SIX TOOLS To OPTIMIZE Your HORMONES For Holistic Health: Kyle Gillett, MD | Rich Roll Podcast

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Hormones are the literal signaling molecules that will communicate amongst your organ systems that give signals of what to do for your health super Geeks assemble because today we weigh deep into the weeds of science hormones and health with Kyle Gillette MD many people have noticed that there

Is an epidemic of hormone pathology so obesity and its related pathologies like metabolic syndrome are extremely common and many Physicians do not treat these conditions at all Kyle is a dual board certified physician and family medicine and obesity medicine as well as an expert in optimizing hormone levels to

Improve overall health and well-being in both men and women achieving Optimal Health is kind of like standing at the top of a quick sand pit and the digging out of the quicksand or the walking on top of it that is learning the lifestyle interventions but you can’t throw a

Shovel at someone that’s sinking and expect them to get out in this wide-ranging conversation we cover the key role hormones play and our overall health and how we can leverage Kyle’s six pillars to optimize Hormone Health the six pillars the first two are diet and exercise and then your stress

Optimization sleep sunlight and then you have spirit it’s a fascinating and stimulating conversation I think you’re gonna dig it so without further Ado this is me and Dr Kyle Uh super nice to meet you Kyle thanks for doing this I really appreciate you coming over here to spend some time with uh me today we’re going to get geeky can’t wait for it but I want to start with just a little bit of your your background I mean you’re a young man

What are you like 31 32 32 32 right practicing out of Kansas like where did this whole um Fascination maybe borderline obsession with human health and human optimization where did that begin and how did that arise I think it stemmed from my childhood education I was

Homeschooled and I noticed that a lot of individuals for example Ben Greenfield is also into homeschooling but it allows you to explore a lot of things that are not part of the norm to discover your unique eclectic self but I began to realize that I wanted to

Go into medicine when I was in high school and I kind of structured my education in order to do so so you were homeschooled throughout like your entire academic career up until College correct right but you went you went to college and then you went to med school you

Didn’t homeschool your way through college no I don’t think you can do that yeah yeah that’s really cool I mean we homeschooled our kids when they were younger and then at a certain age all of them said we want to go into normal school so I have you know quite a bit of

Experience with that my sense is that um it’s it’s really well served when the young person does feel directional in what they’re interested in and it sounds like you kind of had that early on which could really drive the focus of what you were immersing yourself in

Yeah I think it would have been very difficult I think I would have done very poorly in a Traditional School why is that I tend to get on these tangents or obsessions for example Health optimization and then I’m really interested in athletic performance or cognitive performance or just like the

Metaphysical and I concentrate on that rather than whatever happens to be on the agenda or schedule right in your case though your dad is a doctor yeah so you had that in the household yeah my dad is also a family doctor and he delivers babies kind of does full

Spectrum medicine there are still many physicians in Kansas that do so and in the midwest in general and I saw that he was also it was very rewarding uh I think he finds a lot of purpose in it and that was part of wanting to go into

Medicine as well because of the the immersiveness of it because you’re really working with families and young people throughout the you know sort of course of their life as they progress right there’s a different kind of emotional attachment to it yeah so that was the impetus to get into Family

Medicine yourself and then why obesity like why did you choose these Specialties the most common problems are what uh full spectrum or primary care physician should be the best at and I’ve noticed that well many people have noticed that there is an epidemic of obesity and it is technically an

Epidemic according to I believe the CDC and um there is also an epidemic of hormone pathology so obesity and its related pathologies like metabolic syndrome and also different hormonal pathologies like sub-fertility or PCOS are extremely common and many Physicians do not treat these conditions at all so there’s an

Excess demand and very little Supply yeah and those are the very subjects that we’re going to dive in today Hormone Health metabolic syndrome obesity Etc and just uh you know kind of further your point about Primary Care Medicine it is fair to say that Primary Care practitioners aren’t really practicing

For the most part Primary Care are they they’re really practicing sort of secondary care it’s it’s diagnosed and prescribed whereas you are you know one of the many kind of burgeoning functional medicine holistic medicine practitioners and as a young person that gives me hope like I I feel optimistic

About the future because there is so much interest um in expanding uh you know what’s available uh um from our from our from our Health Care system is is your sense optimistic as well I mean there’s a long way to go right but the fact that you can create

These clinics and they have viable business models and you can kind of prove that out establishes that this isn’t just doable like this is like a really good way to establish yourself I agree I’m also very optimistic even looking among my colleagues uh during medical school at the University of

Kansas or during residency many of us not just myself used to listen we would listen to Peter attia and read the content that he would put out so there is many uh many many Physicians not just myself that are very interested in true preventative medicine and health optimization hmm so let’s uh

Let’s get into Hormone Health I mean first you know my first question to throw to you is what is when we’re talking about health like what is is there a difference between talking about health in general and Hormone Health like what is it about Hormone Health

That perhaps sets it a little bit apart and has sort of garnered your Intrigue hormones are the literal signaling molecules that will communicate amongst your organ systems that give signals of what to do for your health there’s many things called feedback inhibition or feedback mechanisms that can be positive or

Negative and hormones can act on these to try to preserve your health but when it’s in a dysregulated state pathology can occur so they’re just the signaling molecules that control all of your health right so it’s a good place to start when you’re diagnosing someone let’s look at what’s

Going on here right and if your hormones are off then there really isn’t a need to analyze anything else until that’s addressed it’s sort of a Top Line and this is more from this side of my practice that also emphasizes integrative medicine or functional medicine or holistic medicine whatever

Terminology you want to use with it I like to find the cause if any biomarker is off hormone or otherwise I like to see the cause because Perhaps it is a benign cause and perhaps it’s not let’s define what a hormone is you call it a signaling molecule but what is it

Specifically I mean I think for the layperson when you say hormones they think about testosterone they think about uh estrogen you know many people might not even know that insulin is a hormone like there’s a lot more to this world it’s a very complex world so let’s just begin with some basic definitions

Here there’s three main classes of hormones or signaling molecules most people are familiar with the first two classes those are your sterol hormones or your cholesterol based they have a cholesterol backbone androgens are one of those for example testosterone estrogens are another one of those for example estradiol and also

Progestogens are included in there I would also include vitamin D in that class as a hormone as is cholesterol based as well you also have peptide hormones so a lot of people are I think you know they talk about peptides and uh culturally peptides are more

Known not really as hormones but as you know Cutting Edge treatments kind of in the same class as PRP or stem cells but a peptide is just a chain of amino acids between about two and a couple hundred so it’s a a short protein and they’re also hormones so growth hormone is an

Example insulin is another example of a life-saving peptide and then you also have hormones that are based just on amino acids for example thyroid hormone is based on tyrosine now we have melatonin adrenaline prolactin growth hormone epinephrine there’s lots going on here yes and I would consider all those hormones things like norepinephrine

Dopamine serotonin those would all be Amino acid-based hormones they would be based on dopamine and then um serotonin and melatonin are based on tryptophan and the definition of Hormone Health would be an appropriate balance of all of these important hormones across the Spectrum correct so if somebody comes into your clinic and says

I don’t feel well or maybe this thing is off or maybe they feel fine and you want to diagnose this person what is the process by which you begin to get a picture of their Hormone Health you want to get what we call subjective and objective information all this means

Is subjective is how the patient is feeling the biofeedback do they feel normal and this could be their cognitive Health it could be their focus it could be their libido it could be their athletic performance and the patient is telling you that information and then you also use objective information for example blood

Tests or Diagnostic Imaging you synthesize the two and that’s where a lot of the practice of medicine comes in and then you come up with a plan has anybody ever come into your clinic and you’ve you’ve done this panel and you said no you’re in perfect balance

Like is that a myth that you could achieve like total optimization with this because of just the daily life stressors and the way we live our lives right on some level we’re all disregulated to some extent yeah there’s always more that you can do and you can

Always do more digging so it’s common for a patient to say I’ve had half a dozen doctors say there’s nothing else that we can test or there’s nothing else that we can do it might be the case that there’s nothing else that insurance will cover as a benefit but there is always more

Digging that you can do if you do more digging you will find things right and how does this I mean maybe this is a longer conversation that we can get into later but you know obviously this is going to depend on on your your sex your age what

Span of life you’re in that picture and what you have kind of come to expect is going to change and how you optimize is going to be different depending upon all those factors absolutely so you can have two individuals let’s say they’re identical twins with the same genome and

Depending on what their goals are or depending on what they are trying to achieve they could have a different plan and that would include the lifestyle pillars or perhaps supplements and medications as well right so that’s probably a good place to drop the disclaimer that although you’re a

Medical doctor there will be no you know medical advice being given today this is general information purposes only correct and uh even when medical advice is given it needs to be given for an individual because it’s different sure so there’s I guess the answer to all questions is it depends sense right it

Depends yeah that’s always a frustrating one right everybody wants the answer yeah and you’re the guy you’re supposed to have the answers but it’s complicated so the pillars that you mentioned let’s go through them you’ve divined these six pillars uh that kind of encapsulate what it means to you know have optimal

Hormone Health so maybe we can kind of go through them Siri Adam yeah the six pillars the first two are diet and exercise and they kind of have the um they’re the most powerful pillars if you will and then the last four I used alliteration so you have uh your stress

Optimization so you you want to have some effort in life you want to have something that you’re working towards you also have sleep and that’s quality and quantity of sleep and you have sunlight and that really just means the outdoors it encompasses cold exposure heat exposure even moving your body and

Being exposed to the elements and then you have spirit and that’s just the self-actualization piece on Maslow’s hierarchy of needs and everybody has um you know spiritual or metaphysical Health which is important because that’s what their purpose is yeah I love that you have that as a pillar I feel like

That’s something that’s often overlooked or sort of somewhat you know dismissed on some level and I think it’s really important and I can’t help but ask like how did you divine these pillars I assume they’re evidence-based you know premised on all the work that you’ve

Done as a scientist but when it comes to the spirit thing you know I think of uh Lisa Miller’s work at Yale on the science of spirituality which I think you probably are familiar with she’s been on the podcast but also um you know the blue zones work like

There’s a lot of uh you know just population studies or you know anecdotal evidence to suggest that longevity or kind of Health long term is rooted in someone’s sense of purpose in life and their connection to something larger than themselves I would say listening and learning from people who have healed themselves

There’s another mindfulness book and I think the title is heal thyself and it’s specifically written for healthcare practitioners and they teach a lot of these lifestyle um modifications and these lifestyle modifications are more powerful than any supplement or medication now the the balance to that is I also

Read a lot of literature so listen and learn and also read literature so you’re hearing anecdotal experiences and many people have the experience of a friend or a family member that is on a dozen different medications and is very unhealthy and another one who is on no

Medications and who is very healthy in fact that at the place where we were staying I overheard a conversation of an individual say you know I’m 70 years old or X just an example and I’m on no medications and healthier than ever and often when you see that they have

Already dialed in up if not all six lifestyle pillars they have at least dialed in the diet and exercise so those are those are like you know on the P they’re the foundation of the pyramid and you’re around like the the Gillette uh hierarchy of needs for hormone

Optimization yeah and I I think that an individual such as yourself has also emphasized and um healed yourself with a lot of these lifestyle pillars as well just learning it anecdotally through life yeah sure I was curious why my my sensibility would be that there maybe is room for a

Seventh pillar which would be Community maybe that that weaves into Spirit on some level because it is about connection um but Community seems to be a big piece especially you know as we really get old like the the people who seem to have a higher quality of life are the people

Who really have deep connections to family community friends and the like yeah there probably needs to be a seventh maybe social if we continue with alliteration yeah but that’s definitely true where your health is deeply connected with your loved ones around you right well let’s let’s go back and go through

Diet so talk to me about the relevance of diet with respect to hormones specifically diet is one of the main modifiable interventions and you can write nutrition prescriptions as well um but they’re a little different than cookbooks but you can write nutrition prescriptions and it is one of the drivers of

Metabolic syndrome which I would consider and by the way metabolic syndrome is just the insulin resistance increasing abdominal body fat dyslipidemia is part of it and pre-diabetes it’s the most common cause of low testosterone in men and also it leads to other pathologies like and ovulation not ovulating insulin resistance infertility

And diet is one of the best ways if not the best way to fix that that’s why many clinics that you see they used to have you know endocrinologists and then cardiologists and now they have cardio metabolic clinics and most academic centers because they are really addressing metabolic syndrome sure

Because metabolic syndrome from there we see cardiovascular disease diabetes obesity and the like right like you it’s interesting that you know we’ve treated these as separate Specialties and yet they’re all rooted in this one thing yeah that’s certainly true obviously there’s no perfect diet and you have to be careful with diet because

You can almost swing too far at the other end where you develop orthorexia where you’re terrified of eating things that aren’t perfectly healthy there’s no good or evil Foods yeah there’s certainly foods that can be better consumed in higher quantities than others but the best diet is just a

Habitual eating habit that can last a lifetime that someone will adhere to yeah I saw a a quote on your Instagram where you said your diet isn’t a diet at all it’s a lifestyle and it’s evidence-based habit formation yeah so like elaborate on that a little bit Um if you do something for a long time and you are teaching yourself the tool to adhere to eating then many people may have heard of um instinctual eating or um you know you’re eating and it’s intuitive intuitive eating and that will work if you’ve given yourselves the

Tools to be able to intuitively eat right there’s a there’s a problematic aspect to that like we’re both smiling right like intuitively I just feel like I need this thing like is that a really a a trustworthy narrator not particularly because it could be that the center in your brain largely it’s in

The hypothalamus that regulates hunger or not being hunger there’s two centers the anorexogenic center which is exactly what it sounds like and the orexagenix center which I call the hangry Center and if those two are not balanced you’re not going to be able to intuitively right you’ll be overridden by some

Craving that doesn’t serve you that you’re powerless to resist yeah and those Cravings are being driven by hormones yeah super interesting you mentioned orthorexia we were chatting a little bit before the podcast I think that that is a often ignored aspect of the the kind of biohacking Universe of

People who are interested in exploring human optimization through diet and other protocols but can easily you know sort of Shadow disordered eating behind like I’m fasting it’s intermittent fasting or I’m doing this you know quote unquote protocol when in truth they just have a you know sort of a real problem

With their relationship with food whether it’s addictive or some other symptomology yes and I think the same can be set of supplements many times patients have the best intentions but they’re taking three dozen or even four dozen different supplements and you can almost take on a

Role which has been termed the sick role from taking on that many different supplements you’re taking uh 40 different pills every day and it’s difficult because theoretically a lot of these can help and usually they have been started on this by a physician or a dietitian or they’ve heard that it

Can be beneficial and on one hand you agree that many of them are beneficial but sometimes you’re taking on a bad guy role when you’re trying to pick which are least efficacious well also you know everything that you put in your body like if you’re taking it for some primary

Rationale there are all kinds of secondary and tertiary Downstream implications of that right that might be doing you more harm or if you’re taking things you know multiple things they’re counteracting each other in certain ways yeah and often that is the case as you introduce more and more supplements and

Or medications which are the Same by the way one’s prescribed and one’s not both of them have pharmacodynamic effects which is what the drug does to the body in a pharmacokinetic effects which is how your body metabolizes the drug so if you’re taking that many things then they’re certainly going to be

Interaction yeah and look everyone loves talking about supplements we were all we were also joking about this beforehand it’s sort of like yeah spirit I get it like sleep okay but like tell me what the supplements are that I want to take because that’s the easy lift it’s the

Easy fix the other lifestyle modifications require work and habit formation like you said um so I’m not against supplementation I take a bunch of supplements um but I’m much more cautious I think than other people who would consider themselves to be like self-experimenters and we’ll get into it I want to get into

The supplements but you know on the subject of the foundation of you know establishing hormonal health and and just Health generally you know talking about diet and exercise you know these things have to come before all of that they’re like the cherry on top right achieving Optimal Health is kind of like

Standing at the top of a quick sand pit you’re never really truly going to get there but there’s many ways that you can uh you know not be sunk into quicksand that would be pathology and the digging out of the quicksander the walking on top of it that is

Learning the lifestyle interventions the medications and supplements are just tools and you don’t just throw a shovel at someone and I do recommend mini shovels those would be your supplements and medications but you can’t throw a shovel at someone that’s sinking and expect them to get out right so diet

Someone comes to you perhaps they’re maybe they’re not obese but they got the love handles they’ve never been able to lose them uh metabolically they’re a little bit off um how are you sort sort of trying to diagnose that person and you know course correct their their habits the first

Part of taking a history is listening very closely to a patient we can call this motivational interviewing that’s kind of a term that’s used in medicine today which uh rightly puts the emphasis on listening to the patient many people have when they by the time they come to you

They’ve tried many things and some have worked and some have not and some people are almost completely better just because they’ve found out what works for them and what doesn’t so listening to them and then also hearing their goal what they’re willing to do or wanting to do at the time

There’s different stages of change and if they’re in the pre-contemplative phase then perhaps they need just more motivational interviewing and a better connection to make a shared decision or their health needs to decline to the point where they’re actually willing to make a change that can happen too yeah

Um and a lot of it then becomes about accountability and follow-up right which is something you’re probably better suited to do than the typical primary care physician yeah it can be very difficult to follow up with for example a specialist some people do follow up with their specialist and for example a

Cardio metabolic clinic at a huge academic center in a you know and usually a academic center in a hospital but um not everybody can do that there’s just not enough Supply so following up with a patient longitudinally and developing that Rapport or that relationship between the health care provider and hopefully the

Interdisciplinary team I’m a huge fan of working with many different Healthcare Providers as a member of a team dietitians included counselors included when possible um having more Minds to answer the question is always better sure sure and uh my sense is that you’re someone who’s who’s fairly diet agnostic like you’re not

Adherent to one particular path right everybody’s individual I’m a plant-based person I’ve been plant-based for for 15 years um and you know maybe we differ on some things but I think we probably agree that most people who are coming in to see you who are having some kind of

Issue with diet are probably not getting enough fiber probably not eating enough Whole Foods probably eating too much processed foods I mean what do you typically see and you know more specifically like what are the things that you’re trying to get people to do more of and do less of more than 90

Percent of people should optimize the fiber in their diet fiber is not talked about very much usually you’re talking about the macros of carbs and protein and fats and sometimes alcohol but fiber will affect your gut microbiome pretty significantly and also your risk of cardiovascular disease there’s many types there is soluble

Fiber and insoluble also known as dietary and non-dietary fiber and then there’s Prebiotic fiber which is heavily utilized by your gut microbiome so having enough of all of these and also not too much there’s also types of fiber called fodmaps which can cause bloating or gas so having a balance which is

Different for every individual is very important another thing that we briefly mentioned about diet is the Mental effects or the stress effects from diet if someone has and I think it’s wonderful for everyone to attempt to grow all of their own food if possible

It is so hard to grow your food so it really makes you appreciate any food if you’re growing it do you grow your own food as much as possible maybe five percent you live in the Bread Basket come on yeah it’s extremely difficult and we have a huge garden and we have

15 maybe a 20 chickens now wow so we do as much as we can and um the my family’s from Kansas and we’ve always had Angus Cattle as well and it’s extremely difficult to raise them we grew up doing 4-H and we raised sheep and we still uh the family still does

And even with that we just like my family requires so many more calories it’s amazing that there’s so many people that don’t grow their own food and farmers and other gardeners make up for it yeah so uh Whole Foods close to their natural state um making sure that you’re meeting fiber

Demands which most people or a lot of people are are insufficient at doing where does that leave you what are your thoughts on the carnivore diet because that just seems to be like you know infecting the internet right now and people seem to love trying that out and

A lot of people are saying they’ve had health benefits from doing that like do you have a perspective I would put the carnivore diet in a category of elimination diets so somewhat in the same category as for example a Whole 30 where you’re trying to you you know you

You want to introduce other foods to see how you tolerate them I don’t think it’s a great Elimination Diet but I understand why some individuals with autoimmune diseases want to eliminate almost everything from their diet and not have to worry about supplementation in order to get their like a nutrient dense

Sure diet but you’re eating a zero fiber diet yeah as a result right I would be particularly concerned for colon cancer and I would also be concerned for elevation in the level of iron in the body it can deposit in any tissues and oxidize almost like a shovel that’s left

Outside what about serum cholesterol it can certainly be concerning for those on the carnivore diet there is a genetic component so people can have mutations and there’s one gene called a psck9 gene where if that’s mutated then it’s almost like you’re on a um the inhibitor of that channel right and those people

Might be able to tolerate a carnivore diet and have a particularly low APO B which is the marker that you really want to look at but if you compare individuals that are on plant-based diets um if you compared that to the same individual that was on a carnivore diet

Their risk of cardiovascular disease would be far far lower and the clinical literature does back this up it’s even been studied looking at plant-based diets for reversal of plaque in the coronaries right and APO B being kind of the favorite marker for establishing kind of where

You’re at where you’re at in terms of cardiovascular disease yeah um there is a an article published in the Journal of the American Medical Association the Cardiology version of it um the fall of last year I believe it was Dr Alan snyderman and I think that

Journal is going to be the Tipping Point or the inflection point to where all lipid panels will reflux so if your LDL is above say 100 then it’s just going to go ahead and the lab is going to go ahead and test an APO B after that right

Because because now or at least recently you have to request that it’s not part of the typical panel yeah yeah but that’s changing hopefully it should change the title of the article if it means anything was the debate is over apob is a better marker to check than LDL yeah yeah

I feel like most people want to eat better they want to improve their diets absolutely have you heard of it I’ve heard of it this trips up so many people we thought hey we know a couple things about how to do this a few so we created

This thing called the plant power meal planner that is this beautiful offering whereby you gain access to literally thousands of plant-based recipes that you can totally customize based upon your preferences your allergies your peccadillos it integrates with grocery delivery so all the ingredients that you need get shipped right to your door so

You can make the stuff that you’ve pre-selected and we all could use a little inspiration and support when preparing meals for our families in our busy lives so we hope you join us no matter what your eating style is we have our arms open wide and we’ve saved you a

Space at our family table to join us in eating more healthy vibrant plant-based meals so if you want to learn more if you want to go on this exploration that’s been so nourishing to Julie and I I would encourage you to visit meals dot richroll.com [Laughter] you mentioned prebiotics probiotics we

Were talking about fiber talk to me a little bit about the relationship between uh the microbiome gut health and Hormone Health and how those what the interplay is between those two things I consider the gut microbiome the front lines of your immune system so your immune system

Is like your military and each any good military worth their salt will practice drills and it practices drills against your gut microbiome as an easy adversary if your gut microbiome is dysregulated for example after an antibiotic there are certain antibiotics that kill more of your gut microbiome and you see far

More atopy which is allergies asthma and eczema and also far more inflammatory diseases like Crohn’s and Ultra ulcerative colitis even after one uh you know course of antibiotics your odds ratio which is kind of like think of it as how many times you’re more likely to get that disease of something like

Crohn’s can increase three to four times wow so if somebody comes in and you’re you’re trying to diagnose them you’re going to have to look at gut Flora as a marker of Hormone Health and Hormone Health as a marker of of gut health yes like these these are not you know separate entities

Some gut microbiota like E coli heavily produce an enzyme called beta glucuronidase and your enzyme metabolizes steroids in part due to glucuronidase for example estrogen is metabolized significantly by Beta glucuronidase so if you have an overgrowth of E coli you’re going to recirculate your estrogen and it could relate an estrogen

Surplus got it so on the subject of diet obviously uh you know what comes to mind is Weight Management you practice obesity medicine I’m sure you see a lot of obese patients or people that are overweight who come to you and say I’ve tried everything I can’t lose the weight and you know

Assuming that the laws of thermodynamics are in place and on some level you know a calorie in a calorie out is a truth there are people who no matter what they do they can’t lose the weight we dismiss them as people who have poor self-will but in truth there is hormone

Dysregulation that creates a different relationship with appetite and hunger and also for whatever reason is making their bodies hold on to weight in in a manner that’s different from somebody who doesn’t suffer from that so there’s a lot of these people out there there and more and more every day so walk us

Through like the experience of of treating a patient like that and how you counsel them and and try to better understand their Hormone Health and how to improve it when I’m counseling a patient regarding improving their Hormone Health specifically from diet or nutrition part of the food is medicine philosophy

Which is absolutely true then but let’s look at two different patients one has tried a lot of different things they’ve done calorie counting for a long time the cat the strict calorie counting or even going on a very low calorie diet um it has not helped and they have either

Not lost weight or they’ve regained weight and perhaps their metabolism is lower and their caloric maintenance is lower as well versus an individual who hasn’t tried anything and the individual that hasn’t tried anything calorie counting is a wonderful tool because in many it does help that being said even the average doctor

Or dietitian underestimates how many calories they consume by at least 10 percent so even doctors and dietitians don’t accurately track yeah accurate caloric intake but in the individual that has tried calorie counting and tried very low calorie diets that individual likely just needs other tools so sometimes that

Is tracking your eating speed sometimes it’s tracking the timing of eating for example in the morning versus the evening sometimes it’s number of meals per day sometimes it’s carbohydrate or macronutrient content sometimes it is the nutrient density versus caloric density of the food so all of those things can work but if

Someone has already tried strict calorie counting usually they just need more help or more tools okay so that’s that person so some people will be able to Cotton onto that resolve their problem Go off into the world but let’s talk about the person for whom that doesn’t

Work and sometimes it can work in between as well but if that doesn’t work then your tools are those dietary tracking mechanisms occasionally uh you can also give patients a list of five foods so this is a good actionable takeaway you list the foods that you really like for me those might consist

Of Greek yogurt unsweetened Greek yogurt eggs or egg whites spinach I can eat spinach all day I love it some people do not like it spinach also has oxalates which can potentially help bind up heavy metals in the gut which could be helpful as well but you also don’t want too many

Oxalates if you have kidney stones it’s just another good example of individualizing a dietary protocol but those are just some examples of food that you can eat a lot of and you are un you’re likely to be satiated and unlikely to be depleted of nutrients right higher fiber higher in nutrient

Density and lower in caloric density yeah is a good principle but I guess what I’m getting at is the person who’s whose hormone dysregulated right and you have to like see what’s going on with that and kind of calibrate the hormones so that there’s a better balance that’s

Getting struck and the body then becomes like the the the the metabolic system of the body becomes more robust and able to um metabolize food and and perhaps lose weight like a normal person yeah and this this would likely require blood tests which I’m a fan of even if

You don’t have any pathology even if you feel completely normal if you’ve never gotten an excellent Baseline panel right now is a great time to do it but uh if there is something off then uh I like to do a full panel including not just your metabolic hormones as you

Think of them for example a fasting insulin or a glucose tolerance test which includes multiple glucose levels or an A1C which is your average blood sugar over three months but including your testosterone including your estradiol many individuals that have a lower testosterone also slowly lose lean body mass which is extremely

Metabolically active tissue and also during a caloric deficit many people um that you just don’t move as much it’s also known as neat or non-exercise thermogenesis some of that is fidgeting some of that’s just moving back and forth more often and um when you have uh problems like these occasionally it requires supplementation

And or medications to address it and those medications or supplements would look like what a good example is if an individual has metabolic syndrome and pre-diabetes a high fasting insulin say over let’s say it’s 20 which is quite high for a fasting insulin then perhaps they’re considering medications like

Metformin or semi-glutide which are insulin sensitizers and uh perhaps their insulin is normal in that case maybe someone would benefit more from a medication that would help balance out that anorexogenic and ores or exogenic Center of hunger in their hypothalamus so that would regulate the hunger impulse to the brain and help

Modulate food intake as a result and perhaps there’s a another example of an individual and their main issue is eating really late at night or after 8 PM or even eating in between sleep so they’ll wake up and they’ll eat and for that individual perhaps they just they’ll benefit from sleep optimization

When you’re sleeping you’re not eating yeah that’s my thing eating late at night like sometimes it just it’s like if I I know that I’ll be able to fall asleep quickly if I eat something right before I go to bed but then inevitably I wake

Up at like three in the morning yeah and a lot of that’s the orexagenic and the anorexogenic center so if you’re hangry you’re not going to sleep very well yeah yeah but if I eat too early and I’m hungry when I go to bed I have trouble falling asleep yeah it’d be interesting

To see what a uh a CGM would look like uh I’ve I’ve been playing around with that actually yeah with levels and that’s been super interesting I’ve learned quite a bit from that yeah um I think the thing with that is you got to be really careful because I’m a lay

Person right I have some signs vernacular but you know I’m not steeped in expertise and when you see these spikes you’re like oh my God I have to stop eating this food like what’s normal what is out of order what should I be concerned about and what should I not

But the one thing that I did learn is that in playing around with intermittent fasting if I only eat dinner and I eat that dinner a little bit too late like that’s a disaster it’s a disaster for sleep and when my sleep is dysregulated then my ability to to metabolize glucose like

Bottoms out and it’s terrible the next day interesting yeah is that typical or normal it can be typical one thing that I see pretty often in very healthy individuals especially that are insulin sensitive so they would usually have a lower fasting insulin it’s something called dawn phenomenon

And that’s where often these people are taking a supplement like berberine which can precipitously decrease your glucose especially if you take berberine at dinner and your glucose will drop very low and you’ll um you can see this on a CGM as well most cgms and as it drops low your body

Makes glucagon which spikes up your your glucose even if your insulin is low so your glucose can be let’s say 50 at 3 A.M but by the time you wake up it’s over a hundred right yeah well I’m not experimenting with that but I I you know

I don’t know what’s going on metabolic metabolically with that but um I learned that like the one meal a day thing is like no boy no you know I talked about that with Peter attia he agreed and I think he had a similar experience with it I think cgms are a

Cool tool I just feel like there needs to be a lot more education for the layperson about how to interpret all this data so that people are are making informed decisions and not reactive decisions to momentary spikes and data inputs that they don’t truly understand yes I certainly agree um again that’s

Another example many individuals see that they have a spike of glucose so they start taking a powerful insulin sensitizer like berberine and it can make the problem worse rather than butter right right right um how about the person who kind of rubber bands like this the guy who or the woman who

Um you know loses a tremendous amount of weight and then six months later has gained all the weight back what is that doing to somebody metabolically and and hormonally like my sense is that over time that’s damaging the metabolic health of the individual and probably making it harder for them to keep that

Weight off in a healthy way long term much of it has to do with losing the lean body mass perhaps not to a point of sarcopenia which is a pathologically low lean body mass but perhaps to the point where their metabolism or their lean body mass is so low that their daily caloric

Intake they’re used to they’re accustomed to consuming this many calories and now they can’t even consume that many so that that’s the main mechanism behind what is kind of culturally known as metabolic damage and it certainly happens more than 90 percent of individuals who lose weight tend to gain it back the

Thing that the small percentage of individuals that keep the weight off have in common is an exercise habit so it doesn’t help lose weight but it can help prevent the lean body mass from decreasing and the body fat from coming back all right well that’s a good segue

Into exercise but before we put diet in the rear view mirror we probably should talk a little bit about the differences between the Sexes right so we’ve just sort of talked about this generally at least with respect to Weight Management like how does it differ hormonally between men and women women do have

Menstrual cycles of course if they’re before menopause and after menarchy and during some areas depending on your genetics you may have different dietary needs for example if there’s a a female that has PCOS men do not have PCOS we don’t have ovaries then they might

Require a diet that is not as a lower glycemic diet or a diet to address the Androgen dominance so something to help increase their shbg which could consist of a low carb diet whereas a male would not be concerned with that pathology on the other end there’s also women with one another

Example of a pathology is hypothalamic amenorrhea which has to do with many different inputs but one of them is leptin leptin is a a hormone that is a signaling molecule from fat cells that can help increase the production of the hormones in the hypothalamus that then

Release FSH and LH from the pituitary so those in each individualized dietary needs for females would be drastically different than right and so what would be common interventions or prescriptions with respect to food in that regard specifically for PCOS often they benefit from less carbs you’re trying to get

Shbg which is The Binding protein that binds up androgens and estrogens you’re trying to get that higher often you see a deficient level of shbg or sex hormone binding globulin in individuals with PCOS or just individuals with insulin resistance insulin acts on the liver to decrease shbg production from the liver

And then their their hormones are metabolized very quickly and they also just run around unregulated right so that’s women right so and what about on the guy’s side for the guy’s side uh guys do have shpg and of course men and women have very similar hormones women have different ratios of hormones

Usually women have about four times as much testosterone than estrogen and men have many times that more testosterone than estrogen but estrogen is particularly important you can see low shbgs and men as well you usually want a medium or a high shpg A good rule of thumb in Min is that you

Want estrogen to be as high as they can tolerate without many symptoms but you want a total estradiol about two to three times a free testosterone and you also want shbg on the high end as well as long as you can maintain adequate free androgens right so when

You say estrogen and Men people lose their minds yeah yeah it’s it is certainly good unless it is High relative test to testosterone so often you want to keep the estrogen nice and high but just increase the testosterone congruently and are there typical foods that can help balance that

Or buttress uh you know things in the right direction for that individual ensuring that you’re getting optimal uh essential fatty acids and essential amino acids for example Omega-3s or your essential amino acids that’s first and foremost for some for many people that might be more than the RDA of that nutrient

And then depending on um you know what other pathology that individual might have that would come next but many people are you know the most common problem is too many calories especially processed calories I think that the effects of phytoestrogens are quite weak in most individuals including males and I think

The effects of xenoestrogen so phytoestrogens are things that can potentially be estrogenic for example soy most individuals do not consume enough to have a clinically significant effect perhaps that’s statistically significant if you design a study to see that um xenoestrogens likely do have a touch

Of an effect an example of that would be bisphenol a and that would bind to an estrogen related receptor the gamma receptor so that could have hormonal effects but again likely these are not significant compared to everything else that is happening but it’s certainly something to keep in mind and what foods

Are Xeno uh uh what did you say you said Xeno xenoestrogens estrogen estrogens in the environment like BPA okay which is known as bisphenol a so you might see your water bottle sure BPA free which is great and then phytoestrogens are somewhat estrogenic from Plants right but usually they are very weak right

Okay and if anything they’re beneficial right okay let’s talk about exercise uh talk to me generally about how you think of think about exercise as this second pillar exercise uh and again another analogy it is how you keep your body using so it would be

Like you have a new brand new car and then you put it in a garage and you put it up on a lift it’s like being in a chair and you never use it you never drive it that car is not going to function well even if you leave it

There for a year you’re going to have to change the oil and whatnot because it hasn’t been moving um but humans are the same way you can’t just put a human and sit them down in a artificial indoor environment they’re designed to move you have anaerobic and aerobic exercise and both are

Particularly important whether it’s the um you know the easier exercise I know Peter attia talks a lot about Zone 2 cardio which is particularly important but vigorous exercise is also important of course as is resistance training so zone two how much when how does that differ with age would

Be my first question and how does that mix in like in the in the if you’re looking at somebody who’s pretty busy and you’re saying you got to do zone two you got to do resistance training you got to do some like interval high output stuff like what is the ratio of those

Activities to your mind the law of diminishing returns applies in this case as it does in almost everything in medicine um so it’s hard to say you know this is the amount of zone two that it’s beneficial for you and after that it completely drops off a good rule of

Thumb is three times a week 30 minutes for zone two and at least one time a week of very vigorous cardio and at least twice a week for resistance training so that would be pretty reasonable for a busy person to do right how about 25 hours of zone two a week

Uh I’ve been there that way that would be a lot um the aerobic base is huge well the great thing about zone two is it’s a day in day out thing like I my my the way I think about it is that’s the kind of thing where you can kind of wait if

You’re doing it properly you can kind of wake up every day and do it you’re not going to be overly fatigued but your high output stuff you got to pace it out because you do I have to allow your body to recover so it’s about like you know

Being mindful of spacing the workouts so that you’re giving your body time to heal and get stronger absolutely true over training is relatively rare although perhaps an individual like yourself yeah would not it would always be on in your world you’re probably always teetering on the edge but for the

Average American most are not over trained they’re just getting used to that adaptation and um for an individual like that the let’s just say the average American starting and emphasizing vigorous exercise can be detrimental because that they feel so tired or sore at least the the first month to where they’re not

Wanting to incorporate things like zone two and and walk me through what’s going on hormonally when you exercise and I’m sure it’s different depending upon the type of exercise but bring the hormones into the discussion the so hormones during exercise have been very well studied there’s a ton of

Clinical literature published on it and there are effects on not only testosterone and estrogen but also growth hormone and igf-1 a lot of this is released in and amongst muscle cells so not necessarily endocrine which is between body systems but autochronoperacrine and usually these effects are very short

So if you do it just a couple times it’s not going to have a sustained effect but over a long period of time it is likely clinically significant so ways to optimize a lot of people ask about how to optimize your growth hormone you have peripheral and Central growth hormone you don’t necessarily

Want to optimize both and you also have testosterone that can be increased one of the studies that many people have talked about is if you do a set of resistance training with legs I believe squats is usually the example and you do a medium rep range for a

Medium number of sets three to four sets six to ten reps then it can help optimize your Androgen profile specifically testosterone if you do this just one time and the testosterone is not going to be around systemically for a long period of time if you look at the graph it decreases

Pretty quickly so if it becomes a habit then it can help in the long run but if you’re just if you’re only doing it once a month or once every other month it’s very unlikely to have a clinically significant effect right on the subject of over training the the kind of

Catchphrase that comes up often is adrenal fatigue my sense is that adrenal fatigue is not a thing it’s it’s something that we attach to a sense of not having energy or general lethargy but if somebody says I have adrenal fatigue Kyle like help me out what’s

Going on like how do you figure out what the problem is and identify is this an over training thing is this a stress thing like what is happening adrenal fatigue is still not an ICD-10 code what does that mean there’s different codes that you can put in and order tests and

Diagnostic under ah and adrenal fatigue is still not one of those you can have Addison’s disease which is a lack of adrenal hormones that are made in this specifically cortisol and I believe DHEA are made in the Zona reticulosa which is a part of the adrenal gland a small gland on top

Of the kidney DHEA in particular is very interesting one because it produces all of the estrogen and post-menopausal women and then two because DHEA is like the pawn on the chestboard of hormones so if you’re looking at your hormones like a chess board specifically your androgens and your estrogens

Let’s say your Queens are estrogen you don’t have very much estrogen but they’re really important and it can be extremely beneficial for your health you also have your say Rooks or androgens but your pawns are DHEA and through life as your Hormone Health progresses your pawns can be Queen so DHEA can convert

To both testosterone and estrogen which it does quite often so if you have worsening function of the ovary or testes the adrenals can back up your hormone function and DHEA is something that you get through omega-3s is that correct DH about right DHA is it omega-3 okay I get confused between all

The DHS yeah um however DHEA is an over-the-counter supplement so in some countries I believe the UK and Canada it is in medication there is a um a scientist uh recently passed away I believe his name was Dr Fernand lobry and he’s interesting because he was the one that showed that prostate cancer

Treatments that basically shut down the pituitary from producing um the hormones that cause Androgen release if you treat that then prostate cancer is not as bad and it actually extends life so that was like the first prostate cancer drug that extended life however he also studied DHEA for quality

Of life so it’s interesting the same scientist studied both a cancer treatment to decrease hormones and also study DHEA however it the the data on DHEA is kind of unclear because there can be a widely different and a full order of magnitude or 10 times between individuals some produce a ton

And that can be called adrenal hyperplasia a lot of people have a gene for this called nccah and then there’s also a phenomenon that’s known as adrenopause which is similar to menopause or andropause but where your adrenals shut down and this happens for everyone but just at very

Different times of life right and if somebody is truly over trained what is what is going on with them hormonally and how do you help them get out of that hole often they have a decrease of cortisol and also DHEA and downstream to that testosterone and estrogen that are peripherally converted

So their adrenal glands are not working as well if you look at the enzymes in the steroidogenesis Cascade it’s very interesting a lot of the same enzymes that tonkat Ali works on also known as long Jack but a lot of the enzymes that that works on insulin and igf-1 work on

So things like fasting or things like a lot of cardiovascular exercise can down regulate those enzymes also the stimulating hormone that comes from your pituitary to stimulate cortisol production also stimulates DHEA to some degree so if you’re very insulin sensitive or if you’re eating one meal a

Day then that is going to detrimentally impact the production of adrenal hormones and also down regulate the stronagenesis Cascade in each tissue right um got that like huberman got me on the tongaat Alley a while back like he’s a big he’s all about that but that would be one prescription to address that

Dysregulation often you hear with athletes who who truly are over trained like Elite athletes who just dig this hole like it takes them sometimes it takes them six months to truly come out of that phase and I’m I can’t help but wondering like if they

Go to see you perhaps there’s a way to if somebody you know oversteps and is in that situation is there a way to shortcut not shortcut but just compress that time period of getting somebody back to Baseline there’s a lag in the upregulation of those enzymes urinary metabolite hormone test or even salivary

Tests can help tell us more because it tells you how your body’s metabolizing hormones both androgens estrogens and progestogens and if there’s a specific enzymatic step which looks like the rate limiting step then we can address that through supplementation or dietary changes you know if you’re looking at two

Individuals and let’s just talk about Tong cat for example’s sake there’s one individual that has PCOS they likely will not benefit as much from Tomcat because they’ve already up regulated many of the same enzymes with their excess insulin or with their adequate insulin or igf-1 signaling whereas another individual who is an

Endurance athlete and who has been in a caloric deficit perhaps and is very insulin sensitive could benefit greatly from Tomcat yeah interesting prophets Walk Among Us as a writer and podcaster for nearly 10 years I’ve become more convinced than ever that our world is populated by scores of beautiful and brilliant people

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Interact with the life-changing ideas contained with this voicing change volume 2 available now while supplies last for a limited time order your copy today only at richroll.com I can’t help but ask about like my own personal you know I’m going to make this about me having a session with you but

You know as an aging endurance athlete like I’m 55 now and I feel good and you know I I go in and out of how fit I am and I’m certainly not doing 25 hours of zone two now but I you know I do get out

And get after it and I have my good days and my bad days and you know as I get older you know obviously the more fit I am the less likely this is but like in my current state I’ll have really good days and but I I do need to be much more

Careful and cautious about my recovery days and perhaps we can get into supplementation later but in terms of how I’m approaching my day in kind of day outfit day out fitness as somebody who you know is the age that I’m at and also as a plant-based athlete you know

Without doing a whole blood panel on me like what would be top level kind of general counsel or advice to help me kind of level up for an endurance athlete in your age group who is presumably Desiring a fairly Optimal Performance a longevity of Optimal Performance in addition to continuing

The activities that you like there is definitely a lot of Truth to use it or lose it looking at supplementation or dietary sources of things like creatine or L-Carnitine would be particularly interesting when you’re thinking about a male individual I also think about the activity of the Androgen receptor

Without getting too technical basically the activity or the gene transcription of this receptor is what matters it’s not the actual level of testosterone or dihydrotestosterone they all bind the same receptor so the sensitivity of that receptor matters and the density of that receptor matters I’ve played around with creatine it’s

Certainly effective uh but I I definitely retain a ton of water weight when I do that so I kind of cycle on and off it it’s pretty safe though like you don’t necessarily have to cycle with that is my understanding um but I don’t like to be on it for

Extended period of times because I I literally feel like I’m carrying around like 15 extra pounds yeah creatine has a couple of hormonal effects it can a somewhat upregulate five Alpha reductase so it can convert a touch more testosterone to DHT which could be good if someone tends to be estrogen dominant

But it could also be bad um also creatine I think of as a backup fuel tank so you can retain water some of it is in the sarcoplasm hopefully most of it which is in the muscle cell so perhaps that works but creatine is kind of like the backup fuel tank

Um NAD which can be converted from nmn and NR that’s kind of like the fuel itself coenzyme Q10 helps convert that NAD into ATP which is the fuel in the mitochondria it’s actually think of it as your Powerhouse there’s also some evidence that uh there may be some cognitive enhancement and mood

Enhancement with creatine it seems like the science on that is more recent creatinine to some degree beta in are also involved in amino acid synthesis and a lot of those amino acids shunt into the different Cycles to help with energy generation within the cell which happens in the brain too of course

Also they can help with depleting your body of intermediaries like homocysteine some people are predisposed for their homocysteine to build up so things like creatine and beta in can potentially help decrease that interesting and walk me through L-Carnitine I’ve never I’ve never taken that I know it’s not very bioavailable

But I don’t know much beyond that correct about what it does and it’s the smallest peptide hormone it’s just two amino acids put together um so you can take L-Carnitine in a supplement it’s very hard it’s kind of like creatine it’s hard for your body to synthesize a lot of L-Carnitine

So if you take it it’s probably only about 10 bioavailable it can also potentially increase tmao like choline which is a potential carcinogen in the gut that’s not so good yeah so you do need to be a bit careful if you have a healthy gut microbiome it’s unlikely your tmao will increase

Conversely if your tmao is increased it’s likely that your gut microbiome is not healthy but back to L-Carnitine it has a couple different functions but just think of it as the fuel pump it makes your pumping the um the energy into your mitochondria very efficient specifically types of fatty

Acids that are average in length I think they’re called medium chain fatty acids and they can also help your cells and mitochondria uptake glucose the main thing that I’m getting from all of this is just how complicated it is right like it’s pretty ill-advised for the consumer

To just say well I’m going to you know take a spin on the L-Carnitine thing without understanding tmao and whether you have a high level or whether you’re more receptive to that getting increased as a results like these are not decisions that should be made casually right decisions like this should be made

With the help of your interdisciplinary team for example a dietitian or a medical doctor right but most people don’t have an interdisciplinary team let alone a Kyle Gillette on speed dial right like you’re running a very unique special clinic and service that is you know probably not accessible for the

Vast majority of people and although there are more and more practitioners like yourself as we mentioned at the outset popping up and available it’s still not you know a highly accessible thing so for the person who’s listening to this who’s just trying to get their head around this and maybe what they

Should or shouldn’t do like I’m wondering like is this more confusing than helpful like if they don’t have somebody that they can call upon who can actually give them you know real guided counsel yeah um any guidance is better than none and I am certainly an advocate of personal freedom so

People are free to do with their bodies whatever they may want to I think that’s a reasonable stance to take for many medications and supplements the dose makes the poison so I guess the action item for that would be if you’re considering L-Carnitine and you just

Want to take it even if you’re not getting blood tests then perhaps take you know 750 or a thousand milligrams perhaps don’t inject a thousand milligrams which does not worry about bioavailability without the supervision of a physician and perhaps don’t take five grams daily without the supervision

Right and and don’t conflate it by taking other things right so you can kind of monitor the variables yeah um as somebody who’s been plant-based for 15 years and there’s a lot of plant-based people that tune into this show like what would be top of mind for

You in terms of what I should be thinking about or perhaps supplementing or if you were to do my blood panel like what would you be looking for in terms of you know things that might commonly occur in somebody who’s been eating only plants for a long time certainly the

Well-known ones like vitamin B12 or ferritin or vitamin D when you’re looking at vitamin B12 especially if you’re on acid blockers and such it can be bioavailable it can also be not very bioavailable and then on top of that there’s many forms of B12 so you have things like

Methylcobalamin which is also a methyl donor and then you have cyanocobalamin or adenocobalamin so there’s many different forms yeah and there’s always this debate as to which one you should be taking my B12 is fine by the way but yeah like there’s plenty of B12 supplements available it’s very

Affordable it’s easy to do but it’s like should I do the cobalamin or the methylcobalamin like which one cyanocobalamin if you check uh but one if you want to get really into it you can check your MTHFR polymorphism there is such a thing as too much methylation

Even if you have one variant of MTHFR but without getting too technical if you check a homocysteine and a B12 and perhaps MMA which is a methylmalonic acid then that should tell you if you need a specific type of B12 most people do not need methylcobalamin so by default start with cyanocobalamin that’s

Safe way to start monitor your levels and if they’re fine you don’t have to worry about it yeah I would say a reasonable like bare minimum biomarker to check for an individual on a plant-based diet is a B12 and a homocysteine yeah mine are good there ferritin’s a

Little tiny bit low but like not alarming so I’ve sort of been upping my iron content in the plant Foods a couple points on ferritin is ferritin is a pretty good indicator of the iron level throughout your body however it is also an acute phase reactant so it can be

Artificially elevated if it you’re during a period of inflammation for example illness or autoimmune disease so if you got your blood work done during that period of time you would be misinformed correct someone could have a ferritin of 200 and they could think uh they actually might think that’s too

High right in some cases but uh they could still be iron deficient right got it um let’s talk about stress and stress optimization so how are you thinking about this in the context of Hormone Health yeah um a lot of people have uh you know in this this kind of encompasses mental

Health as well and social health maybe we do need to add a seventh one there but um you want to have something that requires great effort life is extraordinarily difficult and you want to be able to have a positive mindset or a glass half full or even glass quarter full

Outlook on your stress there’s a lot of tools like mindfulness or meditation or even prayer which kind of delves into the spiritual pillar as well but you want to be Um you want to have just enough effort in the areas that bring you purpose but you also want to control your stress fortunately we are concentrated on the self-actualization part of Maslow’s hierarchy of needs so we’re not as concerned with our physical or bare essential needs

But um the level of stress is still there so humans have had a very stressful existence when the stress is not proportionate to the threat it can be unnecessary and it can affect your Hormone Health and it can affect the health of the rest of your household as well acute stress in

Certain controllable scenarios good chronic stress bad but as you know we live in an epidemic of of chronic low level the high grade stress and we’ve kind of acclimated to that as a as a normal right everybody’s stressed out everybody’s anxious and our lifestyles you know are kind of oriented around

Being in environments that that produce it uh you know support that and you know you could tell people you need to meditate you need to have a mindfulness practice but you know the boss is yelling and the kids are crying and they’re upload you know all of these

Sorts of things that are just part and parcel of like getting through life which is difficult have created in the western industrialized world this epidemic that’s driving Downstream all of these you know metabolic health problems from obesity to diabetes Etc so talk about the like get into the

Hormones of chronic stress and what that’s doing to us and how it’s just regulating our health and how that um impacts us you know down the line in all these other ways we can think about the adrenal axis of stress and we can also think about the neurotransmitter axis of stress

So one of the ways that your body will acclimate to stress including physical stress is increasing cortisol which is a glucocorticoid which can decrease muscle mass and cause an increase in blood glucose if you give someone a medication like prednisone which is basically a medication version of cortisol then and

If you give them to them for a long time then they will develop diabetes and also excess body fat and decreased muscle mass wow so basically like like sort of extrapolating on that idea essentially what you’re saying is if you’re in a chronic state of of stress it doesn’t

Matter how great your diet is or how well you’re sleeping this you know cortisol issue could create type 2 diabetes in you nonetheless correct um a pathologic overproduction of it is known as Cushing’s disease so that can also be very detrimental for your health it needs to follow very closely

But there’s a Continuum or Spectrum in between where you can have cortisol overproduction there’s even supplements that can potentially help control cortisol ashwagandha is likely one of them and emodin is another one I think it’s derived from rhubarb so again with cortisol the dose can make the poison as well

The other act the other main axis of stress that would be hormonal would be your adrenergic um nervous system you also have things like dopamine epinephrine and norepinephrine catecholamines basically the think of this as if you’re acutely stressed your fight or flight nervous system is activated classically this would be you

Know you would either fight a lion or run from it so you have an increase in those hormones epinephrine is also known as adrenaline if they’re elevated for a long period of time again it can lead to body fat accumulation excess hunger and it can also lead to desensitization of

Those receptors dopamine receptors and also adrenaline receptors can be desensitized very quickly that’s why many individuals that are on medications that stimulate or simulate your dopamine and your adrenaline or noradrenaline require higher and higher doses Adderall would be the main example of one of those medications sure and obviously

That’s applicable to the addiction scenario as well substance addiction or behavior addiction right because hormonally your does your body even know the difference and there’s many scientists for example Andrew huberman that talk in detail about the dopaminergic system and how it affects your motivation and how it is closely related to

Testosterone so your androgens and your dopamine are very closely related I describe your dopamine as a pool specifically a wave pool where you do expect natural fluctuations up and down but depending on if you have an overflow of dopamine your body can make that wave pool deeper to try to accommodate for

That and then you’re only filling up half the pool and even if you have a normal amount of dopamine you can feel depleted interesting so for somebody who has enough self-awareness to know that they go in and out of some level of chronic anxiety or stress uh what is the

What does the science look like in terms of from a hormonal perspective like if you adopt a consistent meditation practice like have they studied okay here’s how this is impacting hormone regulation in the body as a result of like a formal practice or some version of that that is a de-stressor

From the cortisol or sympathetic overdrive that has been studied and a a meditation or a relaxation practice or even just walking and being around green plants and trees can be helpful or even being around more sunlight but from a an androgen standpoint I’m not sure if it would optimize your testosterone or estrogen

But clearly effective it’s one of your pillars yes right you stand by it yes for sure um well it gets into it kind of gets into your next pillar the sunlight pillar which you know is kind of about being in nature right and and there’s also a microbiome piece to that as well

Sort of breathe your biome like being immersed in you know a multitude of of you know species of plant and animal life and breathing that in and grounding your feet in the soil and all and you know doing the sun gazing as Andrew talks about and all of that like like

You know our our kind of Western minds are very dismissive of that but this is the missing link we’ve become so detached from you know that that you know very healing and Primal fundamental aspect of what it means to be human humans have uh are definitely adapted to be outdoors

Even if it feels easier to be indoors there are so many uh regulatory checks and balances that come with being outside and being in nature that it is very difficult to have Optimal Health if you are not doing that so people have studied you know cognitive function if you have a Vista

So if you have a view and you can see a mile then it is significantly better than if you can then if there’s another house right next door what about when you’re walking through the forest though the deep forest yeah uh I would say being around the new clean fresh air in

The forest is helpful being around the green is also helpful um being aware of your environment even if there are no dangerous animals in the area then you’re still just more peripherally aware um you can discuss the like the benefits of using your peripheral vision um not looking directly at something and

Your mind will shift Focus and there’s many different benefits from that you also happen to be moving at the same time perhaps you get some cold exposure or heat exposure at the same time it’s a very high yield intervention right so what is the prescription like

What what goes on your notepad to the to the patient when it comes to the sunlight pillar often trying to get good morning sunlight being outside throughout the day often you can combine this with exercise for example if you work a desk job and are indoors all day then take a

Walk after lunch maybe even with your co-workers and colleagues to hit the social piece as well if someone does work Outdoors then perhaps it’s not they’ve already dialed in that pillar and they don’t need to do anything at all but making that some kind of daily

Practice or habit and that can fold into the exercise piece as well obviously right often you can do two or three or four at the same time yeah yeah yeah yeah well while you mentioned cold and heat exposure so maybe this is a good time to kind of explore

Some of those therapies it’s all the rage right now much like you know intermittent fasting and all of that everybody wants to talk about their ice baths and their saunas and how do you think about these protocols and their impact specifically on Hormone Health they’re good protocols for the

Individual attempting to optimize things like any other intervention you need to be careful of the common missteps so I would say if you’re and the sauna is not as much this way but jacuzzi in hot tub or even heated seats could definitely be this way if you’re trying

To optimize your fertility then be careful for heat damage to the testes and testes like to be several degrees cooler than the rest of the body so if you’re in especially warm very warm water for a long period of time then that can decrease sperm counts

Right as far as the benefits of cold exposures like cold dunks you’re avoiding frostbite and you don’t want to get hypothermia as well so usually it is a very quick intervention a cold shower can be it’s not quite as good as a cold dunk but it can be a good start so for

The individual trying to get the most bang for their Buck a cold shower and then if you have access to a sauna Asana from time to time is a great place to start do you have a sense of what’s more efficacious from a Hormone Health perspective uh cryotherapy versus Ice baths

There seems to be a raging debate about the pros and cons of these two things from a hormonal standpoint for let’s say there’s an individual with a varicocele which is basically varicose veins in the gonadal area then they are often already too warm and um cooling can be particularly beneficial

And the more dose of cooling the more helpful it is so for that individual where their testes are likely too warm due to varicose veins it is extremely helpful the more cold exposure you have but I think that you were asking about like cryotherapy versus Ice baths yeah

Yeah ice baths perhaps slightly more helpful from a from like a hormonal but perhaps just from a spermatogenesis standpoint there’s been a lot of debates on whether or not ice baths are helpful for Recovery specifically of endurance athletes I used to run track as well and

Always had to take an ice bath and I don’t believe the evidence on that came out to be as helpful right I mean the the debate has something to do with the the greater conduciveness of temperature in water versus Air so you’re in cryo for a shorter period of time but it’s

Also much colder than the ice bath but the water in the ice bath is gonna conduct that heat transfer more effectively I would think that the ice bath is more helpful for those that have um like more heat damage to begin with so probably probably a nice bath right well

As a as a former track and field athlete who has experience with the recovery benefits of you know being in a nice bath I often wonder I’m interested in your perspective on this I often wonder about many of these recovery enhancement tools whether it’s normatec boots or ice baths

Or sauna or turmeric or some of the foods that are you know hyper antioxidants we’re all trying to expedite that recovery window so that we can wake up the next day and go harder than we would have been able to otherwise so that we can achieve gains

In a more compressed period of time but I often wonder whether taking advantage of all of these recovery tools is robbing the body’s adaptive process like we want the body to figure out how to adapt and recover on its own right and when we kind of do

It for the body are we not um sort of undercutting the benefits that we’re trying to seek by exercise induced stress that’s definitely true there is I believe a a clinician from Harvard years and years ago that turned that coined the term rice rest ice compression elevation

And the it looks like the ice part of rice is not particularly helpful and even the compression part of rice is also less likely to be helpful for Recovery purposes because of a lot of the natural healing mechanisms where you have that warm swelling infiltrate of

Growth factors and uh of vegf which can help with vasculogenesis and healing I’m blocking those things can be detrimental so it is far more rare that we recommend things like NSAIDs unless someone needs them for pain what’s an inside even then they’re usually better options ibuprofen or Aleve so ibuprofen or naproxen would

Be the generic so in general I do not recommend those for injuries and I also do not necessarily recommend rice right so better to be old school like I think there’s certain uh situations in which it’s appropriate if you’re if you’ve really pushed it hard you know and you

Know you still have a big week ahead or you’re you know leading up to a race or something like that but on a day-to-day basis like yeah you you kind of want you you want that inflammatory response on some level like this is where your body

Is doing what it’s supposed to be doing absolutely it’s somewhat like an endogenous form of PRP PRP is just platelet-rich plasma and that swelling and heat is bringing your body’s plasma without having to take it out of your system centrifuge it and put it back in

And so when you do the Heat and the cold and the boots and all the stuff you’re telling your body don’t worry about it you don’t have to do that like we got this yeah so I would say you certainly don’t want to do that every single day

But from time to time it’s reasonable right like what would be the appropriate use case then to your mind leading up to an event where you want to perform well you’re not recovering from injury or like a difficult phase many people have like mesocycles or different phases of their workouts

Um so during a phase where you’re really breaking things down um perhaps trying to avoid it and then in your last phase leading up to the event even if it’s not as difficult to perhaps using then right um sleep talk about sleep uh obviously good sleep hygiene is going to improve

Your Hormone Health and good Hormone Health is going to improve your sleep right so how does this complex interplay work this one’s pretty direct you produce most of your testosterone and growth hormone when you sleep testosterone has a pretty big spike in the morning cortisol actually does as

Well and in the evening your melatonin spikes these different spikes can be offset so they can happen at the wrong time growth hormone is released it’s a very short half-life of just minutes and it’s pulsatile so you’ll get a pulse and get a pulse and then that’ll secondarily help increase igf-1

So if your sleep is disrupted it’s very common to have decreased levels of testosterone or decreased growth hormone in fact obstructive sleep apnea or sleep apnea in general is one of the main pathologies that you see as a cause of hypoconadism right so I want to get into

Testosterone in a few minutes but if you’re thinking well my testosterone is low low but my sleep is dysregulated before going on you know testosterone replacement therapy maybe dial in the sleep yes I have seen it be extremely efficacious it’s a much better testosterone booster than any supplement

If you happen to have a sleep disorder and you do want good quality and quantity so a general rule of thumb is seven to eight hours each night try to go to bed at the same time for some people like shift workers this can be particularly difficult and then

You’re looking to have good deep sleep and good REM sleep as well yeah and and there’s a relationship between REM sleep and fertility right so talk about that a little bit REM sleep along with zone two cardiovascular exercise are kind of the two best interventions to help with mitochondrial health and the mitochondria

Um just like anything else in the body they will produce energy to help you do things like meiosis or to do things like forming the spindle which is basically you’re pulling all your genome apart and then putting it back together but just in in two halves so for both

Males and females they help the mitochondria in the germ cell line which is like the gamete line function so that REM sleep will help your body correctly put all the genetic material where it is supposed to go so on a typical night like I’ve got I’d

Wear a whoop I pay attention to my sleep metrics if I sleep eight hours sometimes my REM sleep is two and a half hours sometimes it’s one and a half hours there tends to be a pretty consistent ratio between deep and REM like I’m always striving to get like I feel best

When I’ve had a minimum of two hours of deep and two and a half hours of REM like that I don’t always hit that right but when I hit that like I’m I’m like good to go right so is that ratio like on par what’s interesting is like I can sleep eight

Hours but sometimes you know those numbers between deep and REM are all over the place so eight just saying you got to sleep eight hours isn’t really the best metric or indicator for Sleep hygiene correct you can sleep a very long period of time but the quality of the sleep

Will not be very good before stressful events your sleep tends to be shorter duration but actually higher quality and part of that could be the cholinergic nervous system acetylcholine is the neurotransmitter that can help with different receptors in that system like nicotinic receptors that nicotine also binds to and muscarinic receptors

So you want to ensure that you have optimal acetylcholine throughout the body some things that uptake acetylcholine like cuparazine is a supplement that some people take to theoretically improve their REM sleep especially if they don’t have enough acetylcholine can potentially help with that what is that called again

Hooperazine a it’s a very weak acetylcholinesterase inhibitor so it basically can help increase acetylcholine there’s also different cholinergic precursors like phosphatidylserine or phosphatidylcholine or Alpha GPC that are precursors to acetylcholine and then some people that are trying to optimize REM sleep will take things that are nicotinic receptor Agonist

Like uh taybacks or cystinium which is a different plant not a tobacco plant that forms the alkaloid nicotine but a different plant that forms the alkaloid cystanine and those are over-the-counter supplements that you have a pension for prescribing to people who are dysregulated in their sleep at times REM

Sleep can be particularly difficult because it’s one of the hardest to track a baseline heart rate and heart rate variability tend to be extremely accurate on wearables but REM sleep is kind of more like the gut microbiome or even cholesterol where you’re really looking at the trend within the

Individual rather than the actual level yeah but your senses HRV is pretty accurate with things like this and the aura and stuff like that um how do we think about HRV like I’m always comparing mine to my friends and you know I know it’s a highly individualized thing yeah and I guess

Intellectually I kind of know what it is and what it means but I don’t think I really know what it means or why it’s important it can tell us a ton um there’s a scientist uh also at Stanford Dr Michael Snyder I believe and he talks about his experience with heart

Rate variability and predicting periods of stress or even predicting illnesses and within the individual if you’re very accustomed to knowing what your heart rate variability is and what makes it Trend up or down then it can tell you a ton but if you’re going to put on a

Wearable and then wear it for one day and look at your artery variability it’s going to tell you almost nothing right so to Define it though HRV means I don’t know that I can say this eloquently but it’s the variability in the amount of time between heartbeats right and

Correct you don’t want that that intermittent in between B to be the same amount of time every time when it varies quite a bit the greater the variability there the greater indicator of Health yes why is that you have uh two different parts of your autonomic nervous system your heart you’re not

Um you know consciously telling your heart to beat so it’s maintained by a balance between your sympathetic nervous system an example of that would be adrenaline makes your heart beat faster and your parasympathetic nervous system the main nerve that that controls is called the vagus nerve which is actually a cranial

Nerve and it runs down innervates some of your gut too by the way and then it goes back into your heart and you have the sinoatrial node and the atrial ventricular node so depending on how much activity your nervous system has on those two nodes that will determine what your heart rate

Is one good way to see how your body can adapt to this is taking a deep breath that’s also known as a physiologic PSI to where you can take one example is two deep breaths or three deep breaths through your nose and then a deep breath out through your mouth

As you do that you can have well one thing is called physiologic splitting of the heart sound you can actually hear the ventricles in the Atria contract that’s slightly different levels because as your lungs expand it basically pushes on the heart the pressure between the heart and the lungs will change so your

Heart rate will change as you take that deep breath or sigh interesting wow and so how did this become why is that related to health like it’s just flexibility like metabolic flexibility or what you know why is it in such an important indicator if your heart does not adapt well to the

Pressure that is put on it then it could mean several things one thing it could be the that the heart is not well oxygenated and it could also be that the actual electrical system of the heart is not working well so it could be you I guess

In layman’s terms it would be it could be a short in the electrical wiring or your borderline blowing a fuse or it could also be a plumbing issue where the oxygen and blood is not developing enough nutrients as the lungs really push on the heart one thing your

Physician might do is they might ask you to take a deep breath in hold it and then listen to the different areas of your heart see if there’s any murmurs or clicks on the valve and then see where the point of Maximum impulse or where the it feels like your heart is really

Beating out of your chest and is this something that can be improved is it like VO2 max where it’s kind of the same no matter what you do it’s really hard to elevate that like if you really dial in your health can you you know over time create a new

Benchmark for your HRV or everybody has different natural set points for that yeah you can certainly improve your heart rate variability some of it just has to do with the body habitus of your mediastinum which is the area of the chest that has the heart and other auxiliary contents but you can

Definitely improve your heart rate variability interesting I mean the other the other metric that’s a more recent add to the whoop is is metabolic rate I’m curious do you know what they’re measuring specifically when they come up with this number every day about where you’re at it has to be

Somewhat accurate because I’ve had covet twice and both times my metabolic rate skyrocketed the day before I had any symptoms so I was definitely reading something that I’m not consciously aware of or experiencing I don’t know the exact parameters that it tracks but I assume that it tracks uh part of

This is just your Baseline resting heart rate so if that is increased then the heart is a muscle as well it requires more nutrients or more metabolism more mitochondrial activity as your heart rate increases right and if you are fighting off an infection there’s an inflammatory response that’s

Going to require more of your heart right yeah so that’s how that is getting into the calculus there yes right interesting um back on sleep for a minute uh why is it that sleep becomes so much more elusive as we age you know as a young person you can

Just fall asleep anywhere sleep for 12 hours it’s nothing but a thing right as I get older I have to like exercise so much sleep hygiene just to you know buy a lottery ticket to get eight hours and sometimes I get it and sometimes I don’t

Despite everything that I do I have to assume there’s a huge hormonal piece of play here that has something to do with you know declining levels or balances as we get older yeah there’s certainly a lot to do with it one of the main symptoms of menopause is also known as

Vaso motor symptoms of menopause and a lot of that is related to your estrogen if you replace a bioidentical estrogen in those individuals often the Vaso motor symptoms like the waking at night the fast heart rate The Hot Flashes as well will improve and in men with very

Low estrogen they actually have they can have very similar symptoms or men on aromatase Inhibitors and again if you optimize the estrogen again then those symptoms will resolve so that’s part of the component a lot of it is also just the amount of acetylcholine that is around some neurodegenerative diseases

Have huge depletions in a acetylcholine and also depletions of dopamine dopamine is also a neurotransmitter hormone kind of combo that can be implicated in disorders sleeping as well four parkinsonian disease Parkinson’s is basically where a little area of the brain called in the basal ganglia called the substantia no longer

Synthesizes dopamine you have almost a complete loss and before Parkinson’s develops it is very common to see restless legs or very restless sleep and waking at night even before it can be diagnosed before any Tremor right so but for someone like myself I feel like I’m relatively healthy but I probably have some

Imbalance or whatever that’s making sleep perhaps a little bit more difficult than it should be um you would you would perhaps say look into acetylcholine or let’s see what’s going on there maybe prescribe you and you know a supplement that would enhance that perhaps I’m also a fan of getting

Uh you know a clinically validated polysomnogram I do love wearable data and I think that it is the future but if there is a very dysregulated sleep perhaps not in your case I have a very low threshold for ordering sleep studies because you don’t know what you don’t

Know and if you find something then you can more accurately come up with a good long-term plan for the right um typically people think when they think of of sleep supplements that aren’t you know sleeping pills uh they think of melatonin right but not a good idea to be consistently taking melatonin

Before any individual would take melatonin which is a form of hormone replacement therapy just like taking vitamin D is also from a hormone replacement therapy I would consider why is it melatonin dysregulated perhaps even look at a melatonin cycle which can get turned off and on throughout the day

It’s regulated through the pineal gland which goes along the optic nerve so that morning sunlight that hopefully most people are getting can kind of help shut down that pineal gland production of melatonin melatonin is also produced by tryptophan so ensuring that you have adequate dietary intake as well

But if you just take melatonin it has other Downstream hormonal effects for example on the gonadotropins which can have to do with estrogen and testosterone release so you want to think about the dose and then everybody metabolizes it very differently so there could be a huge range in dose I’m not against

Melatonin for some individuals but for most individuals it’s not a great idea to try to optimize your sleep but effective if you’re you know flying to Europe or something like that and you have to try to deal with jet lag and time change correct as like a temporary thinking about that circadian rhythm

Whether it’s melatonin or cortisol you want to take it from whatever time zone and put it into a new time zone there are sleep medications that work on melatonin rameltion is the name of one of them that is essentially a different melatonin I believe there’s three different receptors for melatonin and

The third melatonin receptor is the most hormonally indicated and the remeltion just works with the first two mt1 and mt2 receptors so for some individuals that are traveling very often I do a prescription of romelton which is a generic sleep medicine which does not work very well unless you have what’s

Called like jet lag sleep syndrome yeah but that’s a prescription that’s not an over-the-counter correct supplement yeah one thing that I discovered recently a couple months ago I began to notice that that when I eat pistachios I get fatigued maybe you know 30 45 minutes later so I started eating

Some before I go to bed yeah and then I thought like this is actually pretty effective like I so I Googled it and there’s some kind of active I don’t remember but there’s something some active ingredient in pistachios that is working as a sleep enhancement aid for

Myself do you are you familiar with this is this ring true to you or I’m not sure what active ingredient could be in there another mechanism of action it could be it could keep your triglycerides slightly higher which can stabilize your glucose so your glucose and your triglycerides are your

Two main energy sources so perhaps it helps your trigs and glucose stabilize a bit more as well yeah I don’t know I know it’s working though yeah I keep I keep a little bowl by my bedside anyway I’ll find out afterwards what’s going on there um okay let’s let’s move into uh

Uh hormones most more specifically for men and women when you when you think of men and Hormone Health you know what are men concerned about especially men as they’re getting older they’re concerned about virility they’re concerned about fertility hair loss they’re obsessed with testosterone right I think testosterone is a therapeutic

That’s probably I live in Los Angeles I’m sure it’s over prescribed here like I know tons of guys my age that are on it and swear by it but I’m not so sure all those people are are appropriate candidates for this so you know on the

Subject of the kind of things that men are concerned with with respect to Hormone Health uh you know maybe we can start with with uh you know virility and testosterone and how you think about this and maybe how we should be thinking about it instead testosterone of course has effects on

Every system of the body so you’re not just thinking about testosterone for lean body mass in fact what some of the main criteria that many clinicians including the aafp and many large organizations they look at things like libido or sexual function or even metabolic parameters like pre-diabetes if you give an individual

That is hypogonadal testosterone they are less likely to have diabetes and potentially less likely to have coronary artery disease even though it worsens lipid profiles so if you’re thinking about supplementing or getting a prescription of testosterone or trt you really need to check your bases on

Every system of the body the you know the adrenal system the renal system your renin Angiotensin system which has to do with blood pressure your iron balance also your cholesterol and lipids testosterone is an inducer of an enzyme called HMG COA reductase so it does the opposite thing that lipid medications

Called statins do almonds actually kind of do a more of a similar thing to lipid medications and statins so you’re really thinking about its effect on all systems in the body balancing the benefits and detriments and for many people the benefits and detriments could be fairly even but there’s a third option

As well and that’s naturally optimizing and for most individuals the benefits of naturally optimizing outweigh everything else right but I just want to go on it right it’s just I mean I’m not speaking for myself personally I think I think there’s a lot like I think what you said

Is very well put by the way um what I heard is it’s very important to find a practitioner who really understands the interplay between all of these systems because I think the typical guy is not we’re not so great about thinking about the long-term risks like the guy is like

I want to feel like myself I want to have energy I want to have libido I want to be able to put on muscle mass and feel strong in the gym and you know yeah the down the line stuff you know is it gonna is it gonna you know put me at

Greater risk for heart disease all those kinds of things I’ll I’ll deal with that later like I just I need to feel like a man right now right and without a responsible practitioner to say slow down here’s what we’re actually dealing with or if you do this it’s going to be

Counterproductive to the goals that you’re seeking you know guys are just gonna do it nonetheless and pay the price later yes and there is certainly an epidemic of uh use both with physician supervision and not of many different types of androgens and people seek it out for the benefit

And that is why a shared decision-making process and an informed decision with the help of your health care provider is so important yeah um and by the way there’s no such thing as just a hormone expert so if there’s an aesthetic clinic and I do some Aesthetics as well it’s it’s probably

Not the best place to get your hormone advice maybe not there’s always exceptions in everything it depends right but you really need to be an expert in every organ system of the body hematology lipidology Dermatology there’s going to be infertility as well especially so perhaps

So you can’t just be a hormone expert in isolation you have to have a a broad spectrum full spectrum approach with respect to testosterone replacement therapy is it true that once you go I mean I assume if you go on it you’re signaling to your body that it doesn’t

Need to produce it anymore what is the long-term implication of that like if you go on trt and then you go off it I’m sure there’s a lapse of time before your body gets the signal that it has to start producing it again right so do you

Just is it a life sentence like okay once you go on this you have to stay on it or you’re going to have this lull in which you’re going to be sub-optimal 99 of individuals who go on trt can get back their original function but if you don’t know what the original

Function is like let’s say one individual started with a total T of 600 . um two years later their total T may have decreased to 550 just due to aging but individual two has a total testosterone of 100. and they’re not going to gain function because they’re not guaranteed to gain

Better function than they had in the first place right so that’s obviously the better candidate for the intervention yes yeah and if you do go off it how long is that period of time before the body resets to Baseline usually two to twelve months it can

Depend on the type of Ester that you’re on so if you’re on an ester like undecanoate which is very very rarely prescribed by the way then it can take months and months just to clear the amount of testosterone that has not been it has not had esteresis cleave that

Ester which is what for injectable testosterone that helps obviously for like pellets or gels it’s different but a general rule of thumb is two to six months for most two to twelve months otherwise not everyone needs drugs or medications like HCG in order to restore function

But if there is a significant degree of testicular atrophy they get more and more helpful with the degree of testicular atrophy right and on the subject of of hair loss uh how how related to hormone dysregulation is that versus genetic presets what are possible interventions uh that can be

Explored for ameliorating hair loss or I don’t know even maybe reversing it like this is something that you know a lot of guys are super interested in for individuals with hair loss or just for an individual who wants an improved quality of hair you’re thinking about uh

Is it androgenic alopecia so is it related to the activity of that Androgen receptor or is it some other sort of effluvium there’s a lot of different types of telogen effluvium related to low iron or related to poor thyroid function or even related to infection and illness

And once you figure out which category that’s in addressing what is the cause so assuming in this case that it’s androgenic or androgenetic alopecia each individual has a genetic threshold of activity at the Androgen receptor you don’t necessarily know that until you start to have miniaturization and loss of hair

Usually if a hair becomes smaller and smaller and smaller and it’s hard to tell without a magnifying glass but as it becomes smaller then eventually the stem cell will leave the scalp and the follicle will be permanently dead rather than the normal cycle where you have antigen phase catagen phase telogen

Phase and then it kind of dies and is reincarnated so making sure that your androgenic load is not above that threshold is the best way for men and some women have androgenic alopecia as well that’s the best way to make sure that you’re not going to have a permanent

Loss of that follicle and how do you test for that you can do a lot of different tests but because all androgens buying that same Androgen receptor again there’s only one Androgen receptor men have one copy because it’s on the X chromosome women have two copies you can look at DHT which is

Dihydrotestosterone that’s the strongest Androgen it is you know all androgens cause hair loss through the action of the Androgen receptor um the higher your free DHT the more it will be binding you can also check a testosterone and a DHEA sulfate and an estradiol which is

Your main estrogen you want to make sure you have enough estrogen and that’ll also tell you how much testosterone is converting to estrogen right okay got it and then the intervention would be what finding a protocol that is the most highly tolerable with the least side effects that will

Take that patient and take their androgenic load below that threshold so that not only do they not have further miniaturization and loss but hopefully those miniaturized hairs or the follicles that are in between deciding whether or not they’re going to permanently die or enter antigen phase again hopefully all those come back so

You can somewhat experience some regrowth in those situations and in the you know Pantheon of hair loss patients like how what is the percentage of candidates who fit into the category where that would be beneficial most female patients do not require pharmacologic intervention most male patients that are predisposed and you

Can also check your genes to see not only how prone are you to overly sensitive Androgen receptors in the scalp you can also check the sensitivity of your Androgen receptor as well it’s a CAG repeat disease almost kind of like Huntington’s disease but on your Androgen receptor which is another

Tangent which I don’t think we need to get into today but depending on how sensitive you are often pharmacology is required for a male that does not want to lose the hair so then it’s a balance of it’s really a shared decision that you make how important is it related to the potential

Side effects of an intervention the intervention might include topical or even oral five Alpha reductase Inhibitors that just decreases DHT it also might include topical and High androgens like Ketoconazole or for women you can also do topical spironolactone although it is absorbed you can also do topical caffeine and

There’s also new medications one of the most interesting ones is topical class coderone which is a kind of sort of a Psalm but it’s a it decreases the activity of the Androgen receptor through binding to it to crowd off all androgens so not just DHT but also testosterone wow and what

Are those uh potential side effects that you mentioned if any anti-androgen goes systemic you’re looking at a lot of things you’re looking at your ratio of testosterone to estrogen for example for a 5-alpha reductase inhibitor it will increase estradiol or estrogens by about 10 percent so you want to make sure that that

Estrogen is not already teetering on the borderline you’re also looking at your progestogens so just like testosterone converts to DHT progesterone converts to dhp which is the progestogen that crosses the blood-brain barrier and helps you have some of those relaxing side effects so you’re also looking at

That and then last you’re just looking at the actual level of Androgen so if there’s an individual who has a very low testosterone but a mid-normal DHT it is a very poor idea to put them on a five Alpha reductase number wow I think I understood about I don’t know maybe 30

Percent of that but I get the gist of it um and and mainly you know I’m encouraged like there does seem to be so many more effective therapies for this like when I was younger it was just sort of like if you start you know you’re out

Of luck like there’s not much that can be done and whatever protocols or therapies were available everybody kind of knew they weren’t really that effective but it sounds like that’s changed quite a bit absolutely and one thing that I should mention that has changed even within the last year or

Two is our understanding of five Alpha reductase Inhibitors which again are kind of the most common um androgenic alopecia meds one is called finasteride and that only inhibits two of the three enzymes a particular note finasteride inhibits the enzyme that is in genital skin but not the enzyme that is in your

Other skin so you could extrapolate from that it causes of many different side effects from other five afro ductase Inhibitors wow interesting um fun fact also you used to cut and color hair yeah you were a hair stylist yeah essentially um I made a very very little money from

It yeah but this is part of your homeschooling yeah I suppose so um but yeah for quite some time and I I still cut the hair for many of my friends and a couple of my patients as well uh-huh but full service yeah there’s a lot to the same look good feel

Good uh-huh yeah for sure right um cool well well what are other some of the common um male hormonal interventions um that are important to talk about I mean we could talk about PRP peptides placenta stem cell therapy I have some experience with this I’ve had some

Chronic lower back problems and I’ve had some interventions with that with uh with peptides and and PRP and the like so I know a little bit about that um it’s been an interesting kind of Journey with all of that but you know talk a little bit about that world

Peptides of course are medications I think of them as several different classes one class I kind of consider the pseudo PRP class and that would include thymus and beta 4 or tb500 bpc157 and probably ghk copper peptide as well and there’s of course others but those will either help with growth factors

Which is most of them or angiogenesis which is new blood vessels kind of help taking it’s very similar to PRP one of the main uh components of PRP is vegf which is actually a cytokine and if you have a higher level of vegf then you’re going to have more healing

Of tissues that are not well vascularized so tissues that don’t have good blood flow like a lot of tendons and ligaments can need more of this new blood vessel formation or vegf activity in order to heal yeah and effective very effective in that regard yeah yep likely only a matter of time until

Those have patented approvals I think that the presence of PRP has kind of delayed the Medical Science when it comes to those because PRP does many of the same things and one of the benefits of peptides is you don’t necessarily have you don’t want to inject it ever into a ligament

Or a tendon of course all these should be under the supervision of a physician but um some people can be trained to use these at home just like some people that are on trt or growth hormone replacement can be trained at home as well right you

Mean to do your own home injections and stuff like that yeah for some people it’s feasible yeah and and what do you know about the emerging science around placenta stem cell therapy like this is like wild stuff yeah um the earlier the stem cell is taken so for example from a placenta or

From the umbilical cord the more potency it has so you have like pluripotent versus multipotent so that’s why um stem cell banking is something that each individual should consider um we actually chose not to Stem Cell bank with my one-year-old or my two-year-old perhaps my decision will

Change in the future it is something that is emerging and theoretically it can help cure a lot of diseases um some people have heard of you know a family that had a baby specifically just to help cure like a rare bone cancer or whatnot so a lot of this

Um stem cell transplant or stem cell therapy can help with severe diseases but it can also help with less severe diseases as well it’s only a matter of time until the technology catches up and we have no idea when it will yeah it seems to be accelerating though quite a

Bit it’s interesting that you didn’t that you didn’t Bank cells from your kids what was the rationale for that it can be relatively expensive and uh I am not a hundred percent convinced that it will be clinically significant for individuals that do not have a rare disease

So for for example uh using stem cell therapy for a joint or a ligament healing I think there will be excellent alternatives to that whether it’s PRP or peptides I think that there’s going to be you know I don’t think that in most cases stem cells will be the only thing

That you can do unless you’re trying to get a stem cell transplant for like a rare hematologic disease right right so it’s not necessary that you would need your own genetic code in those interventions in which case the importance of of banking your your children’s stem cells become

Less important correct but 50 years from now who knows man it is a long time it’s a tough decision um and what makes it tougher is that often the individual is making that decision are very early on in their life when they are not as financially stable

So the opportunity cost for that is pretty high as well yeah exactly same thing with uh freezing uh eggs or child storage for sperm yeah yeah yeah I want to turn to female hormone Health specifically in a minute but you know on the subject of stem cells I can’t help but think about

Um what’s going on in longevity science and anti-aging science and I just I have to ask you kind of where are your heads at in terms of um some of the science out there like what is the path that we are are we on like are we out over our skis when we’re

Starting to talk about nmn and NAD and all this kind of stuff like I’m trying to get a sense of of what’s real and and what you know maybe in the near or distant future my sense is that it’s really cool to talk about all these

Things and think about them but in terms of their immediate practicality and applicability in our lives like not so sure right so where is your head with all of that so interventions anti-aging interventions we could talk about uh like mitochondrial or growth agonists nmn NR even NAD ion patches or NAD

Infusions and rapamycin correct um rapamycin is a little different correct so that works on mtor so mtor’s mammalian Target of rapamyosin and I think that has amazing promise as well and it is currently clinically applicable as is inimin as is metformin metformin has three main effects that I

Think of its effect on shpg it might it likely bumps your shpg up just a bit partly due to its action on insulin igf-1 and igf binding peptide one which is the protein that binds up igf-1 which is kind of like think of it as your growth hormone long term

And then also it works on your glucose and insulin so for an individual that has insulin resistance metformin is a amazing anti-aging intervention or for someone who is just had has one of those things that are off you can Target that specifically to intervene same for mtor

So let’s say there’s someone that is huge into intermittent fasting and they have great fasting they don’t have very much cancer history they’re not worried about cell senescence as much um which is kind of like zombie cells if you will pre-cancerous cells they’re probably not

As good at a can for rapamycin but if there’s someone on a very high protein diet a lot of proteins like um branched chain amino acids will activate mtor so they might be a better candidate for rapamycin especially if they have a family history of cancers that

Um can likely be prevented with it now it’s all still theoretical but it is a very well tolerated medication with edamin there might be such a thing as too high a dose of an inamin it might be difficult to get because if you’re not consuming it with fat perhaps it’s

Not absorbed as well and also the I don’t think the debate is over about like the absorption of nmn compared to even NAD getting inside the cell getting into the mitochondria where CoQ10 can convert it to ATP so I don’t mean to be overly verbose the

The thousand foot view is each of those is clinically applicable but some individuals benefit far more from others like any growth Agonist whether it’s growth hormone or a growth hormone releasing peptide or nmn if you have a very very high dose then theoretically it can cause increased cell overturn and

Cell growth which can be uh potentially linked with cancer cancer is the big thing to worry about with that obviously right so you don’t play around personally with any of these protocols I actually do yeah I don’t think it would be harmful to most of course what

I do is not what everybody should do but every two weeks I take rapamycin and I alternate days between uh nicotinamide riboside which is NR and inamin which is a nicotinamide mononucleotide and I usually stay around a dose of 250 to 500 milligrams of in a minute NR and

Again I don’t think necessarily anybody should do this cancer does run fairly strong in the family both uh especially like the hormonal cancers like prostate cancer and breast cancer I do take Metformin only with my rapamycin yeah so I obviously I think it’s a full protocol I think it’s

Clinically applicable yeah that’s super interesting do you notice is there any kind of lived experience difference as a result of taking it or is it just something that’s in the background doing whatever it’s doing unnoticeable to you that I know ever haven’t developed cancer yet yeah and hopefully I wouldn’t

Have either even if I hadn’t taken it but no deleterious side effects right and no but no like noticeable energy boost or anything like that um not from taking those I also take ubiquinol which is the active form of CoQ10 again thinking about nmn and NAD precursors in general if you’re on

Inamin the rate limiting step is likely not in a d Plus for your energy many power lifters and other athletes take ubiquinol which is the again the active form of CoQ10 to help with energy just like if you’re fueling up a race car you can’t just keep giving it more

Fuel and expect it to function at some point the lack of fuel is not the rate limiting step it’s the fuel pump which is L-Carnitine or the converting enzyme which I suppose could be seen as octane booster or the backup fuel tank which could be seen as creatine right

Um I could be wrong but I I seem to recall that Peter attia talked about his experience of being on Metformin and I think he did it for quite a while but ultimately um got off it because he felt like as an athlete he couldn’t hit his top end

Right there was some kind of energy limiter on it that was you know problematic for him it likely goes back to metformin’s three main effects if you’re taking metformin one evening every two weeks it’s very unlikely to have a significant effect on those parameters but it can help or it can

Decrease your active or free igf-1 just like you have a free testosterone you have a free igf one so it both increases the igf binding peptide 1 and decreases igf-1 so if you’re already sub-optimal when it comes to growth hormone or igf-1 that could certainly affect your performance

If your free testosterone and free androgens are relatively low then metformin can also slightly decrease your free testosterone because again it increases shbg and then also a lot of athletes are hypersensitive to peptides and bodybuilders are this way as well they know them as peptide guys where something that will increase their

Insulin of course some bodybuilders do take insulin but in general if something increases your insulin and growth hormone and igf-1 that can certainly be performance enhancing and Metformin will decrease all three of those yeah so it kind of depends on what your Baseline is yeah interesting um that’s wild man wow uh

Very very interesting I let’s let’s turn to women’s hormone health for a little bit um you know conversely from men who are obsessed about testosterone and virility and you know what we just talked about you know from a women’s perspective I suspect their concerns uh you know

Orient around fertility uh you know what happens with menopause and the focus being on estrogen and maybe progesterone progesterone right so talk me through kind of how you think about women’s health and Hormone Health specifically and um what women should be thinking about women obviously have a unique decision

To make when it comes to Hormone Health because every woman will inevitably go through at least with current technology we’ll go through ovarian failure also known as menopause there are many things that can likely prolong this the health and the production of both like the ovulation from the ovary and the production of

Hormones from the ovary but when you’re thinking about Hormone Health for women you think about it actually very similarly to men where they just have a little bit less testosterone so maybe one less let’s say that uh Rooks and knights and Bishops or testosterone and the only difference

Between the chessboard of men and women is women have maybe one more Queen and one less Knight but they still have three to four times as much testosterone and they still have a high amount of pons or DHEA women that go through adrenal pause which is where they have a decreased

DHEA at the same time as menopause have in general have particularly severe symptoms the decrease in estrogen whether it’s estrogen made from the ovary or estrogen made peripherally from DHEA is related to more plaque buildup in the arteries we know that women that go through an early menopause called POI or

Premature ovarian insufficiency have a very high rate of plaque in the coronaries and also a higher rate of osteoporosis um so addressing these things by getting a baseline lab before your menopausal or even before your perimenopausal is very important right so let’s say somebody comes into you in

The midst of it though they’re experiencing this kind of symptomology what is like the kind of holistic intervention to you know as best as you can you know course correct the imbalance and you know ameliorate at least some of the more severe symptomology optimize adrenal hormones if there is

Something that’s related to for example uh testosterone production the thika cells of the ovary also cease to function in menopause which gives you almost half of your testosterone um but uh ensuring that your adrenal production is as good as possible is the first step that’s kind of uh Nature’s

Mechanism to account for menopausal changes is that the adrenals will be back up so the better your adrenals can function the less symptoms you have and the less likely you are to need urgent hormone replacement however that being said if you are an individual that benefits more from hormone replacement a female that

Does the earlier you start it right after menopause the better and when it comes to some of the diseases that we see with women like PCOS or endometriosis and fibroids you know walk me through obviously these are all different things but like the relationship between Hormone Health and

The incidence of these types of ailments a lot of them come down to imbalances in not only estrogen but also androgens progestogens and growth hormone and igf-1 many individuals have excess signaling of growth hormone and that not only theoretically increases the growth of endometrial tissue regardless of the

Endometrial tissue is in the uterus it’s the tissue that lines the uterus or if it’s outside that’s known as endometriosis then if you give someone growth hormone then the endometriosis will get worse things like diabetes especially type 1 diabetes precipitously increased growth hormone that’s the reason why those individuals are more

Prone to cancers as well so you want to have optimal growth hormone signaling theoretically something like metformin would actually potentially help for endometriosis but you have to address everything else if there’s an estrogen dominance you have to of course address that as well right because that will also grow endometrial tissue or can

Lead to adenomyosis or it can lead to anovulatory Cycles but theoretically if a patient comes to you prior to succumbing to any of these and you’re able to work with that patient balance their hormones out look at all their blood panels and everything and kind of sort everything out you potentially

Sidestep not only these diseases but the severity of the symptomology incident to menopause when it arises like that’s the power of like Hormone Health really correct yeah and keeping in mind the individual needs for a patient a patient that has PCOS and also really high adrenal hormone production

Might be more resilient to menopause and the less likely to need HRT so there can be benefits um a lot of genetic polymorphisms or variables there’s a benefit to it historically even uh hyper coagulability disorders can be productive against postpartum Hemorrhage yeah well which is not as much of a deal now

As it was 100 or 200 years ago right but keeping in mind the needs of a patients that’s more true preventative medicine you were mentioning Primary Care versus secondary versus tertiary that’s trying to have true primary care and hopefully I think eventually we will have a widespread care that is available

To many that is even before primary where you get not only your baseline lab panel hopefully at age 18 or even before just like a new car off the assembly line you get your full genome sequenced and we can soon make clinically applicable decisions from that as well

Yeah I mean I feel like that’s the direction of the technology of healthcare and telemedicine and wearables like we’re going to have these massive data sets and we’re going to be getting you know information in real time that is getting transmitted directly to our practitioner who is actually qualified to analyze the data

And make conclusions from that like we’re not there yet I feel like most of healthcare is living in a completely different era where they’re faxing things back and forth you know it’s like it’s ridiculous based on you know the technology of 2022 but hopefully you know that’s where we’re headed and

That’s how you can really um not only practice true primary care because you’re seeing things before they happen and addressing them before they become truly problematic um but also it feels like that’s going to create its own business model that’s going to make it of more viable and

Easier career path for the Young Medical practitioner coming right out of school yeah speaking of that there is an odd cognitive dissonance between the individuals who seek out Primary Care they usually do it because they’re not able to get into another specialty some schools like the University of Kansas do

Emphasize primary care and have special programs to incentivize it but it doesn’t make a lot of sense to take the most complicated widest scope of medicine and in general put applicants that are not able to get into any other Specialties to do that so how is that

You know how would that be best addressed you know at the medical school level that’s a really difficult question to answer probably not at the medical school level um there are many people that go into medicine with altruistic um motives but I was Pro I was told at

Least a hundred times throughout medical school not to do Primary Care specifically do not go to a Family Medicine Residency and this was at a medical school that emphasized primary care because like you’re not going to be able to make a living or that’s not as well respected what was the rationale

Those two reasons are often cited and also that it’s just a poor lifestyle because you turn into a referral robot or an algorithm follower right basically you get these tiny Windows to see patients and in order for it to make economic sense it’s a churn and burn

Kind of thing right that’s why that’s part of the reason why burnout is extremely high is one people are in primary care and it wasn’t their preferred specialty and their Heart’s Not really in it and then two because even if they did learn to love it they’re so limited by not just insurance

Companies but what the patient is willing to do that they don’t really feel like they’re helping people right so if you were in a position to overhaul the you know medical education establishment like where would you begin like would you just burn it down and rebuild it or what kinds of curriculums

Or programs would you you like to see you know become part and parcel of the experience of the medical student to best train doctors for this new era and to be able to treat patients holistically think part of the process has been getting better there’s a examination

Called step one and I believe now it’s pass fail and that’s largely not based on clinical knowledge it’s based on scientific or Niche knowledge which I loved and really enjoyed but many people feel like that holds them back because they get a poor score on that but it

Does not have a lot to do with how Adept of a practitioner they will be so that’s probably a positive change a lot of people are also going to systems based or like case-based education so not necessarily modules here and there but they’re trying to get people into more clinically relevant positions

Um and I think that’s a positive change for education but I think a lot of the changes would have to be systematic whether that involves uh single-payer I think one change that has really helped emphasize uh medical students going into Primary Care is direct Primary Care also

Known as DPC we actually had several different recent graduates at the University of Kansas come and speak to our medical school about how they’re helping the underserved uninsured and underinsured community and they’re making a a good solid living doing direct Primary Care helping people that the system normally doesn’t help and I

Think that is probably helping more than anything else yeah that’s super interesting but purely from a a philosophical point of view like my understanding of medical education is that it’s predominated by uh studying disease and how to treat disease it’s not about like how to optimize Wellness right like yeah like

That’s just I mean just talk about systemically like it’s just a different you know like that’s what it’s about right and so you don’t necessarily uh graduate from medical school with an understanding or a tool kit for how to promote optimal well-being in people you just know how

To treat diseases as they come I mean am I being unfair like a no I think that’s certainly true um there are new fellowships that are um coming up for example lifestyle medicine fellowships or perhaps even the Obesity medicine Fellowship you can make a case for but there are new fellowships and board

Certifications that can that can likely help address this um teaching more and more Health optimization or individualized medicine at the academic level or in medical schools will likely help as well but if there’s not a depending on the market for it I think that those two

Things would have to go hand in hand which is changing education and also um just the economics or the supply and demand of the system sure right and so extrapolating on how you would change the medical education industrial complex let’s now fantasize that you have become the Surgeon General of the United States

In charge of Health Care policy like what kind of you know Global systemic changes would you like to see that would make this a more optimally functioning system that’s truly serving patients yeah so it should a Surgeon General I think in the last uh even a decade there

Have been many different good changes for example obesity is considered an epidemic I think that was a wonderful decision there’s also a program called healthy people 2030. and many of the goals of healthy people 2030 is to decrease the incidence and prevalence of certain diseases for example pre-diabetes

And the uh I guess the actionable item for change in order to decrease this is test and treat or screen and treat so more screening for A1C I would have loved if they had added fasting insulin or even a glucose tolerance test to that but more screening for A1C more

Screening for fasting glucose um and earlier screening correct yep there’s also goals for childhood obesity and actionable items in order to achieve these but there is not very widespread application of this many of these are not included in what’s called meaningful use or mips it’s called mips criteria now mips

And the hinge of that that sways is if you do not fulfill these then you will not get your extra reimbursement from insurance so inside the insurance model um there are certain things that are looked at as more or less important for example a Statin in a diabetic

Yeah and when you look at the incidence of type 2 diabetes and pre-diabetes and what’s being projected in the coming decades I mean there never has been an epidemic of such proportions I think they’re looking at something like 50 of 40 to 50 percent of the population will

Be suffering along the spectrum of this metabolic disorder right so you know to the extent that we can test for it early and develop lifestyle protocol interventions as early as possible it’s not only in the best interest of the patient it’s in the best interest of the

Economy and the Health Care system in order to do that because otherwise we’re looking at some kind of you know economic bankrupting disaster like how are we going to manage all of this yeah not a lot of tertiary care yeah I mean it’s just economically impossible um a lot of primary care

Um one interesting thing uh you mentioned that it’s happening earlier and earlier the New England Journal of Medicine did a study uh an epidemiological study that’s probably a retrospective cohort basically looking at groups of people and as they progressed throughout their childhood and Adolescence and we used to think that many people

Would uh grow out of their fat phase so during puberty they would um you know kind of thin out and their BMI does change but if you look at what happens throughout their life if you look at kids over the age of five up to puberty if they have a a high

Percentile a high class of obesity it’s not done by BMI in kids it’s done by percentile so if they’re in a high percentile before they almost always return to a high class of obesity after puberty a lot of people see this anecdotally because after puberty you

Have a couple years that you’re kind of catching up on and then during your last year of high school or first couple years of college then those individuals were re-enter obesity so it does not appear that you really grow out now it’s certainly a chance to change your lifestyle

But a lot of this epidemic comes from a cultural standpoint because the the family teaches the same lifestyle habits to their kids that they’re doing yeah sure so on that subject matter how are you so you have two young kids right I assume these kids are going to be homeschooled

Right they’re going to be growing food and you know undergoing the same academic you know protocol that you did is that the plan yeah absolutely for their ages they are a huge help in the garden and the two-year-old even picks up the chickens and collects the eggs

And everything yeah so they’re a huge help especially for their age um definitely being outdoors I don’t think they necessarily need to be need to be homeschooled all the way through but I would certainly plan on it I think that it helps um it’s not as regimented it helps create a

Unique individual and I think that’s a lot of the strength of an Eclectic Society is that people have different ideas rather than just being taught the same thing I think that it could be done in schools but that’s certainly our plan for that right and is it do you have a

Specific homeschooling protocol is it unschooling is it like a rigorous academic you know curriculum like how does it look how did it look for you and what do you envisioned for your kids growing up I did about every homeschooled curriculum that there was and perhaps that was for the best I did

University model stuff I did tapestra Grace abeka um all there’s a whole bunch of different ones and I think that kind of helped me because I would have lost interest if it was the same thing and for them uh they’re two and a half and one so they haven’t really started a

Lot of school yet but uh I do like the Montessori model I think that is great especially for young kids my wife is speech language pathologist and she taught in early childhood for a while as well and she’s also a fan of a mostly montessori-based model unschooling is an

Interesting standpoint but I think just like there’s an optimal Health protocol for each individual for each kid there’s an optimal protocol some kids do fantastic in a Traditional School model and some kids do well in kind of like the antithesis of that the unschooling model uh

In this area I think that just because the thesis isn’t true it doesn’t mean that the antithesis isn’t true so I A lot of people are like well you know all school is bad everyone should be homeschooled or nobody should be homeschooled um there it’s too much dependent on the

Parent and not the society so the truth is probably somewhere else right so if you’re going to practice personalized medicine you’re going to practice personalized Academia yeah yeah right definitely and so maybe it would be good to just share a little bit of insight for the parents or young parents out

There or parents of young children out there who are trying to set their kids up for Success not necessarily academically but in terms of Lifestyle habits healthy habits um you know with Hormone Health in mind of course but um but you know with with obviously the

Intent being to sidestep all of these uh you know terrible lifestyle illnesses that are debilitating all too many people A good rule of thumb is try to eat at least one meal a day one meal a day as a family don’t have any Electronics or screens around when you do so

Try to have one movement past time that’ll last a lifetime that you can do with your family whether it’s taking walks or whether it’s doing chores on the farm or whatnot try to have at least one of those things and then on a if not a day-to-day basis at least a few times

A week regardless of what your kids do for academic education try to teach them something to pass it along as well even if it’s cultural a lot of people will um you know not pass along whether it’s a language or whether it’s um just cultural knowledge that will not get

Passed along to Future generations and that is one thing that has been lost a lot for example some parents are great at gardening and they don’t pass that along some parents are great at music and they don’t pass that along so passing along that gift of knowledge is

Super important yeah that’s beautiful I I haven’t heard anyone articulate that but I would agree with you wholeheartedly that’s that’s beautifully put and solid advice my friend I think the last thing I want to uh just kind of quickly get into is is some counsel for for the average person out there who

Doesn’t live in Kansas and is not going to be able to come and see you and is thinking how do I find a Kyle Gillette in my area like are there resources available like where do you point people uh to find out more about how they can identify a holistic health practitioner

Functional medicine doctor and even if there isn’t someone in their area perhaps some resources that would be valuable and helpful yeah um there are obviously many good doctors out there even in traditional health clinics just like if you’re searching for a mechanic or someone to fix your fence or whatnot

It is totally okay to read profiles and reviews of healthcare providers online I would emphasize for the for the average person at least try to have a nurse practitioner or PA or MD or do that they see if they have someone like a DC or an indie as part of their

Healthcare providing team or dietitian whatnot or a health coach and that is also okay but they would just kind of be part of the team if they’re specifically looking for obesity medicine advice as many people are then looking for a doctor that is board certified in obesity Medicine of which there are tons

All around A-bomb is the certifying organization American Board of obesity medicine that is also a great place to start that’s good and if somebody uh wants to get a blood panel or let’s just assume maybe there isn’t an obesity medicine specialist in their area or there isn’t a Doctor Who’s sophisticated in Hormone

Health but this you know uh excited individual wants to get a picture of their Hormone Health like uh you know maybe they could tell their doctor like I want to make sure that we test for these things or whatever like to the extent that they can shoulder responsibility for their health and you

Know be a little bit more you know active and have some agency in this relationship for that individual I would uh advise them to be brutally honest even down to the tiniest little niche if they feel like their energy or Focus or libido or athletic performance is even a little

Bit off or their sleep then tell the healthcare provider that and tell them that they would like diagnostic Labs specifically to look for that the healthcare provider could potentially use those changes even if they’re not severe even if they’re let’s say moderate they can still use that as a

Code to where potentially the insurance might cover it however conversely fortunately there’s many different services that patients can use to get their labs done without having to go through insurance I would venture to say for 90 of people they’re just best off not even bothering with insurance especially if they don’t

Have anything if they’re looking for a true Baseline panel then your insurance is very unlikely to cover it it’s not going to cover looking for another service to cover for that at some point I will post my recommended lab panels at gillettehealth.com but it’s perfectly fine to shop around

For labs just like you shop around for everything else yeah cool meanwhile uh you are practicing in Kansas the Gillette Health Clinic people can come and see you if they want to travel to Kansas right so they can go to your website uh contact you if they’re interested in that

Correct uh they can go to gillettehealth.com and it tells a lot about our in-person options and also our telemedicine options for many individuals that you just described I would consider that individual underserved I recently wrote an article that was published in the MSL journal with my friend Alec McCarthy

About the role of tele of medical Affairs in telemedicine basically the balance between on one hand yes in-person medicine is always better than telemedicine but on the other hand telemedicine is a whole lot better than nothing and a lot of individuals that we see via our telemedicine let’s say maybe this person

Sees this one time in person and then after that almost all their follow-ups are telemedicine or things like lab reviews or even meeting the patient seeing if they’re a good fit telemedicine can be a wonderful option for that yeah very cool and uh if people want to learn more about you they can

Listen to your podcast the Gillette Health podcast you’ve done you’ve done a couple not a ton of it did you just start it or did you just do it intermittently it’s brand new we’re trying to figure it out but we do plan on talking a lot more and bringing a lot

More content that is applicable that is an actionable item to the public we kind of do every other one we do one where we just go way down the rabbit hole that’s very Niche and then we do one that’s kind of in layman’s terms right cool

Yeah I enjoy it check that out I did say at the outside of this podcast that we were going to kind of get into supplements we didn’t do so much of that like there was a million things I wanted to talk to you about that we didn’t get

To but you and Andrew huberman did a great job of that was a very supplement Centric conversation that went on for at least two and a half hours so people can check that out I I don’t know that I could do any better than you guys did on that regard

Um and uh that’s it man I think that’s it for today I just wanted to kind of end it by um by saluting you I think it’s really cool what you’re doing I think it’s important work and and and I really think that you are um

A model of the future and a role model for future doctors and uh I I really appreciate you coming here and and sharing time space with me and and the audience man and I’m at your service if there’s anything I can ever do to support you or help help you out thank

You it’s an honor and a pleasure yeah cool um Instagram also drop your Instagram yeah you you do a lot of cool stuff on Instagram Instagram is definitely my main Hub it is Kyle Gillette MD and Gillette Health on all other platforms yeah right on man and and always welcome

To come back here there’s plenty other stuff I could talk to you about and uh it was really cool man so thank you thanks peace yeah thank you