Following Doctor’s Orders in More Ways Than One

As the Chief Medical Officer at a nonprofit organization and long-time internal medicine specialist, Dr. Nancy Van Vessem is in prime position to see how certain habits can severely impact a person’s long-term health.

She’s also seen the way healthcare issues are impacting everyday people.

One of the major concerns is rising costs. In our chat, we highlighted strategies to account for that, especially in retirement. We also spoke about the importance of discussing end of life care with your family – so your wishes are followed.

Tune in now to discover…

  • Things you can do now to live a long and healthy life

  • What accounts for 50% of the impact on your health

  • How to tweak your retirement plan to account for increasing lifespans

  • The very real consequences of not listening to your doctor 

  • The #1 health risk in the United States – and how to avoid it

  • And more

Listen now…

Episode Transcript:

John Curry: This is John Curry. Welcome to another episode of John Curry's Secure Retirement Podcast. I'm excited about today's guest, because Dr. Nancy Van Vessem is with me today. Welcome, Nancy.

Dr. Nancy Van Vessem: Thank you.

John Curry: Every time we get together, we have, I call them dynamic conversations. We talk about healthcare, we talk about financial planning, retirement planning. I'm always amazed at how much you know when it comes to tax planning, retirement planning and financial planning. But first let's talk about your career.

Dr. Nancy Van Vessem: Okay.

John Curry: You're a medical doctor. Tell our audience about your background. When did you decide to become a physician and what you're doing today.

Dr. Nancy Van Vessem: Well, that goes way back. I actually graduated from medical school in 1983. So, if you do the math there, that was 35 years ago. And as to why I became a physician, I think it was a little unusual for women back then. I think when I went to medical school, there's was only 10% women and that's changed a lot. Now it's over 50% women. But I think a lot of it was that, like most people that go to medical school, I was very good in science and at some point I had to make a decision about, am I going to be somebody that stands at a bench and does chemistry and that sort of thing or am I going to be out among people and using my skills to help people and I decided to go that route. And then one thing led to another after that and I became an internal medicine physician and the internal medicine physician is a physician for adults with complex medical problems, typically, and that's sort of what happened.

Dr. Nancy Van Vessem: I moved here to Tallahassee 24 years ago and I've been at Capital Health Plan since then, first as a practicing physician, but gradually I have morphed into more administrative roles and I'm now the Chief Medical Officer.

John Curry: Very good, very good. Tell us about your day-to-day work at Capital Health Plan. So you're not doing practice anymore, is that correct?

Dr. Nancy Van Vessem: I'm not doing direct patient care, no.

John Curry: Okay, so none at all now. So you see a lot of the issues that impact the public from the standpoint of healthcare issues or lack thereof and also the money side of it.

Dr. Nancy Van Vessem: Yes.

John Curry: So tell us a little bit about what you're seeing and what concerns you or just whatever pops into your head regarding the future of healthcare in our country.

Dr. Nancy Van Vessem: Well, first of all, CHP is a nonprofit organization and we serve the seven counties up here in the panhandle, so we're a small health plan. We're a small, nonprofit HMO and the only product that we have is HMO product, which is platinum coverage and so what it means is that the people in our area have more access to platinum coverage which means insurance pays 90% or so of the medical costs and I think one of the things that we're seeing is that there's now been more of a switch to high deductible products where people have like $2,000, $5,000 deductibles, that sort of thing, and that's actually one of the requests that we get a fair amount from employers, but that's not really what we do.

Dr. Nancy Van Vessem: We're an HMO and we take it serious in terms of trying to manage the care for patients and so I'm involved with the disease management programs, for instance. You know, how do we get diabetics the appropriate care across the community, no matter who their primary care doctor is, if they're seeing an endocrinologist, so we actually have worked on those types of things for many, many years and that has paid off in terms of high quality and those types of things.  I work on a day-to-day basis a lot with the disease management programs, the pharmacy benefit, the physicians in the community, so all of those things.

John Curry: To take a minute for those who are listening and may not know what an HMO is, explain the different levels of that, HMO's, PPO's, individual plans, just educate the audience, please.

Dr. Nancy Van Vessem: Well, HMO is Health Maintenance Organization and there used to be a lot more of them than there are now, but generally the trade-off is that you have comprehensive coverage, so most patients will have a copayment of let's say $15 or $40 or something like that. They're not paying a percentage of the actual bill, so it's that type of cost-sharing which is relatively low, but the trade-off, you usually have a network of physicians and the idea is to try to manage the care so, like for instance, when people have high blood pressure, we try to work with the physicians to manage that high blood pressure because we know that high blood pressure leads to stroke which isn't good for anybody.

John Curry: Nope.

Dr. Nancy Van Vessem: It's that type of thing, so managed care and there's something called the Triple Aim, which is from the Institute for Healthcare Improvement and something we pay attention to. It's to try to improve the service to our patients to improve the quality of what the patients get and to try to keep costs in an affordable range.

John Curry: How did HMO's come about?

Dr. Nancy Van Vessem: Oh, I think it was really an evolution from a long ... I mean, there's HMO's that were from the turn of the century, you know, the early 1900's, but I think the government got very interested in them back in the 70's and made it possible for more to start up and I think, though, that the more recent wave is to go away from that, is to say, "Here's higher cost-share and you can do whatever you want, but it's just going to cost you more money" sort of thing.

Dr. Nancy Van Vessem: And you asked about PPO's, Preferred Provider Organizations, and they typically will be like 20% cost-share within the network and then maybe 30 or 40% cost share outside of the network so if you decide to go outside the network, you have higher costs and they rely on that sort of mechanism to reign things in.

John Curry: From my perspective over the years of working with clients on the retirement planning side, it seems like what you do at Capital Health Plan is help people prepare for what's coming down the road, instead of all of a sudden, I've had the heart attack or the stroke or high blood pressure. It's almost like you're helping manage the care.

Dr. Nancy Van Vessem: We try to because we don't think those things are good for anybody, really. So, for instance, statins are a drug that most diabetics should be on so we actually try to see, are they on it, are they taking it, that sort of thing. If somebody prescribed it and what is the glucose control? Are they being followed to get that measured at least annually, so we try to follow all those things. And our patients are typically in the state of Florida, city, counties, the school teachers. You know, a lot of our members are from those groups.

John Curry: What do you see is the biggest challenge for healthcare going forward? We know it's getting more and more expensive. We've talked about that several times. We just did a webinar yesterday on Medicare and the costs for Medicare is going up, it seems like every year.

Dr. Nancy Van Vessem: Right.

John Curry: We know Medicare has issues, financial issues, Social Security, Medicaid. From a physician standpoint and having the advantage of seeing it from an administrative role, based on being the Chief Medical Officer, what are your concerns going forward?

Dr. Nancy Van Vessem: Well, I think everyone agrees it's affordability. I think Milliman, they do an index every year and the average family insurance across the U.S. now is $28,000 a year which, of course, exceeds people's ... many times their income, so that's the biggest problem and that's the biggest problem in Medicare, Medicaid and every other program and there's some estimates that about 30% of that money is wasted on unnecessary care, elective procedures that don't need to be done, et cetera, so that's the thing. We can't afford what we have and yet we know there's significant waste in that and how can we ratchet that back, so.

John Curry: What do you say to the people who argue ... 'cause you hear it a lot, we're spending too much money trying to prolong life beyond a certain point. Where's the ethical side of that? If we can help somebody live longer by giving good care, I have the sense that we should do that, but I hear other people, physicians say, "You know, there's a line. How much more life can we squeeze out of that and is it worth the cost?"

Dr. Nancy Van Vessem: Well, I think it's a good question. It's a really deeply personal question. I think part of the problem is that people don't ask themselves that question because they let things happen and physicians have a view of it because they know reasonably what can be done and what can't be done. And so, for instance, physicians many times won't sign themselves up for the same therapies that patients will sign themselves up for because if you're talking about living, it becomes a quality of life issue. It doesn't become just more days, months, whatever. There's actually a couple articles that are interesting that are called, Why Doctors Die Differently and they actually talk about how physicians don't sign themselves up for some of the care that is available and it's because of, of course, knowing more about it.

John Curry: Right. I learned a lot from my dad. My dad died August 15, 2015 and when he was diagnosed with kidney cancer, he told the doctor, he said, "I'm not taking chemotherapy and no surgery. I'm going to just live the best I can with what I have," and all of us were against that at first and my dad was adamant, he said, "Son, I'm not going to do that. My quality of life is important to me," and right up to the day he died, he insisted on that and his physician, once I told him, he said, "John, your dad's right. This is his choice, not yours, it's not mine."

Dr. Nancy Van Vessem: Right.

John Curry: "He has the information he needs. You should respect that."

Dr. Nancy Van Vessem: Right.

John Curry: I was very impressed with that.

Dr. Nancy Van Vessem: I agree and I think the main thing is for people to kind of think about what do I want for myself, no matter what that is, but then it's very important to communicate with the family and make sure the family agrees to go along with your personal wishes. There is a program at Big Bend Hospice called the Peace Program where they try to get everyone ... you know, the patient will say to get the family there. They'll say, "No, this is what I want, this is what I don't want," and one of the things that we hear, I mean we've seen over time, some family member comes in from out of town and says, "No, no, no, don't ... I don't like that idea that mom wants this and doesn't want that. I don't like that idea," and the whole idea then is to make sure everybody is on the same page and, in fact, if you choose a surrogate ... like if you can't talk or you're not aware, you choose a person that can express your wishes and a lot of times it can't be a family member because many times family members can't do what you want them to do.

Dr. Nancy Van Vessem: And I know of married couples where the spouse is not the surrogate because they can't do that. So, I know of people who've chosen their business partner to be their surrogate because that person is more likely to actually do and uphold your wishes and that's what this is about.

John Curry: Because they're not as emotionally involved.

Dr. Nancy Van Vessem: Or maybe they have more information.

John Curry: True.

Dr. Nancy Van Vessem: Mm-hmm (affirmative). Because it's one thing to say, "Oh, do everything." And you don't even know what do everything is.

John Curry: What is everything, right?

Dr. Nancy Van Vessem: Yeah, mm-hmm (affirmative).

John Curry: From a cost standpoint, if the average cost is $28,000 a year and we know it's going up and then we have things such as long-term care situations, okay, chronic care. So, how do we, as a nation, continue to pay for all of this.

Dr. Nancy Van Vessem: Well, that's the problem. What it's doing is crowding out other things that people are social goods, like education and highways and all of these other ... if you look at the federal budget, all of those things are getting crowded out. So if we think education is a good idea, but we're crowding it out with healthcare, then you either have to raise taxes or cut back ... something has to happen.  And, in fact, in North Carolina ... just this week, North Carolina said we need more money for education and highways and infrastructure. We don't want these bridges falling down and so, therefore, the healthcare providers just need to start cutting their costs. And so I think we'll see more of that and of course, there's a lot of talk now about single payer, which is basically government payment and moving in that direction to control those costs.

John Curry: Well, we have the best healthcare in the world, we're told, but yet it's the most expensive.

Dr. Nancy Van Vessem: Well, I guess it depends on which metric you're looking at. I think we have the best rescue care in the world, but if you actually look at-

John Curry: Wait a minute, back up, say that again. We have the best what?

Dr. Nancy Van Vessem: Rescue care.

John Curry: Rescue care, compared to what? Preventive care?

Dr. Nancy Van Vessem: Yeah, mm-hmm (affirmative). So, I think France is number one. The U.S. is pretty well down in the double digits if you look at some of the worldwide metrics, but that's where we put all the effort, like you're saying, end of life care. You know, once something happens, cancer care, that sort of thing and so yeah, the U.S. is focused on that and does that very well.

John Curry: Well, I know this. When I'm talking with people about planning for retirement, one of the first things they tell us they're worried about is the cost of healthcare, whether it be the premiums they've got to pay or the out-of-pocket cost and that's before you even get into such things, "What if I need to go into some type of long-term care situation?" And we're spending a lot of our time helping clients understand you may not know how to pay for everything, but you better be thinking about it, because if all of a sudden, you don't have care and you go back to the expenses of Medicare, almost unlimited what happens, so we're trying to help people plan for that, but it's difficult because it's a moving target.

Dr. Nancy Van Vessem: It is a moving target, but let me tell you, you and I and anybody listening cannot control the cost of healthcare, per se.

John Curry: Correct.

Dr. Nancy Van Vessem: What people need to do is start focusing on the things they can control.

John Curry: I've heard you say this a dozen times over the years.

Dr. Nancy Van Vessem: Yeah, and so that's basically doing what your mother told you you should do, which is eat a healthy diet, get some exercise, proper sleep, but some of those things just aren't that much fun. So I think that's the biggest problem so the effort should be put into how do I stop eating highly processed sugary foods? That's probably the number one thing to do ... stop buying stuff in a box. And if you can't get yourself around that, then you better start saving for healthcare.

John Curry: It comes down to personal behavior.

Dr. Nancy Van Vessem: Yeah, basically health is at least 50% personal behavior on a day-to-day basis. The access to healthcare is only like 15%. We have some genetics in there. We have social stuff, where if you live in a neighborhood where bullets are whizzing around, you know, that's not very safe but over 50% of what happens to you, you've done it yourself.

John Curry: That's interesting, 50% or over.

Dr. Nancy Van Vessem: Yeah, if you just look at what are the components of health, yeah, 50% is lifestyle.

John Curry: Over the years, I've accepted the fact that sometimes people refer to us as being money managers.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: We're more of behavior managers.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: Because if we can get people to monitor their behavior and pay attention to what they're doing, they make fewer mistakes.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: And that's a good segue to talk about some of the conversations we've had over the years. How is it you have been so interested in learning and reading as much as you do about financial planning, retirement planning, tax planning? Talk about that for a minute.

Dr. Nancy Van Vessem: Because it's a reality and you know, that if you don't take responsibility for those things, you're just going to let them happen to you. So I think that the way I approached it years ago was being a physician, you know the ultimate outcome. You're going to die. 100% chance of that.

John Curry: Well, you just popped my bubble.

Dr. Nancy Van Vessem: No, really, you're going to die.

John Curry: Yes, that's right, the question is when, right?

Dr. Nancy Van Vessem: So if you ... right, the question is when, so if you accept that, think out to there and then work your way back. So, actually if you kind of know your family history or you know your current health status and you can even go online and put in information about your gender and age and whether you smoke or not and come out with a life expectancy. So, if you say okay, my life expectancy ... mine comes out to be like 92 years, which is probably pretty good because of my parents' longevity and whatnot. Then you say, if I'm going to live to 92, let's work my way back from there. And if you start thinking about that, then you start ... all of a sudden you realize that retirement planning isn't what if I need to do it, it's how do I cover this segment of my life? And you had that tape measure example.

John Curry: Right.

Dr. Nancy Van Vessem: And so, but if you start at the end and then try to work your way back, you start at the end and say, "Okay, I live to 92. I'm going to be an old lady. What are old ladies like?"  I've had decades of taking care of old ladies. Well, I can tell you they get frail, all these things and like, what can you do to ameliorate that risk? Well, exercise pretty much helps, you know, those types of things. So how do you actually work your way back from that so that you can get more of what you want, so to speak, as you age. You know, if you say, well, being independent is very important to me to be independent, well then you better get some exercise under your belt on a regular basis. It's good to avoid the classic health risks like smoking and eating the wrong foods or eating too much food, that's the biggest problem we have around here. So, you start working your way back to figure out what you should do now to ensure a better future for yourself.

John Curry: It comes back to the quality of life.

Dr. Nancy Van Vessem: Exactly.

John Curry: The choices you make today, and we see people that have been retired 25, 30 years in retirement. In some cases, actually retired longer than they worked in their careers.

Dr. Nancy Van Vessem: Mm-hmm (affirmative), yeah. And that's sort of a new phenomenon and not everybody knows quite how to handle that and we know, for instance, that pensions and those types of things are becoming increasingly common, so how do you fund all of that?

John Curry: Like the dinosaur, becoming instinct, 401K's, IRA's, but the fine benefit pension plans falling by the wayside, so it's all up to you and if you've done a good job of saving the money, now you've got to make it last for 25, 30 years. In your case, I'm convinced you'll live to be 100.

Dr. Nancy Van Vessem: Oh, really? Hopefully I'm not too whoopsie in the last five years of that.

John Curry: Over the years, you and I have exchanged books or talked about books we've read. I have a number of professional people like yourself who will say things such as this, "I don't have time to read those things. I have a hard enough time to keep up with my career, my profession." So, how is it over time that you have made yourself or motivated yourself to take the time to read and study because you're one of the sharpest people I know when it comes to the financial side, especially in the medical profession.

Dr. Nancy Van Vessem: I just make it a priority.

John Curry: Okay. So, no big secret. It's just I'm going to take the time, read and study.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: And that comes down to anything that we want to have some level of mastery in.

Dr. Nancy Van Vessem: Mm-hmm (affirmative), and I think too, and I know you've heard me say this before that some people are willing to fly by the seat of their pants, you know, and take a risk here, take a risk there, it doesn't ... where, I like that solid floor.  I want to ... whether it's for me and my children, you know I want to have a solid floor beneath my feet and so the thing is, is what do you have to do to get there?

John Curry: Right. And you're very disciplined.

Dr. Nancy Van Vessem: Yeah, well apparently.

John Curry: You take the time to learn what needs to be done and then you act on the information when you get it.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: You have shared stories with me over the years about working with patients who did not do the things they needed to do and you shared some interesting stories about how you encourage people or motivate them to take action. Can any of those pop into your head right now you could share?

Dr. Nancy Van Vessem: Well, actually, sometimes people will say, "I remember when you told me" and I'll say, "I did say that?" Or like somebody told me the other day, "I remember Dr. Van Vessem, when you told me that if I didn't lose this weight, my knees would never stop hurting."

John Curry: And you were right, huh?

Dr. Nancy Van Vessem: Well, she actually lost the weight. That was great. She and her mom went to the gym and she was like ... and she goes, "You're right, my knees stopped hurting." But I think that's it. The idea is knowing at the end of the day the consequences don't fall to the physician, the consequences fall to the person who didn't stop smoking, et cetera, and I think a lot of people, they vaguely feel betrayed if they're the one that gets lung cancer or even though they knew it was a possibility, they know people that it didn't happen to and those types of things and so I think the main thing is to try to impart what you already know to be the case because you've seen it happen over and over again. But it's up to people to take those risks to say, "Well, you know ..." I've had patients tell me, "I really love to smoke. Smoking is the best thing in my life and I just can't give it up," and so that's okay; however-

John Curry: Consequences.

Dr. Nancy Van Vessem: -there are ... just like every other decision you make in life, there's consequences, mm-hmm (affirmative), and maybe you'll get lucky and maybe you won't.

John Curry: How do you deal with that as a physician? I know when I'm trying to help someone with financial advice and they choose to ignore it or they Google something that's contrary, it's frustrating and I had to learn early on. I've been doing this 43 years now. I had to understand, all I can do is guide and coach to a certain point. If somebody won't follow through, then it's on them. Is that the way you have to deal with it as a physician, also?

Dr. Nancy Van Vessem: Sure. If you believe in free choice. And I think one of the things that people don't quite understand, though, is a lot of times when they fall ill, it doesn't just fall to them, it falls to their family. So if somebody doesn't want to use glaucoma drops and they go blind, that becomes a much more difficult situation for whoever is taking care of them, their spouse or kids, whatnot. And so, I think just understanding that these things can happen. And I think people need the resources to try to do what they need to do, but again, having the resources and doing it are two different things. I mean, we see a lot of people that just choose to not be bothered by things.

Dr. Nancy Van Vessem: I remember this one diabetic patient telling me ... he was a type one diabetic and he was coming in for a shunt because he needed to go on renal dialysis and he was in his 30's I would say and he said, "The first 20 years weren't bad," so it's that type of thing where you think like, "Well, I'm getting along pretty well," but now all of a sudden, when you fall off a cliff, you fall fast and hard and so then it was like, "Uh oh." And the idea is not to get religion too late and a lot of the chronic disease we see is avoidable. Now, some isn't. Some people are just very unlucky, but a lot of the chronic disease we see in the U.S. has to do with obesity is a big one in terms of being sedentary. I think now that's crossed over smoking as the biggest health risk and so I think we have to say, "Well, if I'm going to protect myself and my family from these chronic health problems, I need to start putting a little effort into it."

John Curry: What advice would you offer people listening to this who say, "Okay, I hear this physician who is telling me I've got to make better choices, I have to deal with the consequences." So, if you were just going to give a blanket type advice to anyone when it comes to exercise, eating, healthcare in general, what would it be?

Dr. Nancy Van Vessem: Well, I think the number one problem we have here in the U.S. is obesity, really, in terms of the contributions of various cancers like breast, colon. I mean, it just really ... we used to think fat just kind of sat there as a white lump, inactive, but as it turns out it's very active and produces all these bad things that affect your health and so for that, I would suggest people buy this book called The Obesity Code. It's written by Jason Fung. He's a nephrologist actually from Canada and he sort of got disheartened by all the patients showing up for dialysis, many of whom are diabetic, and he wrote this whole book about why people can't lose weight, really, and it has to do with your native insulin levels and those types of things and so the idea of changing the way you eat. You know, just eating healthier and eating less, that's a big part of it.

Dr. Nancy Van Vessem: And to try to get down to ... those extra pounds are really harmful, particularly as you age. It's a really major contributor to arthritis of the knee that leads to knee replacement because you have all that pounds per square inch on your knees, so a lot of these things-

John Curry: And your back.

Dr. Nancy Van Vessem: -that cause pain and disability, which nobody wants to have pain and disability, are related to all of that. But it's not easy and it's not fun, but I think what it is is like everything else in life. You get used to things. Got to get used to eating less or eating healthier or not eating the dessert, you get used to it, mm-hmm (affirmative).

John Curry: I keep that heart-shaped pillow over there to remind me of my heart surgery. July 10th will be 10 years ago and when I got serious about exercising and eating, eating the right foods and the right quantities, I went from 284 pounds, now I bump around 230, 232 sometimes, that now if I don't go walk 30-40 minutes or go to the gym, now it's like, "Oh, I don't feel good because I didn't do it." Whereas, in the past, I didn't want to go do it. I just sat on the couch, you know? So, it is a matter of making some of these things a habit-

Dr. Nancy Van Vessem: Right.

John Curry: -and just getting used to it and enjoying it.

Dr. Nancy Van Vessem: Right, and I think that's it, because once you start doing it, then you realize you feel a whole lot better than you used to feel, so it's not even for the long-term health effects, you're doing it because you'll feel better today.

John Curry: Absolutely.

Dr. Nancy Van Vessem: Mentally and physically.

John Curry: What went through my head, though, when you're talking about the knees earlier, what I remember having the most improvement in, I mean almost instantly, within 30 days, I could tell a difference not only in my knees, but also in my ankles and my lower back because I had back surgery in 2006 and I was amazed when I started dropping the pounds that all the joints were just better.

Dr. Nancy Van Vessem: Right.

John Curry: Even the elbows, because I was doing martial arts, so I mean everything was better because I was moving.

Dr. Nancy Van Vessem: Well, the thing is, your body was only meant to handle so much, you know? Like your heart ... I read this. They say there's a mile of blood vessels for every extra pound you have.

John Curry: Say that again.

Dr. Nancy Van Vessem: Yeah, what I've read is that there's a mile of blood vessels, because you you know, all those little capillaries have to be right up against every cell or it dies, of blood vessels per extra pound and-

John Curry: A mile of blood vessels.

Dr. Nancy Van Vessem: -you heart has to pump to it. So that's why when people get overweight or really overweight, their heart gets enlarged and gets really muscular, just like your muscles would if you're working hard.

John Curry: They wear out.

Dr. Nancy Van Vessem: But then it's hard because it starts wearing out. Yeah, you're really stressing your whole system and most of weight loss is what you eat, like 75%. Everyone thinks, oh, my knees hurt so I can't exercise. Really, in terms of putting fat on and keeping it on, 75% is what you eat. And then in terms of exercise, you don't have to become a marathoner. Pretty much it's go walk for a half an hour, you know, 3, 4, 5 times a week and keep moving. That movement is very important for your joints. That's what they were meant to do.

John Curry: So true. Tell us the name of the book again? The Obesity Code?

Dr. Nancy Van Vessem: The Obesity Code by Jason Fung. And there's a lot of good stuff out there. I mean, you don't have to look far, but that's just the more recent one I've seen and I think that what he tries to explain to people that if you eat carbs all the time and keep your insulin levels up, the high insulin levels are what make you [inaudible 00:32:25] ... you know it's meant to save calories onto your body for hard times that never come. So you've got to stop stimulating your insulin level, if your insulin level is high and it'll be high for 20-30 years before you get more and more insulin-resistant. You've probably heard that term.

John Curry: Yes.

Dr. Nancy Van Vessem: Until you flip into type 2 diabetes.

John Curry: Okay, if I tuned in and I'm listening to this, I might be the kind of person to say, "You know, I hear about all these different diets." You've got a low carb diet, you've got a high protein diet, you've got all this ... what in the world should we be eating?

Dr. Nancy Van Vessem: Well, I think the problem is that general advice ... and you know, the stuff that comes out of the government, for instance, that's for your average, healthy 30-year-old. If you've got a problem already ... let's say you're pre-diabetic or your diabetic, you've already got a problem and your problem is you've got to lose that weight and a lot of that, it has to do with ... and low carb Mediterranean is the diet that's been gelling, like for men to lose more belly fat and all of that sort of thing because you don't want to keep stimulating your insulin levels. You want to get that down so you can actually burn some of that fat.

John Curry: Right.

Dr. Nancy Van Vessem: And so the other thing is, you can't be eating all the time. You know, this whole idea of six meals a day or whatever? That might work for somebody who's hypoglycemic and age 25, but for your average adult in America, uh-uh (negative), not good advice. And a lot of the countries where people don't gain as much weight. You know, we talk about the French, "Oh, the French, they have all these rich sauces." Well, they eat three times a day and the eating is, they call it a restricted eating window, that you're only eating maybe over a 12-hour period, where in the U.S., people have started pushing that out, you know.

John Curry: Eat all day.

Dr. Nancy Van Vessem: And all night and then wonder what's going on, yeah. And so that's it. It's sort of like in the life care planning, who are you? And so the advice for a healthy 25-year-old is going to be different for a 60-year-old that insulin resistant.

John Curry: Well, let me challenge you on something here. A lot of people listening to this because this is the Secure Retirement Podcast, are in their 60's, 70's, some in their 80's and 90's. Let's just say mid-60's. What would the advice look like or sound like for someone mid-60's, maybe 70 years old, that they're doing the exercise, but you said a moment ago and I wrote this down, because every time I'm with you I learn something, 75% of weight loss is what you eat, so in their situation, would you say anything differently that's ... me, I'm 65 years old, so-

Dr. Nancy Van Vessem: But see, what's the gender, what's the weight, what's the chronic health problems? So, the thing is that you can't really just, in general ... you know, in general, the general things are stay away from processed foods, stay away from sugar. If you are trying to lose weight, you're going to have to knock down your calories some and then the studies show carbs or just fats, that sort of thing. But a lot of it has to do with, let's say you have kidney disease already, well all of a sudden you need to be watching your protein intake, so it really depends on-

John Curry: As in having more protein?

Dr. Nancy Van Vessem: Less.

John Curry: Less.

Dr. Nancy Van Vessem: So, that's why I want to say it depends, because it does depend. That's why one size doesn't fit all, really because there's plenty of 60 and 70-year-olds that are bopping around out there that are doing perfectly fine, just what they're doing.  

John Curry: True.

Dr. Nancy Van Vessem: They don't need to change anything.

John Curry: I see them in the gym. There's nine of us that work out together and there are people there half our age that can't keep up.

Dr. Nancy Van Vessem: Right, so there's a wide diversity and that has to do with what they've done their whole life. Your lifestyle starts catching up with you definitely by that age. You know, I used to see it about age 50, you'd have 50-year-old patients that look 60 and ones that look 40 and some of that's genetics, but a lot of it has to do with, "What were you doing for the previous 30 years?"

John Curry: Mm-hmm (affirmative).  We've got about five minutes left.  I know you've got a schedule today. Talk a little bit about the next step for you and your training and your knowledge. You love what you do. You are reading and studying constantly. We're not going to reveal your age, but from the standpoint of a professional woman, it seems like you're not slowing down. It seems like that you're doing things other things you want to do, but you're constantly learning and growing and it's contagious.

Dr. Nancy Van Vessem: Well, there's just so much to know and the thing is, is that the more I learn, it benefits me personally, too.

John Curry: Sure, it benefits you personally and you get to help other people.

Dr. Nancy Van Vessem: Right.

John Curry: That's why I love doing these podcasts. People are calling us and, "Hey, thank you so much. I'm learning about things that had nothing to do with money."  You know, this doesn't have anything to do with money per se, but if you retire and you've got a lot of money, folks, but you're in poor health, what good is the money?

Dr. Nancy Van Vessem: Not very much.  

John Curry: You can't enjoy it. You're going to leave it behind for someone else.

Dr. Nancy Van Vessem: Right, exactly. But it's not only me. I think there's a lot of this. I see it more in the young doctors, too. You know, we talked about the American healthcare system is a rescue system. You know, you sort of waltz around doing whatever you want to do and then when the bad thing happens and bad things happen fast, you know, you're like, "Help, help!" And so I think this idea of saying like, "Wait a minute, let's try to ratchet this back and what's it going to take to kind of change what ... they call the Standard American Diet the SAD diet, you know, for instance.  So, what's it going to take to have people eat a healthier diet? But a lot of times it's just eating less. We get too much. We get too many calories. Or to stop eating out as much because that's a huge thing because you don't have any idea many times how much, what you're getting.

Dr. Nancy Van Vessem: And of course, restaurants need to make that food taste good so you keep coming back, so I think people should look over and say, "If I really want to age and be healthy and be able to pick up my grandkids when I'm 75 years old, then what do I need to do right now to get there?"  And the thing is, is that it's been shown that even people in nursing homes in bed with physical therapy can get stronger and so at some point in time in life, there's going to be a time where it's too late, but it's amazing how resilient the body is, if you just do a modicum of the right things on a regular basis.

John Curry: I remember one time, you were sitting here and you were talking about ... I don't know if it was an experiment or if it was scientific research, what it was, on cutting back on the calories and the dramatic improvement it had in people who already were sick. Do you remember that study you mentioned?

Dr. Nancy Van Vessem: Well, I don't know about people who are sick, but it's been shown to improve longevity.

John Curry: That might have been the issue. But I just remember you talking about just changing the amount of food. Not necessarily of what, but the amount of food improved the longevity and then when you start working on the quality of the food, it made even better improvement.

Dr. Nancy Van Vessem: And then if you read Dr. Fung's book, it's also about when you eat. You know, you can't be eating at midnight and going to bed and stuff like that. I mean, basically our bodies are pre-primitive. They're not a whole lot different than they were 100 years ago, but some of what we have, which is shear luxury in our current way that we live, that we have all of this great food, too rich, but food that wasn't really available to everybody even 100 years ago, but what we have to do is to say, "Wait a minute, our bodies were designed for X and we're giving them Y and that's why we're going to have more problems." So, I think that he talks about this idea of not eating as much, of giving your body time to reset, all of those types of things and I think there's a lot of good information in there.

John Curry: I'll be getting that book. I'm going to read that. Okay, closing thoughts. What would you like to end with and just share with our audience, just any thoughts that you have, whether it be from the world of healthcare, financial planning, retirement planning, money management, whatever you'd like to share?

Dr. Nancy Van Vessem: I think the thing is, is that a lot of these things, if you apply yourself, whether it's about your own personal health and what you should do or about financial aspects or how do I get what I want at the end of life, you can do that, but you do have to apply a little effort, but anybody who has access to the internet has a wealth of information at their fingertips. But, again, you have to sort of say, "Well, I really need to do this, not only for myself, but for my family and get my affairs in order," so to speak. And if you get them in order a lot, like when you're my age, then it's not a big old scramble when you're 20 years older than me, so I think that's it, is to just sort of take a measured approach like that and in things like health and lifestyle choices. It pays you just like you were saying, your joints stopped hurting within 30 days. It doesn't only pay off 20 years down the road, but it pays off right now.

John Curry: It does.  But you know, when you start doing the research and the studying, there's such a misery of choice, too. There's so many different opinions.

Dr. Nancy Van Vessem: Well, I really think that ... and I would say this because I was a primary care doctor for years and years, that you should have a primary care doctor and you should go ask them to say, "Okay, I'm a type 2 diabetic." They should have an understanding of your health problems and so some of the things are the same. Don't eat processed foods, limit your sugars, that's true for everybody across the board. But then, to just say, "Really, what should I be doing?" And some doctor is going to say, "I think you should be on a plant-based diet. Go eat some plants." You may not like that advice, but that's pretty good advice. So, I think that's what I would do and that's basically your expert, so to speak. And don't get all wound up into this supplement, that supplement, the other thing. That's kind of an excuse for confusion because at the end of the day, the basic building blocks are hard to do, but they're simple to understand.

John Curry: Stick with the basics.

Dr. Nancy Van Vessem: Mm-hmm (affirmative).

John Curry: Very good. Great session. Nancy Van Vessem, thank you so much.

Dr. Nancy Van Vessem: You're welcome.

John Curry: Thank you.

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