
Living A Full Life
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Living A Full Life
Blood Pressure, Glucose, and Beyond: What Your Body's Metrics Really Mean
In a world where fitness trackers count our steps and smartwatches monitor our hearts, we're drowning in personal health data. But which metrics actually matter? Dr. Enrico Dolcecore tackles this question head-on, ranking vital signs from most to least important in a compelling exploration of what our bodies are trying to tell us.
This episode was inspired by a troubling observation: too many people in their 30s, 40s, and 50s are experiencing serious health issues that might have been prevented with proper monitoring and understanding. Dr. Dolcecori cuts through the confusion by establishing a clear hierarchy of vital signs based on their ability to predict health outcomes and detect problems before they become emergencies.
Blood pressure claims the top spot as the most crucial vital sign, with blood glucose and A1C following closely behind. Heart rate variability, triglycerides, and VO2 max round out the top five, while more commonly obsessed-over metrics like weight and BMI fall lower on the list. For each measurement, Dr. Dolcecore provides context on healthy ranges, what abnormal readings might indicate, and practical ways to monitor and improve these markers.
Perhaps most illuminating is the distinction between functional and traditional vital signs, representing the shift from reactive to proactive medicine. While many healthcare providers are moving away from physical exams in favor of advanced imaging, understanding and monitoring basic vital signs offers an accessible way for everyone to take charge of their health. The episode provides concrete recommendations for establishing personal baselines and implementing simple monitoring practices without becoming obsessive.
Don't miss this opportunity to understand what truly matters in your health data. Listen now, and consider sharing this episode with someone who might be ignoring important health metrics – it could literally save their life.
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Welcome to another episode of living a full life. I'm Dr Enrico Dolcecori and this week we're doing a fun podcast. At least I think it's fun. No one's ever ranked vital signs and all the metrics that we use on our smartwatches, our OR rings and all these things in a categorized order of most important to least important. We use all these stats and I think we have so much information now that we just have at our fingertips about ourselves that. Do we really know what to do with it? What's important, what's not important? Is it all important? What does it all mean? So some of the little things you may get automatically is arrhythmia notifications of your heart rate, o2 saturation in your blood. There's some blood glucose monitors out there. I can show you your blood glucose levels. What does it all mean, and do we actually understand this as consumers? Do we all need a medical degree to understand? Are the apps doing the right thing by telling us what's going on? Let's dissect this.
Speaker 1:I thought this was going to be a little fun. I couldn't really find anything on the internet about like what's more important or least important. When you go down certain pathways, you get into exercise physiology and they'll talk about endurance and VO2 max. And then, if you get into mainstream medicine, they'll talk about, you know, blood pressure and triglycerides being the most important thing because they can be indicative of imminent disease. So I thought we'd do a fun podcast about these signs. What do they mean? Dissect into them so that you can take them home and understand more about what to do with them. And I actually rank them from the most important to least important, and I don't want it to be for most life-threatening to least life-threatening, but the signs that actually tell us how we're doing in the moment are really important, and maybe, if we rank these and take them to heart, we'll take them a little bit more seriously and, instead of ignoring them, maybe start doing something about them.
Speaker 1:This is inspired by 2025 and a lot of people close to me that are just dropping dead I'll be completely honest with you in their forties. One was in their thirties and fifties. I mean, I feel like that's too young. So that's what inspired this. I'm going down the whole thing. I'm in my forties and I'm like, well, hang on a second, I don't want to be another statistic. What is this all mean? Let's dive into it together and go through this, and this is what I've put together for this podcast. We're just going to break down what these things mean. Maybe 10 of them I think I've put together here about the vital signs that you have access to.
Speaker 1:You have them on your watch, you have them on apps that you can use by. You know when was the last time you had your vitals checked? You got to think about this and if you're in the healthcare field, as a nurse or a doctor or whatever, you know that vitals are really important. When a patient comes through the door and they have symptoms, any type of symptoms fainting, migraines, extreme pain the first things you do is take their blood pressure, their heart rate, their O2, and listen to their lungs, listen to their heart. These are vitals that are there to show imminent distress, which then can tell us some other things. Is their heart rate 200? Is their blood pressure 200 over 150? What's happening? Do they need nasal dilators immediately?
Speaker 1:Whatever it is, that is what we think of vital signs, but there's a lot of them to go through. That is what we think of vital signs, but there's a lot of them to go through. So you know, many of us only monitor the metrics like weight or BMI, but are we paying attention to the right ones when we do all this? There's a lot of fluff out there too, so we're going to define, you know, the key vital signs, explain their critical significance and rank them from the most to least predictive of health outcomes. So a vital sign is something like blood pressure, heart rate, respiratory rate, body temperature. It's functional and preventative. Medicine is included in HRV VO2 max, blood glucose, triglycerides, body fat percentage and more Weight, height, circumference. All these things are used in histories exams as vital components to be measured. So what are all of these things measuring? Why does it matter? Is there a healthy range that we should be within? What happens when it's abnormal? And let's look at some of the scientific backing for each and every one of them.
Speaker 1:So I'm ranking these. We'll go through about 10 of them and the most important one I know this is like the peak of the podcast the most important vital sign across all research is blood pressure. It is the most important one. We should know our blood pressure. Do you have to measure this every single day? No, but we should be on top of it. I would measure it every week. It's linked directly to heart and kidney health. It tells us a lot. The renal veins, the renal arteries control and the kidneys themselves control a lot of the proportion of our blood pressure more so than the heart, of the proportion of our blood pressure more so than the heart and the heart pumps. So we need to pay attention to the, the blood pressure and its metric difference from systolic to diastolic.
Speaker 1:I've always I learned that in medical school and it was like the, the larger the variation. So someone who has 110 over 70 and someone who has 120 over 60, who is healthier? Well, the 110 over 70 is because the difference between that is 110 minus 70, 40. And the other person, even though 120 is not high, the 120 over 60, has a 60 point spread. We want to stay within that 30 to 40 point spread. We want to stay within that 30 to 40 point spread. The larger the spread, the more elasticity and the more pressure up and down variation is happening in the arteries. So it's pushing up to 120 grams of pressure, down to 60. And that's putting a lot of strain every heartbeat on the arterial system. I learned that early on. I thought that was interesting. So that's one.
Speaker 1:High blood pressure is a silent killer. It predicts heart attack, stroke and dementia. So living with high blood pressure over time is just a potential risk for strokes, heart attacks and other long-term organ damage. The ideal range is 110, 120, over 70 to 80, that 40-point spread and this is from tons of research on the internet Wheaton and hypertension guidelines from the AHA, acc they've all shown this for years to be that range. I would say for the last 100 years we've known that that's been the normal for blood pressure.
Speaker 1:So don't overlook this. I find a lot of men, especially 50 plus, like to ignore that number. They're like ah, it goes up to 160. And I think there's a little bit of a fear that happens when we see those numbers. When we see that, we're like oh no, it's not like BMI or our weight on the scale where we look at it. We just tip our heads. We're like dang. Blood pressure is a little bit more scary because I think it's universally known that that is a vital sign and it is the number one predictor of many things. So knowing your blood pressure is smart, not knowing it is ignorant. We need to be on top of that. Anyone you love, tell them about that.
Speaker 1:Get a cheap electronic blood pressure monitor in the house from Amazon. Leave it there, those battery-powered ones. Are they 100% accurate? No, but you can use it. If it's there, you'll use it. That's great Number two on the list.
Speaker 1:Number two the second most important is our fasting glucose. An A1C, our blood sugar. That is number two. Chronic elevation is linked to diabetes, heart disease and brain aging. So the longer we live with higher numbers, the more damage we're creating each and every day to our major organs. The pancreas strains, the brain gets broken down and the cardiovascular system is under a lot of stress. With that, fasting glucose should be within that 70 to 90 percent milligrams per deciliter. That's where we want to be in that range. That's every time you do a wellness test or wellness blood work. That's where you should be. You fast overnight, you go in the morning, take your blood after 12 hours and you should be in that 70 to 90 range. A1c under five, under 5.4, actually shows optimal functional range. So under 5.4. So if you're right around that five mark, it's good. Four, something's fantastic. And that's from the ADA Standards of Medical Care and Diabetes from 2024. Shows that staying in those ranges prevents things like brain aging and heart disease, yet alone diabetes. It could be a pretty marker for diabetes as well. So number one, blood pressure, number two, blood sugar we're not exploding anyone's brains yet.
Speaker 1:The rest of this list gets interesting. It's still ranked for most important to, I think, least important, but they're all important is heart rate variability. This is why in our office, we test it on everyone. It just gives us a little bit of an insight on the nervous system and the cardiovascular system at the same time to see what is going on in overall function. Its main focus is the marker of the nervous system's health and stress resilience. It's really an important test. It's so simple to use and many of our watches and aura rings keep track of this. High heart rate variability equals better recovery, adaptability and reduced mortality. In our office we see people in the red all the time, and I mean the blunt thing to say is like you're going to die a little younger than you think. And when we see people in the green, we're like well, you're right on pace for a long, healthy life and it's a great marker to see that it's not exactly predictable, but it is a very useful marker. Then it leaves us, as nervous system doctors, chiropractors, to make sure that we clear out the nervous system as well as possible to make sure it functions as optimally as possible so that markers like HRV, blood glucose and other things stabilize.
Speaker 1:It's not diagnostic. It can't tell us really anything about the patient. So when we get a score, whether it's good or bad, it doesn't really tell us anything on what to do next. There's no prognosis for it, but it is highly predictive of something is up and it can lead us to other testing. So if we have strains in the nervous system we can then look and ask more history questions, dive a little bit deeper and see where the strains are.
Speaker 1:Is endurance an issue? Is getting lightheaded an issue? Is going up a flight of stairs an issue? Maybe we need some more cardiovascular testing, angiograms, ekgs, whatever it may be. Or is it more alertness, endurance-based brain fog, memory, that we can do some more brain work on that and get into more vitamins and nutrition on that side as well? So Schaefer and Ginsberg they talk about this a lot in the frontiers of public health, about heart rate variability. It's at the forefront of a lot of research right now, not exactly to be predictive of anything in particular, but more so as a general testing source of wellness to see how well people really are. I think that goes on the top of the list for wellness.
Speaker 1:Number four on the list is triglycerides. They are important. I think they've been demonized because if the number is high, automatically the prognosis is statin drugs and unfortunately we go down a different path when we do that and we won't get into that today. But because of that, triglycerides are easily ignored and high levels are linked to insulin resistance and cardiovascular disease. The optimal range is under 100 milligrams per deciliter, even though under 150 is normal. The optimal range is to stay under 100 milligrams per deciliter. It correlates with metabolic syndrome. This is triglycerides, particularly your triglyceride testing. There's LDL HDL another testing as well. We're talking about that triglyceride testing. There's LDL HDL another testing as well. We're talking about that triglyceride testing Under 100, and this is from Toth, from 2005,.
Speaker 1:Current arthrosclerosis reports showing that triglycerides are a very important blood marker that should not go ignored. We should always keep an eye on that, including the HDL. It dives deeper into which cholesterols are there the good ones, the bad ones? Good cholesterol repair our arterial system and our tissues. Cholesterol is important. So having too low cholesterol can be another issue there where we don't heal properly, but too high of bad cholesterols lead to atherosclerosis, plaquing, stroke, arterial disease.
Speaker 1:Number five on the list, vo2 max. You may have come around this or not. It's hard to get this testing because it's usually in exercise physiology, personal training and in the fitness industry, but it measures maximal oxygen consumption. It's the top predictor of longevity. So now, if you're biohacking which I hate that word, but it's popular right now and you're trying to figure out what's going to help you live longer and more youthful, vo2 max is one of the top predictors of longevity. If you have an optimal VO2 max the higher the better it's directly tied to cardiovascular endurance and lifespan. So people into their 70s with higher VO2 maxes lived longer than people who had lower. If they made it to their 70s and this is from JAMA, physical Medicine and All Causes of Mortality We've seen that across all exercise physiology.
Speaker 1:In my undergrad in exercise physiology we looked at this deeply through all of that to see what took elite athletes over the top with the VO2 max and that distinguished great athletes from elite athletes. It was. It was unbelievable what they could do. The swimmers, the, the, the cross country, uh, runners, the, um, the Olympians they just went over the edge. The tour de France bike per. You know people. Um, they just went over this tipping point of like unbelievable numbers with their VO two max and it was a distinctive feature in not only athletic ability but long-term longevity. Very cool.
Speaker 1:Resting heart rate, different than heart rate variability. Your resting heart rate this one is on your Apple Watch. You just look at it and it'll tell you your resting heart rate while you're sleeping, during the day, while you're exercising. You may actually look at this while you're exercising. If you're trying to stay in a fat burn mode or endurance mode or doing high interval training in a HIIT mode, you may be keeping an eye on your heart rate variability, seeing if you can push the 160s on the high end during a HIIT exercise and coming back down into the 120s to try and get that variability in the HIIT, the high intensity In others, maybe steady state cardio. Maybe you're trying to do the elliptical, the stair stepper or walking and you're trying to maintain 125 beats per minute or 120 beats per minute to stay in a fat burning zone. So you've looked at this, maybe in your fitness journey.
Speaker 1:But are we looking at it overall? What is it when I sleep? What is it when I'm sitting at the desk working. What is it when I'm going for a walk? And it indicates cardiac efficiency and overall conditioning. So the optimal range is 50 to 65 beats per minute. Elite athletes can sometimes show lower long distance swimmers they can be like in the 40s and long distance runners, but typically 50 to 65 is the optimal range. So when we're resting, 50. When we're up, walking around, 70. That's pretty much just tasks around the house.
Speaker 1:Higher resting heart rate equals higher risk of mortality. So when we're resting here we're not between that. 50 to 60 heart beats per minute. It increases the risk of mortality. Unlike VO2 max, which shows us longevity, resting heart rate can show us a decrease in mortality. That is interesting stuff. So these are things that you want to look at and as we go through this list, what's more important, what's less important? I mean you can kind of see how that's all a little bit important.
Speaker 1:What about oxygen saturation? This one is you'll see it as O2 on your Apple Watch. I use an Apple Watch so I know it's there. It measures the hemoglobin oxygenation and this is the most critical in acute settings. So acute settings meaning in the moment. So if you're, you know, 96 to 99 is the normal on your watch.
Speaker 1:If it's ever below that, it all is dependent on the situation. So it could be that you're sleeping with your neck kinked and decreased airway and you're falling down into the lower 90s, but as soon as you move your position it goes back to 99. That's situational and in hospital settings letting patients go after discharge from surgery or from a procedure, their O2 should be up higher so that they know when the patient leaves they'll be able to breathe and be healthy and make it through the next two nights at home without any support, medical support. So chronic low O2, oxygen saturation can indicate pulmonary and cardiac issues. But variation is limited in healthy people. So where we start to see issues with the O2 is in the unhealthy people, people with some type of condition COPD, emphysema, cardiac distress, cardiac failure, kidney failure then we have to give them some grace on those numbers and keep them as optimal as possible. But for the rest of us we want to stay in that 96 to 99 range at all times. That's an important one as well and, as you see, we go down this list.
Speaker 1:Body fat percentage, weight, height, circumference isn't in the top and there's a reason for that, but it is important BMI is. Body fat percentage is actually more important than BMI, and we're going to bring both of these up right now. Better than BMI at assessing metabolic health is your body fat percentage. High visceral fat equals high disease risk, even at a normal weight.
Speaker 1:So when we do some scanning not they're not all accurate. The dunk test, the water test, is probably the best one. Many of us don't have access to that, so using these uh conductance scales where you hang onto the metal bars, are a little bit more accurate. They're. The conductance is going through you, measuring the frequency of hydration so water, which we know is in muscular tissue, bone and then deciphering which one's which, and then giving you a percentage of your overall weight, telling you that this much is hydration, this much is muscle mass, this much is bone, this much is skeletal, this much is whatever. So are they 100% accurate? No, but that number can give us a little bit of a distinction of what's going on, and we use one in our office that I think is a little bit better than the average one, a little bit more techie, and it ends up showing us the body fat percentage and the visceral fat amount as well and ranks it, and this is so useful as a doctor for a patient to tell them listen it. And this is so useful as a doctor for a patient to tell them listen.
Speaker 1:I'm so proud of you for taking the first steps in your weight loss journey, or getting healthier. The amazing thing that's going to happen for you is that your visceral fat is in a dangerous area and as soon as you start burning fat, it is going to go after the visceral fat first, which is, as a doctor, the most proud thing I can tell a patient is. I'm excited for you. For these next month or two, you're going to be burning strictly visceral fat. So keep with it, because as you, as you go through this journey, you're only going to end up healthier, which is amazing.
Speaker 1:For other people who are in an optimal visceral fat range, what that? What will happen with their weight loss? If they have any weight to lose will end up going straight to subcutaneous fat. I call this the mirror fat. When you look in the mirror, you can see it around the waist or wherever it is that you're trying to lose it. You're going to go straight into that fat burn because your body's going to hang on to 5% to 10% of your visceral total fat around the visceral. It's going to hang on to five, six, seven, 8% of that at all times because you've got to keep a little bit for protection around the organs. But too much visceral fat around the organs is what causes toxic overload and pathology on those organs. Typically we see this around kidneys, liver, which causes fatty liver, and even the heart in as obesity. As the obesity scale increases, we get more and more visceral fat around those organs. So that's why that's really important.
Speaker 1:So body fat percentage is really important. The healthy range for men is 10 to 20%. That's a huge range. Being 10% body fat and 20% body fat are two very different things. The 10% guy is going to look ripped and the 20% guy is going to look healthy and in that range it's quite different. So 10% is an audacious goal to try and live your life at. I'm just being honest with you. I like the 20% one. I like the 17, 18%. That's an athletic, healthy body fat percentage to be in. For women, 18 to 28%, 18%. I mean those are the runners, the fitness women. They're in that 18% range. Even up to 28% for women has been shown to be a healthy and normal body fat percentage, and this is from the American Journal of Clinical Nutrition and you can find it all over the web sites citing the same numbers over and over again. So that is fantastic.
Speaker 1:So these goals of 3% body fat, 5% body fat, 6% body fat are so audacious and so difficult for the human body to get down to because it's hanging on to visceral fat. 5% of your body fat is visceral fat and you're trying to get down to five percent. That means that you're burnt. You want to, like, eliminate all fat on the body. It's stressful on the whole, on the whole system. Fat cells do have a purpose in the body and, uh, I think pushing that limit and fitness does this. It's nowhere else, it's in the, in the bodybuilding culture and all that that really pushes. That is bodybuilding culture and all that that really pushes. That is a dangerous and steep thing, and that's why it's so hard to maintain that long-term. Without hormonal therapy and injecting a bunch of stuff into the body, it's virtually impossible. So don't aim for that. Unless it's a short-term goal, that you just want to compete once, then that's cool. But doing that for too long can be just as stressful.
Speaker 1:Weight and BMI so it's easy to measure but one. So then that's cool. But doing that too for too long can be just as stressful. Weight and bmi. So it's easy to measure but not always meaningful without context. Okay, my bmi over the last three years has continued to decrease uh sorry, stayed the same but my body fat percentage has continued to decrease. So when I hop on, the scale still tells me overly fat, so overweight, not obese. I'm at the 20, you know 25 percent range and what that tells me. But my body fat percentage has gone down. So my lean muscle mass has gone up. And that's out of context. Because if I look at the just use the BMI, then it's telling me that I'm not in a healthy range. So easy to measure but not always meaningful without context. Bmi doesn't account for muscle mass hydration or fat distribution, so knowing the fat percentage is more important. Is it visceral? If that's in a healthy range, then we're in a healthy BMI, it's great. If it's not, if the visceral fat's high, then we're not in a healthy BMI.
Speaker 1:Even though two separate people can be right around that 26, 27, 28, 29% body fat, one is in a healthier boat than the other. Make sense and they're about the same height. So that's the issue there. It's better used with weight, circumference and body fat percentage. That's when you tie in all three and then you can see it and you'll see the difference. Two people at 29% body fat. One has a weight, a waist circumference of 46 inches, the other one has a waist circumference of 40 inches and it's a little two different boats that they're in. So you looking at all those things congruently tells us a better story on that one. The rest is all pretty straightforward. So that is our top 10.
Speaker 1:There's a lot of different markers out there, but I think these are the most important. Blood pressure number one. Blood glucose in A1C. Number two. Vo2 max if you can get that tested with spirometry in some way or form is important on longevity. So making sure that we can breathe in and out inspiration and expiration of the lung capacity and maintaining oxygen saturation at a high level shows longevity. Heart rate variability you can get this done at your many chiropractic offices and medical offices are measuring that Triglycerides through your blood work If you're resting heart rate, keeping an eye on your aura ring or your watch on that body fat percentage, always keeping an eye on that. I would do that quarterly to make sure you're staying and maintaining overall health.
Speaker 1:The weight scale can be useful as well, making sure you maintain your weight. That could be useful as well. That's your BMI, oxygen saturation and of course, your weight as well. So functional versus BMI Oxygen saturation and, of course, your weight as well. So functional versus traditional vital signs.
Speaker 1:There are two different perspectives on all these. Medicine is shifting away from reactive to proactive. A lot of the new medical grads are barely doing vital sign checks or checking anyone in the physical exam anymore. They're talking to them, listing and ranking their symptoms and saying these are the scans we need to go to next, straight to CT, straight to blood work, straight to MRIs, straight to scanning to just look on the inside. Hrv, vo2 max and body composition are underutilized.
Speaker 1:But tell us a lot about lifestyle and long-term resilience and I'm encouraging you to just get a blood pressure cuff and leave it at home and check it. Check it every week or every couple weeks, at least once a month, and just making sure that number stays about the same. You'll find your homeostatic number, whatever it is 122 over 82, whatever it is, you'll be like, oh, that's my normal, or 114 over 72. It will be your number and once that changes and you put your arm in there and one day it's 132, over 96, and you're like, whoa, hang on a second, let's redo this, is this right? And you do it, repeat it two or three times and you either realize oh, that was a glitch or something's up.
Speaker 1:That's where we need to start going in for our wellness checks, going in for our blood work, seeing our primary care and getting checked for overall markers enzymes, liver triglycerides, sugar and see what's going on, because catching these things early are immediately affected through diet change quickly. You could just easily clean up your diet immediately the next day, do well for 30 days and see your blood pressure come right back down. It was probably an over salt in the diet, an over processed food in the diet, over sugar in the diet. Whatever it may be, that's probably for most people what's going on. For others, we may be sliding down the slope of disease and we need to be careful and be on top of it.
Speaker 1:Preventative medicine is much more beneficial and better outcome than reactive medicine. So what I say you guys should do is get your baselines Blood work, body comp, hrv, vo2 max. Use this on your treadmills at the gym or on your smartwatches. Focus on improving metabolic flexibility, fitness, sleep and nervous system regulation. This is what it's all ties in together and HRV apps like on your Aura, your Elite HRV, your Fitbit, your Apple Watch VO2 Max you can get these done at gyms. Home blood pressure monitors and continuous glucose monitors as well. These things for short times, wearing those for 60 days and just seeing how your normal lifestyle when you get peaks and valleys in the blood glucose, or is it just a steady flat line?
Speaker 1:And don't obsess over the lower tiered markers. I think we do. Weight, bmi we're all over that scale and always worried about the number on the scale. Bmi we're all over that scale and always worried about the number on the scale. The number on the scale is different on what planet you live on and we live on earth. So gravity at 9.81 meters per second, pulling us down at that force times our weight, our mass, is how we calculate weight. It's based on gravity. It's just a number. It's just a number. It's the markers on the inside body fat percentage, hydration these things are more important.
Speaker 1:Don't obsess over the scale and then share this episode. Share this episode with those people that ignore these numbers your husband, your spouse, your family members, your friends that you try and nudge. Because you're a health-conscious person and you love people, this is a great one to share with them. It dissects the most common markers that are out there, that we all have access to with all the new little gadgets we have, and it keeps us on top of it, and I think the purpose of it is it's going to save someone's life. So share the podcast and have a great and healthy week. Stay well, take care.