Dynamic Dialogue with Danny Matranga - 205: Testosterone, Cholesterol, and Blood Pressure (What YOU Need to Know for your HEALTH) W. Alex Jabourian MD

Episode Date: July 7, 2022

In this episode, coach Danny sits down with Alex Jabourian MD to discuss the value of monitoring blood pressure, cholesterol, and testosterone - and how these three things are connected.Visit the Marek Health website by clicking HERE- (use code "corecoaching" to save)Thanks For Listening!  LEAVE A REVIEW OF THE SHOW:There is NOTHING more valuable to a podcast than leaving a written review and 5-Star Rating. Please consider taking 1-2 minutes to do that (iTunes) HERE. You can also leave a review on SPOTIFY!OUR PARTNERS:Legion Supplements (protein, creatine, + more!), Shop (DANNY) HERE! Get comprehensive lab analysis of the most important biomarkers for your health from our partner Marek Health HERE (save using the code "corecoaching")Get Your FREE LMNT Electrolytes HERE! Care for YOUR Gut, Heart, and Skin with SEED Symbiotic (save with “DANNY15)  HERE! Put your nutrition on autopilot with our amazing partner CHOW meal prep HERE (save with code "danny")RESOURCES/COACHING:  Train with Danny on His Training AppHEREI am all about education and that is not limited to this podcast! Feel free to grab a FREE guide (Nutrition, Training, Macros, Etc!) HERE! Interested in Working With Coach Danny and His One-On-One Coaching Team? Click HERE!Want Coach Danny to Fix Your S*** (training, nutrition, lifestyle, etc) fill the form HERE for a chance to have your current approach reviewed live on the show. Want To Have YOUR Question Answered On an Upcoming Episode of DYNAMIC DIALOGUE? You Can Submit It HERE!Want to Support The Podcast AND Get in Better Shape? Grab a Program HERE!----SOCIAL LINKS:Follow Coach Danny on YOUTUBEFollow Coach Danny on INSTAGRAMFollow Coach Danny on TwitterFollow Coach Danny on FacebookGet More In-Depth Articles Written By Yours’ Truly HERE! Sign up for the trainer mentorship HERESupport the Show.

Hey everybody, before we get into today's episode, I have a favor to ask you. If you're a regular listener or somebody who gets value out of this podcast, somebody who's learning from me on your health and fitness journey, whether you're a trainer, a high-level athlete, or you're just getting started, other people need this kind of advice. And the best way for you to help me grow the podcast is to take a little bit of time, literally one to two minutes max, to leave a rating and review on the app that you listen to your podcasts on. The majority of you probably listen on an iPhone and you probably

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Thanks so much for tuning in. This is Coach Danny. And today we're going to be sitting down with Dr. Alex Jabourian. He's a dual certified emergency room physician, medical doctor, and hormone specialist with Merrick Health. We're going to talk all about cholesterol. We're going to talk about blood pressure. We're going to talk about testosterone and the ways in which people tend to struggle

with elevated blood pressure or dysregulated lipids and cholesterol and low testosterone and what you can do from a lifestyle and habit standpoint to actually improve these things, improve these things with your clients, your friends, your loved ones. We also talk about the value of preventative care. And Dr. Jaborian works with Merrick Health, who is the company I use specifically when it's time for me to order up my annual labs. I always like to take a in-depth view anytime I run labs, and Merrick's has been the easiest so far for me to use. I use their comprehensive mail panel, and you can use any of their panels as well using the code CORECOACHING at checkout to save 10%.

I hope you guys sit back and enjoy the episode because we get into the weeds on some pretty interesting stuff that affects almost half of American's health. Enjoy. Hey, Alex, how's it going, man? Not bad. Yourself? Not bad. Enjoying the weather out here in California, relaxing in the middle of a move so things are chaotic, but I'm glad we're getting the chance to sit down and talk. For those of you who aren't yet familiar with Dr. Jaborian, I'm going to kind of hand things over to him to let him discuss what got him into health, fitness, performance optimization. But more generally on this podcast, when I talk about things or open up topics that I'm not an expert with, I like to have somebody in the room or on the other end of the microphone who is legit. And we're lucky enough to have a legitimate

medical practitioner, a doctor, a physician with us today to talk about some really cool topics. So Dr. Alex, why don't you talk to everybody first about how you got into medicine and how that segued into health optimization? Yeah, absolutely. First, I want to thank you for the opportunity. Thank you for sitting down with me. But yeah, as far as me getting into medicine or specifically like health and performance optimization, which is primarily what I focus on now, it's basically my background in sports. Growing up, I did a lot of different sports. In high school, I was always a skinny kid, so I kind of got interested in bodybuilding, wanted to get bigger. And then that kind of led to my interest in human physiology.

And it kind of just grew from there. That went on through college, went to medical school. And then I always had this idea in my head going through medical school. So I'm an ER physician by training. My board certification is in emergency medicine, which is obviously very different than what we're going to be talking about as far as like performance optimization. But I always had this idea in the back of my head where I'd run a clinic at some point in the future where I kind of combined nutrition, exercise, and medicine together. Because I think that's really lacking in the, you know, in the clinical scenarios we typically will see now in medicine now. Totally is.

Yeah. So that, I mean, that's really where my passion, how my passion kind of led me to Merrick Health, because that's Merrick Health. And granted it's telemedicine, but that's essentially what we're doing. We're trying to optimize your health via lifestyle modification and through pharmacologic treatment. Which is really awesome. And for those of you guys who are listening, Merrick Health is the lab provider that I use when I run my annual lab panel. And one of the things that's really cool

about that partnership in particular and the experience with Merrick is I can pick self-service labs. I can pick labs that I want individually, which not everybody's apt to do or educated enough to do. So for me, wanting to keep it simple, I just pick the basic male health optimization panel. I get tons of biometrics. I sit down with my patient care coordinator. We go over the results. And then I actually get the opportunity to sit down with a physician like Dr. Alex to talk about whether we're looking at lifestyle interventions, whether we look at supplemental interventions or pharmacological interventions, if need be. And obviously, like you said, your training and more of your day-to-day might be on the emergency side of things. But I can imagine in that setting, you come across people all the time and you think, wow, how helpful a little bit of preventative care would have been for this person. And so I think just a nice segue into the value of preventative

care of labs, with what you see on a day-to-day basis, do you think that preventative care is something that we're really missing the ball on or missing the boat on dropping the ball on? Like with what you see on a day-to-day basis, do you think that preventative care is something that we're really missing the ball on or missing the boat on dropping the ball on? Huge. I mean, if you look at our rates of obesity now, if you look at the rates of hypertension, obesity is, I mean, we're north of 40%. Hypertension is getting close to 50%. One in every two adults has hypertension.

It's huge, right? So, and a lot of that is, I mean, obviously there's some genetic component to this as well, but a lot of what we see can be completely prevented with lifestyle modification before we get to medications. So that's just dialing in your nutrition, fixing your sleep, exercising regularly, trying to mitigate stress to the best of your ability. All of those things will drastically improve your health to the point where you may never need medications. And hopefully you never see me in the emergency department. Well, I like that because you don't typically hear physicians speak so positively about non-pharmacological interventions. There's always like a, I don't want to say a mistrust, but people are often skeptical of different medical practitioners. And I just find it really refreshing to sit down and hear somebody

highlight those various interventions outside of pharmacology. Because most people interface with their doctor for seven minutes at a time and they get a prescription, which is oftentimes warranted. There's nothing wrong with writing prescriptions. But I think a lot of people, especially in the fitness and health community, would prefer to look for a lifestyle intervention, something that they can lean into. And to the point you made, I was actually just looking at the data this morning from the CDC. I think it's 41.9% of adults are obese. And that data was before the pandemic. The most recent data is pre-pandemic. So that number is probably higher. And one in two adults being hypertensive is something I see all the time. I own a strength and conditioning slash physical therapy clinic. And almost every single adult who comes in for physical therapy has

high blood pressure or elevated blood pressure. And so I think that would make for a really, really good segue, which is why is blood pressure such an important proxy for overall health or cardiovascular risk? And should people be monitoring their blood pressure even if they're healthy? should people be monitoring their blood pressure even if they're healthy? Yeah. I mean, that's an important point. And I mean, to the point where you could do it in a healthy manner, right? I sometimes will get patients who stress so much about their blood pressure that they actually become hypertensive just by stressing over. I can see that. Well, white coat syndrome? Yeah, that's exactly what it is. So it's, you know, you can potentially check your

blood pressure once every day upon waking up in the morning, keep it consistent, if you really want it to a lot of, you know, I'm this way, I'm very data driven. I like objective measures, I do my blood work on a regular basis, even though I'm perfectly healthy. And, you know, I, for and we can get into diet for a while. I was on a ketogenic diet. I would check my beta hydroxybutyrate like multiple times a day, just because that's just the way I am, but not everyone is like that. Not everyone wants those needs those objective measures. So, um, there are obviously things that you can do and subjective means of assessing your

own health, but definitely checking your blood pressure is one good measurement. And obviously, and we we've touched on this already, but blood pressure is so prevalent that I, especially at the lower ends of hypertension, you may not be symptomatic yet. You likely will not be symptomatic. So you won't know that you have high blood pressure unless you check your blood pressure. So that's really one way, but I wouldn't, it's really important to stress to anyone who's listening in. I mean, this isn't something where you should stress over it or panic about it. If it's elevated, there are things you can do to correct it. Definitely discuss it with your physician. But it's just one measurement out of dozens that we can check. I like it as a measurement generally because it's fairly accessible. It's something that you can do from home.

And like you said, you don't have to do it every day. Maybe you do it once a week. Maybe you do it once a month't necessarily understand what is happening when blood pressure is chronically elevated in somebody's hypertensive. What is the difference between an individual who's hypertensive and who is not hypertensive? What's actually happening physiologically there to cause elevations in blood pressure? And when you're wearing a blood pressure cuff, how is it generating this data for those who aren't informed? Because I can tell you, I went to school for pre-physical therapy and I had a lab where I took blood pressure

and I still kind of grasped it, but it's not super intuitive. Yeah. No, it's not. And so it starts with just defining what blood pressure is first. So a normal blood pressure is considered 120 over 80. That is two different numbers. They've recently, within the last five years or so, changed the definition of hypertension to include anyone with a systolic blood pressure. So that top number greater than 130, or the lower number, the diastolic blood pressure greater than 80 before it was 140 was a top number. So that may also contribute to why we're seeing an increased rate of hypertension is because they've kind of changed the goalposts a little bit, they've lowered

the standard, but obviously, it's important, because anytime you're over 130 systolic blood pressure, your risk of a lot of cardiovascular diseases increases. And one, especially when your blood pressure, the systolic blood pressure gets over 160 or 180, then you're at significant risk of heart attacks, strokes, and all kinds of bad stuff that I'll typically see in the ER. So after the definition of hypertension one 30 over 80, it's important to know how we're deriving those numbers. So the top number, the higher number is generally the pressure within the lumen of your blood vessels that's generated with each contraction of the heart. Okay. So as the heart contracts, pushes blood through the blood vessels, and that's what we're measuring as that systolic blood pressure. Gotcha. And then the pressure that remains as the heart relaxes is the diastolic blood pressure,

which is why it's a lower number. So those are the two numbers that are generated with a blood pressure cuff. So, I mean, there's obviously there's a specific technique to measuring your blood pressure with a manual cuff. Most people don't need to know about that because most people are going to get an automatic cuff. It's going to do all the work for you. But just breaking down the numbers specifically, what you're looking for is that top number being close to, or potentially even lower than one 20. And then that bottom number being close to you or potentially even lower than

80. There is a degree at which your blood pressure can be too low, but that's, I mean but that's generally not what we're concerned about. Most patients have hypertension and that's what we're trying to treat. High bow tension or low blood pressure would be that top number less than 90, but just for completeness sake. No, very, very informative.

So what is happening in the lumen or what is actually happening in the walls of these vessels or in the structure of these vessels when an individual is showing elevated blood pressure? Or can it be caused by a multitude of things? What is happening there when you say get somebody, you put them down and they come back like 140 over 100? What might we think is going on? So that basically tells us a couple of different things. One is you're getting inefficient pumping of blood.

So there's potentially more strain on the heart and the heart is needing to produce more pressure to get blood circulating through the blood vessels. And what that actually does to the lumen of the blood vessel, to the inside of the blood vessel is basically just more turbulent flow, potentially causes more damage. And then that potentially leaves your blood vessel more susceptible to deposition of LDL, for example, which I mean, something else we'll discuss later today, but obviously circulating cholesterol or LDL lodging into your blood vessels, ultimately causing inflammation, oxidation, plaque formation.

Yep. That's what causes all the downstream effects. That makes a lot of sense. In theory, more pressure in the artery, it almost makes the artery or vein more vulnerable to the accretion of these small particles of circulating lipid that can cause a plaque, that can cause all kinds of problems. So cholesterol and blood pressure actually can be working in a kind of nasty tandem here if you have elevated blood pressure and perhaps elevated cholesterol. I actually had no clue that those two things were related like that. That's very interesting.

Yeah, absolutely. Yeah. They all are to some extent. I mean, you could include sugar in this conversation, which is why, I mean, we talked about the prevalence of obesity and hypertension, but if you look at the entire picture, we tend to see significant elevation of metabolic syndrome in the entirety of the population, which is a constellation of obesity, hypertension, specifically central obesity. And then you get the lipid abnormalities and the insulin resistance as well. All of those kind of play together. It's this vicious cycle that feeds into itself and ultimately causes downstream negative

health effects. Would you say it's more common to see at least one or two of those things than it is to just see one? Like if you usually see elevated blood pressure, you might see a poor lipid panel or glucose dysregulation as well. Yeah. And a huge part of that is probably just because of our lifestyles. Yeah. We could definitely point the finger and say a sedentary lifestyle with less than ideal nutritional intake could exacerbate and cause all three of these things. Definitely. Something specific to blood pressure that I've always wondered about. I have a number of clients who

take medication to manage their blood pressure. I have a number of clients who manage it exclusively with exercise. But many of these clients have been told by physicians specifically to stay away from sodium. And sodium can be beneficial for athletic populations and it can be detrimental to hypertensive populations. So how does one parse out sodium intake if they're dealing with a continuum of people who might be active and hypertensive all the way to active with extremely normal blood pressure? Do we make adjustments there? How do we look at sodium? Yeah. So when it comes to, so we can kind of split this up into patients who have hypertension and are sedentary, they definitely will benefit from decreased sodium intake. The reason why is because with increased blood pressure, you also get kidney dysfunction,

kidneys responsible filtration of the sodium. Um, so you will potentially get increased sodium retention, increased water retention. That makes your blood pressure worse. That makes your kidney function worse. And that just repeats. So sedentary hypertensive definitely will benefit from decreased sodium consumption. Athletes who don't have hypertension may need drastically elevated increases. I mean, increased sodium intake, excuse me. Now, somewhere in the middle where you have a hypertensive athlete, it really depends on their level of activity. If you're doing prolonged activity where they're potentially sweating for extended periods of time and losing a ton of salt, they may benefit from salt supplementation.

If they're not doing that, then they may not necessarily need to increase their salt intake, but they may not necessarily need to decrease their salt intake either. So it really depends for that middle ground, for that athlete who also has hypertension. Now, that makes a ton of sense. We'll talk a lot about cholesterol as we move through the conversation today. There's so many foods that get brought up when you talk about elevated cholesterol. But when we talk about elevated blood pressure, the thing that I always hear discussed is sodium intake. And so that's very helpful in terms of giving somebody an idea of where they might fall in terms of whether or not they should adjust their sodium intake. As for lifestyle interventions to manage blood pressure, because this is, like you said,

literally half of adults have elevated blood pressure. Exercise is the most obvious one. And just to speak anecdotally, I've worked with a number of clients who have come to me with high blood pressure on medication. They've exercised regularly to the point where the blood pressure medication is so potent for their actually reduced blood pressure, they end up with low blood pressure. They get lightheaded, they're dizzy because exercise is just that effective. It can be a really life-changing intervention. But what else can we do nutritionally,

maybe with sleep, maybe with stress you mentioned, to better manage our blood pressure? Yeah. So, I mean, exercise is huge. That's the number one intervention for everything across the board. I can't recommend exercise enough. I can't think of a particular individual where exercise is not warranted. I mean, even if you look at patients for a while, we were not recommending resistance training for patients with heart failure. Even now they're kind of moving towards

recommending resistance training for patients with heart failure. So it benefits everyone across the board, but awesome. The thing with exercises, number one, it can help with energy expenditure and it can potentially push you into a caloric deficit and contribute to weight loss. And I have to say though, I've seen even patients without significant weight loss still have improvements in blood pressure with exercise alone. Beyond that, beyond the effects of exercise, when we're talking about nutrition, the most beneficial thing besides the sodium supplementation or the sodium intake would be weight reduction. Yeah.

So anything that induces weight loss, and we can go into details about specific diets. I am not very particular of a certain diet. I'm in the mindset that any diet that a patient chooses, as long as they can stay consistent with it, I mean, within reasonable means, if they want to eat Twinkies all day, I'm not going to recommend that obviously, but it's, if it's a diet where they're getting their nutrient, micronutrient and macronutrient needs, and it's something that they enjoy and can sustain. And it's something where they can potentially be in a mild caloric deficit. If they need to lose weight, then that's it. I don't care if it's carnivore.

I don't care if it's vegan or anything in between. It's just whatever you enjoy, whatever you can sustain and whatever provides you with the micronutrients and macronutrients you need for health. But that's where nutrition plays a huge role is weight reduction. Majority of these patients are overweight. Obviously, if you're not overweight, you may have a genetic predisposition to hypertension, in which case weight loss is not going to be as beneficial. But most of our patients that we're talking about with high blood pressure are overweight. So losing weight as little as five pounds makes a drastic difference.

When somebody is carrying around too much body fat or adipose tissue, and this is just me not knowing, so if I sound silly for asking this question, correct me, is the additional fat actually placing pressure on the veins and arteries? And is it the reduction of that fat that helps? Or is it just generally having less weight and less overall mass to pump blood through that makes the difference? Probably more of the latter. You don't tend to see, especially with the arteries, you won't see, it takes quite a bit of pressure to compress an artery, right? I don't know if you have any experience with blood restriction training. I do actually have a Katsu. I used it yesterday for arm day.

So yeah. So that, I mean, even with that, you're, you're compressing the veins, which are much easier to compress, but you're still, there's still blood flow going through because the arteries are still patent. So having that excess weight doesn't necessarily put compressive forces. I mean, it can, but it's not going to compress the blood vessels and that's not going to impede blood flow. But generally speaking, you're now carrying, it's just like, imagine training, doing like a ruck, right? You're now carrying a 45 pound pack. And how much harder is that on your entire cardiovascular system? Your heart is pumping way harder, way faster. You're breathing way heavier. And imagine carrying that on a daily basis. That's kind of how it, and obviously chronically, if you're doing it as exercise and getting that potent dose and then recovering,

that's beneficial. Doing this on a chronic basis, obviously not so great. Not to mention the effects it has on your joints, not to mention the changes to your hormone levels that we'll see with increased adiposity. So all of those things kind of play a role. Gotcha. And so I feel like when we look at blood pressure, it's going to be pretty global. You're going to be able to influence your blood pressure by making some pretty modest lifestyle changes, usually through caloric expenditure via exercise and hopefully body fat or adiposity reduction through the maintenance of a small deficit. So just the quick and dirty way to say it is diet and exercise. And this is something that you can monitor on a weekly, monthly basis, but it's very much

worth keeping an eye on. Another metric for physiological health or just keeping an eye on your health, wellness, and longevity that I think we talk about a ton is cholesterol and elevated markers of the bad cholesterol and probably suboptimal levels of the good cholesterol. And so cholesterol is something I'm not necessarily an expert on. I know there's different types, but I think it'd be really interesting for the audience as we talk more about these pathologies that can obviously interact with their cardiovascular system.

What the heck is cholesterol? What and why are there different types? And then why is the good cholesterol good? And then why is perhaps the bad cholesterol bad? Yeah. So yeah, this provides a lot of confusion for a lot of people. And cholesterol, generally speaking, is not the culprit, right? Cholesterol, for example, for a while, there was this notion that eating cholesterol is going to elevate your cholesterol. That's not technically how it works. Cholesterol is some, so what we're really tracking with our biomarkers are our lipoproteins.

And lipoproteins are what are carrying the cholesterol through your bloodstream. Cholesterol is vital. Your body produces cholesterol. So if you don't consume cholesterol, your liver is going to produce it. You need it for your cell membranes. You need it for steroid production or hormone production. So it's extremely important. What we track and what we're talking about when we say someone has high cholesterol is their lipoprotein, specifically low density lipoprotein, very low density lipoprotein, high density lipoprotein, lipoprotein A, and then we also track ApoB. And we can kind of break all those things down. So generally what people will consider your quote unquote bad

cholesterol or bad lipoprotein is LDL. LDL is with increased LDL, we do see increased cardiovascular events. We do see worsening morbidity and mortality. So that is one risk factor that we track and try to mitigate by lowering. The reason why is because LDL basically just is increasing circulation of cholesterol through your bloodstream. And conversely, HDL, high density lipoprotein is removing cholesterol from your bloodstream. So one creates more circulation, more potential for lodging into the arteries, more potential for plaque formation. The other is removing it. So less likely that you're going to get atherosclerosis. I've heard it described before as like one of them is a bus that drops them off and the other one is the one that takes it away. So less of it you have available, the less potential damage. And LDL would be the one that drops it off potentially in your arterial wall.

And that's what causes downstream effects. Gotcha. Now with those LDLs, and again, I might get off the reservation, so correct me if I'm wrong, some of them are smaller and more likely to cause these plaque buildups than others. Is that true? Dr. Yeah. So they do vary in size, but I feel like this is, a lot of people will focus on this minor detail and really clinically, I don't think it makes much of a difference because whether it's a larger fluffier LD or it's a smaller, denser LDL, it still has the same function of LDL.

And it's still small enough to lodge into the arterial wall. Gotcha. Regardless of the variations in size. Now, some people will argue that. Some people will say if it's a larger, fluffier LDL functions, more like an HDL. I don't see anything convincing enough to prove that. Yeah. I've heard that, but I don't have the training or mechanistic understanding to know whether or not that's true. I think what you described makes a lot more sense, which is

regardless of size, functionally, these things are going to act about the same. Something that you hit on that I'd like to unpack as we expand this conversation is like, okay, so our bodies make cholesterol. We use them as the backbone of forming a lot of our steroid hormones for our cell membranes. But when we eat and ingest cholesterol, it doesn't necessarily correlate directly with an increase in cholesterol. So why is it that Americans seem to have such poor cholesterol figures when they get labs done? To use myself as an example, I'm pretty active. I eat pretty healthy. Thankfully, my labs, when I do them with Merrick, they come back great. But most people, when they go to the doctor and they get a panel done up,

great. But most people, when they go to the doctor and they get a panel done up, they're going to come back with a pretty consistent elevated LDL and a lower than optimal HDL. Why is this such a prevalent pattern in America? Yeah. And this comes back to lifestyle. So, and what I mean by that is the type of foods that we're eating it fast food is so accessible but fast food is so high in carbohydrates and fats yeah that combination and they're so hyper palatable they're so loaded with sodium we can eat so much of it and being a caloric surplus that's really the issue that's i mean i i don't want to demonize a particular food and I generally won't. I tell my patients like, if this provides you joy, you can eat it as long as you're maintaining your, like the sufficient caloric intake, our goal caloric intake. If you're not in an excess,

then it's likely not going to cause as deleterious effects as if you were in a caloric surplus. But part of it is the type of foods that we have available to us. And it's honestly more affordable in the short term to go get fast food than it is to go get grass fed beef prices now. So I understand the struggle there. Obviously, you could argue downstream the health cost is going to be outweighing the savings you're making now. But regardless, I understand that struggle. Yeah. And I don't think people are hardwired to be thinking 20, 30 years down the line about their financial decisions, their food decisions. We kind of act on the influence of what it is that we want right now. And to your point, we live in a hyperpalatable food environment. We kind of act on the influence of what it is that we want right now. And to your

point, we live in a hyper-palatable food environment. So attempting to demonize these and stay away from these things altogether is very impractical for a practitioner because it's just not reasonable with how most people operate. For people like you and I, we can probably stay away from them more easily because some part of our identity is tied to like, yo, I prefer to eat these things. I prefer to train. It's part of who I am. Most people just aren't there. But it sounds like the calorie surplus that so many people are chronically in due to these hyper palatable foods in the food environment is a big precursor for cholesterol dysregulation. That and I mean, the other side of that argument also is someone may not be in a caloric surplus as far as ingestion goes, but they may not be expending

any calories either. So sedentary lifestyle also plays a role there. So not everyone that's overweight necessarily eats too much. They may just, they may not be moving enough is sometimes the problem. So a combination of those two factors definitely contributes to the abnormalities that we're seeing in the lipid profile. And so when people go to the doctor, they get a panel drawn up and they see cholesterol dysregulation. It's very common for statins to be prescribed or cholesterol-lowering medications. How do these work for people who aren't familiar with them? And what are some of the alternative or complementary interventions for people who might be more interested in a lifestyle-focused route, a supplemental route? what are the options beyond

statins? Hey guys, taking a break from the show to tell you about our amazing sports nutrition partner, Legion. Legion makes the best evidence-based formulas for sports performance, sports nutrition, recovery, and fat loss. I don't recommend many supplements. In fact, I think you can get the majority of the nutrition you need from a whole foods diet. But let's be honest, many of us are either on the go and need assistance, or quite frankly, we're not going to settle for average and we want to get the absolute most we can out of our training. So Legion is the company I go to for all of my supplement staples, whether it's creatine, which I get from their product Recharge, my protein that I get from either Whey Plus or

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whether that be via phone call, email, text, right? This one-on-one coaching program is really designed to give you all the support you need with custom training designed for you, whether you're training from home, the gym, around your limitations, and your goals, nothing cookie cutter here, as well as easy to follow macronutrition programs that are non-restrictive, you'll get customized support directly from your coach's email, or they'll text you, or they'll WhatsApp you. We'll find the communication medium that best supports your goals, as well as provides you with accountability in the expertise you need to succeed, as well as biofeedback monitoring,

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What's going on, guys? Taking a break from this episode to tell you a little bit about my coaching company, Core Coaching Method. More specifically, our app-based training. We partnered with Train Heroic to bring app-based training to you using the best technology and best user interface possible. You can join either my Home Heroes team, or you can train from home with bands and dumbbells, or Elite Physique, which is a female bodybuilding-focused program where you can train at the gym with equipments designed specifically to help you develop strength, as well as the glutes, hamstrings, quads, and back.

I have more teams coming, planned for a variety of different fitness levels. But what's cool about this is when you join these programs, you get programming that's updated every single week. the sets to do, the reps to do, exercise tutorials filmed by me with me and my team. So you'll get my exact coaching expertise as to how to perform the movement, whether you're training at home or you're training in the gym. And again, these teams are somewhat specific. So you'll find other members of those communities looking to pursue similar goals at similar fitness levels. You can chat, ask questions, upload form for form review,

ask for substitutions. It's a really cool training community and you can try it completely free for seven days. Just click the link in the podcast description below. Can't wait to see you in the core coaching collective, my app-based training community. Back to the show. It depends on what type of abnormality we're seeing with your lipid profile. Statins are particularly beneficial for elevated LDL, so low-density lipoprotein. It's an HMG coenzyme A inhibitor. So basically, it works blocking uh production of cholesterol so that that's very different mechanism of action than some of the other lipid lowering medications that we will prescribe it's very effective in lowering your ldl um so if you have significant elevation there you may need a statin um and it may it'll benefit you to be on a set and also has some

anti-inflammatory effects which are beneficial as. Cause as we talked about when the part of that process of plaque formation in your blood vessels involves inflammation. So it may help there as well. So if it's necessary, it's helpful. Obviously if your problem is something like elevated triglycerides, you may benefit from something different entirely. So triglycerides, we tend to see, and what causes elevated triglycerides and what causes elevated LDL are not necessarily the same like lifestyle intervention. As far as nutrition goes, triglycerides, we tend to see some elevations with elevated

sugar consumption, as opposed to LDL, we'll tend to see elevations with increased saturated fat intake. sugar consumption, as opposed to LDL will tend to see elevations with increased saturated fat intake. So different modifications to your diet may cause different changes to your lipid profile. That's interesting. I would have never in my life thought that increased saturated fat tends to trigger a jump in one form of cholesterol, whereas increased intake of sugar might trigger a jump in another. I just figured they all went up or they all went down. Yeah. I mean, we tend to see elevations of all of them across the board when it gets to a certain point. Sure. Because a lot of these things come together. We talked about the hyperpalatal foods. They're

both elevated in- When are you ever getting fat with no sugar? When you ever get sugar with no fat? I think where you run into this issue is with like this huge movement, like towards the carnivore diet and keto. Yeah. That's then that's when you may see like significant elevations of LDL in particular, you may see very low triglycerides, which is great. I mean, you want to lower your triglycerides, but then you're seeing that elevation of your LDL in particular, you may see very low triglycerides, which is great. I mean, you want to lower your triglycerides, but then you're seeing that elevation of your LDL. So that's really, that's where it gets a little bit tricky. But generally speaking, if someone is just eating like these foods that are widely available, you're probably going to see some abnormality to some

extent of all of your lipids. So that's lowering of your HDL, that's elevation of your LDL, elevation of your triglycerides. Gotcha. Now, when I did my panel with Merrick, there were, I'm almost positive, every single lipoprotein you mentioned was in that panel. And I have had numerous clients over the years get a conventional cholesterol panel done. numerous clients over the years get a conventional cholesterol panel done. And usually what they get back is HDL, LDL, and triglycerides. They don't always get these other things. So if somebody wanted a more comprehensive look into their cholesterol, what kinds of things would they want on that lab? So one that's really helpful and I like to track is, I mean, so obviously HDL is important, triglycerides are important, LDL is important. One So one that's really helpful and I like to track is, I mean, so obviously HDL is important,

triglycerides are important, LDL is important. One other one that's extreme, two other ones, I should say, that are really important would be ApoB. So apolipoprotein B is basically on the surface of all of your atherogenic lipoproteins. So that includes LDL, VLDL, lipoprotein A. Basically when ApoB, it's like a collective measure. As that increases, that tends to tell us that we are trending towards increased cardiovascular risk. So that's like, if you're going to check one metric, that's the one that I would choose. Oh, wow. So ApoB is a nice little catch-all proxy for a cardiovascular event or issues down the road. Yep. And then another one that's often not checked is lipoprotein A or LP little a,

and this one has more of a genetic component to it. So that's a lab that I'll generally just check once. And if it's elevated, then that tells me that you have some genetic predisposition to hyperlipidemia and increased cardiovascular risk. And there's certain lifestyle modifications and medications that we can prescribe to improve that. But that's another one that's generally not checked. That's worth checking at least once. Gotcha. So I like what we talked about today with blood pressure and what we've talked about with cholesterol and with the clients and patients I see in my clinic, I would say more frequently, not always, it certainly affects both sexes, but more frequently, I will see elevated blood pressure and elevated cholesterol with men. And I think a lot of this has to do with dietary preference and lifestyle

commonalities amongst men. And another thing that I've seen more prevalent, obviously, I'm not testing for this, but I see side effects of this is reduced production of testosterone or reduced uptake or availability of testosterone. Men who are experiencing symptoms of lethargy, fatigue, inability to repair properly from whether it's sessions that we're doing in the clinic or just the stressors and wears and tears in life. And so like obviously cholesterol, we talked about it, plays an integral role in the formation of testosterone, but dysregulated testosterone is way up there for men in terms of things that they struggle with. And we've talked a lot about the causes of dysregulated blood pressure, talked a lot about

the causes of dysregulated blood lipids. Why are we kind of living, if you had to guess or make the most informed guess you can, in kind of an epidemic of dysregulated androgen production for men? It's a lot of different factors there. I mean, one of which is the same factors that we talked about with hypertension, high cholesterol would be the diet, would be sedentary lifestyle. But beyond that sleep is vitally important for testosterone production. Um, you know, being overweight is, can potentially lead to increased aromatase activity, which means that you're converting more testosterone to estrogen, which means you have less testosterone. So you may potentially run into issues there. And with elevated estrogen, we tend to see elevated prolactin. These, these things are going to cause gynecomastia. They're going to cause decreased

energy. They're going to cause a poor libido, which is a very, very common subjective complaint. You know, so a lot of those factors, but sleep is really important. And one thing that we didn't mention with high blood pressure with with as patients as our population is becoming more and more obese, we're starting to see a lot more obstructive sleep apnea. So that's one other thing that is worth getting checked, especially if you have a spouse, or significant other who's basically saying that you're snoring a lot at night, or you tend to wake up a lot at night, or you feel like you're dead tired when you wake up in the mornings after eight hours of sleep,

then it may be worth getting checked if you have sleep apnea, because that's something that's very easily correctable and will definitely benefit your hormone profile, will also benefit your overall health, including your blood pressure. Yeah. And that's really common and prevalent amongst bigger dudes, whether it's from having a lot of muscle or whether it's from having too much adiposity. If your sleep is long but not restful, you probably won't be giving your body what it needs to form testosterone. Is that because we make testosterone while we sleep? I've always just made that assumption that obviously there's something at the mechanistic level that happens when you are in deep sleep that helps with testosterone formation. But why is it like, because I can speak from my own example, when I do not sleep well,

not only is my libido tanked, not only are my workouts tanked, and I'm very irritable, which I think I would attribute to testosterone dysregulation and just general lack of sleep. But what's happening in those evenings of deep sleep that helps with the formation of testosterone that most men are missing out on. Yeah. So we do produce quite a bit of testosterone and growth hormone when we sleep. And that tends to be from everything I've read primarily during REM sleep, which is the later parts of sleep. So I know like I work night shifts and, uh, when I'm between night shifts, I will tend to get, even if I get like six to seven hours of sleep, I get very, very little REM sleep because that

happens at the very end for me, at least, um, of my entire sleep duration. So those days, I tend to have a lot of the same symptoms you just described. But that's, that's, that's primarily when we will produce a large amount of our testosterone and a lot of things to especially with growth hormone as well. There's a lot of factors that kind of come into play that can potentially increase production with sleep. But all of these factors are the way they're primarily working is by improving your sleep quality. And so that entails, you know, your factors, including sleep latency, the total duration of sleep, and whether you're getting sufficient amounts of deep sleep and REM sleep. And I mean, if you've never used a tracker, it really provides really cool data. But it's not

necessary, obviously. But one other thing that we mentioned already, and I'll say it again, is if you're one of these individuals who's getting sufficient duration of sleep, but you're still feeling restless throughout the day, if you're still feeling tired, you might have sleep apnea, especially if you're on a heavier side, even if you're more muscle bound and you're not carrying a lot of fat. We see that quite often. So with testosterone, I think this is interesting because a lot of people think about testosterone, they go, okay, I'm good. I maybe want to have more because I want to build more muscle. I know what having more testosterone does for me. But what do we see in populations

with subclinical levels of testosterone? Does having too little testosterone actually present as dangerous? Because oftentimes, especially in the fitness community, we're discussing, okay, maybe somebody wants to use testosterone to take their performance to a new level and they're concerned about going too high because everybody's aware of the impact of using exogenous testosterone and going too high. But what about, where do people end up if they're too low? Are there deleterious effects to being too low? There can be. The issue is, to being too low. There can be. The issue is, obviously, we see benefits in cardiovascular health when we replace testosterone for someone who is deficient in testosterone. The problem is, at what point do you pull that trigger? At what point do you say your testosterone is low enough

to replace exogenously? And that's really a personal decision, one that should be made between an individual and their practitioner or provider. Yeah. Because I've seen several patients who have testosterone, their 300s, who are functioning optimally. They have no complaints of low testosterone. That is not someone where I'm going to give them exogenous testosterone and try to get them closer to a thousand. They don't need it. And the range is between usually three and 12, right? That's what we're looking at. Broadly. Yeah. We try to, with Merrick Health in particular, we try to keep it a little bit more narrow. It's somewhere between like, you know, I try to keep it between like 500 and a thousand, especially if someone's on exogenous testosterone, because you can fine tune their treatments. But for natural production, yeah, it's a much wider range, somewhere between

300 and 1200. Gotcha. And for anybody listening, who's like, I wonder where I fall on that spectrum. I can tell you myself, I was at like 681 on my last lab. So about as close to right in the middle as you can get. I think the middle of that range would probably be closer to seven something, but I'm about halfway to 12 and I feel pretty good. And I think fortunately I'm able to use that 681 pretty well. And this is something that I've learned about more recently. You can have two men, This is something that I've learned about more recently. You can at. And maybe they're like, oh my gosh, I'm worried they're going to come back low or they came back low. Does that necessarily mean that they don't use it well? What are the variances between... Because like you said,

you sometimes have people at three that are functioning just fine. Why would that be? Yeah. And you mentioned it. The androgen receptor plays a huge role. So you could have an increased sensitivity at the androgen receptor where someone who has less circulating testosterone will have more of a profound effect from that testosterone than someone who has more testosterone, but their androgen receptors are a lot less sensitive. Those patients may sometimes need to be pushed to almost super physiologic levels to feel a performance enhancement or health benefit from testosterone replacement therapy. And that is largely genetic. And it's primarily from your mother's genes. It's generally carried on the X chromosome. So that's where we get it. And this is the same kind of deal we'll see with

like incidents of male pattern baldness. We tend to see very similar pattern there. So if you got the, this could be a big jump, but if you got the male pattern baldness from mom, maybe you also got some like high level androgen receptor density from mom too? Potentially. It tells you that you're at least very sensitive to the effects of DHT, dihydrotestosterone, which is primarily what's causing the prostate issues and then the male pattern baldness. And DHT is a much more potent androgen testosterone itself. So yeah, I mean, you can kind of gather that information.

Obviously, it's not completely accurate, but yeah, to some extent. And guys, don't make inferences like this if you can just get quality labs done and actually know the answer. It's fun for somebody like myself to ask a physician this on a podcast, but a lot of you guys are going to go online and you're going to make inferences about your health that are not guided by actual data. You're just going to make assumptions based on your perception, which could vary a lot day to day. And I've talked about this numerous times. The investment in labs with the variety of different

servicers now is very affordable outside of your insurance coverage. So just get your labs done at least once a year so you know. Because the time a lot of men, myself included, have spent spinning their wheels on internet forums. I remember explicitly before I got my labs done recently, I was sure, I was vehement that I had low testosterone. I was like, everything in my life, all my issues right now are because my testosterone is low. And I came back normal. And so sometimes getting labs done will give you a peace of mind.

You can stop noceboing yourself. So don't make the inferences that I'm making. Get the labs done. But for people who are interested in optimization, because I do think we oftentimes... I work with a lot of women who are menopausal, and it's extremely common for them to have access to hormone replacement therapy or to have discussions with their physician about hormone replacement therapy. And many of the men I work with who are in that same age range, they've never had a physician discuss with them the ways in which their testosterone might be influencing their health and their wellness. Do you see on a fairly regular basis, obviously you're working with Merrick, so you're a little bit more, I would say, with the times on this stuff, like what are some of the

non-performance, non-gym side of things we see when men get that testosterone in a range that's more optimal? What are some of the health benefits? I mean, huge cardiovascular benefits, right? You'll see improved hypertrophy. With that, you have increased insulin sensitivity. With that, You have decreased adiposity. Generally speaking, an individual will have more energy so they can go out and do more stuff. They have improved libido, um, and improved sleep. If you're deficient in testosterone clinically, and then we replace it, you tend to feel and perform a million times better. Yeah. Uh, now that is not the same as someone who has

an optimal range and then we get you to super physiological levels. That potentially is more deleterious to your health than had we not done that. Totally. And I think that's great because I think when I think about somebody who's using testosterone to go into the super physiological range, I think about that as being deleterious to the effect of the heart. But if you are too low, that's also suboptimal. And so what forms of... Let's first talk about what forms of testosterone replacement therapy seem to be the best and most efficacious. And then let's kind of round things out, circle the wagons with lifestyle stuff. Obviously, exercise and diet shouldn't surprise you guys at this point, but maybe things beyond exercise and diet.

So most efficacious forms of testosterone replacement therapy from a pharmacological standpoint, and then lifestyle stuff outside of diet and exercise. Yeah. When it comes to exogenous testosterone, it's the go-to is primarily injectable in testosterone and then there's different esters uh sipionate and anthonate that will typically they're longer esters there's propionate you can get one in water suspension which i don't recommend because you have to do like multiple times a day injections but yeah yeah the esters um dictate how infrequently you can get get by with injection.

But the reason why I prefer injection over all the other forms, I mean, there's topical, there's pellets, there's an oral form as well. There's a testosterone on deconate that's like lymphatically absorbed. Oh, wow. Yeah. So it doesn't quite affect the liver as much as you'd expect an oral testosterone to affect the liver. But still the issue with a lot of those other forms is their, um, the bioavailability and the, every individual has

such a drastically different, uh, like they, their levels are impacted so differently with those other forms of testosterone replacement therapy. Injectable seems to be the one that we can modify the easiest and get their levels as stable as possible, where you will get a lot less conversion and a lot less side effects from your therapy. And when you say conversion, you're talking about the conversion of testosterone into estrogen. Yeah. And DHT as well. But yeah, primarily estrogen is what we're tracking. Gotcha. So for anybody listening who says, okay, I'm going to get my labs done and I'm open to the idea of a pharmacological intervention if need be, but I'd like to do something on the lifestyle end. I'm already dieting. I'm already

exercising. What can they do with sleep, with supplements, with stress reduction? Are there things that we can really lean into or should they just focus on dieting, exercising, and sleeping? Yeah. So, I mean, there are, there are definitely supplements available now that can improve your testosterone before. I think it's important to, especially for someone who's going to get their lab markers drawn, it's important to make a distinction between primary hypogonadism and secondary. So where one is a lot of these things, a lot of our hormones are produced along the HPA or hypothalamic pituitary adrenal access.

So hypothalamus will create gonadotropin releasing hormone, which stimulates your pituitary to make LH and FSH. LH is what stimulates the testes to produce testosterone. So you can have an issue with the testicle itself where you're producing sufficient amounts of LH and not enough testosterone. That could be from a genetic issue. That could be from a varicocele. That could be from trauma, fromcele that could be from trauma from an infection of the testicle um so that is treated a lot differently than someone who has a suppressed lh which is secondary hypogonadism um so you have some uh supplements like fedosia agrestis for

example that's gained a lot of like popularity recently where that functions by essentially stimulating LH. Um, so if you have suppressed LH, that may be a little bit more beneficial than had you had an elevated LH and a low testosterone, it probably won't benefit you much to take that. That is one supplement. Uh, Tongkat Ali is another one that's gained a lot of popularity. That one works primarily on your sex hormone binding globulin,in, something that we haven't touched on, but as you mentioned, free testosterone earlier, a lot of our testosterone is bound to SHBG, sex hormone binding globulin, or weakly bound to L. And the degree to which the testosterone is bound dictates the effects that we get from testosterone. The free circulating

testosterone is what causes the positive benefits that we see with testosterone. So if your SHBG is elevated, potentially taking something like Tomcat Elite or Boron, which is an elemental supplement that frees up more testosterone, You have more free testosterone and therefore you get more benefit. So there are some things that you can take that are over the counter that may potentially bump up your testosterone, but it's still really important to get your labs drawn and kind of dictate where the deficiencies are because that really changes management a lot. And even for us, pharmacologically, that changes management a lot. management a lot. And even for us, pharmacologically, that changes management a lot.

Absolutely. I mean, I know people that will, myself included, at many points in my training career, we make assumptions. So we just take the shotgun approach with supplements. And you guys will spend a lot more shotgunning supplements than you will snipering your labs. So just get the labs, you'll understand more about what might need to be addressed at the most granular level. And you'll have a patient care coordinator and a physician there to actually help you make guided treatments, which I think is so much better than just self-diagnosing and then buying supplements that might not be worth your money whatsoever because they might not actually be treating the problem. But just to circle the wagons, Dr. Jaborian, it seems like we're obviously living through an epidemic, if you will, of obesity, elevated adiposity, sedentary lifestyle,

hypertensive population everywhere, elevated or dysregulated lipids, and testosterone kind of being lower than I think most men would need it to be to feel their best, move their best, look their best. And it sounds like preventative healthcare, diet management, weight management, and exercise are the things that you're recommending for the majority of people. That's foundational. That's where it starts. So I obviously am fortunate enough to have had the opportunity to have panels done with Merrick. If somebody who's listening says, enough's enough, I want to know where I'm at. I want to make a habit of getting my labs done, which I highly recommend for all of you guys. This is seriously

something that we talked a little bit about the investment in your health. An $800 panel today could save you $25,000, $35,000, $45,000 emergency room visit in 20, 30 years, which I understand for a lot of you that just are like, I don't care. I can't see, I can't forecast that far. Trust me, as somebody who works with people in their 40s, 50s, 60s all the time, the most common thing I hear is, I wish I took this stuff more seriously earlier. So if somebody wants to do that, how can they work with you or get a lab panel, not necessarily with you, but a lab panel comprehensive enough that's really aligned with what we discussed today. Yeah. I mean, MerrickHealth.com is a great resource. It's your choice whether or not you want to kind of link up with a physician or a patient care. Our patient care coordinators are great. They have so much knowledge and they can guide you in the right path. And if you needed

one other step to, if you needed more prescription medications, that's generally when they'll connect you with a physician. But the way Merrick Health primarily works is you go to merrickhealth.com and then you kind of fill out a health questionnaire. And then you'll, based off what service you want, if you wanted to do the entire service of patient care coordinator and meeting with the physician, there's a particular lab panel that they'll recommend. That's very, very complete. But there are other less complete panels, they'll still give you a lot of very beneficial information that are cheaper. So if you can't afford the entire package, then at least get the smaller package where you're still getting a lot of your lipid profile, you're still getting your fasting insulin, your A1C, your CBC, your metabolic panel, plus your hormone panel. You'll get more than what

you need. And it's effective when you consider... I mean, it's cost-effective is what I meant to say, when you consider the cost of potentially avoiding this and having all the deleterious effects downstream. It's also extremely efficient, guys. I did get the Cadillac panel and I learned more about my body than I ever thought I needed to learn. And one of the other cool things that nobody talks about is, yes, you're always looking to potentially screen for something that could be negative, but it's really freaking awesome when you get labs back and a lot of shit is going right. And you can go, you know what? This exercise routine I've got going, this thing I'm doing

with my nutrition, this is reaffirming my decision and commitment to this. You want to stay motivated to continue to work on your health, go get some labs. You're going to get some stuff that you can probably work on. But if you're like me and you're doing stuff right, you're going to get some really positive, cool, insightful data. You'll learn a ton when your patient care coordinator walks you through it and explains how these things work and how these things are influenced. It's like a mini masterclass in your physiology, which I think for you guys who are into it is super cool. And it's so easy. You just go to a lab core or some kind of out of office lab. You're going to get a mild non-invasive blood draw. That's going to go right to Merrick and it's going to get reviewed. It took me under 40 minutes

to drive to the clinic, to get the blood draw, to get the Band-Aid put on. And I literally went to work the same day and I got my labs back in under a month versus if I were to harp on my doctor, which as a young man, if I go to the doctor and I say, hey, doc, I want to see what my testosterone is like. It is like I have to fight tooth and nail to get anything out of them. It is like I have to fight tooth and nail to get anything out of them. And that is unfortunately one of the shortfalls of our system. We are a little bit more aligned with, we're less aligned with preventative healthcare than we should be. I will leave it at that.

So guys, check out Merrick.com. Be sure to keep up with Dr. Alex Jaborian. Where can they find you if they want to keep up with your work? Or if you're not on social media and you're too busy being a doctor, I totally respect that too. Yeah, I'm on Instagram, Dr. Alex Jaborian, but otherwise you can find me at Merrick. You don't want to find me at the emergency department. I love that. I think that's a great place to jump off. Dr. Alex, thanks so much for coming on, man. I really appreciate your time. Appreciate your time. Thank you, Danny.