The Rich Roll Podcast - Kyle Gillett, MD: Hormones & Holistic Health Habits

Episode Date: November 28, 2022

Hormones are the body’s chemical messengers, signaling a slew of physiological processes, including your metabolism, mood, sexual function, and more. Here to help us understand this complicated endocrine language is hormone health specialist Kyle Gillett, MD. A dual board-certified physician in family medicine and obesity medicine, Kyle is an expert in optimizing hormone levels to improve overall health and well-being in both men and women. He earned his medical degree at the University of Kansas School of Medicine, practices at the Gillett Health Clinic in Olathe, Kansas, and is the host of The Gillett Health Podcast. In this wide-ranging conversation, we cover what hormones are, the key role hormones play in our overall health, and how we can leverage what Kyle calls the six pillars of health to optimize hormone health. Kyle explains how diet, exercise, sleep, stress management, sunlight exposure, and spiritual practice are more powerful than any medication or supplement out there. Show notes + MORE Watch on YouTube Newsletter Sign-Up Peace + Plants, Rich

Achieving optimal health is kind of like standing at the top of a quicksand pit. You're never really truly going to get there, but there's many ways that you can not be sunk in the quicksand. And 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. I consider the gut microbiome, the front lines of your immune system. So your immune system is like your military. The most common problems are what full spectrum or primary care physician should be the best at. And I've noticed that there's an

epidemic of obesity and it is technically an epidemic according to, I believe the CDC. There's also an epidemic of hormone pathology. So obesity and its related pathologies like metabolic syndrome and also different hormonal pathologies like subfertility 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. The Rich Roll Podcast. Hey, everybody, welcome to the podcast. Super geeks assemble because today we weigh deep into the weeds of science, hormones, and health

with Kyle Gillette, MD. Kyle is a dual board certified physician in family medicine and obesity medicine, as well as an expert in optimizing hormone levels to improve overall health and wellbeing in both men and women. Dr. Gillette earned his medical degree at the University of Kansas School of Medicine. He practices at the Gillette Health Clinic in Olathe, Kansas, and is the host of the Gillette Health Podcast. In this wide-ranging conversation, we cover what hormones are, the key role hormones play in our overall

health, and how we can leverage Kyle's six pillars to optimize hormone health. Those six pillars more powerful than any medication or supplement being diet, exercise, sleep, stress management, sunlight exposure, and spiritual practice. This episode is both dense and granular with tools and practices relevant to improving everything from mood to fertility, longevity, disease prevention, relationships, and more. But first... We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since,

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Okay, so this was a fascinating and stimulating conversation. I think you're going to really dig it. So without further ado, this is me and Dr. Kyle Chalette. Right on. Super nice to meet you, Kyle. Thanks for doing this. I really appreciate you coming over here to spend some time with me today. We're gonna get geeky. Can't wait for it. But I wanna start with just a little bit of 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 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 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 quite a bit of experience with

that. My sense is that 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 have 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. 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 immersiveness of it, because you're really working with families and young people throughout the 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 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 there's also an epidemic of hormone pathology. So obesity and its related pathologies like metabolic syndrome and also different hormonal pathologies like subfertility 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 gonna dive in today. Hormone health, metabolic syndrome, obesity, et cetera. And just to 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 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 diagnosed and prescribed. Whereas you are one of the many kind of burgeoning functional medicine, holistic medicine practitioners. And as a young person, that gives me hope. Like I feel optimistic about the future because there is so much interest in expanding what's available from our healthcare system.

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 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, many, many physicians, not just myself, that are very interested in true preventative medicine and health optimization.

So let's get into hormone health. I mean, first, my first question to throw to you 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 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 wanna 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 called it a signaling molecule, but what is it specifically? I mean, I think for the lay person, when you say hormones, they think about testosterone, they think about estrogen. 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, they talk about peptides and culturally peptides are more known, not really as hormones, but as 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 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 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 wanna 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 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 dysregulated 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's 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 obviously this is going to depend on 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 gonna 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're 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 medical advice being given today. This is general information purposes only. Correct. And 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.

Right, it depends. Yeah, that's always a frustrating one, right? Everybody wants the answer. Yeah. And you're the guy who's supposed to have the answers, but it's complicated. So the pillars that you mentioned, let's go through them. You've defined these six pillars that kind of encapsulate

what it means to 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, they're the most powerful pillars, if you will. And then the last four, I used alliteration. So you have your stress optimization.

So you wanna have some effort in life. You wanna 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 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 dismissed on some level.

And I think it's really important. And I can't help but ask, how did you divine these pillars? I assume they're evidence-based, premised on all the work that you've done as a scientist. But when it comes to the spirit thing, I think of Lisa Miller's work at Yale on the science of spirituality, which I think

you've probably are familiar with. She's been on the podcast, but also, you know, the blue zones work. Like there's a lot of, 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 themself. 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 modifications. And these lifestyle modifications are more powerful than any supplement or medication. Now, 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, at the place where we were staying, I overheard a conversation of an individual say, 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, if not all six lifestyle pillars, they have at least dialed in the diet and exercise. So those are like, you know,

they're the foundation of the pyramid in your own, the Gillette hierarchy of needs for hormone optimization. Yeah, and I think that an individual such as yourself has also emphasized and healed yourself with a lot of these lifestyle pillars as well, just learning it anecdotally through life. Yeah, sure. I was curious why, my sensibility would be

that there maybe is room for a seventh pillar, which would be community. Maybe that weaves into spirit on some level, because it is about connection, but community seems to be a big piece, especially as we really get old, like 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 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. 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 prediabetes. It's the most common cause of low testosterone in men. And also it leads to other pathologies like anovulation, 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 endocrinologist and then cardiologist, and now they have cardiometabolic clinics at 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 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 to 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. There are 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 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. 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 instinctual eating or you're eating and it's intuitive, intuitive eating. And that will work if you've given yourself the tools

to be able to intuitively eat. Right, there's a problematic aspect of that. Like we're both smiling, right? Like intuitively, I just feel like I need this thing. Like, is that a really 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 anorexigenic center, which is exactly what it sounds like, and the orexigenic center, which I call the hangry center. And if those two are not balanced, you're not gonna be able to intuitively eat. Right, you'll be overridden by some craving that doesn't serve you, that you're powerless to resist.

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 kind of biohacking universe of people who are interested in exploring human optimization through diet and other protocols,

but can easily sort of shadow disordered eating behind, like I'm fasting, it's intermittent fasting, or I'm doing this quote unquote protocol, when in truth, they just have sort, 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 said 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. 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 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 dietician, 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 or 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, 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 and pharmacokinetic effects,

which is how your body metabolizes the drug. So if you're taking that many things, then there's certainly going to be interaction. Yeah, and look, everyone loves talking about supplements. 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 wanna take because that's the easy lift. It's the easy fix. The other lifestyle modifications require work and habit formation, like you said. So I'm not against supplementation. I take a bunch of supplements, 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 wanna get into the supplements, but on the subject of the foundation of establishing hormonal health and just health generally, talking about diet and exercise, 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 quicksand pit. You're never really truly gonna get there, but there's many ways that you can not be sunk in the quicksand, that would be pathology. And the digging out of the quicksand or 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. Metabolically, they're a maybe they're not obese, but they got the love handles. They've never been able to lose them. Metabolically, they're a little bit off. How are you sort of trying to diagnose that person and course correct 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 rightly puts the emphasis on listening to the patient. Many people have, 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. 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 cardiometabolic clinic at a huge academic center and usually an academic center in a hospital, but not everybody can do that. There's just not enough supply. So following up with the patient longitudinally and developing that rapport or that relationship between the healthcare provider and hopefully the interdisciplinary team. I'm a huge fan of working with many different healthcare providers as a member of a team, dieticians included, counselors included when possible. Having more minds to answer the question is always better.

Sure, sure, sure. And my sense is that you're someone 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 15 years. And 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 more specifically, what are the things that you're trying to get people to do more of and do less of? More than 90% 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 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 are growing it. Do you grow your own food? As much as possible, maybe 5%. You live in the bread basket, come on. Yeah, it's extremely difficult.

And we have a huge garden and we have 15, maybe 20 chickens now. Wow. So we do as much as we can. And 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 the family still does. And even with that, 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 whole foods close to their natural state, making sure that you're meeting fiber demands,

which most people or a lot of people are insufficient at doing. Where does that leave you? What are your thoughts on the carnivore diet? Cause that just seems to be like, infecting the internet right now. And people seem to love trying that out. what are your thoughts on the carnivore diet? Cause 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 the category of elimination diets. So somewhat in the same category as for example, a Whole30 where you're trying to, 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 diet. Sure, 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 the inhibitor of that channel. And those people might be able to tolerate a carnivore diet

and have a particularly low ApoB, which is the marker that you really wanna look at. But if you compare individuals that are on plant-based diets, 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 ApoB being kind of the favorite marker for establishing kind of where you're at in terms of cardiovascular disease. Yeah, there was an article published in the Journal of the American Medical Association, the cardiology version of it.

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 gonna go ahead and the lab is gonna go ahead and test an ApoB after that. Right, 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, yeah. You mentioned prebiotics, probiotics. We were talking about fiber. Talk to me a little bit about the relationship between 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 ulcerative colitis. Even after one 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 trying to diagnose them, you're gonna have to look at gut flora as a marker of hormone health and hormone health as a marker of gut health. Yes, like these are not 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.

So on the subject of diet, obviously, 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 assuming that the laws of thermodynamics are in place and on some level, 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 a manner that's different from somebody who doesn't suffer from that. So there's a lot of these people out there and more and more every day. So walk us through like the experience of treating a patient like that and how you counsel them

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 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 strict calorie counting or even going on a very low calorie diet, 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, and perhaps their metabolism is lower and their caloric maintenance is lower as well, versus an individual who hasn't tried anything. In 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 dietician underestimates how many calories they consume by at least 10%.

So even doctors and dieticians don't accurately track 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 mac 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, 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'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 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 metabolic system of the body becomes more robust and able to metabolize food

and perhaps lose weight like a normal person. Yeah, and 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 if there is something off, then 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, 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 when you have 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 prediabetes, 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 semaglutide,

which are insulin sensitizers. And perhaps their insulin is normal. In that case, maybe someone would benefit more from a medication that would help balance out that anorexigenic and orexigenic 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 another example of an individual and their main issue is eating really late at night or after 8 p.m. 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 orexigenic and the anorexigenic center. So if you're hangry, you're not gonna sleep very well. Yeah, yeah, but if I eat too early and I'm, when I go to bed, I have trouble falling asleep. Yeah. It'd be interesting

to see what a, a CGM would look like. 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. I think the thing with that is you gotta be really careful because I'm a lay person, right? I have some science vernacular, but 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 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 is something called Don 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 can see this on a CGM as well, most CGMs. And as it drops low, your body makes glucagon, which spikes up 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 don't know what's going on metabolically with that, but I learned that like the one meal a day thing is like, no bueno. You know, I talked about that with Peter Atiyah, 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 lay person about how to interpret all this data

so that people are making informed decisions and not reactive decisions to momentary spikes and data inputs that they don't truly understand. Yes, I certainly agree. 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 better. Right, right, right. How about the person who kind of rubber bands like the guy who, or the woman who, you know, loses a tremendous amount of weight and then six months later has gained all the way back. What is that doing to somebody metabolically 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 accustomed to consuming this many calories and now they can't even consume that many.

So that's the main mechanism behind what is kind of culturally known as metabolic damage. And it certainly happens. More than 90% 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 menarche. And during some areas, depending on your genetics, you may have different dietary needs. For example, if there's 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, 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 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 niche 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 hormones are metabolized very quickly and they also just run around unregulated. Right. So that's women, right? So, and then what about on the guy side?

For the guy side, guys do have SHBG. 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, And men have many times that more testosterone than estrogen, but estrogen is particularly important. You can see low SHBGs in men as well. You usually

want a medium or a high SHBG. A good rule of thumb in men 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.

It is certainly good unless it is high relative 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 things in the right direction for that individual? Ensuring that you're getting optimal essential fatty acids

and essential amino acids, for example, omega-3s or your essential amino acids. That's first and foremost. For many people, that might be more than the RDA of that nutrient. And then depending on what other pathology that individual might have, that would come next. But many people are, 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 xenoestrogens, 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 it's statistically significant if you design a study to see that. 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, what did you say? You said xeno? Xenoestrogens are estrogens in the environment, like BPA, which is known as bisphenol A. So you might see your water bottle says BPA free,

which is great. And then phytoestrogens are somewhat estrogenic from plants, but usually they are very weak. Right, okay. And if anything, they're beneficial. Right, okay. Let if anything, they're beneficial. Right, okay. Let's talk about exercise. Talk to me generally about how you think of,

think about exercise as this second pillar. Exercise, and again, another analogy, it is how you keep your body using. So it would be like you have a 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 and you never drive it, that car is not going to function well.

Even if you leave it there for a year, you're gonna have to change the oil and whatnot because it hasn't been moving. But humans are the same way. You can't just put a human and sit them down in an artificial indoor environment. They're designed to move. You have anaerobic and aerobic exercise,

and both are particularly important, whether it's the easier exercise. I know Peter Atiyah talks a lot about zone two 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, if you're looking at somebody who's pretty busy and you're saying, you gotta do zone two, you gotta do resistance training, you gotta 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.

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. How about 25 hours of zone two a week? I've been there. That would be a lot. The aerobic base is huge. Well, the great thing about zone two is it's a day in day out thing. Like 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 gonna be overly fatigued, but your high output stuff, you gotta pace it out because you do have to allow your body to recover. So it's about like, you know,

being mindful of spacing the workout so that you're giving your body time to heal and get stronger. Absolutely. True overtraining is relatively rare, although perhaps an individual like yourself would always be on. In your world, you're probably always teetering on the edge.

But for the average American, most are not overtrained. They're just getting used to that adaptation. And for an individual like that, let's just say the average American, starting and emphasizing vigorous exercise can be detrimental because they feel so tired or sore, at least the first month, to where they're not wanting

to incorporate things like zone two. 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. 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 autocrine and paracrine. And usually these effects are very short. So if you do it just a couple of times, it's not gonna 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 10 reps, then it can help optimize your androgen profile, specifically testosterone. If you do this just one time, then 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 overtraining, the kind of catchphrase that comes up often is adrenal fatigue. My sense is that adrenal fatigue is not a thing. 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 overtraining 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. And adrenal fatigue is still not one of those. You can have Addison's disease, which is a lack of adrenal hormones. They're 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 in postmenopausal women and then two, because DHEA is like the pawn on the chest board 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? DHA, is it omega-3? Okay, I get confused between all the DHS. Yeah, however, DHEA is an over-the-counter supplement. So in some countries, I believe the UK and Canada, it is a medication. There's a scientist recently passed away. I believe his name was Dr. Fernand Labrie.

And he's interesting because he was the one that showed that prostate cancer treatments that basically shut down the pituitary from producing 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 studied DHEA. However, 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 adrenal shut down. And this happens for everyone, but just at very different times of life.

Right. And if somebody is truly overtrained, 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 Tongkat 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 steroidogenesis cascade in each tissue. Right, got that. Like Huberman got me on the Tongkat 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 truly are overtrained, 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 can't help but wondering, like, if they go to see you, perhaps there's a way to, if somebody 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 is 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 Tonkat for example's sake, there's one individual that has PCOS. They likely will not benefit as much from Tonkat because they've already upregulated 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 who's very insulin sensitive could benefit greatly from Tonkat. Yeah, interesting. athlete and who has been in a caloric deficit perhaps, and who's very insulin sensitive could benefit greatly from Tonkat. Yeah. Interesting. 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 go in and out of how fit I am. And I'm certainly not doing 25 hours of zone two now, but I do get out and get after it. And I have my good days and my bad days. And as I get older, obviously the more fit I am, the less likely this is. But like in my current state, I'll have really good days. But 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 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, but 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, but I don't like to be on it for extended period of times.

Cause I literally feel like I'm carrying around like 15 extra pounds. Yeah, creatine has a couple of hormonal effects. It can somewhat upregulate 5-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. 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. 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 to actually think of it as your powerhouse. Mm-hmm, mm-hmm. There's also some evidence that there may be some cognitive enhancement and mood enhancement with creatine. Seems like the science on that is more recent. Creatine and to some degree beta-ene 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-ene can potentially help decrease that.

Interesting. And walk me through L-carnitine. I've never taken that. I know it's not very bio available, but I don't know much beyond that. Correct. About what it does. It's the smallest peptide hormone. It's just two amino acids put together.

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 of different functions, but just think of it as the fuel pump. It makes your pumping 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 result. 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 dietician 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 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, I'm wondering, is this more confusing than helpful? if they don't have somebody that they can call upon

who can actually give them, you know, real guided counsel. Yeah, 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 wanna take it, even if you're not getting blood tests, then perhaps take 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. And don't conflate it by taking other things, right? So you can kind of monitor the variables. Yeah. As somebody who's been plant-based for 15 years, and there's a lot of plant-based people that tune into the 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 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, 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? Like which one? Cyanocobalamin? If you check, well, 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 a MMA, which is a methylmalonic acid,

then that should tell you if you need a specific and a B12 and perhaps a 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 a safe way to start. And 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 of 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 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, they actually might think that's too high in some cases, but they could still be iron deficient. Right, got it. Let's talk about stress and stress optimization. So how are you thinking about this

in the context of hormone health? Yeah, a lot of people have, and this kind of encompasses mental health as well and social health. Maybe we do need to add a seventh one there, but 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 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 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 chronic low level to high grade stress, and we've kind of acclimated to that as a normal, right? Everybody's stressed out, everybody's anxious,

and our lifestyles are kind of oriented around being in environments that produce it, support that. And you could tell people you need to meditate, you need to have a mindfulness practice, but the boss is yelling and the kids are crying and they're up, 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, et cetera. So talk about the, like get into the hormones of chronic stress and what that's doing to us and how it's dysregulating our health and how that impacts us down the line

and 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 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 sort of extrapolating on that idea,

essentially what you're saying is if you're in a chronic state of stress, it doesn't matter how great your diet is or how well you're sleeping, this cortisol issue could create type two diabetes in you nonetheless. Correct. A pathologic overproduction of it

is known as Cushing's disease. So that can also be very detrimental for your health and 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 Imodin is another one. I think it's derived from rhubarb. So again, with cortisol, the dose can make the poison as well. The other main axis of stress that would be hormonal would be your adrenergic nervous system.

You also have things like dopamine, epinephrine and norepinephrine, catecholamines. Basically, 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 well, substance addiction or behavior addiction, right? Because hormonally, 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 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, 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 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 an androgen standpoint, I am not sure if it would optimize your testosterone or estrogen. But clearly effective. It's one of your pillars, right? You stand by it. Yes, for sure. Well, it gets into,

it kind of gets into your next pillar, the sunlight pillar, which is kind of about being in nature, right? And there's also a microbiome piece to that as well, sort of breathe your biome, like being immersed in a multitude of species of plant and animal life and breathing that in like being immersed in a multitude of species of plant and animal life and breathing that in and grounding your feet in the soil and doing the sun gazing as Andrew talks about

and all of that. Like our kind of Western minds are very dismissive of that, but this is the missing link. We've become so detached from that you know, that, that, you know, very healing and primal fundamental aspect of what it means to be human. Humans have, are definitely adapted to be outdoors, even if it feels easier to be indoors.

There are so many 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 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 there's another house right next door. What about when you're walking through the forest though, the deep forest? Yeah, I would say being around the new clean, fresh air in the forest is helpful. Being around the green is also helpful. Being aware of your environment, even if there are no dangerous animals in the area,

then you're still just more peripherally aware. You can discuss the benefits of using your peripheral vision, 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 goes on your notepad 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 coworkers 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, 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 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 and 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. The testes like to be several degrees cooler than the rest of the body.

So if you're in especially very warm water for a long period of time, then that can decrease sperm counts. As far as the benefits of cold exposures like cold dunks, you're avoiding frostbite and you don't wanna 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, a sauna 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,

cryotherapy versus ice baths? There seems to be a raging debate about the pros and cons of these two things. From a hormonal standpoint, 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 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 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 debate has something to do with 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 like more heat damage to begin with. So probably an ice bath. Right, well, as a former track and field athlete who has experience with the recovery benefits of being in an ice 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 Norma Tech boots or ice baths or sauna or turmeric or some of the foods that are 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 sort of undercutting the benefits that we're trying to seek by exercise-induced stress? That's definitely true. There is, I believe, a clinician from Harvard years and years ago that coined the term RICE, rest, ice, compression, elevation. And 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 of VEGF, which can help with vasculogenesis and healing. 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 NSAID? 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 situations in which it's appropriate 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 kind of want, 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 the boots and all this 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 wanna 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.

So during a phase where you're really breaking things down, 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. Sleep, talk about sleep. Obviously good sleep hygiene is gonna improve your hormone health and good hormone health

is gonna 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 then 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 hypogonadism. Right, so I wanna get into testosterone in a few minutes, but if you're thinking, well, my testosterone is low, but my sleep is dysregulated before going on, you know, testosterone replacement therapy, maybe dial in the sleep. Yes, I've 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 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, 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 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 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 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 just saying you gotta 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 wanna ensure that you have optimal acetylcholine throughout the body. Some things that have optimal acetylcholine

throughout the body. Some things that reuptake acetylcholine, like huperazine is a supplement that some people will 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? Huperazine 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 Taybex or Cystenium, which is a different plant,

not a tobacco plant that forms the alkaloid nicotine, but a different plant that forms the alkaloid cysteine. And those are over the counter supplements that you have a penchant 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. 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 sense is HRV is pretty accurate with things like this and the aura and stuff like that.

How do we think about HRV? Like I'm always comparing mine to my friends and I know it's a highly individualized thing. And I guess intellectually, I kinda 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.

There's a scientist 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 heart rate variability, it's gonna 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? Correct. You don't want that intermittent in between beat 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 two different parts of your autonomic nervous system. Your heart, you're not 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 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 atrioventricular 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 sigh 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, one thing is called physiologic splitting of the heart sound. You can actually hear the ventricles and the atria contract at 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 why is it 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 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, I guess in layman's terms, 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 do, it's really hard to elevate that. Like if you really dial in your health, can you 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 metric that's a more recent add to the whoop 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 COVID twice and both times my metabolic rate skyrocketed the day before I had any symptoms. So it's 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 part of 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 gonna require more of your heart, right? So that's how that is getting into the calculus there. Yes. Right. Interesting. Back on sleep for a minute.

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 at 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 vasomotor symptoms of menopause. And a lot of that is related to your estrogen.

If you replace a bioidentical estrogen in those individuals, often the vasomotor 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 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 acetylcholine and also depletions of dopamine. Dopamine is also a neurotransmitter hormone kind of combo that can be implicated in disorders sleeping as well. Before Parkinsonian disease,

Parkinson's is basically where a little area of the brain called in the basal ganglia called the substantia nigra 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. You would perhaps say, look into acetylcholine or let's see what's going on there,

maybe prescribe you and, you know you a supplement that would enhance that. Perhaps, I'm also a fan of getting a clinically validated polysomnogram. I do love wearable data and I think that it is the future. But if there's 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 that. Right. Typically people think when they think of sleep supplements that aren't sleeping pills, they think of melatonin, right? But not a good idea to be consistently taking melatonin. Before any individual would take 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 a form of 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 wanna 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 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. Remeltion 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 romaltion, 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 supplement. Yeah. One thing that I discovered recently, a couple of months ago, I began to notice that when I eat pistachios, I get fatigued maybe 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. 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 keep your triglycerides slightly higher, which can stabilize your glucose. So your glucose and your triglycerides are 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 now. Yeah. I keep a little bowl by my bedside. Anyway, I'll find out afterwards what's going on there. Okay, let's move into hormones more specifically for men and women. When you think of men and hormone health, 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, 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 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, you know, maybe we can start with 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, 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 prediabetes. 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 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 wanna go on it, right? It's just, I mean, I'm not speaking for myself personally. I think there's a lot of,

like I think what you said is very well put by the way. 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, we're not so great about thinking about the long-term risks. Like the guy is like, I wanna feel like myself. I wanna have energy.

I wanna have libido. I wanna be able to put on muscle mass and feel strong in the gym. And yeah, the down the line stuff, is it gonna put me at greater risk for heart disease, all those kinds of things, 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 gonna be counterproductive to the goals that you're seeking. Guys are just gonna do it nonetheless and pay the price later. Yes. And there is certainly an epidemic of 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 healthcare provider is so important.

Yeah. 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 probably not the best place to get your hormone advice. Maybe not, there's always exceptions and 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, and fertility as well, especially so perhaps. So you can't just be a hormone expert in isolation. You have to have 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 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 suboptimal. 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, 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 or 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 12 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 esterases 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 12 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 hair loss, how related to hormone dysregulation is that versus genetic presets? What are possible interventions that could 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, 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 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 bind 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. 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 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 pantheon of hair loss patients, like 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 5-alpha reductase inhibitors that just decreases DHT. It also might include topical antiandrogens 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 clascotirone, which is a kind of a sort of a SARM, but 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 potential side effects that you mentioned? If any antiandrogen 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%. So you wanna 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 inhibitor. Wow, I think I understood about, I don't know, maybe 30% of that, but I get the gist of it. And mainly, 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'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

androgenic alopecia meds. One is called finasteride and that only inhibits two of the three enzymes. Of 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 many different side effects

from other 5-alpha reductase inhibitors. Wow, interesting. Fun fact also, you used to cut and color hair. Yeah. You were a hairstylist. Yeah, essentially. I made very, very little money from it. Yeah, but this is part of your homeschooling.

Yeah, I suppose so. But yeah, for quite some time. And I still cut the hair for many of my friends and a couple of my patients as well. Full service. Yeah, there's a lot to the saying, look good, feel good. Yeah, for sure, right? Cool, well, what are other,

some of the common male hormonal interventions 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 peptides and PRP and the like.

So I know a little bit about that. It's been an interesting kind of journey with all of that, but 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 TB 500, BPC 157,

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 components of PRP is VEGF, which is actually a cytokine.

And if you have a higher level of VEGF, then you're gonna 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 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, yeah, yeah. For some people it's feasible. Yeah, and what do you know about emerging science around placenta stem cell therapy?

Like this is like wild stuff. Yeah, 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 stem cell banking is something that each individual should consider. We actually chose not why stem cell banking is something that each individual should consider. 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. Some people have heard of a family that had a baby specifically just to help cure like a rare bone cancer or whatnot. So a lot of this 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 bank cells from your kids. What was the rationale for that? It can be relatively expensive.

And I am not 100% convinced that it will be clinically significant for individuals that do not have a rare disease. So for example, 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,

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 banking

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. And what makes it tougher is that often the individuals 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 freezing eggs or cryo storage for sperm. Yeah, yeah, yeah. I wanna turn to female hormone health specifically in a minute, but on the subject of stem cells, I can't help but think about what's going on

in longevity science and anti-aging science. And I just, I have to ask you kind of where your head's at in terms of 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 what's real

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's your head with all of that? So interventions, anti-aging interventions, we could talk about like mitochondrial or growth agonist,

NMN, NR, even NAD ion patches or NAD infusions. And rapamycin. Correct, rapamycin. Correct. Rapamycin is- That's a little different. Correct, that works on mTOR. So mTOR is mammalian target of rapamycin. And I think that has amazing promise as well. And it is currently clinically applicable as is NMN,

as is metformin. Metformin has three main effects that I think of. It's effect on SHBG. It likely bumps your SHBG 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 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, which is kind of like zombie cells, if you will, precancerous cells. They're probably not as good at a candidate for rapamycin, but if there's someone on a very high protein diet,

a lot of proteins like 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 can likely be prevented with it. Now it's all still theoretical, but it is a very well tolerated medication. With NMN, there might be such a thing

as too high a dose of NMN. 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 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 potentially linked with cancer risk. 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. You 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 nicotinamide riboside, which is NR and NMN, which is nicotinamide mononucleotide. And I usually stay around a dose of 250 to 500 milligrams of NMN and NR. And again, I don't think necessarily anybody should do this.

Cancer does run fairly strong in the family, both especially like the hormonal cancers, like prostate cancer and breast cancer. I do take metformin only with my rapamycin. Yeah. So you're on the 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 of, I haven't developed cancer yet. Yeah. And hopefully I wouldn't have even if I hadn't taken it, but no deleterious side effects.

Right, but no like noticeable energy boost or anything like that? 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 NMN, the rate limiting step is likely not NAD plus for your energy. Many powerlifters and other athletes take ubiquinol, which is 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 booster or the backup fuel tank, which could be seen as creatine. Right, I could be wrong, but I seem to recall that Peter Atiyah talked about his experience of being on metformin. And I think he did it for quite a while, but ultimately 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 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 decrease your active or free IGF-1. Just like you have a free testosterone,

you have a free IGF-1. So it both increases the IGF binding peptide one and decreases IGF-1. So if you're already suboptimal 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. So it kind of depends on what your baseline is. Yeah. Interesting. That's wild, man. Wow. Very, very interesting. Let's turn to women's hormone health for a little bit. Conversely, from men who are obsessed about testosterone and virility and what we just talked about, from a women's perspective,

I suspect their concerns orient around fertility, what happens with menopause and the focus being on estrogen and maybe progesterone, right? So talk me through kind of how you think about women's health and hormone health specifically and 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, will 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 rooks and knights and bishops are testosterone. And the only difference between the chess board 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 adrenopause, which is where they have a decreased DHEA at the same time as menopause, 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. So addressing these things by getting a baseline lab before your menopausal 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 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's something that's related to, for example, testosterone production, the theca cells of the ovary also cease to function in menopause, which gives you almost half of your testosterone, but ensuring that your adrenal production is as good as possible is the first step.

That's kind of 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, walk me through, obviously these are all different things, but like the relationship between hormone health and the incidents 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 if 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 one diabetes, precipitously increase growth hormone. That's the reason why those individuals are more prone to cancers as well. So you wanna 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, because that will also grow endometrial tissue or it 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.

A lot of genetic polymorphisms are variables. There's a benefit to it historically, even hypercoagulability disorders can be productive against postpartum hemorrhage, which is not as much of a deal now as it was a hundred or 200 years ago. But keeping in mind the needs of a patient, 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 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 gonna have these massive data sets

and we're gonna be getting 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.

It's like, it's ridiculous based on the technology of 2022, but hopefully that's where we're headed and that's how you can really not only practice true primary care because you're seeing things before they happen and addressing them before they become truly problematic, but also it feels like that's gonna create its own business model that's gonna make it

a 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, how would that be best addressed at the medical school level? That's a really difficult question to answer. Probably not at the medical school level. There are many people that go into medicine with altruistic motives, but 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 gonna 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 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 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 like to see 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?

I 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 a case-based education. So not necessarily modules here and there, but they're trying to get people into more clinically relevant positions. 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 a single payer. I think one change that has really helped emphasize 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 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 philosophical point of view, like my understanding of medical education is that it's predominated by studying disease and how to treat disease. It's not about like how to optimize wellness, right?

Like that's just, I mean, 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 graduate from medical school with an understanding or a toolkit for how to promote optimal wellbeing in people. You just know how to treat diseases as they come. I mean, am I being unfair? Like, no, I think that's certainly true.

There are new fellowships that are 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 likely help address this. 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 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 healthcare policy. Like what kind of global systemic changes would you like to see that would make this a more optimally functioning system that's truly serving patients? Yeah. So as Surgeon general, I think in the last 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, 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. And earlier screening.

Correct. Yup. 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, M-I-P-S.

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, 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 two diabetes and prediabetes 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% 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 healthcare system in order to do that. Because otherwise we're looking at some kind of, you know, economic bankrupting disaster.

Like how are we gonna manage all of this? Yeah, not a lot of tertiary care. Yeah, I know. It's just economically impossible. A lot of primary care. One interesting thing you mentioned that it's happening economically impossible. A lot of primary care. One interesting thing you mentioned that it's happening earlier and earlier, the New England Journal of Medicine did a study,

an epidemiological study, at 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 grow out of their fat phase. So during puberty,

they would 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 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 of years

that you're kind of catching up on. And then during your last year of high school or first couple of years of college, then those individuals will reenter 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 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 gonna be homeschooled, right? They're gonna 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. So they're a huge help, especially for their age, definitely being outdoors. I don't think they necessarily need to be homeschool

all the way through, but I would certainly plan on it. I think that it helps, 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. 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 do you have a specific homeschooling protocol? Is it unschooling? Is it like a rigorous academic curriculum? Like how does it look? How did it look for you? And what do you envision 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 a Tapestry of Grace, a Becca. 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, they're two and a half and one.

So they haven't really started a lot of school yet. But I do like the Montessori model. I think that is great, especially for young kids. My wife is a 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. In this area, I think that just because the thesis isn't true, it doesn't mean that the antithesis isn't true. So a lot of people are like, well, all school is bad.

Everyone should be homeschooled or nobody should be homeschooled. It's too much dependent on the parent and not the society. So the truth is probably somewhere else. Right, so if you're gonna practice personalized medicine, you're gonna practice personalized academia. Yeah, 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, with hormone health in mind, of course, but with obviously the intent being to sidestep

all of these 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 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 tours 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 not pass along, whether it's a language or whether it's 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 haven't heard anyone articulate that, but I would agree with you wholeheartedly. That's beautifully put and solid advice, my friend.

I think the last thing I wanna just kind of quickly get into is some counsel 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? Are there resources available? Where do you point people 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, 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 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 ND as part of their healthcare providing team or a dietician and 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. ABOM is the certifying organization, American Board of Obesity Medicine. That is also a great place to start. That's good. And if somebody 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 excited individual wants to get a picture of their hormone health. Like, you know, maybe they could tell their doctor, like, I wanna 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 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.

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, 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 to contact you if they're interested in that? Correct. 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 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 us one time in person. And then after that, almost all their follow-ups are telemedicine, let's say, maybe this person sees us one time in person. And then after that, almost all their follow-ups are telemedicine for 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 if people wanna learn more about you, they can listen to your podcast, the Gillette Health Podcast. You've done a couple, not a ton of it. Did you just start it or do 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 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 outset of this podcast that we were gonna 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 don't know that I could do any better than you guys did on that regard. And that's it, man. I think that's it for today.

I just wanted to kind of end it by saluting you. I think it's really cool what you're doing. I think it's important work. And I really think that you are a model of the future and a role model for future doctors. And I really appreciate you coming here and sharing time and space with me and the audience, man. And I'm at your service if there's anything I can ever do

to support you or help you out. Thank you. It's an honor and a pleasure. Yeah, cool. Instagram also, drop your Instagram. 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 always welcome to come back here. There's plenty of other stuff I could talk to you about. And it was really cool, man. So thank you. Thanks. Peace. That's it for today.

Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive, as well as podcast merch, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power

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See you back here soon. Peace. Plants. Namaste. Thank you.