Episode #124: Dr. Kyle Gillett: Health Optimization for Our Mind, Body & Spirit + Hormone Health Tips & Microbiome Discussion
My guest today is family practitioner and obesity specialist Dr. Kyle Gillett.
Dr. Gillett is a wonderful example of where I think medicine is going. He believes in treating each patient, and their lifestyle, to come up with the best options for whatever they are medically navigating. Dr. Gillett is not opposed to medication but he believes in treating the mind, the body, and the soul. We discuss hormone health for men and women and how that not only impacts fertility but our overall well-being. He shares some of his interesting observations about obesity and Neurotransmitter receptors.
Dr. Gillett is incredibly bright and I spent a lot of the conversation trying to catch and translate all of the helpful information he so eagerly wants to share. We should all be so fortunate to have such a passionate and informed doctor. Enjoy
Listen to the episode here:
- Dr. Kyle and His Obsession [00:02:01]
- On Children Allergies [00:06:16]
- Gut Health and Microbiome [00:13:57]
- Six Pillars of Health [00:18:03]
- Peptides [00:29:37]
- The Stress Pillar [00:38:56]
- The Spirit Pillar [00:43:01]
- Intermittent Fasting [00:52:31]
- Obesity [00:59:00]
- Personal Supplements [01:21:30]
- Hormones: TRT and HRT [01:27:16]
- Supporting the Cell Powerhouse [01:41:56]
- Managing Inflammation [01:44:34]
- Infertility [01:52:10]
- Micronutrient Panels [01:56:20]
- Joint Replacements [02:00:36]
- Metabolites [02:03:59]
- The Calling to Educate [02:07:37]
- Something to be Excited About [02:09:11]
- On Faith, Family, and Self [02:12:53]
- Running a Business [02:17:30]
- Dr. Kyle’s Irish Wolfhounds [02:19:24]
Dr. Kyle Gillett: Health Optimization for Our Mind, Body & Spirit + Hormone Health Tips & Microbiome Discussion
My guest is Dr. Kyle Gillett. Dr. Gillett is a board-certified physician. He specializes in family medicine. We talk a ton about hormones, obesity, how we can improve the levels of our hormones both for men and women, and how that can relate not only to fertility but our overall well-being, recovery, and sleep. What are some practical ways to test for where we’re at whether we’re younger and maybe things are out of balance or as we age and we’re trying not to drop off a cliff?
Dr. Gillett is smart. I spent the conversation trying to make it into layman’s terms. He is an endless source of information. I learned so much. I’m inspired by his approach. He seems like a true first generation of doctors that are blending West and East. It’s not that he’s only going to take a natural approach or only going to give you pharmaceuticals to fix everything but it’s case by case and that’s the other thing that’s so important. He looks at each individual in their unique way and then manages their health accordingly. I hope you enjoy the show.
Dr. Gillett, thank you for coming to my house.
I appreciate it. Maybe you’re a kid wonder or something. You have a tremendous amount of information and experience for such a young person. How have you crammed this in? You have two children.
There’s not a specific, perfect way to explain it. I was listening to Joe Rogan talk to Mr. Beast.
I have sent that interview to everyone I know. For the first seven minutes, you think, “Mr. Beast is complaining about headphones and that he was going to kill himself at Community College.” He goes into brilliant land about giving back and creativity. It was a powerful interview.
I found some corollaries with that. It’s not that I’m Mr. Beast. He has a unique set of skills. I related to where he said, “I got obsessed with YouTube when I was 12. That’s the only thing I thought about.”
That’s the same thing that happened to me. Some kids will become obsessed with YouTube, some will become obsessed with sports, and some will be obsessed with cars or even video games. I got obsessed with health optimization for people’s bodies and people’s minds.
Their spirits. You’re the one doctor I’ve ever seen and that’s a big envelope for you.
If you think of a Venn diagram where you have three different colors in the middle, they all converge into a unique color. You have the body, the mind, and the soul. Optimal human health is at the convergence of those three regardless of what you think about your spirituality. Everybody’s spiritual, even agnostics and atheists. You find that unique individual spirituality, you find your unique individual mental health as well, and then you have the physical health component, which a lot of doctors concentrate exclusively on that. That’s where you’re going to find optimal health.
Your dad was a doctor. Was this natural? You’re good at the sciences and other things, you cared, and you were interested. Is this something in the family? There are families where it’s like, “I’m a doctor and you’re going to be a doctor.” How was that?
It was more related to how my upbringing was. I was homeschooled. I was a bookworm. Ben Greenfield talks a lot about being a homeschooled bookworm.
Are you comparing yourself to Ben Greenfield?
You’re coming out. Take it easy.
We’re both homeschooled though.
I homeschooled some of my daughters.
There’s a component that makes you more eclectic. I don’t want to say more unique but it gives you opportunities to do things that other people wouldn’t. A lot of times, that stems from your interest in science and that leads to your interest in human biology because you’re interested in all animals. There’s no animal more complicated and unique than the human.
You have siblings. Are they also into the sciences? How many brothers do you have?
I have two brothers. My older brother is a dentist and my younger brother is an engineer. I went through school with my older brother. We’re a little over a year apart. We were classmates.
Did your mom teach you?
She taught us to some degree. When we were around 15 or 16, we did exclusively community college classes.
That’s what smart people do.
There’s a community college in Johnson County. We called it Johnson County Community High School because there are many high schoolers that are taking classes there.
You have two sons. We’re going to talk about insulin resistance and all the science. It always fascinates me when I see a person who also is navigating it in an interesting way. You’re one of those people. You have two sons. Is there a plan to try to do a version of that for your kids as well?
All that is up in the air. My wife’s a speech pathologist. That’s been excellent for looking into things like baby-led weaning. Baby-led weaning is where you introduce solid foods and even foods with allergens at earlier times. The medical community used to emphasize the late introduction of allergens. Now, the science is looking more and more that you want to introduce small amounts of your main allergens early on.
I have a friend who’s going through this process. His son has quite a few food intolerances and they’re pretty severe. His reactions are severe. They’re doing exactly what you’re saying. You have to be on it. If you’re doing it, maybe the approach is preventative. They’re doing it 1 piece of something for 2 weeks and then 2 pieces or 2 peanuts and things like that. It’s highly measured. That’s fascinating. Do you feel differently? You see patients and you deal with people all the time. Now you have your own children. No one’s objective with their own children.
It’s easy to look at the speck in someone else’s eye when you’re not seeing the log in your own eye. There are always things that you can do better with your children. We do the best that we can. There’s a difference between the treatment of atopy, which is allergies, asthma, and eczema. That’s a triad. Allergies are in your sinuses. I have them.
You’re away from your local honey.
I take my local, raw honey and my bee pollen. Those are a type of desensitization. They have little bits of allergens in them including bees and wasps. Theoretically, if you feed your kids bee pollen or local honey, it can decrease the risk that they become allergic to bees and wasp stings. There’s a difference between desensitization. One of my best friends did peanut desensitization as an adult as well. Also, the prevention of those things. Early exposure is one thing that can help. With lots of family history, you want to be more aggressive with that. Another thing that can help is microbiome exposure.
Don’t you think a lot of the allergens, especially now that everyone for the past several, has peanut intolerance? Remember that sticky butter that they would pack with nutrients and minerals and then send to Africa and they go, “How could you put in peanut butter?” They don’t have any peanut butter allergies because they probably don’t have leaky gut and all these other issues with their microbiome. You can’t say every case but a lot of it is connected. We’re more vulnerable in certain ways because of our guts.
That’s true. Early exposure to certain antibiotics can play a difference as well. If you’re on acid blockers or macrolides like azithromycin, Z-Pak, or erythromycin, those can lead to decreased titers of H. Pylori, which can be a bad microbiota component. It’s in the upper gut. It’s in the stomach and the early part of the small intestine. If people have low titers of that, they’re more likely to get asthma, allergies, eczema, and then inflammatory bowel diseases like Crohn’s or ulcerative colitis.
If someone’s reading this and they have children that are navigating certain allergies, what’s the first step? You guys have talked a lot about this like getting their blood work done. When they say, “You’re allergic to garlic,” I always think, “Who can be allergic to garlic?” Do you hear that? For a kid, what are some of the easy ways to enter into trying to navigate this path because it is complicated?
I don’t think every child needs baseline bloodwork of their different antibody titers. It’s important to remember the different types of antibodies. You have your IgA antibodies, those are your mucosal-associated antibodies. Some Caucasians and some people, in general, have an IgA deficiency but it’s a higher risk if you’re Caucasian. They have fewer antibodies and they’re more prone to getting respiratory infections and sinus infections.
[bctt tweet=”My strength comes from God, first and foremost, my family, and then my close friends as well. I feel very socially connected.”]
There’s also your IgE antibody and that’s more associated with allergies, parasite infections, and things like that. There’s also your IgG and IgM and those are usually associated with diseases. If you test your antibodies to garlic, a lot of them will randomly be positive. It’s not because you’re clinically allergic to it but because you have a randomly high antibody titer. It’s similar to thyroid antibodies. The main two are TPO and thyroglobulin antibodies. About 10% to 15% of the population without Hashimoto’s or thyroiditis will also be positive.
A lot of times, you feel like you’re chasing how to make it better, fix it, or improve it. It can be confusing. It’s one thing when you’re doing it for yourself but you get an extra layer when you’re trying to do it for your kid. If a kid is having eczema, for example, it’s an indication that there’s probably something they’re allergic to going on. Even acne, I know some of it is hormonal but do you think sometimes that that’s an indication that they’re eating something regularly that they’re allergic to?
It can be. A lot of times, your IGF-1 level is associated with acne, dairy especially. To a lesser degree, red meat. If you’re eating a lot of it, you also have inflammation and a poor skin microbiome. You have microbiomes in your skin, your gut, and your mucosal membranes. Those are three different niches that interplay or crosstalk. With kids specifically, the first three months of life are essentially mini puberty. In the first three months, kids will produce more hormones and that’s usually why they have baby acne.
Do you think that someone can solve some of this by figuring out their microbiome and things like that?
Likely so. Good skincare regimens always help, too.
For example, young females, if they’re teenagers, almost overdo it. When you’re talking about the skin microbiome, you can almost destroy that by over putting on too many products, cleaning too often, and things like that. I’m always trying to figure out the microbiome. Let’s start there since it’s a popular topic but it is important. It’s a hard thing to figure out your microbiome or your gut health if you will.
I try to break all of this down at my seventh-grade level because I don’t know what you were doing in seventh grade but I have a feeling it’s not what I was doing. If someone comes to you and they are concerned about their microbiome or they want to understand if they’re doing some of the right things, how does somebody start wherever they live? What’s your clinic’s name?
My new clinic is Gillett Health. Also, I am the medical director for College Park Integrative Medicine. I did work for Marek Health for about a year.
If someone were to come into the Gillett clinic and say, “I want to get an overview. I want to optimize my health. I’m interested in my gut health.” How does someone start?
One good way that you can get an idea of all the different bacteria, viruses, fungi, and protozoa is you can get what’s called a GI-MAP. That’s from the company Precision Analytics. There are a few of them. There’s Genova testing. There’s different Zoomer testing as well for allergens. It’s a PCR test for all those different microbiotas. It’s not every single one but they have about 20 to 30. It includes H. Pylori, streptococcus, enterococcus, gram-negatives like E. coli, and anaerobes. It’s all the different species and they test a quantitative number to see if you have more or less than the normal level.
If you do these tests on lots of people, you’ll find that some people are carriers of things like C. diff. Not many but there are some carriers. A lot of people have too high of a titer of H. Pylori or too high of a titer of certain types of bacteria. We call that SIBO or Small Intestine Bacterial Overgrowth. You don’t necessarily have to use antibiotics to treat it. Sometimes you can use an antibiotic to target certain groups if there’s a consistent pattern. The frequency and the consistency of stools also matter. If you’re only stooling twice a week, it’s giving the bacteria more chance to reproduce and overgrow.
My friend, Paul Chek, was like, “Twelve inches every day.” I used to go, “Thanks a lot, Paul.” He’s like, “I don’t care if it’s 1 or 2. Those are six inches.” I’m like, “Got it.” People don’t notice.
The stool chart is called Bristol Stool Chart as well. Some people will even put it in their bathroom and take a look at it.
Are we that busy?
Some people like to be specific and they keep a log, almost like their exercise log. It seems a little bit much.
Me and my husband made it so far, over 26 years. That’d be the killer right there. I’d be like, “That’s it. I can’t take it anymore.”
It’s too much for me as well.
It’s better than not noticing. It’s like, “When’s the last time you used the restroom?” You probably see that with patients and you have to keep a straight face.
In layman’s terms, the way that I explain it to a lot of people, your gut is like a fish tank. You have species in there. It’s an ecological niche. The input to that fish tank is both your fish and then your fish food. Your fish food is your prebiotic fiber. Your fish, the good ones, are your probiotics. The bad ones are the bad bacteria, infections, colitis, and things like that. Your fish tank is slowly leaking out and that’s your stools. You can turn that dial up and you can turn that dial down.
I’ve never thought about it that way. You talk about the six pillars of health, diet, exercise, sleep, stress, how people manage how much stress they have, how they react to stress, sunlight, and spirit. People know this. Everyone has all the reasons why they’re not getting there. I’m never sure. I always feel people are ready to talk about it when they’re not feeling well. On the other side of the spectrum, they’re into the performance that they’re obsessive about it, which has its own set of issues.
I live in a performance world. To perform at an optimal level, you almost have to also be in the middle when they get too far and too analytical about their health. Maybe we could go through the pillars lightly. For a person who’s looking for optimum health, they want to avoid health issues later like dementia and things like that. When you talk about diet, you’re talking about low sugar, a low inflammatory diet.
Low processed foods. I’m a big fan of a whole food diet. It doesn’t mean you need to be on a Whole30 diet, which is a type of exclusionary diet. The carnivore diet is another one of those, by the way. A whole food diet with minimally processed foods helps. You implement your fermented foods or natural probiotics and you implement your prebiotic fiber in your diet, your garlic, your onions, your chicory, your leeks.
On top of that, there is some individualization to diet plans. They’ve done studies on cyclists and they look at carb consumption. Carbs are not completely evil to everyone. They can improve performance and be burned while they’re doing ultra-endurance events. Some people also metabolize carbs better. Some people have a genetic polymorphism. A lot of people of Icelandic descent have this genetic polymorphism. They do better with carbs and they don’t get the subsequent insulin resistance and pathology from it.
I see that you will eat bread but you eat it the right way. You’re not saying, “I never eat certain foods.” Your wife made you bread. What’s the difference between your bread and the bread at the market?
Occasionally, I will have regular processed bread. Madelyn does love making sourdough bread. She’ll make cinnamon rolls with her sourdough bread. You start it from a mixer. Some of these are hundreds of years old, too. It’s minimal ingredients and you ferment it. When you ferment it and bake it, it does kill the bacteria and yeast that are helping ferment it. When you ferment it, it takes the carbs and breaks them down into a form that’s more easily absorbed and that’s not going to inflame your gut as much.
It’s heaven when you have bread, isn’t it?
Yeah. Bread is awesome. I’m not totally against gluten or casein. Gluten and casein are both mu-opioid receptor agonists. They can slightly slow down the gut and slightly increase prolactin giving you a little bit of that blah feeling. In moderation, those are fine as well.
It’s not that I’m surprised. It’s that we have so much information out there and you think, “People still think it’s okay to eat this or that.” What about the microwave? For me, it’s better than eating processed food. If you cook your food and you cut your food and you’re preparing it at home, it seems like it’s the best way to go. How do you direct it to make it as simple as possible?
People ask Laird all the time, “What do you eat?” He’s like, “Plants and animals, highly sourced.” If that means organic, you can get it. If my friend hunted it, great. If he eats dairy, he tries to get whole raw or whatever it is. Usually, it’s butter. Is there anything else to add to that? It’s not like, “We never eat grains.” It‘s not part of the constant. It’s funny when you have food that you’re like, “This isn’t fully supporting me.” You’re aware of it. IT doesn’t mean you torture yourself and you’re not happy. You like, “This isn’t what I do all the time.” For you, how would you lay that out for people?
There’s a spectrum or continuum of nutrient-dense foods versus calorie-dense foods. In general, in this culture, we have a problem finding foods that are nutrient-dense but not overly calorie-dense.
If I’m at the market and I’m stressed out of my mind and I barely can pay attention if I’m going to the bathroom or not, how do you direct people and go, “Think of it this way.” I’m trying to simplify it for people but also remind them that it is achievable. You don’t have to be tortured. You don’t have to be starving. We’ll get into some caloric restriction and the benefits of that and the time for that. Ultimately, we’re using food to medicate, understandably. How would you direct someone in trying to take this on?
One good step that people should take is don’t shop for food when they’re starving.
I do that. I come home with a lot of chocolate.
That changes your choices. Another thing that helps some people but not everybody is going in with a stringent list. That can help. Another thing to keep in mind is if there’s a specific condition or pathology you have that you’re trying to treat. If it’s hypertension or high blood pressure, you look at your electrolyte balance.
What do you mean? You want to have your electrolytes higher.
Usually, you do. Many people don’t get enough magnesium or potassium. The old-school diet for hypertension is called the DASH diet, which includes two grams of salt. That’s an antiquated model and it’s more of a model for people that have hypertension and also renal disease.
Rather than only taking supplements of that, you’d say, “Look for foods that are high in potassium and magnesium.”
With exercise, are you saying, “Let’s go walk around. Maybe if you can, lift a weight or do something outside that you enjoy.” You’re not saying, “kill yourself every day.”
Zone 2 cardiovascular exercise with brisk walking that people think of is fantastic. There are a lot of benefits to that for your mitochondrial health. There are specific benefits of high-intensity interval training or vigorous exercise. There are also specific benefits of resistance training, which is mainly the prevention of age-related diseases like osteoporosis and sarcopenia. If I had to take the average person or an avatar of your average 30-year-old, most males need to do a lot more aerobic exercise and cardiovascular exercise.
They want to get yoked. They want their beach muscles.
If you look at all these bodybuilders that are yoked or having health problems, that’s another tangent. It’s important for their cardiovascular system. In general, the average male is slightly heavier as well. They have more tissue that they’re going to have to pump blood to and also detoxify with antioxidants. For the average guy, more aerobic training. For the average female, more resistance training. If you don’t implement that resistance training, your lean body mass will decrease and then your metabolism will decrease and it’s going to put you at risk of having a crash metabolism.
I love it when you see women that cardio out because they don’t want to get bulky. That’s our favorite word. I go, “In your lifetime, you wish you could bang as much iron you take to get bulky.” What you try to get them to say is, “When you’re running or doing whatever exercise, you’re only burning then.” You try to remind them, “If you put a little muscle on, that burns for you beyond that.” You’re not even saying heavy weight. You’re saying some time under tension and getting that resistance is good for your bones. With women, you could say it’s good for your skin.
It’s good for cognitive health as well.
Women will do something for skin over cognitive health. They’ll deal with that later. I don’t know though. I’m at the age now where I’m like, “Cognitive health.” With sunlight, is this again in nature? Is this like, “Get your Vitamin D.” Is it to be a human being and get outside? What’s the sunlight?
The sunlight stands for being outdoors in general. Being outside, cold exposure, heat exposure, sauna, that’s all within the same realm of sunlight. Humans are losing this. Your connection with the outdoors is something that’s between the mental and the spiritual aspect. Maybe some of this has to do with things that we don’t understand within the brain.
It’s hard to do a study where you do a double-blind study with this but some people love to walk barefoot outside. They feel like they’re more in tune with things. Even hearing what animals are doing, hearing the insects, and hearing the birds. All of that is encompassed within the sunlight. Sunlight is interesting past vitamin D as well. Specifically because of its effect on the hypothalamus and the pituitary, two regions of the brain that are the control centers for your endocrine system, which is signaling of hormones and then hormone-related peptides.
The peptide is a protein that signals between different tissues. An endocrine steroid or steroid ring is a hormone that’s derived from cholesterol instead of being derived from a string of proteins. Endocrine is signaling throughout the body and then paracrine and autocrine are signaling right around the same tissue. You have this hormone called Alpha Melanocyte-Stimulating hormone. If that or the receptor that it stimulates is deficient, you have an extremely high risk of obesity and also several other related things as well. You treat it with a peptide that’s pretty much the same as your endogenous Alpha Melanocytes-Stimulating hormone called Bremelanotide.
Even in the morning, looking at the sunset, your melatonin, your sleep cycle, and all these things. Besides not being always at 75 degrees, getting hot, getting cold, getting uncomfortable on the ground, being barefoot, there is nothing like when you listen to birds. Have you ever been on a hike and you hear a lizard through the rocks or some critter that you can’t see but you hear them? There’s something about that.
Being in the sun regulates all these other systems. I’m guilty of this a little bit, how we’ve gotten so far away from some basic things. We used to be outside most of the day, work outside, transport outside, and things like that. Now we’ve got artificial lights inside that we act like it’s the sunlight, the red light, and all these things. There are a lot of opportunities for us to take peptides now. I find it confusing. I’ve tried it. Here’s one for the night and here’s one for the day. I believe in it. Also, you don’t know if it’s working, whatever that means. Do you have patients you’ll prescribe peptide therapy to?
What does that look like?
It depends on the patient.
Let’s say I came to you. You’re not allowed to give prescriptions. You’re not telling people that this is for everybody. We’re having a general conversation.
Everyone should get individualized medical advice from their doctor. What I like to start the conversation with because people are always asking about peptides is explaining that they’re strings of amino acids or proteins between 2 and about 200 amino acids. Amino acids are the building blocks for proteins. My favorite peptide is insulin. Insulin was discovered less than 100 years ago. After discovering it, either in a sheep, a pig, a goat, or something similar to that, they quickly experimented with diabetic animals. Within a year, they were injecting it into every Type 1 diabetic.
Over 100 years ago, did they have diabetic animals?
I believe so. They did animal studies first and then they did human studies. I’m not exactly sure what the structure of the animal study was but they injected insulin over glucose. Right away, they were rejecting it.
Is it the notion that if we can keep our insulin resistance high, that’s better than going to my fancy anti-aging guy, taking peptides, and giving myself a shot before I go to bed at night?
That can be one concept but the main point is that when they discovered insulin, which was the first peptide to be used widely, they used it in Type 1 diabetics almost exclusively. There also was not near as much Type 2 diabetes many decades ago, especially in children.
I have an uncle who was a diabetes specialist. He was the only guy who would see kids in the ‘80s. Now it’s pretty common. What about prescribing peptides? Do you give your patients peptides?
Yeah. It’s like any other medicine. A peptide or a supplement is like any other medication. There’s more opportunity to get peptides and supplements over the counter not prescribed by a doctor. Like you prescribe medication, you look for an indication for that. You also look for an indication for the peptide. A lot of indications are skincare and skin health. You have things like GHK copper peptide that you can use as a skin cream. It’s a peptide. It’s made in your liver. It’s made less and less as you age. It helps things heal.
Rarely, people can become copper deficient. If you have bariatric surgery, you’re likely to become copper deficient. I’m seeing a lot more copper deficiency. It is attached to copper, which is good for your nervous system health. The GHK copper peptide in the liver might be one of the reasons why the liver can regenerate from only part of one lobe and then regenerate into a completely whole organ. It has amazing regenerative capabilities unless it’s cirrhotic. That’s one that you can apply to your skin. It helps with preservation. It brings in growth factors.
People are familiar with the growth hormone effect on the skin. It’s almost similar to that growth hormone effect because of its growth factor upregulation in the area. TB 500, a synthetic version of Thymosin Beta 4, is similar to that but it’s not used in the skin as much. Another one is AOD 9604 or GH Frag. By the way, growth hormone is a peptide as well. It’s a peptide hormone. You cleave off the parts that you do not want that lead to insulin resistance and things like that. You keep the part that’s related to lipolysis. This is more related to a fat-burning cream that can be combined with other things as well.
Aminophylline is a theophylline derivative. It’s similar to caffeine, which also increases lipolysis. Situationally, that can be useful, especially after things where there’s been stretchy or saggy skin or lots of subcutaneous fat. It’s an alternative to CoolSculpting or the laser machines that people have that attempt to shrink down the fat underneath the skin.
Which one is this? Is this the GH Frag? Is that the one that you’re talking about?
People are going to be like, “Which one was that?”
That’s AOD. AOD stands for Anti-Obesity Drug. It was developed because, in the ‘80s or ‘90s, the New England Journal of Medicine had this landmark study about giving growth hormone to individuals. That led down up a not very good rabbit trail because it turns out the risks almost outweigh the benefits. It’s similar to hormone replacement therapy in some cases but not all cases. They cleaved off the parts that were causing the most side effects and then kept the part that had the lipolysis benefit. There’s some evidence that injecting it can help a little bit. Mostly, it’s used in topical creams.
[bctt tweet=”Having a routine or a habitual routine can build less stress in general over time.”]
I’m going to ask you this a lot because you do this in real life. It’s not theoretical. There are the basics like getting to bed, don’t drink crazy, and being reasonable with food. If you’re doing some of the basics of the six pillars, you’re doing a good job. Let’s say you’re 30 to 40 and then maybe you’re older, is there a peptide where you’d say, “I would lean into asking about these.”
It depends if someone wants it for cosmetic purposes or if they want it for nootropic purposes or if they’re using it to aid with body composition.
Let’s start with beauty.
The beauty ones are a lot easier to use because a lot of the peptides are minimally absorbed systemically and they’re mostly locally active. You don’t have to worry about the effects of systemically acting peptides. The next tier is injectable peptides. Peptides along with dutasteride are going to be at the forefront. There’s something called Mesotherapy, which is tiny little injections right under the surface of the skin. That’s going to be at the forefront of aesthetic cosmesis for hair loss prevention and also hair growth eventually. A lot of people will get stem cell therapy or PRP. One of the most active compounds in PRP is Vascular Endothelial Growth Factor, VEGF. Many people, at this point, know about BPC-157, which is up-regulating vascular endothelial growth factor.
You’re never going to get old. You and your wife are going to have long hair and lots of hair. Your brain is intact. You guys will be lean. I’m excited for you. Laird and I might have missed that window. I don’t know. You’re saying to get to bed.
Some people have to do shift work and that makes it particularly difficult.
How about the poor nurses? They’re taking care of everybody else. They have the worst schedule ever. Let’s say this is what your job is. Is there a way to make up any of that slack?
There are some ways of trying to shift back and forth between daytime and nighttime. Every single day is suboptimal. If you can go at least 3 or 4 days without shifting, that’s the next best thing if you will. Make sure you get your sunlight still. Even if you’re at nighttime all the time, try to at least get a little bit of either morning or evening sun, which is difficult in the winter. I had plenty of night shift rotation so I definitely know. There’s no perfect way to fix that. It seems that with increasing age, there’s an exponentially higher risk that it’s going to affect the quality of your sleep as well.
If someone isn’t doing shift work, do you have an hour that you like? Do you say, “Could you get to bed by 9:00?” Is that too early?
Between 9:00 and 10:30 is probably the best in general. There’s a lot of wide variation between how much sleep you need and when you’d like to go to bed. Also, smartphones, computers, screens, and all that alter things as well. If you look at what cultures did before, they did wake up slightly earlier and went to bed slightly earlier. I’ve noticed that once we’ve had kids, we get up a lot earlier and we go to bed a lot earlier too.
You don’t stay up. My favorite is when kids are little so then you’re trying to do everything you can get done during the day when they’re sleeping. It’s insanity. It’s exciting. I always remind people that these are guidelines. If you have young children, you will move around these guidelines. For example, you’re doing shift work. We all have stress. One person can deal with 1 million things and another person has enough. Are you saying you have things in your life that are a practice to de-stress when you talk about the stress pillar?
There are a lot of habits that can lead to lower stress. Having a routine or a habitual routine can build in less stress in general over time. There are benefits to mindfulness or meditation There’s a lot of heterogeneity to what that can mean. One way that you can think about it is the science of gratitude. There are a lot of things that you can do for stress. Some people operate better with enough stress.
A lot of people think of cortisol as the stress hormone as evil. Cortisol also stresses you waking up every morning. Also, it stresses you to make those first couple hours every day particularly good. If you look at structures of animal packs, especially in the canine world, a lot of times they have higher cortisol if they’re more motivated to get something done.
When you have busy days and busy personal life as well, there are times when you can almost make it worse by thinking, “I won’t get to train today.” Instead of doing it that way, go, “This is going to be one of those days. I’ll be buttoned up in my eating. I’ll try to internally calm down a little bit.” Even though things are coming at you, it’s still hitting you slower than the way you’re receiving them. It’s okay to tell somebody, “I feel a little overwhelmed and I’ll get through it.” Everyone’s always holding their breath and holding it in and not saying to somebody, “I bid off maybe more than I can chew,” or, “I feel overwhelmed.”
A reminder too though is that a lot of it is a choice. Sometimes people don’t have a choice. To me, that’s the real stress. You said the word gratitude because that puts everything in perspective and people do it whether it’s breathing, a prayer, a meditation, or however they want to do it. I always encourage people that if they’re in their car by themselves, use that time. Don’t necessarily have something on. Use that time to down-regulate a little bit and get recentered. Especially when you have little kids, they’re sleeping in the back. It’s the best.
Some people will drive around so that their kids can sleep.
Use that for yourself, too. It’s magical. There’s something also about looking in the back. You look at your rearview mirror and you see your sleeping kid in the back, there’s something pretty magical about that.
It’s pretty nice. With stressful family situations where you feel like you can’t be the stressed one where you have to keep it together for the kids or stressful work situations where you can’t show that stress because of the boss or whoever you work with. Even in situations with athletes, you can’t show that stress because of a coach, a teammate, or an opponent.
You don’t want them to see that you’re like, “Oh, no.”
I’ve always thought of it as a situation where you don’t want to let that stress boil up almost like a pressure cooker. You want to find a way not necessarily right then but at a different time to let that boil. Get it into a nice rolling, open boil. Maybe some resistance training can help with that. That way, you don’t explode your pressure cooker when it builds up.
Cardio can agitate it. Maybe swimming would make it easier. Lifting weights is a real place to put it into. With spinning and running, you’re out of your mind. For you, it might be specific. Is it a spiritual-religious practice? When you say spirit, what are you inviting people to pay attention to?
I’m a Christian. I believe in God. I don’t believe I’m particularly religious. There’s a difference between spirituality and adherence to religion. That’s the interplay between spirituality and culture. A lot of people have the culture and the religion that comes with it but not necessarily the spirituality. Everybody has spirituality, their connection to however they believe that we got here and what our purpose in life is. It’s at the top of Maslow’s hierarchy of needs, the pyramid where, thankfully, most people in the developed world at least have their baseline needs and cornerstones met. Now they’re worried about the higher needs and a lot of people’s mental health issues stem from that.
We have this conversation a lot in our house. Laird and I are analyzing words and certain titles. He’s like, “Because we’re all so comfortable.” He’s a person who wants to go out in nature. It makes sense to him. It is interesting that when we get too far away from some of our basics, we get into trouble. It’s the basics and how can I contribute?
You use the word purpose. Sometimes it’s like, “My hair color. My eyelash extensions. What is Uber Eats going to bring me today? Should I get it toasted or not?” We’ve gotten in the weeds with all the extras and the fluff that makes us nutty a little bit. I don’t know that we’re meant to have that many options and not have to work for it.
The age of transportation made a big change in that because now we can choose our mode of transportation, driving or airplanes, and go almost anywhere quickly. Whereas we had a significantly lower limitation of options of what we can do, who we can talk to, and what we can eat. It forced us to have a more local connection.
You’ve talked about this a lot. We have all these biological things and we’re living in a world that goes in contrary to that. How would you intentionally almost strip that away for yourself? In the long run, it’s better. That’s a practice that we try to do in our house, which is trying to simplify it. In the end, it’s going to be easier on you. It’s hard to do it, especially with social media and the way the world is coming at us but it makes getting to bed earlier, communicating and focusing and all these things easier.
The same thing with food. I always tell my friends, “Don’t say that you can’t have it. Say you’re not making those choices.” I could eat whatever I want. I could stay up and watch every Netflix movie. I know that, in the end, I’m probably not going to be better. I can’t wait to see what happens. Do you almost isolate your kids to get that message into them early?
I don’t know if to isolate is the perfect term but I isolate them from social media in that context. That’s a wise thing to do in general.
You have the ability and a lot of people don’t. Now it has become a luxury to make those choices. Also, what are you giving up to do that? People don’t realize they have as many choices as they do. They go, “I can’t do that.” You guys will have to work differently and more to make that happen. It is interesting. With small children, if they get enough of the natural living as much as you can, they keep that in their lives longer. They know what makes them feel good and they go and do that.
It makes me happy when I see kids growing up outdoors. Kids who can never go or almost never go outdoors in their childhood are missing something when it comes to their development.
It’s a scary place. If you don’t grow up in it, when you’re an adult, it’s like, “I haven’t been on the mountain, the river, or the sea.” It’s hard when you’re in a city, certainly. You even write a prescription for each of the six pillars to your patients. You give them homework. That’s how serious you are about each one of these pillars. That’s great. You mentioned cortisol is a good thing and it motivates us. It’s like stress. These things can be productive. How do you explain cortisol and the role it plays in your patients?
Cortisol is somewhat the opposite of melatonin. In melatonin, you have a spike in the evening when there’s less light input that goes through your optic nerve to your pineal gland, which is the gland that produces melatonin and then you start to produce it. It’s not inhibited. Cortisol will start to spike while you’re still sleeping. Eventually, it spikes up enough to where it’s high in the morning and then drops low in the evening. It’s a circadian rhythm, the opposite of melatonin.
There are a lot of things that it does but one of the things is it binds to glucocorticoid receptors. The glucocorticoid receptors are throughout the body. They’re the same receptors that medications like prednisone or dexamethasone bind. It helps with inflammation. You also don’t want too much of it. It also causes muscle protein degradation. It can upset the balance between accrual and degradation.
Most of us though have too much cortisol. What is it doing to us? In the morning, it’s the highest. You have everything uncomfortable happening then. You do the hard stuff then. You train. You have those uncomfortable conversations. You can even be with your partner in the morning. Everything’s hard. It’s not that sex is hard but it’s stressful to have it early. As the cortisol drops, it’s mellow-out time. How does somebody get it checked? Is it a change in lifestyle? Is it a change in practice? Let’s say they are working out and they’re eating good but they’re stressed out.
You can do a couple of different tests for cortisol. One is salivary. One of them is known as a Dutch test. You can also get urine cortisol testing. Usually, it spikes in the morning and then drops in the evening. It is possible to have a pretty even cortisol level, which is not ideal because it’s not high enough in the morning, and then it’s not low enough in the evening. There are a few things that you can do to help with your cortisol release.
It is interesting because adrenocorticotropic releasing hormone or ACTH is a hormone that’s produced in your brain. If you have a pituitary issue, it can be off. It helps with the release of both cortisol and DHEA, which is the other hormone that your adrenals make, dehydroepiandrosterone. You don’t want to shut down your adrenals completely. A lot of times, if you have too high cortisol, your body can burn out. It’s not an exact diagnosis. Even if you have this happening in your body, there’s no such thing as adrenal fatigue. You can’t diagnose someone with that. That’s the phenomenon you see.
In general, people are either driven by cortisol or driven by adrenaline, which is essentially epinephrine. You need to find the balance between the two. A lot of that has to do with balancing your rest and digest nervous system, which is your parasympathetic and sympathetic nervous system, which is your fight or flight.
What time do you eat dinner?
Usually around 6:00 PM.
If you can, how many hours do you get to sleep after? Do you consciously have a gap in there between when you go to bed and when you eat?
Yeah. It’s usually about four hours.
That leads me to talk about intermittent fasting. I know that you’re involved in obesity, weight management, and things like that. There are many interesting things that I learned that I had never heard about, especially with the obesity that you talked about. Maybe we could talk first of all about how you feel. They think maybe at my age with intermittent fasting, I have to do that in a special way. I don’t get to not eat and that’s good enough. That has to be calculated now.
It’s hard to talk about intermittent fasting in the context of obesity. It’s easier to talk about intermittent fasting or caloric restriction in the context of health or less cell turnover. I hesitate to say anti-aging. Your cells don’t turn over as much. Your cells are younger in the long run because they’re not turning over as much. That hormesis process is regulated by a lot of things. Some of them are called sirtuins. You have genes for your different sirtuins. Depending on your gene, on the 1st one and the 6th, that can alter your risk of things like diabetes.
If you’re talking about it in the context of obesity, as a Board Certified Obesity Medicine Doctor, it’s a catch-22 Because caloric restriction and fasting can be such good health tools and so can exercise. They’re the most powerful health tools but they won’t necessarily increase weight loss. They can slightly alter body composition. There have been lots of studies that show that when you’re trying to lose weight, specifically lose body fat, it’s not going to make that number go down faster than it wouldn’t otherwise. It becomes an esoteric discussion or discussion whether you’re arguing over semantics. I try not to spend too much time on it because then the opportunity cost is you don’t talk about the other things.
Let’s narrow it to fasting for health and we’ll slide over and isolate obesity or weight loss. For health, do you practice it? Is it once every three months? Do you go and do some intermittent fasting? Do you do it a day a week? How is the way that you approach it also works? Do you have any tricks?
A lot of my patients practice intermittent fasting very well and that’s had significant benefits for their health. Personally, I have tried to intermittent fast but I’m not good at it. I’m hungry every single morning. I like to eat dinner. Even if it’s social, I like to eat dinner. It’s hard not to, especially if you’re doing it for business-related reasons or even a family-related reason. You’re wanting to eat dinner with your kids. You’re at the table and everybody’s doing it. It’s pretty much impossible for me.
I don’t talk about it too much because everything is individualized and you talk to your doctor. My doctor has me on rapamycin, which is medication. There are other types. There’s rapamune and everolimus. Rapamycin is also known as sirolimus. There are different mTOR inhibitors, which are usually used as anti-rejection medicines. If your situation is deemed to be where the benefits outweigh the risks, that can be something that you consider.
You do talk to your patients about the positive effects of intermittent fasting. If this is too prescriptive, you can say, “I can’t talk about it.” If you can, do you think it’s better to integrate it as a weekly thing? One day of the week you lay off. Do you like this idea of months going by or one week out of the month you put your foot down and do some fasting? Do you like the one-day to give your body a break approach?
One day a week is a pretty safe approach for most fasting strategies and fasting mimetics. It depends on the situation. If someone is also trying to do it because they already have a diagnosis of cancer or something like that, they might consider adding in something like a ketogenic intermittent fasting diet or even a ketogenic prolonged fast.
Why can’t middle-aged women fast the same way? How did we get isolated? You’re over there, the way you fast.
They can fast.
The window is shorter. It’s supposed to be 12 or 14 hours. Autophagy doesn’t happen until 20 or 30 hours?
It depends on how many slowly digestible proteins you have. If you have what’s called branched-chain amino acids, those are strong mTOR agonists. mTOR stands for Mammalian Target of Rapamycin, which rapamycin and its other analogs inhibit. When you’re activating that, you’re causing more cell turnover or an anabolic state.
Glycine, leucine, isoleucine, and these BCAAs will activate it. If you intake a large meal or a large shake with something like casein protein in it, that’s going to stay in your gut for eight hours. After eight hours, you’re going to be getting those last branched chains. That’s high in BCAA and casein. Finally, you take those into your bloodstream, and then they’re still activating mTOR. If you took a 40-gram casein shake every single night, you’re probably never getting to the autophagy state in many of your cells.
You must laugh at all of us. It’s like, “What are they doing?” I know you’re nice and you’re not judgy. Sometimes we get thrown into these trends and then nobody knows how to do it right. You guys must be like, “Look at these guys. They’re not eating and suffering and it’s not doing any good anyway. It’s pretty fascinating.”
Part of the reason I use that analogy is I know that a lot of athletes, usually male athletes, take a large casein protein shake every night.
I want to slide over to obesity. There’s obesity and it’s like, “I have to get the last ten pounds. I can’t lose twenty pounds.” I know it’s specific to each individual. I know it’s sensitive. You even said that there were conversations about treating it as pathology, as an actual disease itself.
It is considered a disease now and it’s considered an epidemic.
Is that why you got into it? You’re like, “I can help some people out.”
The main reason why I got into it is that it’s one of the most undertreated conditions. If you go to your doctor and you have diabetes, they’re going to try to treat it aggressively 100% of the time. It’s the same thing for hypertension and cancer. With obesity, many people will go to their doctor and get their A1C checked, which is average blood glucose over three months. Usually, they check their fasting glucose. Their fasting insulin might be sky-high. Over nineteen is an indicator of cardiovascular disease risk. Usually, they get their fasting glucose, their lipids, their red blood cell, and their white blood cell checked. That’s pretty much it. It’s an undertreated condition.
It’s been treated more and more as a disease or a pathology. It’s part of the point of primary care see. You have primary, secondary, and tertiary. Tertiary is like safety-net care in the ER. The whole point of primary care was supposed to be practicing preventive medicine and it’s gotten away from that. Now they pretty much practice by the algorithm, however they’re allowed to order something that will be covered by the insurance company.
Its symptoms. It’s not caused. All these other things show up. If obesity is one of the constants, it expresses itself. One person will get cancer and one person will get diabetes. You’re saying, “I want to go back because this is a form of prevention.” It’s complex. I even appreciate that you wish people did neurotransmitter testing to find out what was going on in people’s brains and other hormones. How do you start to even unpeel that onion? It gets overwhelming. It seems pretty challenging.
[bctt tweet=”There’s a difference between spirituality and adherence to religion because that’s the interplay between spirituality and culture.”]
You start simple and then you escalate from there. If you need intensive testing and workup, then you do that. If there’s somebody that comes in for the first time and they’ve never attempted weight loss, a lot of times, you can start basic. Do your lifestyle interventions that are more powerful than any medication. A lot of times, not always. It depends on the severity of their disease and how you assess their mental health and how ready they are as well. If they’ve already tried lots of different things and they’ve been on a hardcore diet and they’ve exercised at the same time and they’ve been to a lot of different doctors, they probably need a more intense workout.
It’s a delicate conversation. Years ago, it was their fault. Now it’s this understanding, like, “We’re dealing with something else.” What are the first things that you ask people to look at or invite them? Let’s say they’re trying to eat well and take a good walk but nothing’s happening. If you go down to caloric restriction, all of a sudden, the metabolism is going to sleep and they’re in this cycle. How do you help someone?
I like to work with interdisciplinary teams, dieticians, or health coaches. I keep in mind that telling patients that they’re eating more than they think they’re eating calorie-wise is not usually helpful. They usually understand this. Most people will eat 30% to 50% more calories than they think they’re eating even when they’re stringently tracking their caloric intake. Even doctors and dieticians eat significantly more calories. Statistically, if I was on a 2,000-calorie diet, I’d probably eat around 2,200 calories.
We don’t know what calories are in our foods. We’re eating more than we realize.
Both. Some people don’t track oil. There are nine kilocalories per gram of that. Even if you have 5 or 10 grams, it’s a significant amount. Also, the portion sizes are sometimes overestimated or underestimated. Some people don’t tear their scales correctly. Some people don’t even weigh things, they just estimate them. Also, a lot of apps are incorrect like MyFitnessPal. Cronometer is decent but a lot of food tracking apps are also not perfectly accurate.
Do you have a rule about oils? Do you steer them to stay in the pocket with certain oils and avoid other types of oils?
Is that too deep in the conversation?
I tell most people to avoid canola oil and soybean oil for health reasons. I emphasize olive oil, which is part of the Mediterranean diet, which is a pretty good diet as well. It’s not the exact copy of the actual Mediterranean diet. If anybody’s been to the Mediterranean area, they know that. It’s a diet that’s artificial. The Paleo diet is not an actual paleo diet. It’s an artificial diet that can be helpful for many people to lose weight.
What oils will you eat?
I like avocado oil. I like olive oil. I usually stay away from soybean oil and canola oil. The thing with the oils is you’re looking at their ratio of unsaturated to saturated fatty acids. Also, you’re looking at their Omega fatty acids. You have your Omega-3s and Omega-6s, your linolenic and linoleic acids. Your omega-3s are further divided into subsets, DHA, EPA, and other types as well. EPA seems to be underutilized. Most people’s diet in America does not have enough EPA.
Omega-6s are also essential fatty acids and you can eat fairly high amounts of them and they can be healthy but the ratio is usually off. It’s similar to how most people are not eating enough fiber in their diet. Most people are also not getting enough Omega-3. However, most people have plenty of amino acids. There are two different types of malnutrition, marasmus and kwashiorkor.
What does that mean? Can you break those down?
There’s malnutrition because you’re not getting enough calories. There’s malnutrition because you’re not eating enough amino acids.
We don’t have the first one.
We also don’t have enough amino acids. Some people, especially women and older people, benefit from higher protein diets. The moral of the story is there are not many people that are truly amino acid deficient. There are probably not many people in developed countries that are Omega-6 fatty acid deficient. When people talk about the benefits of Omega-6 fatty acids, it’s within the context that we’re getting enough of them.
With obesity, do you feel more hopeful? You’ve had a lot more patients. You’ve helped people. For me, health and being your own advocate for your health, that’s always what I want to encourage people to do. Also, it’s like life. Hope is important. Do you feel the more hopeful, the deeper you’ve gotten into this practice?
One of the things that give me a lot of hope is the renewed emphasis on mental health and how it relates to obesity. It’s now standard of care to where if a patient is seeking obesity medicine or weight loss, you make sure that if they need their mental health is taken care of as well or even an eating disorder, they can currently have that taken care of.
I learned this many years ago and I was blown away. Also, you think, “They’re eating so much more than I am.” The fact is they’re not. They might be binge eating in there or whatever. Because of where they’re at, it could be 30 more calories a day, 100 more calories a day. There’s a lot going on that lends itself to how a person has gotten somewhere. It’s probably so much more complicated than even they would know until maybe they go through the whole process.
There’s a balance between orexigenic signaling and anorexigenic signaling, which makes you want to eat more than it makes you want to eat less. This happens in the hypothalamus. There are a lot of different connections to the endocrine system and also your central nervous system too. When you’re in a state of stress or when you’re in a state of dopamine depletion, you can learn to eat as a coping mechanism almost like an addiction.
A lot of the medicines that we use in obesity medicine are also used in addiction medicine. There are things like Contrave, which is a combination of naltrexone. It decreases cravings. We also use it after alcohol addiction, opiate addiction, and things like that. Also, bupropion is an antidepressant that helps dopamine be increased. It’s interesting to see how something like that causes almost as much weight loss as many of the other drugs that are insulin sensitizers.
It must be amazing as a patient. You tried everything, you’ve yo-yo dieted, you tried all these things, and then you go and you get the whole situation looked at and taken care of to get that opportunity. It’s life-changing, but it must be pretty profound.
Obesity medicine clinicians are essentially becoming what functional medicine doctors used to be, or integrative medicine doctors, which is, they’re finding the cause, because the cause can be different. The cause can be stress, a family situation, or the cause could just be appetite dysregulation secondary to insulin resistant. That’s one of the classic causes, and they specifically addressed that cause.
When you’re having increased weight, it’s like being stuck in quicksand. The deeper you go, and the more you try to get out by yourself, if you’re not very coordinated, you’re going to get deeper and deeper into that quicksand. Supplements and medications are just the tools to get out. Depending on where you’re stuck in the quicksand and how deep you are in the quicksand, you might need a shovel, or you might need a backhoe or something in between.
What about when you have a couple? Sometimes you see couples come together and they have a system in place and they relate over food or they medicate. Do you invite the other partner to come in and then do this as a whole collective? How does that work?
If there’s food addiction, and oftentimes, if both partners are overweight or obese, they have a similar backstory or similar trauma or stress that’s happening within their family. Just like when two people living together are trying to have smoking cessation or nicotine cessation, they’re far more successful if they both do it at the same time. We see the same thing in obesity medicine.
I heard a comment that you said that that was great because it’s the truth of life. You were like, “Usually, the person with the worst habits wins.” I was like, “It’s so true.” It’s interesting how the easy way or sometimes the way that doesn’t serve us the best. I think about that like with making offhanded comments and things like that. We have to have the discipline to not do that. But if you live in a house where there’s maybe one person that’s like, “That guy,” or whatever, then the whole house goes there. It’s like a pylon, and it’s the same thing with habits.
I thought that that was a really beautiful and important reminder for people. It’s like, who can you be in your house? Because we can we can help each other and be that example. We can’t make other people change but we can be an example or a motivation to do that. You talk about ways to prevent yo-yo dieting, but when I talked about the neurotransmitter testing you talked about, maybe you could explain that? I think that’s pretty new for a lot of people to think about like, “My obesity, but I should get this test over here.”
There are lots of other things that you can test or at least assess what your average level is. Neurotransmitters vary up and down quite a bit but you can think over the spectrum of things like serotonin and dopamine. You can also think about things that have what we call adipose-brain crosstalk. Those are things like ghrelin, which tends to make you more hungry, and then things that change very acutely even day to day, depending on your caloric intake. Things like lectin and adipose lectin.
On the serotonin and dopamine side of things, your serotonin is in general your mood hormone. You have peripheral and central serotonin. Peripheral serotonin, almost all of it is made in the gut. Gut-brain crosstalk, and then adipose-brain crosstalk. This serotonin cannot cross the blood-brain barrier, but it’s important for lots of functions in the gut. It’s also important for having positive feedback inhibition with the good bacteria that make serotonin. You can take probiotics that are specifically serotonergic probiotics.
One thing was serotonin, if people are taking a supplement, like 5-HTP, there are downsides as well. Serotonin also acts in the heart of the 5-HT2 receptor, I believe. There’s a receptor that can lead to the risk of valvular fibrosis. That’s why some medications that are serotonergic, like Cabergoline, if you take them for a very long time consistently, it can increase your chance of having valvulopathy, an issue with a valve, or it becomes fibrotic, or it does not work as well.
Theoretically, 5-HTP which is very similar to serotonin can do the same thing. It also does not cross the blood-brain barrier, so a better option for some people is tryptophan, which is a serotonin precursor. But again, a lot of people get decent amounts of tryptophan through diet. Serotonin is active in the central nervous system as well.
Where else do you get it besides turkey?
You get it from almost any meat. Supposedly, the tryptophan in turkey is not the main thing that makes you tired.
It was all the other crap you ate with it?
The combination of everything that you eat causes a glucose spike and then a big insulinemic response, and then the glucose drops. Also, something called alkaline tide. Because of turkey and a lot of other things, your body senses all those amino acids and then it pumps out a bunch of acidic, essentially hydrochloric acid, stomach acid. The gastric veins that take away what’s left are less acidic to where they’re slightly alkalinized, the opposite of acidic, and that can make you a little bit tired, too.
Do you eat sweet potatoes with marshmallows on them? Come on, do you?
I will eat sweet potatoes and marshmallows at Thanksgiving. I don’t think I’ve ever had it other than Thanksgiving.
That’s what I mean. I was just wondering because I want to talk about inflammation. I want you to finish that, so 5-HTP and another, tryptophan would maybe be milder and safer.
Yeah. There are some medications that affect serotonin and some supplements that are associated with weight gain, and some with weight loss. It’s because there are so many serotonin receptors that it’s hard to differentiate which ones are more weight positive or weight negative. That’s an individualized thing to decide with your doctor. Dopamine is more commonly associated with weight outcomes. Bupropion is a dopamine reuptake inhibitor. That is active all throughout the brain but it’s specifically active in the balance of orexigenic versus anorexigenic signaling in the hypothalamus. Second, it helps decrease cravings and, a lot of times, it’s used in binge eating disorders.
There’s a relatively new medicine Vyvanse. It’s not generic for some time, but it’s Lisdexamfetamine. It’s basically Adderall, but only the half of Adderall that works more on the dopamine receptor rather than the adrenergic receptor. It doesn’t work as much as adrenaline or as much as noradrenaline, but it works specifically on the dopamine receptor because it’s the dextro. Dextro is the right-handed Adderall molecule that’s a slow-release. It has a new indication for binge eating disorder. Usually, in cases of true binge eating disorder that is not otherwise controlled with other options for binge eating disorder, other dopaminergic agents.
Is it a social thing why women have a tendency to eat not enough as response versus men? Is it more like what’s socially acceptable or is there something with our hormones and in conjunction with this, on how we deal with it, whatever the trauma or what have you, that women are more prone to that side of the reaction?
Part of it is lean body mass and basal metabolic rate. Part of it is societal. Those are probably the two main things. With your neurotransmitters, there are a lot of other things to think about as it relates to women and men. Testosterone, exogenous or endogenous, will inhibit an enzyme called monoamine oxidase. This monoamine oxidase or MAO is an enzyme that helps convert things to serotonin.
A lot of guys that I talked to, they’re very willing to sign up for testosterone injections. Not only does that affect their serotonin but it also decreases their serotonin, it affects their cholesterol. It’s essentially the opposite of a statin and the opposite of medication to increase serotonin. There’re things that you could do more naturally, too, as natural as they come. One of the interesting ones is a weak MAO inhibitor that works on serotonin and dopamine. It’s called the wild green oat extract.
I wasn’t expecting that.
I’m not sponsored by them or anything but one of the companies that make it is called Life Extension. Some of my family members have taken it and had good results with it as well. It’s a good option because it potentially helps with dopamine and serotonin balance for things like nicotine cessation, binge eating cessation, and just neurotransmitter balance, in general. One interesting thing about association between dopamine and serotonin is a lot of females have more serotonin, but not as much dopamine. Dopamine and testosterone are close cousins.
Does not that make perfect sense?
Like, “Let’s go get it. Let’s kill, let’s have sex, let’s run.” We’re just trying to keep it together.
Serotonin is kind of a social hormone that’s why a lot of women tend to have, there are exceptions, much higher social IQs or social intelligence. That’s why there’s a 4:1 or 5:1 of males that are much more likely to have autism. These males that have autism, and also females that have autism, tend to have lots of dopamine and not enough serotonin. There’s a balance between the two that’s ideal. There are also benefits and detriments to being more weighted to dopamine. Oftentimes, you’re very motivated, or more weighted to serotonin.
You have a lot of friends but you’re not getting stuff done. I’m just kidding, but the calibration is constant, isn’t it?
Personally, what do you take for your supplements and why? This isn’t for everybody. I’m asking you what you do. 31 years old, what do you need?
For my supplements, I take a baby aspirin if you consider that a supplement. It’s a medication, too. It’s 81 milligrams of aspirin, three times a week. There are a couple of benefits to it. It can decrease the incidence of colon cancer prevention. I eat plenty of meat, I have a family history of polyps and things like that. Baby aspirin can help decrease the risk of some types of colon cancer. Also, it’s a mild antiplatelet and it also lowers your CRP. There are a couple of different benefits to aspirin. The medical societies keep changing the recommendation. Every 5 or 10 years, they’ll say, “Everybody should be on aspirin over 50.” Now, as of 2021, it’s that, “Nobody should be.” There’s a balance between the two.
There is another blood thinner option for people that are at high risk of bleeding or some people who tend to get bruises all the time and don’t want to be on aspirin and it’s called the EPA. I’m on a tiny bit of EPA just to help my balance. I like to do Omega checks to see where I’m at. A lot of people do benefit from the Omega check. You can see your EPA and your arachidonic acid. By the way, aspirin works on the arachidonic acid pathway, it’s a type of omega. You can see the ratios of all of them including your DHA and your EPA.
If you’re at risk of something like a heart attack or a stroke, you can take more EPA. I don’t think my risk is that high yet but I do take an EPA supplement fairly regularly. Every once in a while, I take L-carnitine. Both are injectable because it’s not very bioavailable and oral L-carnitine. I think of L-carnitine as the fuel pipe or the shuttle that takes your fuel or your NAD to your engine. Your engines and your mitochondria. The mitochondria have two membranes. In your mitochondria, your CoQ10 as the Coenzyme that’s helping convert that NAD fuel to ATP. The most active form of energy is ATP.
From time to time I take creatine, which also stores an ATP phosphate donor. Think of that as your backup fuel tank. You have your backup fuel tank, I take that fairly often, I also take CoQ10 in the form of Ubiquinol. You have Ubiquinone and then you have Ubiquinol, which is the more active form of CoQ10. A lot of things for mitochondrial health. I also try to optimize my REM sleep as much as possible.
What do you mean? Do you have tricks for that?
The more you improve your cholinergic function, the simplest thing is eating good free-range egg yolks that are nice and orange, not just orange because you add xanthophylls. They do this for salmon but they do it for eggs too. If you add xanthophylls like pumpkin seed or alfalfa and you feed your eggs that feed, they can live in a barn and they’ll have bright orange yolks. The orange yolk that you want is very high in fat-soluble vitamins and D, A, K, and E, like cake with a D, and also high in choline.
Choline’s an acetylcholine precursor, and the acetylcholine is what helps your REM sleep. There’re also hardcore choline precursors, which you probably shouldn’t take all the time, especially if you have high blood pressure. Alpha GPC, which is phosphatidylcholine. It’s a cousin of Phosphatidylserine. These are essentially acetylcholine precursors.
There’re also acetylcholine esterase inhibitors, which sounds scary because there are a lot of gases that are also acetylcholinesterase inhibitors like sarin or VX. Those are toxic gases that are banned but there are very weak versions. Huperzine is one of them and there are other ones too and it inhibits the breakdown of acetylcholine. If you have really poor REM sleep, you can utilize these things. I don’t recommend nicotine. Nicotine also affects your acetylcholine.
A bunch of people who are like, “Yes, my REM sleep.”
[bctt tweet=”It’s easy to look at the speck in someone else’s eye where you’re not seeing the log in your own eye. There are always things that you can do better with your children.”]
Unfortunately, there are a lot better options. There’re many better options.
Nicotine itself isn’t that bad for you. It’s all the crap that they put with it. Isn’t that kind of true?
That’s mostly true. There are a ton of carcinogens. Smoking things, in general, is not optimal.
Burning your lungs is probably never a great idea. Stay away from burning your lungs. Can we slide over? I know I’m torturing you because you are away from your local honey and I’m so sorry but I want to talk to you about hormones. The magic word for men is, you know what it is.
Yeah. They hear that word and they get so excited. There’s a lot of TRT, for women, women and men, HRT, and all these things. Again, we’re not giving specific prescriptions because this is about people going to their doctor, getting their bloodwork done, and checking into this. First of all, what age do you think someone should even look into something like TRT?
At age 18, they should get their hormones checked and see what their baseline is. As soon as they start to feel abnormal or something’s wrong, they should get their hormones checked again.
Is that stress in going to the real world? Is it when you start having kids because life is never quite the same? Or is that just like, “I’m really tired and I don’t recover.”
I’m an advocate for getting your baseline hormone panel checked. That way you know what your normal is. That way you know how you feel when you have those levels of androgens. Check all your androgens, your DHEA, your testosterone, and your DHT. As you age, if you feel like something’s off or just when you’re doing your routine checks, then assess what you can modify. If you can’t modify, then assess if TRT is an option.
There are some people that are teenagers that just don’t produce androgens. I believe Kallmann syndrome is one of these. There’re a bunch of other various syndromes where TRT is indicated at a very low age. These are usually rare conditions and they’re almost always treated by specialists. They’re similar to lupus where they’re rare enough to where there are normally several years between the incidence of symptoms and then the diagnosis itself.
Let’s say you’re middle-aged, all things are sort of normal, whatever that means, and you get your bloodwork done, but you’re like, “I’m active and I’m trying to optimize my performance.” Do you think it’s reasonable for somebody around 50 to start exploring that for either performing at a higher level forever and longer, and getting the opportunity to recover? Do you think that that’s a reasonable conversation for people to have with their doctor?
It’s always a reasonable conversation, even if somebody is 20 or 30 but it’s much more likely that something will be done if someone is 40 or 50. If you look at the curve of, essentially your likelihood, being hypogonadal, having testicular hypo function, only about 20% of people have it when they’re 40. If you follow people to age 80, 50% to 60% of people are clinically hypogonadal. You also have your 80-year-olds with total testosterones over 1,000. There are lots of people out there.
I know people like that. He was ready to beef any moment. He was Laird’s dear friend. He was unbelievable. He just thought, “That’s how I’m going to do it.” Right to the end.
Some of those people don’t even have every single lifestyle component dialed in. It’s just luck of the draw and genetics. If you look at a chart of what your likelihood is, I would say you can do it as early as possible but when you’re around 40, you need to at least start tracking to see how things are. If you’re going to optimize things naturally or put off TRT, if you are inevitably going to benefit from it in the future, the earlier you intervene, the better.
With TRT, because I know there are a few ways people can do it, do you have a delivery system that you’re the biggest fan of for most people?
For most people. I’m a fan of subcutaneous administration. Subcutaneous is when you inject it just under the skin into the little fat layer, just beneath the skin. It takes a little bit longer for the esterase, basically the enzyme, to cleave off the cypionate or an anti-ester or undecanoate ester. It takes a little bit longer so you have a little bit more stable levels. You also have a little bit longer half-life and a little bit less risk of too thick of blood, too high red blood cells, high hemoglobin, and high hematocrit.
I couldn’t help but notice when I was doing all this homework, all the muscle heads love you. You got to appreciate every guy is so yoked but they somehow have their PhD in something. They’re brilliant. They are like, “Dr. Gillette.” It’s cute. I’m just here for high performance and longevity. For women, obviously, it’s complex. It’s a complex system. I want to ask you at the top, if there are supplements, let’s say overall her health and blood work looks good. Do you like any supplements for a woman, I get women always asking me about menopause, to support them? It doesn’t have to kick everybody’s butt. It’s not a sentence necessarily. Do you have supplements given that there’s no unique situation to support women through that time?
Part of it depends on the age of menopause. As you approach menopause, the average is the mid-50s. If you’re even 5 or 10 years earlier from your expected menopause, then your progestogen activity is slowly dropping. Usually, sleep or vasomotor symptoms are one of the first things that start.
And happiness, because that’s your feel good, let it go, then you’re just pissed.
Yeah. Your estrogen is still high so you started to have more estrogen dominant symptoms. If you are someone that has fibroids, sometimes those will get worse. After menopause, they essentially dissipate if you can make it until then or if you have endometriosis, that can be the same.
What do you mean if you can make it? Until you don’t go crazy? If you can make it? Until your house can make it? What does that mean?
You could look at it that way. I meant if you can make it to menopause without a hysterectomy.
Women are quick to despair like, “I’ll just get a hysterectomy.” I’m like, “No, I think you want to hold on to all that stuff if you can.”
If you can, especially your ovaries. If you do have to take if you do have to have a full hysterectomy, which there are many reasons why you do or if you have early ovarian failure, you should strongly consider HRT.
I haven’t done any of that yet. I don’t know why I’m dragging my feet on it but I think it’s time. I guess I’m trying to figure out the right way to do it. Let’s go back to menopause. Let’s say everything’s normal. She’s in her early mid-50s. Do you like any supplements?
Pregnenolone is a good one. Pregnenolone can be converted to progesterone and it can be converted and reduced into dihydro and trihydro progesterone. Pregnenolone is essentially a different endogenous progestogen and that can help. Depending on your risk of blood clot and depending on what form of contraception is used, you can be a good candidate for aspirin as well. A decent number of women benefit from aspirin.
Lots of people have tiny little blood clots in the lungs. When they’re inflamed, it’s going to be more likely to happen. When you have a long airplane ride or a car ride, you can get blood clots in the legs as well. A lot of people have different thrombophilia or they’re more likely to have a blood clot. It’s called venous thromboembolism because it’s a blood clot in the venous system that can travel along. That’s one thing that’s particularly important for women that are on oral contraceptives, if they have to be, or if they’re on oral estrogens.
Can we talk about oral contraceptives? I took some in college for a little bit but I didn’t have great success. It didn’t work out but I have three daughters. You should take a drink of that Kombucha because you have sons and you will never know what it’s like to have three daughters.
It’s a lot of daughters.
How do you feel about it? Sometimes it makes sense but it gets tough on you.
I usually start this conversation by noting that if you’re taking contraceptives for contraceptive purposes, then a lot of times even with significant risk, the benefit is so amazing that the benefit outweighs the harm. If you’re having a child at not the right time, then that can be very detrimental to your health in many ways. Past that, there are a lot of risks and benefits of specific, usually, an oral contraceptive is a synthetic estrogen and a synthetic progestin, which is a type of progestogen.
A synthetic version of estradiol. Ethanol estradiol is the most common one. There’re other new ones, too. Synthetic progestins, there are many more types, but usually, they’re derived from testosterone. Almost derived from nandrolone, which is a 19-Nortestosterone. Some are also derived from spironolactone, which is an anti-androgen diuretic. Some of the synthetic progestins will increase your SHBG and platelets more, which is more correlated with risk of blood clot. It’s also correlated with risk of persistently high SHBG and low free testosterone.
What does that mean?
If your platelets are high and your SHBG are high, then you’re slightly more likely to have a blood clot. If your testosterone is low, then you’re more likely to have less activity at the androgen receptor, so that’s going to vary your libido, your level of attraction to people, and the type of people you’re attracted to.
That’s why it’s birth control because you’re like, “I’m not interested.” I’m joking.
Kind of. Pick the right one for you. Some women have lots of androgen dominance and for them, then maybe one that is more of an anti-androgen if that makes sense.
Testosterone is important for us women, too. Is that what you’re saying?
Did you read that? It’s for all of us. Testosterone’s for everybody. Especially when you’re not in childbearing years anymore, like my age, that’s an important hormone for me to have as well.
It’s extremely important, as you’re making less and less estrogen from your ovaries. Think about the actual level of estrogen and testosterone. Women have much more testosterone than estrogen. Women also get estrogen from the aromatization or the conversion of testosterone to estrogen. They get a lot of testosterone from the conversion of DHEA. Depending on how active your enzymes are converting DHEA to testosterone and testosterone to estrogen, then that can significantly alter the balance between your testosterone and estrogen. You want enough estrogen because it helps prevent cardiovascular disease. You also want enough testosterone that making effort feel-good hormone and also to help maintain lean body mass and maintain a more stable motivation as well.
You have to be very diplomatic. I appreciate that. More stable motivation. That’s a good way of saying, “To get after it, don’t sit around, watch movies, and eat bonbons.” It’s interesting because the other thing is that this goes back to your Six Pillars. The spirit and the sunlight are also the narratives, the acceptance. Once I hit my mid-40s, everyone around my age, and I have friends that are much younger and older, whatever, but everyone was like they’re all marching towards the narrative of, “I’m going to get belly fat. I’m going to get all this.”
I don’t believe in resisting it either, though. I don’t think it’s about going like, “I’m not doing that.” I think it’s about understanding, yes, you might have to put a little different effort into feeling good and trying to keep your lean body, your muscle mass, and things like that. Never once was I thinking, “That’s my sentence.” Things change. It’s nature, it’s natural. I like to remind people, with people like you out there and available. If we take responsibility for the things we are in charge of, we don’t just have to march into not feeling good, not sleeping good, being miserable. It doesn’t mean that everyone can avoid it. I’m sensitive to that but just to remind people. I find that people use that a lot like, “In this age,” or, “I’ve got this now because I’m this age.”
I don’t think that you should ever attribute anything just to getting old or aging. I’m in a camp that believes that age is inevitable. It’s okay to try to slow it down but I do think that at some point, it’s inevitable. Premature aging, I do think is pathologic, and I do think that premature aging is a disease, maybe it’s the precursor to other age-related diseases like sarcopenia and osteoporosis. Premature aging is kind of, to those diseases, just like obesity is to obesity-related diseases.
That makes a lot of sense. I joke about the mitochondria because I feel like we always hear it. It’s like our battery, we need it, and it needs to communicate. You mentioned some of the things that we can do to support the mitochondria. I wanted to revisit if I missed anything that feels important to you.
The main two things that support mitochondria, I think of them as the powerhouse of the cell. Think about it as the engine in a race car. The number 1 and number 2 are good sleep and good cardiovascular aerobic exercise. That’s essentially building your engine. Don’t think about a Tesla, but 2 or 3 or 4 engines. If you exercise more and you also sleep better, then you might double the number of mitochondria in your cells and help them function better as well. That’s step number one. Put a nice big engine in your car with those two things.
Passed that you can feed it extra gasoline, NAD repletion happens a lot during the night as you sleep. Also, you can take NMN or NR. NR leads to NMN, which leads to NAD, and then the NAD with Coenzyme Q10 leads to ATP and then creatine, again is the extra fuel tank. The L-carnitine is a shuttle to get the actual fuel into the mitochondria. That’s how I think about it in layman’s terms. I know it sounds perfectly scientific.
It’s excellent. I know it’s a big topic and it’s hard to sum it up. After doing this, just being in the space of, whether it was coming from athletics or moving in and being surrounded by really knowledgeable people, three things keep showing up for me all the time. Mitochondrial function, metabolic function, and inflammation. If people say to me, “Simplify it.” I go, “Those are the three things aside from trying to find some joy.”
Everyone focuses on like, “Calories and lean body mass and all these things.” I’m like, “Yes, but if you aren’t helping someone else having a practice where you get the joy.” Happiness sort of floats in and out throughout the day, sense of purpose and joy. Inflammation, people are trying to figure out how to keep their inflammation lower. We know you can do it with food and exercise. Stress creates a lot of inflammation. Just reminding people to take a couple of deep breaths. Is it worth freaking out about? Do you have other things that manage inflammation or help with inflammation?
When I think of inflammation, one easy way to think about it is reactive oxygen species and reactive nitrogen species. You have antioxidants that help with reactive oxygen species. Caloric restriction can help to some degree, and then not having your mTOR turned on all the time can also help. If you look at brain remodeling, if people are at a more consistent weight, that helps remove things like amyloid or tau, which can lead to neurodegenerative diseases.
On top of that, your level of inflammation can be measured. It’s a cardiovascular risk factor. You can measure something called a CRP or a C-Reactive Protein. If you ask for it, it’s High-Sensitivity C-Reactive Protein or HSCRP. Over three is a high risk of heart attack and then under one is a low risk. If someone has a condition like rheumatoid arthritis or an inflammatory condition, that’s why rheumatoid or psoriatic arthritis or certain autoimmune diseases are as big of a risk factor for heart attack and stroke and things like diabetes because of the CRP. You can also have perfect lipids. I think of inflammation as the glue that sticks the lipids to the plaque wall. It’s important for cardiovascular health, and cellular health as well, but especially the cells in your brain as you age.
You want to avoid dementia and Alzheimer’s and things like that. Everyone’s so different, I think certain people get it from food, I can feel it for me, with lack of sleep, and when I’m reacting and I internalize it, but I can feel like my whole body tighten up. All the joints feel tight. Are there supplements? Even things like the sauna, I would imagine, are very helpful with that. Are there things that you like that you encourage people, “Did you ever think about incorporating some of this into your life?”
The sauna is excellent. There are lots of supplements. Curcuminoids like turmeric are a good one. Cayenne is another good one. Red yeast rice can increase your CRP but it’s a precursor to statins so it can help your lipids, but it increases your CRP. If your CRP is high, then that’s probably not a great choice. There’s also L-Carnitine, which can lower your CRP slightly. Aspirin can also lower your CRP. Melatonin, if you need it, can also lower your CRP. You can take just a very small dose if you’re trying to lower your CRP, that way you don’t affect other things with too much melatonin that lasts too long.
In addition to that, there are also various compounds that can help decrease inflammation in the cell itself and those are antioxidants. Lots of people know resveratrol, but lots of plants’ polyphenols can also help. There are also certain fungi and mushrooms, and then also other compounds that can help decrease the inflammation at the cellular level itself. There are a bunch of different ones that people like to take, depending on the scenario, it’s pretty individualized, but a lot of your brain health or cognitive supplements have these in them.
That is something interesting as you do get older, the recall and all these things that you become conscious of. Instead of putting stress around it because that almost makes it worse, you have to figure out ways. It feels like a hardening of the brain and seeing if you can get that back being soft. There are certain practices beyond what you take that help with that. One, not freaking out about it, but go outside. Take a minute, look around, unplug, and give your brain a break.
That’s one of the things that vigorous exercise is particularly good at. There’re two main theories on why vigorous exercise can prevent atrophy of the brain and also neurodegenerative disease, even better than light exercise. One of them is the blood flow, which is pretty self-explanatory, more blood, and more nutrients take the bad stuff out.
Another one is that when you vigorously exercise, the cells in the brain purge those. I’m not a fan of like many cleanses, but it purges the amyloid plaques and tau tangles and things like that, so that you have less build up. A little bit and a little bit less build up over time. One of the new treatments of Alzheimer’s is a monoclonal antibody to β-amyloid and then some people take supplements like Shilajit that helps with tau tangles.
Don’t tell Laird, it’s his favorite thing. Excuse my mouth but he’s always like, “Shilajit’s amazing.” I’m like, “Yeah.” He’s been taking it for a long time. Have you ever smelled Shilajit?
I probably did when I was trekking in the Himalayas but I’ve never taken a bottle and smelled it. In my mind, the worst smelling supplement is NAC or acetylcysteine, a glutathione precursor. That stuff just smells like booty.
Must be good for you.
It is good for you.
I don’t want to cut you off so Shilajit and was there anything else? Because I love this.
That helps with tau tangles kind of similar to how vigorous exercise can also help. With β-amyloid, there’s a monoclonal antibody to it. The problem with that is that you’re ripping it out all at one time. You have to treat it over the course of 3, 4, or 5 years. Vigorous exercise could probably treat it similarly if you started it earlier. Instead of starting it after you already have been diagnosed with Alzheimer’s or dementia, you can start the vigorous exercise that works as not a direct monoclonal antibody but works to remove that plaque.
I love that visual because that can empower people if they think, “I’m also doing that.” Just a little bit, a little bit, whether it’s support or diminishing any damage that’s there. It’s a beautiful thing. Infertility, I know I’m all over the place, but there’s a lot to go over. You talk about infertility and obesity rates rising. There’re certain things that cross-connect and all of that but 1/3 of it are usually Female, 1/3 of it’s usually male, and then 1/3 is this combination.
Your thing is, “Let’s get in there first and figure out why.” There’re environmental components to infertility, people are waiting longer, and they live more stressful lives. There’s probably a myriad of things. For someone who’s experiencing this and going through this, how do we get them to start to unpack this a little bit?
If you’re younger than 35 and you’ve been trying to conceive for more than a year, you’re considered infertile. If you’re older than 35 and you’re trying to conceive, then it’s six months. It’s important to start thinking about working up to see why earlier than that. With infertility, you don’t have to wait that long to work things up. If you have a history of Oligomenorrhea, not enough periods, if you go longer than 35 days, even once, or if you have less than around nine per year, then you could be at higher risk. That’s called Oligomenorrhea.
[bctt tweet=”If you exercise more and you also sleep better, then you might double the number of mitochondria in your cells and help them function better as well.”]
If you have a history of anything like PCOS, insulin resistance, or obesity, then getting a fertility workout earlier rather than later is important. You can do this by doing LH test strips when you think you’re ovulating usually on days 12 to 14, or you can do progesterone to see its level. If it’s over 5 or 6, it’s very reassuring on day 22 or so to see if you have that spike after ovulation. If you’re a male, you can take an FSH level. Make sure that your FSH is high enough. You can also do a semen analysis. They have one called Legacy.
I wish that people would do an earlier assessment of their fertility and talk to their doctor about it beforehand, rather than waiting because then you’re chasing things. There’s this, if you wait longer and longer until you would meet the criteria for infertility, there is haste or a hurry to get everything done as soon as possible. When that’s the case, you have to be much more aggressive. In general, the more aggressive, the more side effects of whatever treatments you would need.
You’re also saying, “Even if someone’s single, just find out where you’re at.” Maybe you meet someone a little bit later at least you have, again, back to these baselines and understanding like, “Am I going to be managing this or not?” People who try and are not able to conceive and then they adapt and then they get pregnant right away. That’s my favorite story that happens all the time.
It’s such a powerful thing where when you want to have a child and then it’s a challenge, then it becomes layers of stress. I have had friends where it’s like, “He has low sperm.” “Her eggs are.” I’m like, “That’s the worst thing. You have to be as together as possible.” She might be like, “I’m fine and his sperm…” He’s like, “My sperm is fine.” I also want to say to people, if you are navigating it, it’s easy for me to say I have three kids, and I honor that, but adding on blaming yourself or your partner or anything is probably not helping.
That’s a great point. There’s too much shame when it comes to fertility. Some people are hesitant, and some people have the financial means. For whatever reason, maybe it’s stigma, they’re hesitant to freeze eggs or sperm when it’s the right time to do so. That’s something that can help a lot of people if they’re able to make it logistically happen.
That’s why I want to bring it up because I don’t think we should shame each other. We should support each other and if something’s not going the way you want, then get help. Use your village, whatever village that is, to get that support. For hormone optimization, whether you were talking about your adrenals, sex hormones, or even hormone replacement, you talked about micronutrient panels. I’ve heard of it, but maybe you could share why you like that.
Selenium is an important one. It’s a cofactor for the conversion of mostly inactive thyroid hormone to mostly active thyroid hormone. Pass that testing zinc is important. As people age, the level of intracellular zinc goes down. Even if your zinc and your blood or your serum are normal, then your zinc inside the cell can be less active. This has a lot to do with the health of the testes. Another important one is for your nervous system, and also your hemoglobin being too high or too low.
Iron is another important nutrient as well. Ferritin is a protein that is a marker of the general iron level on your bone. You can test the ferritin in your blood. As long as it’s as long as your inflammatory markers aren’t high, ferritin is also an inflammatory marker like CRP, then your ferritin can tell you if you’re becoming iron overloaded. It’s where your iron can build up and cause hemosiderin deposits, and it’s in the brain or the thyroid, or in the gonads.
Tell me what you think about this. We joke that we think probably men have higher iron because you got cut more, you bled more before, the way you used to live out in nature but now that’s not probably happening as often.
There’re a couple of different reasons for that. One is that women menstruate and have children. The other one is estrogen and its assistant known as hepcidin. When your estrogen is high, it inhibits hepcidin, which subsequently inhibits the absorption of iron in the gut. If you’re a male and you have relatively lower estrogen, you inhibit hepcidin less and you intake more iron, so you absorb more iron even if you’re eating equally bioavailable forms of heme iron. That’s probably an adaptation to why they might bleed more. Part of it is that men have slightly higher testosterone and slightly higher erythropoietin or EPO and then they also need more iron for slightly higher hemoglobin.
You have a lot going on in that head of yours.
That iron homeostasis is a very complicated topic that not a lot of people think about but the good news is the treatment for it’s pretty simple. It’s supplementing with iron and/or vitamin C and/or doing therapeutic phlebotomy, which is essentially letting go of red blood cells that happen to have iron in them.
I’m anemic, weirdly. I’ve been low-iron my whole life. I did my blood work and I’m anemic. I did IVs. You usually say you can tell no matter what background someone’s from, their colorings and lip coloring’s different. For whatever reason, I feel okay. They’re always like, “Are you tired?” It’s interesting. It’s one of those things like, “I’ll take iron, I’ll take C.” Again, I feel like, in some ways, maybe that’s a weird thing about me. I think a lot of us can be healthy and things aren’t perfect. It’s like, “That seems not to be hurting too much.”
It’s very individualized. The classic example is celiac disease. They don’t absorb iron hardly at all. Some people have a different gene for their hepcidin that helps absorb the iron. Some people are runners and the red blood cells in their feet explode. They have like a runner’s anemia. That can happen as well.
I’ve heard of that. I had a friend who went through chemo. She had to be careful with that too, as well. You were talking about joint replacement. I want you to revisit that because I’m selfish and I have an artificial knee and you were talking about a 3D printer version? Can you share that?
More and more people are getting joint replacements. Joint replacements are a difficult thing to assess because a lot of times the risk and benefit analysis is complicated because a lot of joints have a lifespan. It used to be that joints had short lifespans, 5 to 10 years. Now that technology is getting better to where they mimic your natural knee and they even have something called Conformis.
These Conformis joints are 3D printed exactly to your knee, hip, or shoulder and exactly how they line up so that there isn’t too much bone that’s taken and they’re also isn’t too much tissue or anything else that’s altered. That’s a good option for a lot of people. There’s also resurfacing rather than replacement. The risk of that is metallosis where you have metal leaching from the resurfaced knee into the bloodstream. You also have to be extremely careful with the angle, which is why a lot of surgeons had gotten away from it.
The recovery on that’s terrible, by the way. It’s pretty tough. Laird and I both had joint replacements and we had to consider all these things. We tried everything before and we were gimpy. It was pretty funny. If my kids were like, “Catch me,” I’d be like, “No chance. Come here. Get over here.” They’re like, “What are you going to do about it?” It got to that. That’s why we went with the full joint replacement because the recovery was quicker. There were some other things. You’re saying also with the resurfacing for women, that can have a little additional risk if they have the metal, the little shavings, or any of that.
I don’t believe resurfacing is done in women anymore. It’s mostly just in men. There’s a risk of metallosis and things like that. Also, there’s a pretty good alternative in the Conformis joint.
Do we know the recovery? Do you know anyone who’s had the Conformis joint? How long has that been around? Where was I?
I’m not sure how long it’s been around but they take a special CAT scan, and they 3D print it. I don’t know anybody that’s had several years of that joint but I do know of people who have had that joint replacement and been happy with it. It’s pretty similar to a good pre-design like a standardized joint. The more different your joint is from the average general population, the more it could potentially help you. In general, knees are way harder to recover from than hips.
I know because I had my knee the same day Laird had his hip. We did it together. He left the hospital at 3:00 walking. He also stayed awake. I was two days later. I want to say if anyone’s getting a knee replacement, don’t worry about it for 30 days. Do your exercises, be diligent, but it’ll be pretty tough for 30 days.
The hip, if you know someone that’s like, “I play golf.” It’s a completely different recovery. Can we quickly talk about metabolites? They’re important in relation to women’s health. Maybe we could journey over there a bit and you could explain that and in conjunction with different parts of your health and women’s health and all of these things.
An important thing to remember when you’re talking about both supplements and pharmaceutical drugs is, what is it metabolized into? Some things will have what we call an active metabolite, and some things have an inactive metabolite. If you’re converting into an active metabolite, then it can have a very long duration of action. One, that a lot of doctors know about because we use it in conscious sedation and vasectomies and things like that, is valium.
Valium metabolizes to something called chlordiazepoxide, which is also Librium, which is another active metabolite. They’re both GABA agonists or benzos. Despite it looking like Valium that has a relatively short half-life. It has a very long, active half-life because of its active metabolite. Some drugs are not active at all. They’re called prodrugs because they have an active metabolite that does the work. That’s the case a lot of times. You could consider Synthroid or thyroid medicine, a prodrug, kind of. T4 does have some options, but T3 is its active metabolite.
In a way, you almost want the active. It goes and does the job and it’s done and out. I’m oversimplifying it. Is there a way, let’s say, with certain people, that they may prefer to try not to take certain things? In any of these instances, would you have the choice of a drug that could do it and not be in your system, and there as long?
Often there is a choice, but a lot of these active metabolites are not as stable as the prodrug so you would have to dose it 3 or 4 times a day to have a nice steady-state serum concentration. Another thing to remember with active metabolites is the duration of the drug is also affected in different tissues to a different degree. You have tissue-specific enzymes. Whether you’re talking about the deiodinase enzyme that makes active thyroid hormone or whether you’re talking about the 5α-Reductase enzyme, which converts testosterone to DHT, each tissue has a different level of these tissue-specific enzymes.
Testosterone is a prodrug too to DHT. If you’re treating people with DHT or with T3, which is called Cytomel, then you’re not going to have as even of a steady-state. The tissues that can tell via homeostasis are deciding how much or how little of the hormone they want, they cannot do that in any tissue-specific manner.
Dr. Gillett, people are going to be wanting to talk to you and get your point of view and communicate. Andrew Huberman called me up and knew I would enjoy talking to you. He talks about public education. Do you feel that calling as well where it’s like, “I can help my patients and a larger audience.”
Absolutely. One thing that I noticed that helped convince me or helped guide me to where speaking to the public is a huge benefit is you can essentially provide this education to everyone and they have a higher baseline when you might be otherwise talking to them. I noticed that I would say the same things dozens and dozens of times and my patients would all hear it. One time I said the same thing, it was about insulin resistance or maybe it was about the probiotics and probiotics being like the fish in a fish tank. Not even my nurse had heard my spiel on that yet and I thought I need to be telling the spiels to a wider audience. This helps provide that which is pretty high on Maslow’s hierarchy of needs for me, so good self-actualization.
It almost, I would imagine, will get you where now you have maybe even more of a reason to fine-tune a message to start to figure out that conciseness. All of those things. Also, not keep learning, I would imagine you’re a person who’s looking and paying attention but there’s an interesting thing where it’s like, “I have to see what’s new and what’s next. I can’t just get buried in my office hours because it is changing so quickly.” Is there anything, in particular, that’s coming out or coming up that you see on the horizon that you’re especially excited about?
There are a lot safer formulations of both contraception and also hormone replacement. There are several new types of TRT that are subcutaneous and that have longer-acting esters for a nice even steady state. There are also new synthetic estrogens and progestins, which are likely improved and there are also a lot more of the low dose options.
Are they available already?
Are these injections?
Yeah. There are lots of new formulations for those but they’re not generic yet so they’re not widely available. There are a lot of exciting things on the horizon when it comes to both contraception and hormone replacement. There are also a lot of good, new obesity drugs. Hopefully, a lot less people, unless they need bariatric surgery, can have the backhoe tools that I referred to. A lot more people will be able to have access to these.
There are a lot of different ones. There’s the GLP-1 receptor agonist, which there are more and more of. There’s an SGLT2 inhibitor, which is going to start being indicated for obesity as well. There’s even a triple reuptake inhibitor that’s been studied, serotonin, dopamine, and norepinephrine. There are a lot of exciting tools that we can provide people to use in a preventative way in the future.
Wasn’t there something created off of the Gila monster? I remember GLP-1. What was it called? I can’t remember.
They’re Glucagon-like peptide-1. A lot of these are also made in the pancreas. These GLP-1 receptor agonists are similar, only a couple of amino acids different from what we produce naturally. Carbs spike it but then it almost all goes away. Our proteins increase it and then it goes away after several hours and then fats take 2 or 3 hours for us to make GLP-1 and then kick in in the long run, which is one reason why a meal with some of all three helps with satiety in the long run from a GLP-1 standpoint.
Eventually, the first two medicines that were GLP-1s were Byetta and Bydureon. The generic for those was Exenatide and we’ve formulated it to last much longer to where you’ll have to inject it twice a day. Lots of them are once-a-week injectables and at some point, pretty much all of these will be indicated at increasingly higher doses for obesity.
The guy got it off of a desert lizard or something.
The research team was randomly sequencing peptides so the amino acid chains that were found in the saliva of a Gila monster.
Do you ever get overwhelmed? You seem even-keeled. I talk to people all the time and you go, “That person is born with a big brain and a high IQ.” They are people like that. The computers were running differently. You have a family and you have a lot of people’s demands. If you ever feel overwhelmed, do you personally have a practice or is it your faith? Where do you get your strength from to be able to do all that you do?
My strength comes from God, first and foremost, my family, and then my close friends as well. I feel socially connected and I’m blessed and fortunate to be able to have good social or community health.
Do you ever get angry?
Everybody gets angry.
How do you get angry? Is it like when you’re tired and somebody gets you off guard like, “A-ha.” When I see somebody, intentionally trying to go out of their way to be mean, that aggravates me. When my kids act entitled, that can trigger. You can watch all the stuff that I know not to do go out the window and I go right for it. Are there things that get you?
I’ve been upset with my health insurance company several times. As a doctor, I am also not immune to that. That’s what’s got me.
On a personal level, what are the tools that work for you because we’re all navigating it, that seems to be showing up that are making you successful in your relationship? What things do you show up with? I’d have to ask Maddie, what she shows up with but I’m asking you. Maybe you’ve developed whatever tools you’ve developed to move in the right direction.
Since our relationship was in its infancy, we decided that wherever we would go, we would go as a couple. Instead of completely going our own ways, we still give each other our space and all the individual personal needs. As a family, we have a unified vision. I’m not trying to do something different with our kids than she’s trying to do. We came up with that together.
One other thing that helps is that we knew that the initial dopamine or honeymoon phase would end so we developed connections other than dopamine I like you, you like me. Some of that is my bond with her family. Some of that is her bond with my family and some of that is our collective belief in God and our worldview.
For Laird and I, what is helpful is we’re different but our values are pretty similar. It’s not me lobbying for him to come over to my side to see it the way I do. It’s how we feel about things. Money, relationships, and all of that are lined up. How you get there and do it, you have to stay your own individual self. Is there anything that you’ve been surprised about that only you could know going through it about being in a relationship and now having a family?
Is there anything about it that surprises you? It’s not just your love for your children, but is it something that you go, “I didn’t see that coming.” One thing that is a little bit unique about having children is that there’s always going to be something that’s suboptimal. There will always be a time when they’re going to be looking at a screen and going to be having processed food.
That’s well said. Only you could say it sub-optimally. We’d say it differently. That’s amazing. You even made that sound good. Justin, do you want to ask any last questions that your brain generated that I forgot?
When is the book coming out?
I caught the, “I don’t care if you know, Andrew. I caught the science mafia.”
I like that.
You can borrow that, Andrew. The Science Mafia was started with Andrew Huberman, then Sinclair, then Matt Walker. He’s clearly getting the young buck over here and so we’ll see where it goes because they and they take over the science area. They’re trying to help us and explain stuff. It’s for the layman. They’re making science sexy again. I appreciate your time. I would love to have you come back and only talk about hormones. One last thing in running a business. How do you make that work? How are you finding the right people?
Running a business is a necessary component to help people. I’ve found that some potential business partners, specifically in the healthcare industry, have people that are small businesses, and they’re hyper-focused on sales and not on quality patient care. A lot of those businesses are not run by doctors. You have a huge national health organization that’s so big that it doesn’t even know what’s going on on a small scale and it’s hard to work with those organizations as well.
Starting my own business with Gillett Health was a necessary component of providing high-quality patient care. It was not something that I saw myself doing and it’s a lot of work. Thankfully, I’m surrounded by a lot of good people, other doctors, nurse practitioners, and pharmacists, that I would definitely not be able to do without.
It’s hard, you being a doctor and you’re listening to people and patients. You’re being a therapist, and you’re a businessman. It’s an interesting combination. Last question. Right now, what’s your dream?
I’m living my dream. If I imagined myself years from now, I would continue doing podcasts and build my business. Hopefully, I would still work at all the places where I’m working. If I was not able to grow my business or podcasting past this, I would be pretty happy and at peace. I’m blessed to have a family including my wife, both my boys, my dogs, and my chickens too.
Your Irish Wolfhounds are huge. They’re like horses. Why that breed?
I’ve always been enamored by Wolfhounds. I’ve always wanted them.
Is it the size and the little somewhat aloofness?
They say, “Gentle when stroked. Fierce when provoked.” They’re fierce when they have to go run after the coyotes that are after our chickens, but they’re gentle around my boys. I’ve been enamored by their duality of nature and their loyalty to humans. At some point, when my life has a little bit more time, I would like to breed my own breed of wolfhounds. I’ll call it the American Wolfhound because the genetic diversity is not great in dogs like that. My dog’s on rapamycin as well. There’s a dog aging project that you can look into for certain breeds of dogs that have lots of genetic problems or cancers. That’s probably a topic for a different day.
This is another cross-section for you and Huberman. When they say, “Dogs are like their owners,” I get that about you, too. You’re gentle and I’m sure you’re pretty fierce. Thank you for your time. Maybe tell us where everyone can find you. Your patients are lucky to have access to you. I want to say that to you. If you can remind people where they can find you.
Thanks so much for being here. If you’d like, rate, subscribe, and leave us a review. All of my music was graciously done by Frank Zummo and Tom Thacker. If you want to see some of the behind-the-scenes action, follow me, @GabbyReece. Remember, don’t miss new episodes every Monday.
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About Dr. Kyle Gillett
Dr. Gillett enjoys providing holistic individualized care to his patients. His practice includes preventative medicine, aesthetics, sports medicine, hormone optimization, obstetrics and infertility, integrative medicine, and precision medicine including genomics. He believes that each human is a unique creation that requires attention to their body, mind, and soul to achieve optimal health. He enjoys caring for others using shared decision-making and an evidence-based, patient-centered approach. He is active in Obesity Medicine organizations and firmly believe “food is medicine” and “exercise is medicine”. Dr. Gillett describes the “6 pillars of health”: exercise, diet, sleep, stress, sunlight, and spirit. These are more powerful than any medication or supplement. He enjoys spending time outdoors on the farm with his wife, two sons, and two wolfhounds.