Yeah.

 [00:44:35.770] - Dr. Lemanne
And perhaps there are population differences, and perhaps we need to pay attention to those, and perhaps, I'm gonna say this, I don't really believe in population differences in terms of diet. These are really personal differences, and one, one, meaning like a doctor, has to take each patient and see by measurement which diet is best for them.

 [00:45:01.180] - Dr. Gordon
And personal experience. I know, I, and this is, so the cognitively recommend— the diet recommended for cognition by Dr. Bredesen and others is high in plants. And I think, oh no, but you're giving up too much meat, which I think has been an issue. And I'm always the person, particularly with older people, to defend their consumption of preferably animal protein. But there, when some people say, you mean I have to eat vegetables 2 or 3 times a day?

 [00:45:33.240] - Dr. Lemanne
Yes.

 [00:45:35.310] - Dr. Gordon
A substitute for French fries, potato chips, and corn chips dipped in salsa. I can't make any heads nor tails of how that could be. It's got to be better to substitute real food. Broccoli, salad, squash, whatever.

 [00:45:51.870] - Dr. Lemanne
Oh, yeah.

 [00:45:52.930] - Dr. Gordon
But the plants— but, you know, one of the thoughts I have, I'm just going to hearken back to your Japan story a little bit. One of the risk factors we see in dealing with cognitive patients, people who have 2 copies of the APOE4 gene are at higher risk for stroke, and we are careful with the amount of fish oil we give those people.

 [00:46:21.580] - Dr. Lemanne
Is this a hemorrhagic stroke?

 [00:46:22.590] - Dr. Gordon
Yes, a hemorrhagic stroke. And so if it was hemorrhagic stroke, you know, the Japanese diet is obviously heavily seafood-based as opposed to land animal-based. So they have a higher proportion of omega-3s. So I wonder if— I have 2 questions. Number one, is part of their stroke risk from the fact that some of those people were ApoE4 and having fragile vessel walls and having hemorrhagic stroke? But my second comment, I just have to check to see if our listeners were listening a year or so ago.

 [00:46:58.700] - Dr. Lemanne
Yeah.

 [00:46:59.010] - Dr. Gordon
You know, one of the reasons that people in Japan live so long, we can credit Dr. Bruce Ames with our understanding that it's the high taurine content in seafood as well as heart muscle of land animals and poultry dark meat. But the seafood-consuming populations have a much higher level of taurine without supplementing Well, that's really interesting.

 [00:47:29.600] - Dr. Lemanne
Well, you know, there is a study—

 [00:47:31.460] - Dr. Gordon
Okay, I figured that somebody had it.

 [00:47:34.060] - Dr. Lemanne
So yes, by increasing serum cholesterol from— with dairy and animal fat, the cerebral blood vessel walls were strengthened and that was associated with a decreased risk of intracerebral hemorrhage. Meaning a hemorrhagic stroke. So yes, you're absolutely right. And this was also present in the African studies. So African studies also show that higher intakes of animal saturated fat— saturated fat was inversely associated with total mortality and stroke. And as well as animal protein intake specifically associated with lower overall mortality.

 [00:48:19.010] - Dr. Gordon
Okay.

 [00:48:19.830] - Dr. Lemanne
And as well as total protein intake. So animal products are—

 [00:48:23.470] - Dr. Gordon
And they're coming back into the favorable spotlight, you know. Well, I'm just saying, I'm here mentioning about cognition and you're pointing out these studies in—

 [00:48:33.570] - Dr. Lemanne
Oh, so we're doing that.

 [00:48:35.320] - Dr. Gordon
We're changing the culture. Okay, all right. I think particularly in the greater appreciation of— well, I'm not sure what prompted a huge rise in vegetarianism in the vaguely alternative cultures of Well, you know, it is.

 [00:48:54.350] - Dr. Lemanne
It bugs me to have to eat animals. That was— I think that, you know, I wish I didn't have to eat animals, and I feel very sorry about that. I love animals, and I kind of— I get that, and it's a conflict I have, but I absolutely— my health is not Good if I am vegetarian. It's not, and I have to— I become weak. I become cognitively inflexible and depressed. I get cold. I get all sorts of things that go away when I eat plenty of animal foods and fats. I eat a lot of animal fats.

 [00:49:43.390] - Dr. Gordon
I think the thing that got stronger for me when I was a vegetarian was my craving Well, there's an interesting book called Eating Animals by Jonathan Safran Foer. Oh, I know him.

 [00:49:57.560] - Dr. Lemanne
Yes, I've heard of him. Yeah, he wrote some other really wonderful books like Everything Is Illuminated. Oh, just an amazing writer. But anyway, Eating Animals is a survey. It's not meant to be a polemic against Meat eating, but it is about the suffering of animals and our response to that, how we compartmentalize thinking about that. And it was very thought-provoking for me. But unfortunately, I do eat meat. I need to eat meat. I enjoy eating meat. I try to eat it with gratitude to the animals and the people who grow it, and I try to eat the highest—

 [00:50:40.470] - Dr. Gordon
Quality.

 [00:50:41.350] - Dr. Lemanne
quality that I can find.

 [00:50:43.590] - Dr. Gordon
I would, you know, I might invite myself over to your house to eat some of what you've raised. I tell you, we have to do this before it's all gone because it's the best lamb we've ever raised. And yes, and we make sure that the butchers who come are quick and efficient. And, you know, it's a moment of pain in a life of— after a life of freedom. So certainly better than the animals that are raised in factory farms.

 [00:51:08.430] - Dr. Lemanne
And that, yeah, yeah, we can all hope our ends are kind, however we all end.

 [00:51:16.280] - Dr. Gordon
Yeah, okay. Well, that's kind of a dark note. So let's wrap this up because what I got off on, you know, with this gentleman who worked in the very overheated work situation that he had, that's kind of an unusual, kind of a shocking, surprising way that, gee, now we can independently do with saunas to lower your dementia risk. And I would— I was sort of looking around for what are the things that I may take for granted that I understand or that I could learn about that improve your chance of having a healthy brain longer. And I just want to share a fun one because this is also really good.

 [00:51:58.850] - Dr. Lemanne
Oh.

 [00:51:59.330] - Dr. Gordon
For people who have knee pain.

 [00:52:03.660] - Dr. Lemanne
Oh, I have knee pain sometimes.

 [00:52:06.500] - Dr. Gordon
Or balance problems, or people who have low back pain, or maybe people— Oh, I have that. You're being so cooperative here. This is also really good for people who might spend too much time on the computer. Watch me self-consciously try and sit up straight here. But this activity that I'm going to suggest has some evidence of doing all— helping all these kinds of complaints and increasing the activity of your prefrontal cortex, which is associated with problem-solving, logic, decisions.

 [00:52:46.460] - Dr. Lemanne
Oh, I know what you're going to talk about.

 [00:52:48.370] - Dr. Gordon
Well, have you seen me doing it outside the office? So we have— Dr. Lemanne and I are in the same building, and right across from us is a nice big level parking lot. There's lots of places to walk around there that are nicer, but on the days that I go out at lunch to walk backwards, which is called retro walking— It has a name?

 [00:53:09.420] - Dr. Lemanne
It has a name. I think people just say, oh, there's Dr. Gordon doing one of her weird exercises.

 [00:53:15.990] - Dr. Gordon
Yeah, but walking backwards says, oh, these are her walking muscles. Wait, you're using all of this completely differently than you usually do. You get better at it, and it's enticing to, oh, I wonder if I can walk backwards up and down that slightly hilly slope, or can I do it around the rough property around my house?

 [00:53:39.050] - Dr. Lemanne
Well, we are watching to see, like, is she gonna fall down?

 [00:53:42.650] - Dr. Gordon
Well, I hadn't done it in a while, and I took it up again this week after I reminded myself with this article, and I wasn't as— I used to be really good at walking backwards. I had forgotten some of how to walk backwards, so you're going to see me out there Well, we'll be cheering you on. And it's a little more convenient than a sauna, but I've got to do something about this.

 [00:54:10.370] - Dr. Lemanne
Before we stop, you have to talk.

 [00:54:12.650] - Dr. Gordon
Tell our listeners about speech and cognition. Oh, yes. Okay. Don't try that with your backwards walking.

 [00:54:21.490] - Dr. Lemanne
Don't run backwards?

 [00:54:22.500] - Dr. Gordon
Okay. So everybody does these brain training exercises, and, you know, there are a lot of computer-based programs online, and I usually have encouraged people to do the one that works for them. But lately I've gotten more heavy-handed and suggested they really have to do one particular commercially— one commercially available kind of brain training. Anybody can sign up for it. You can do it for free. It works a little bit better if you pay for it, but they're brain training exercises. But there's only one kind that really works, right? It's when your brain has to work quickly, and the way they test you working quickly is they show you a picture and you have to remember that it's got 2 cars and a highway sign, and it flashes for a second, and then you have to identify where the car was or which car it is and where the highway sign is on a blank screen that comes up next. So you have to observe 2 things really quickly and hold on to them, and that process is called Double Decision, and the brain training program is BrainHQ. But that particular exercise is— seems to be a great facilitator of moving your brain Quickly, and that's what seems to carry the greatest benefit for general cognitive improvement.

 [00:56:00.280] - Dr. Lemanne
And what surprised me was that the other things didn't work, like memory games and looking at lists of numbers and trying to do calculations. That didn't really improve cognition, but the speed element. Adding that, so doing things fast. So I think I would recommend people do things that require speed, like ping pong, and trying to remember things quickly. And if when you're doing something like walking, go as quickly as you can. Don't just stroll. You don't have to do that all the time, but some part of your walk should be quick so that almost at the edges of your abilities so that you keep that— Yeah.

 [00:56:44.560] - Dr. Gordon
We took those 2 different speed— I was thinking of the speed of your observation and memory, and I'd say what you're referring to, which has to do more with your memory scores, I'd say what you're referring to by doing things quickly is a part of a brain evaluation that we refer to as processing speed and really motor speed. Both those 2 are related to how effective your memory is, how quickly those things can work. But coming at just pure observation, sitting still and looking at things quickly, it's great for certain aspects of your brain function. But you're right, we're using something quick and ideally alternating sides. And that's why ping pong is the perfect game, unlike pickleball where you're destined to either get a racket in the face or a sprained ankle. Do you ever play ping pong?

 [00:57:40.750] - Dr. Lemanne
I do. I love picklebal

 [00:57:42.430] - Dr. Gordon
You do? Do you play pickleball?

 [00:57:45.020] - Dr. Lemanne
Oh, yes. Well, I have a few times, and very casually, and so I haven't gotten a team together and signed up at the park and all of that. I just, if the park is empty, the pickleball court, and I have someone to play with, yes, I'll just go and we'll bat the ball around, and it's a lot of fun. It's kind of between tennis, which is too much distance for me at this point, And ping pong, which is fun. That's also very, very fun. But pickleball is—

 [00:58:15.590] - Dr. Gordon
It looks like fun, and it also looks like it's so good for you because you have to move so quickly.

 [00:58:22.800] - Dr. Lemanne
I love speed things. I love ping pong. I love pickleball. I love air hockey. I mean, silly little games. Yeah, I like some slow games. This is embarrassing, but Oh, I play mini golf sometimes. I'm out there with the 5-year-olds.

 [00:58:42.970] - Dr. Gordon
Analogous to your speed hockey is I used to do quite a bit of pinball at some very remote part of my life.

 [00:58:49.370] - Dr. Lemanne
Oh yeah, yeah, yeah.

 [00:58:51.620] - Dr. Gordon
Oh, big on that. I can remember where I learned, where I met Pac-Man for the first time. So the takeaways for today are walk backwards Walk quickly to your sauna and cold plunge and then walk backwards carefully to your meat-rich dinner. Okay.

 [00:59:14.580] - Dr. Lemanne
Okay? Okay. New lifestyle hacks from the brilliant Dr. Gordon. There's no one like her. And then after that, she'll take 10 tubes of blood.

 [00:59:25.080] - Dr. Gordon
And tell you what supplements you need to take. And one of them would be vitamin D because vitamin D in midlife is associated with less P-tau later in life, but let's— we'll leave that aside for today. Good talking to you, Susan.

 [00:59:39.440] - Dr. Lemanne
Oh, so good talking to you.

 [00:59:40.890] - Dr. Gordon
Thank you.

 [00:59:41.770] - Dr. Lemanne
If you haven't already, please, please take a moment to subscribe. Your simple click is not abstract. It's not anonymous. To us, it's very, very real. It helps us reach more patients and physicians to challenge the old ways of thinking about And to keep these evidence-based conversations going. Hitting that subscribe button actually makes a huge, huge difference. And thank you.

 [01:00:11.730] - Dr. Gordon
You have been listening to the Lemanne-Gordon Podcast, where docs talk shop.

 [01:00:17.440] - Dr. Lemanne
For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.com.

 [01:00:26.870] - Dr. Gordon
Happy eavesdropping!

 [01:00:36.840] - Dr. Lemanne
Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, See a qualified professional promptly.

[01:00:53.700] - Dr. Gordon
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 [01:01:05.840] - Dr. Lemanne
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 [01:01:15.070] - Dr. Gordon
Your use of any information presented in this podcast Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

 [01:01:27.090] - Dr. Lemanne
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 [01:01:44.500] - Dr. Gordon
Doc's Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.