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Most people think about their health when something goes wrong.
Next Phase Human is for everyone who wants to start thinking about it before that moment arrives.
Hosted by Dr. Sandhu — a cardiologist with a focus on prevention, longevity, and whole-body wellness — this podcast brings together physicians, researchers, and wellness professionals for honest, evidence-based conversations about the topics that actually move the needle on your long-term health.
Each episode covers the intersection of cardiovascular wellness, modern medicine, lifestyle optimization, and human performance — translated into practical, approachable conversations for professionals, business owners, and anyone serious about living better longer.Topics include heart health, metabolic health, sleep, stress, nutrition, longevity diagnostics, wearable technology, recovery, burnout, and the future of preventative care.
This is not clickbait wellness. This is a forward-thinking physician who believes the best healthcare happens before you need it.
New episodes weekly.
I think we're toxic. We're our own toxin.
We are living in a toxic soup, of course.
There's a lot of chemicals around us.
Welcome to Next Phase Human podcast,
where medicine meets
spirituality and wellness.
I'm your host, Rashim Sandhu,
a cardiologist, but however, with a deep interest in wellness.
Interested in not how we live just
healthier, but how to overall live better.
And my guest today is Dr. Valerie Ciwiula, and
she is right in that zone where we are
talking about health and wellness. Valerie, tell us about yourself.
Thank you so much for having me on. Yes.
Thank you.
So I have really fallen into functional medicine.
I have a practice here in California and also in
Florida, and it's really about the root cause
of what is the problem, not the
symptom.
A lot of times in traditional pathways, I find people
just are asking me: How can we fix...
You have a cough-
Mm-hmm
... let's give you a cough suppressant. But maybe there's something underlying.
So I do functional medicine
and I do put a lot of energy
into why somebody is sick and
when they were last fine.
Mm-hmm.
So that pivot, that switch is what I really try to
identify with each new patient or client
and just support them along that pathway
of what's wrong with my body?
Exactly.
Yeah.
I feel health is not just absence of
disease.
Mm-mm.
I think we are
really trying to do disease care, but where's the
vitality?
Yes.
Seem to miss that. Where is life happening?
Totally missed.
And that's why, I'm going to pick your brain on a
lot of these questions-
Let's-
... that I am intrigued about and I'm-
Okay, I'm going to stretch
... and I'm sure our patients are, too.
So,
ready? Here we go.
Let's do it.
So
this is a common thing that I see, and I'm sure you run into this
too. A lot of women when they say, "I just don't feel like
myself anymore," in their
40s. They get to their 40s, and they're not the same person anymore.
And we know it's perimenopause, or you're getting to early
menopause, and that's part of it is hormonal, and there's a lot
of dismissive attitudes about that.
What do you see in your practice, and
how do you perceive it, and how do you handle it?
A lot of it
begins with sleep.
Yeah.
So I always start there. I start with the behavioral category before I
go further.
I also would check their levels so we have data to work with.
Mm-hmm.
So we're mixing that clinical with the data and
lab results and a wearable device, so all of that information
together.
Mm-hmm.
Hearing people describe their symptoms,
you can typically pick out a predominant issue,
and so
say, "I'm so tired." I hear that one a lot.
"I'm so tired," or, "I don't feel like myself," like you said.
So based on their age and even just their body
distribution, just looking at somebody, the puffiness of the face,
sinus, dark circles,
weight, if it's a healthy weight or not, all of those things go
into that conversation for me and weigh into that picture.
Hormones, you can pretty much clinically identify.
Mm-hmm.
It doesn't mean that you
always are right, but 9 times out of 10,
it's pretty classic, "I don't feel like myself." And if you do
have somebody who's made all these other lifestyle changes and
say they're not losing weight, or they can't get their
mind cleared, they have-
The brain fog
... brain fog.
You hear that a lot.
All the time. So there's, in my opinion,
hormones, yes, that's a huge flag. It's probably the hormones.
And replacing, you can just empirically trying, right, to
just see do I get a therapeutic response with just trying this?
Because this person's already suffering.
Mm-hmm.
They finally made it to you, and they've been suffering for a long time.
So if you just want to skip the step of prolonged waiting,
then yes, I would just go ahead and start it.
And how much of the weight gain around that time goes into that?
I hear it all the time, "Can't lose weight. I've tried everything.
I used to lose it easily, yet now I can't."
Yeah.
So how much of that is hormones?
That's such a good question. Depends on where the adipose
tissue is at.
Mm-hmm.
So there's a lot of places where the adipose likes to go when
it's more inflammatory driven. So if inflammation's
a problem, well, what's the inciting event?
Is it
bad sleep, so you're not recovering?
A lack of recovery is the base of inflammation
for a lot of people. They are overdoing, overachieving.
It's probably
my profile. If you ever hear me complain about weight-
Mm
... you know I probably am not recovering enough.
Mm-hmm.
So making sure you have that category
marked off. But aside from that, there's
cortisol, there's
a lot of other reasons that your body would signal to hold onto weight.
Or other lipodystrophies where you have lost and gained, lost
and gained. The yo-yo, right?
Mm-hmm.
And so
after doing that multiple times, your body does create stronger
bonds, and it is harder to break them for the fat
tissue. So it holds on tighter. You do have to put in
more energy to burn it
That can be fixed, but in the short-term phase,
the studies have shown that you really need to
focus on which type
of situation you're dealing with
to lose it. And if there's an underlying issue, like
inflammation or a lymphatic drainage problem, or your
environment is not conducive, or your activities are not, and
your microbiome.
Right. That's a big part of it.
And so simple. It's just these 20 things.
Well-
It's a lot
... right. Your microbiome is like-
Yeah
... your fingerprint, very unique.
It really is, yeah. So, I guess it's not a simple
answer.
I get it, but
let's try to distill it down a little bit.
Yes, I can do that.
So,
do you test for microbiome?
I do test the microbiome. I think
it's very helpful for the nutrition category
and for an action of your customized
probiotic. So if I'm only talking about the microbiome and your
immune health, that is it.
And do you advise keto diet too, when people come to you?
Cut the carbs. Does that work? Do you advise it?
I actually don't. I think there's certain situations that I would.
So if somebody has a lot of mental fog,
I would probably mention it to them because there is
just a lot of--
Keto benefits the brain.
Right. That's the preferred fuel for the brain.
Yeah. Yes. So, if that is the predominant symptom,
then typically that's our conversation.
So, I don't know if that helps to answer, but-
Absolutely
... yeah.
And is cortisol truly the big villain?
Yeah. We still need it. It's not a total bad guy.
I think there's some-
I agree
... good, right? If we had zero cortisol, we would not be okay.
I had a flat cortisol curve- ... and I checked it, and I wasn't living very well
when that happened, right?
You what? Yours was flat? That's the worst, the hardest.
Exactly. That's like-
It's true
... typical tired but wired. It was not fun.
Oh, man. It should be an S curve, for anybody listening.
It should be a S curve, so it peaks in the morning-
Right, morning and then-
... and then it dips. And yours was like-
Totally flat
... asystole.
Yes. That's not a fun feeling.
No.
It's not.
Now, another thing that we see, a lot of these women, when they are not feeling
it, they feel like, "Okay, I'm not working hard enough.
I'm not exercising enough," and they exercise harder, and they feel worse.
Yes.
What happens then?
So, it just depends on the situation, but typically, there's
a lack of rest. That recovery is just so important, and it's really
the message to myself, because you can work out and you're just
catabolic. At what point are you anabolic?
If you want to build muscle and burn fat,
theoretically, a lot of people will say that you can't
do both at the same time, but you actually can because we have the
microbiome that does offset. There's a growth hormone that
offsets. And so you can. It doesn't mean
that you are going to make-- If you're in competitions, that's a different
situation. But a female, say, in her 40s,
perimenopausal,
I would first look at her
cortisol levels, her stress levels.
And inflammation is like
low-dose GLPs, for example.
Mm-hmm.
Anti-inflammatory properties. So, that is just
so helpful. We're just seeing tremendous
science backing the use of it for inflammation at low
doses, and then the weight is just
going off at that level, at subtherapeutic doses.
And do you use that routinely in your practice?
I do.
The microdosing, so to speak.
I do.
Empirically, I'm seeing results.
And why do you think that works?
Gosh. I think it has to do with the insulin.
I think the insulin is the secret bad guy.
Ah.
Yeah.
So-
And
so a steady,
rather than a high and low insulin level, you see a
lot less inflammation, and there's just so many other
robust things that would otherwise be problematic that are
being noted in different studies.
So, whenever it's less volatile, with the lower
low and lower-- Let's see. It doesn't go as high-
Mm-hmm
... and it doesn't go as low.
So it works with a smaller range. That is better.
So flattening the curve, primarily, the glucose curve
is what you want to flatten, that there's not-
Yes
... too many spikes of that.
Exactly. A steady-- Yes, a flat line there would be great.
There are places you need a flat line.
Yeah.
Yes. So, if a
28 or 30-year-old woman were to come to you today, she's
not your patient, but she's asking for a, "How do I make
sure
I get to my 40s, and I don't run into these problems?
How do I live a life that sets me up well?"
Is this person having any symptoms?
Are their weights-
No, she-
... good?
... totally healthy person.
Yeah.
Living life, but they want to actually land into 40s without
turbulence.
Okay. I love-
How do they do that?
Okay. Well, I love the flight analogy of anything.
Right.
So really, there's your
routine blood work that you would do with your doctor every
year, and so that's your first checkpoints, your
vital signs, data from a wearable device.
Doesn't matter if it's Whoop or RingConn. Any of those are good.
And then how you feel. If you notice a drop in your energy,
that's a signal that something is different.
But if your energy is good, your cycle is normal, you have
great skin, hair, and nails, which is another
clue to hydration
It's not just vanity.
It's not
It's actually how your body is giving you signs.
Yes. It's telling you happy liver, happy
metabolism, hydration status is good, protein
status is good. So it really is a window to the
inside.
And
a little controversial question, where do oral contraceptives fit in that
age group, and do they actually do the damage for later also?
How do you feel about that? There has been a lot of use of that.
I know. I don't like them. I think
they make you feel awful.
Mm-hmm.
There's a time where urgently you might need them, such as
unresolved abnormal uterine bleeding, say there's a polyp or
endometriosis. It can help more
acutely to reduce that bleeding.
But then topicals can as well. They are a little slower.
There is a little bit more to it, such as the patient
knowing to do more clicks.
So there's education there.
It's
easier to just prescribe an oral. It is easier.
Right.
And it's covered by insurance. So it's almost like
it's a no-brainer, but then
for me, I just can't do it. So yeah, the orals
I don't love, and that's for estrogen specifically.
Right.
Progesterone oral, I like. I think that's wonderful.
Compound pharmacies do a great job.
Hair, skin, nails benefit from it. Sleep is improved.
The dose makes a huge difference. If somebody's on a high dose,
you'll see they're kind of hungover the next day.
It relaxes you.
Yeah, relaxes. So if somebody feels irritated
or just like that, it's called estrogen dominance,
but whenever somebody feels racy or crawly,
a lot of women describe it in unique different ways, but it's
just an anxious feeling.
So the progesterone helps with that.
So someone who comes to you,
the person has been on oral contraception for years, and
obviously the whole axis is off now.
Yeah.
How do you go about fixing it?
I have this happen a lot, over and over.
So first we have the conversation about why you just
cannot feel good and why-- And really, that's their words.
"I don't feel good. I don't feel good."
And then if they were to just stop taking those pills, then they would feel
withdrawal.
So
explaining that topicals are your replacement,
so you do stop the orals. My method is bring
in the topicals, do as many clicks as you need to.
Now, sometimes the estrogen, I nail it the first time,
but I make sure to explain then this is a process that we're going to do this
together. And then the liver detox is another major thing that
just makes a difference. Because I've tried it without
and with, and just,
it's incredibly
better when I give the cocktail for the liver,
along with this transition to topicals.
And then they feel better. Now, sometimes there's a prolonged
phase of the hot flashes. That's really challenging, and I'm finding
cortisol seems to be the problem, and I check it, so it's not just
an easy way out to say.
Right.
So you can see cortisol in the 20s. So
it's double digits, high.
So getting that down
is super important in that whole process.
Got it.
Switching gears a little bit, so we talked a little bit about semaglutides and-
Mm-hmm
... the microdosing that
in your practice you feel like that does help people.
Yes.
But in general, are we overusing them?
Everyone seems to be on it.
They are. I
don't know. I'm kind of extra.
Wrong person to ask. I don't think we're overusing them.
I think-
You think we are underusing them?
I think we're probably underusing them, and our food has something wrong with it,
and our lifestyle is something-- I think we're toxic.
We're our own toxic-
We're living in a toxic soup, of course.
There's a lot of chemicals around us that obviously-
I like the soup. Yeah.
Yes.
And who
is an ideal candidate that comes to you and you'll be like, "You know what?
I feel comfortable telling him, visit one,
you should be on GLP-1"?
A lot.
And really, it just depends on the person and their goals.
So if somebody has a lot of mental work and say,
so we spoke about keto being a great diet.
Keto is not possible for everybody.
Mm-hmm.
They physically cannot stick to that.
Right.
So
GLP would be a great way to keep your blood
sugar more stable and at a lower number and
keep your insulin more stable, which is the problem.
So your brain improves. The inflammation that would otherwise be
there reduces. So I think, yeah, if somebody
has a lot of mental work, that is important for them.
So I would already be thinking that.
So what somebody does matters in the plan of care,
and their performance needs. Like you're a cardiologist, you
have to physically have your hands, so there's
mechanical, there's a lot of
coordination, there's answering your phone if there's an emergency,
all of these things. So just keeping
those in mind plays a part in the care plan.
And do you tell them there's a way to live when they are on GLPs?
What are the top five things you'll tell someone who is going on GLPs?
"Okay, make sure you do this, this, this, and don't do this."
Always, we talk about alcohol, so reduce it
because your dose is now going to be adjusted with its impact on
acetaldehyde.
Mm-hmm.
So drinking less is important.
And-
They'll get drunk more?
Drunk more.
Same amount?
Yes.
Okay.
Same amount, and your hangover lasts longer.
Oh, that's not fun.
It's not fun. It's fun till it's not fun.
Right.
So, those things, and then protein,
because we're removing the signal to eat,
so you have to mindfully
eat your proteins, plan for your protein, and start with
that, and then vegetables, and then the carb.
So it's just more attention.
Weight training?
Yes.
They all must?
They must. Non-negotiable. You must load the
muscles or don't expect anything. You're not winning.
You have to load the muscle.
100% agree. And
lately, I've seen a lot of people on GLPs-
Mm-hmm
... dizziness, passing out. They don't drink enough water-
Yes
... because you don't get thirsty.
Yes. Isn't that crazy?
Yes. So-
Yeah
... should they all mostly use electrolytes with water?
I think so, because even it seems the people who drink
enough water, theoretically,
it's just not going where it should go.
So I don't know.
Volume depletion is real.
Yes.
Yeah, I agree with that one.
So
with GLPs, you're essentially treating,
in a way, food addiction.
Yes,
which I think you could almost cause depression.
Yes, and there've been reports on that, of course.
Yeah.
That's been an issue-
Yeah
... with prolonged use.
You're reducing the pleasure.
You're reducing the dopamine signal.
Yeah.
Right.
So that's the downside.
Have you seen a lot of that in your practice?
Not a lot, but I have seen it. And it is on the
item of things that I sometimes discuss based on
the person. Some people like to know a lot
about a medication before they start, and then other people,
they say, "Okay, just tell me what I need to know."
There's different styles.
Right.
But yeah, I do see it.
And what's the right way
to take off with these medications and land it right
also? Because obviously you're going to get off some at some point or cut
the dose.
Mm-hmm.
So
obviously you'll define the goals early.
Okay, this is how much we are looking to lose.
Mm-hmm.
This is what you will do in that.
Yep.
So I believe a lot of it is almost like a contract between you and the patient.
Okay, you've got to do this if you want this to work right.
Yeah.
And then when you start, so you escalate the dose.
But when you're coming off, how do you manage that?
Same. Just like you're taking off,
low and slow, and then whenever you're landing,
you back the power off. So it's-
Do they start gaining weight again very quickly?
No, not when it's done right.
So yes, it is a common thing when it's just abruptly
stopped because you do have rebound, okay?
But if you are tapering your dose and you're maintaining your
behavior, your habits,
if that's dialed in, then you can safely stop
it. It's not your forever. I don't think that it's your forever to be on
a GLP. If you start it, don't feel like you're stuck on it for life.
And do you have a lot of your patients who just continue to maintain a
very, very low dose and just never go off completely?
Yes. And sometimes it means taking it once per month
or once every other week, something like that.
You're doing pulsatile therapy as needed.
You don't always have binge tendencies, right?
Sometimes stress is a trigger for eating.
Sometimes stress also means holding onto weight
or, say,
somebody's more sedentary, so they kind of slack on their behaviors.
There's a lot of factors involved.
Let's talk a little bit about men.
Yay. Okay.
About testosterone.
Love it.
It's all in vogue.
Yes.
And
men are talking more and more about it, okay?
And there is a lot of people that I see,
sometimes you get it from appropriate source and some of them don't,
and you see all kinds of problems happening with this.
Mm-hmm.
So what is the person-- Patient walks into your
office, he's, say, 30 years old, feeling low on
energy-
Mm-hmm
... or runs out of gas by the end of the day.
Let's address it,
part one.
Do they all need testosterone?
So of course, we're still talking about sleep.
Right.
And if they snore.
So I would definitely have that conversation.
Say we confirm that it's not a sleep problem,
we have data that shows maybe a wearable that helps us to also
know that information. We do blood work, which you don't have to, but
clinically
you can be low at 30.
Say it's borderline-
Mm-hmm
... or
they're not super low.
Yeah.
It is borderline. But my concern with that is
starting is the easy part.
Mm-hmm.
Now it's a lifelong commitment.
It doesn't have to be. The way it's currently prescribed, it is.
But in other countries, they're treating the brain and the gonads.
So really, here it
is a full lifetime commitment, which I think-
Unfortunately, that's what I worry about.
They're on it for two years, and now they got to go on for the rest of their life
because the-
Yeah
... axis is permanently suppressed.
The brain just-
Yeah
... expects it to come from outside.
Yeah.
So what do they do in other countries?
In other countries, there's a term that's used, it's called bioregulators.
So And really, in this country, we could start there,
hCG is a good option to
increase the testicular volume and return the signal.
So that's here, but if you're outside of here,
bioregulators. So it's actually testicular extract,
just different extracts. Just like you would take adrenal extract
if you have adrenal issues and you're taking the natural approach,
cordyceps, same thing, same principle.
So treating the brain with
bioregulators.
So Spanish bullfighters are onto something.
Do they eat that?
I heard.
Really?
It's a delicacy in Spain, bull's testicles.
Are you kidding me? Okay. Hey, different cultures, we respect it.
Different cultures. But I don't know, does it work? Is it supposed to work?
It does work. It does work. And then there's different forms that you can
buy it. There's the dehydrated form, where it's unchanged,
and then there's the other form where they've done a little bit of
processing, and it's also dried, but it's
a different form.
So coming a little more mainstream here, so you're here.
Mm-hmm.
What if it's not the testosterone that much, if it's what's upstream?
If its DHEA is low, if its pregnenolone, that's low.
Do you see that often, and you just start there?
I do, and you can.
And they can regain their energy?
Yes. And in that case, when you see that, you are really
saying the cortisol and the stress.
The stress is not managed, the cortisol is involved, and then there's
conversion of the molecule. So
those two in particular, they're a
sign of depletion and chronic stress.
So if you fix that, is there a possibility that,
one, they feel better-
Mm-hmm
... second, the testosterone level will just improve-
Yes
... with that?
Yes, absolutely.
It's usually minor corrections, especially in a 30-year-old.
They don't take much to see that improvement reflect
clinically and in their blood work.
So it's pretty amazing.
When you check blood work,
if it's low normal DHEA-
Mm-hmm
... is that something you would correct, or it has to be out of range?
I would weigh in with how does a person
feel.
But if they're chronically wired, that feeling,
and their DHEA is low, then you simply replace it so they're a little bit more
anabolic. Because if they're the opposite, then
that's more catabolic. You can't build muscle like that.
You can't feel calm.
Right.
So yeah, I'd clinically correlate.
And what's your method of supplementing if you were to go with
testosterone, injectable or how do you-
Injectable for men.
Injectable is the right way?
Yes. And for women, I would not.
So for women, topical, and then for men, men can do
topical just fine, but injectable seems to be a
stronger impact, so
that's the preferred option.
And they have to inject multiple times a week?
Some guys like to. They feel a more stable level doing
subcutaneous twice per week.
Okay.
But once per week intramuscular, totally fine.
It peaks with the cypionate testosterone, cypionate typically is
seven to 10 days,
so you're really beating that
drop-off.
So it should be like this, and then it drops off around seven to 10
days. And some people I'm noticing are very sensitive
to conversion, aromatizing.
So in that case, an estrogen blocker is needed.
But I listen for any symptoms, like nipple sensitivity,
irritability, stuff like that.
And the oral testosterone, Kaisertrex,
do you use it or-
Oh. I don't know. I wouldn't even think about it.
Okay. So not yet.
No. Do you?
I have not.
Should we?
The idea is very intriguing. It is oral, it's twice a day,
and at least based on theory,
it seems like because you're taking a morning dose and an afternoon
dose, and the peak and fall
is with that at night, you will still release your stimulating hormones, the
FSH and LH, and you may actually not go into a total
shutdown mode that would happen with-
Hmm
... intramuscular testosterone.
Interesting.
So the theory seemed intriguing to me.
Yeah.
Disclaimer, I've never used it, so.
Okay. I think the downside would be, I do
like those perks-
Mm-hmm
... if they do rise and fall at that time to help support your cycle.
But I guess the downside would be it goes through the
liver, so you get those metabolites and how much of those
convert.
Yeah.
It is a different compound, not your standard.
Yeah.
But it'll be interesting to see.
What it's bound to is also a little bit different.
Yeah.
So the whole absorption pathway is a little bit different.
Okay.
So without digressing too much,
it's just an intriguing option. A lot of guys, testosterone is a thicker
syringe.
Yeah. It's like syrup.
Exactly. So if there were to be an oral
option that really works, I feel that'll be great for a lot of guys.
Hey, I'm going to read about it.
I'm open to anything new that might be better.
That's the journey that we're on.
Right.
Yeah.
And
we've gone through this pendulum of hormone replacement therapy.
Everyone was on it, then no one was on it.
And now everyone's wanting it again, right?
So bipolar, I know.
Right?
Yeah.
What's your thought on this?
I think if it feels good, do it. I'm just kidding.
Boundaries, okay. So if we're judiciously deciding
safety, so far the safety supports, it's fine.
So that being said, and also quality of life is
a major for me. That's how I lead
my decisions and discussions as I talk to patients.
So I think if it makes you feel better
and more like yourself while you're living on this earth,
then
go for it. Now, there's boundaries to that, but I don't see any
major harms.
Obviously, under supervision.
Yeah, under supervision. We're checking
blood work. We're looking at the person's blood pressure,
clinically thriving.
Perfect. And do you usually check urine tests, like Dutch test with that to
see which-
No
... metabolites are coming through, what's happening to-
I wish that there was time and energy for that.
I
feel like the turnaround time was too slow.
Okay.
So just getting somebody to
get the test done,
ordering it, it's a whole process.
I feel like we would get the results way later, and
so
logistics weren't there.
Does it make it a little more nuanced in terms of personalizing it for someone,
or?
Oh, gosh, good question. I don't think that I would really
change anything because I still mostly decision make off of
their clinical. How are they feeling? How's your performance?
How's your mental clarity? How's your sleep?
Are you irritated if somebody's breathing around you?
Those sort of things are still the most important.
I'm looking for spikes, anything unusual that is not
explainable on the labs. So for me, for that
reason, I feel comfortable with the blood work.
And what's your method of choice for estrogen supplementation and
progesterone for females?
So topical estrogen, I like the 50/50.
And
so
I start low dose, usually two to four milligrams,
and-
Patch or?
In a 40 milliliter tube.
Uh-huh.
And so usually that's like a 30-day supply.
And
I like them separated so that the person can decide their dose that
day, and we talk about it.
They're not going crazy with all the clicks.
Right.
If you can do one, if you feel like you need a little extra
because you had poor sleep, then that's okay.
Progesterone, I like to start around 50 milligrams oral capsule.
Oral works for progesterone totally fine.
Yeah.
Yeah.
Yeah. People seem very happy with that.
And then testosterone,
we usually do a four milligram per ML in a
40 ML applicator as well, and one, two
clicks per day or every other day seems to be a
happy place for a lot of people.
And do
you use testosterone for females in perimenopause group?
Yeah, they love it. I say they, but I mean I love it.
Well, females need testosterone too.
Yeah.
So they actually have more testosterone-
It's crazy
... from what I understand, than estrogen.
Yeah. Well, the DHT version, which is useless. I don't even know the point of DHT.
It seems like a problem.
It is, but...
Do you know anything good about DHT? I don't.
Not for females, I would say.
Like hairs on your chin, acne.
Right.
Men go bald. I'm sorry, why are we dealing with DHT?
I guess there must be a reason evolution left it in place, right?
Like, can we get this guy out of here?
So
what is the biggest myth that you see around menopause that you feel,
"I wish that was not the case?"
I think that there's an easy way out with a
GLP,
or that if I work harder, then I can get this
weight off. If I just do A, B, and C, then
I can get these things. You've tried it.
That's why you're in the office.
Right.
Any supplements that work-
Oh
... actually?
Yes. So, okay, what's our symptom?
Let's say hot flashes. Let's start with that.
Okay.
Black cohosh is on all the boards. It's always recommended,
but it seems the jury is still out.
Clinically, I don't recommend it. I don't mention it.
It's not in the conversation. Okay, so there's that.
Liver detox is my go-to whenever somebody has hot flashes.
Let's just improve your liver because there's
different bioactive estrogens that you're withdrawing from.
So
it takes a little bit to get rid of that.
And I know there's SSRIs. I don't ever prescribe those.
I'm like, "The last thing somebody needs is one more pill."
Right.
So supplements, I go minimal with that.
I don't really claim that anything is going to be the magic
it for that. You have to just detox.
So you mentioned liver detox a couple of times.
Yeah.
How do you do it? How long is the process? What works?
So it's as long as it takes.
Mm-hmm. That's fair.
Yeah.
Most people, I feel like one to three months is
pretty adequate and average. Six months was
the worst that I've seen. This person was on
a lifelong oral
estrogen since a total
hysterectomy when she was in her 20s or 30s, some
tragic situation. So,
yeah, she was the hardest, and she was very stressed,
so I think those together,
it was tough to liver detox her. But I didn't add anything
additional. We talk about it, so it's
recommended that we offer SSRIs
in family medicine. So it's discussed
as an option,
but the person can ultimately decide.
So there's walking through it. You're in the fire,
you have to get to that other side.
And you use milk thistle?
Yes. Glutathione.
Glutathione is
really a rising star for me. I feel like it's helping a lot of people.
Do you use oral or injectables?
Both.
Both?
Yeah.
Orals work still?
Orals work.
Okay.
Yeah. I
like it. I like the results that I'm seeing for people.
So, your
liver is such a machine. That is the guy.
That is the one, the meat.
That's cleaning up everything.
It is. I feel bad for him. It has so much to do.
So anything to support the liver is it.
Agree. And then we put all the toxins on
top of it.
Yes.
Everything that comes, it's got to take the-
We poison ourselves.
Exactly.
Which we also call
wine.
And so wine, where does that stand in your world?
You're choosing your poison. I'm choosing to poison myself in this
moment with this cup.
It's consent.
Consent for poison.
Fair enough.
Yeah, there was a time red wine was, okay, it's the greatest thing.
Yeah.
But the data doesn't really bear out.
And the resveratrol, the magic compound that you
need in red wine,
you need a ridiculous amount of wine for that per day.
Upwards of 1,000 glasses, and I think a pill is easier on that.
Yeah, and the damage that you're doing to your mitochondria in the meantime.
It's not worth it.
Yeah.
What about symptoms like irritability or lack of sleep?
Well, so for that, I guess the question is why are we not
sleeping?
That's age-old question. I know we keep beating that horse, but it's just so
relevant.
It's just-
Progesterone?
Progesterone is great for that.
Supplement category-wise, L-theanine.
Do you use tryptophan?
Okay, so yes I do, but I'm just torn on what I've read about it.
Do you have any opinion?
I use it.
Yeah.
Disclaimer, and to me, it seemed like the better alternative than using
melatonin.
Yeah. Okay, so the thing that
I guess is hard for me,
or the gap that exists for me is
the tryptophan orally has to get to your brain, so it has
to cross the blood-brain barrier. I haven't seen enough...
There's not a lot of data.
Yes. It's so frustrating.
Yes.
Can some scientist please just do this?
How do we get tryptophan from here to here?
Yeah, that I'm not aware of-
Yeah
... a lot of data on it. I could be wrong, but not that I've come across.
And GABA as well.
GABA also, same problem.
I know.
Of course.
Sometimes I take it. I'm like, "Maybe this will work," but then that puts me in
the category of just
placebo.
Let's hope it sticks.
Yeah, let's hope it sticks. So,
yeah, your enzymes in your gut play a role.
So there's some things like histamine can
be problematic. I've noticed some people on their DNA testing
that I offer, DNA Intellex, they have a
DAO deficiency.
Well, they have the alleles for a DAO deficiency.
So based on that, it shows me the percentage of their activity.
So if somebody has a high percentage of activity and
a deficiency of this, then they can't break down histamine.
So it stays in their gut longer, so that can give you similar
outcomes to high cortisol.
What does that make you feel?
Kind of wired.
Okay.
Flushed.
Constant inflammation.
And does it get affected with certain foods more, or?
Foods, definitely.
And another fun thing is that famotidine
and say Benadryl or Xyzal or any H1,
H2 blocker is not adequate because
it goes to your bloodstream and then it's systemic, but the
gut is not getting enough of a dose to treat
it.
So what do you do then?
You supplement the DAO enzyme that you're missing.
Okay.
That's interesting.
So it sounds so simple, right?
That's interesting. Okay.
Yeah, I know.
So for someone who has this problem, okay, too much histamine in the gut.
Mm-hmm.
What would the person present to you with?
Usually, awakening at 3:00 a.m. and their
cortisol's fine.
Okay, so they are don't-
Or flushing.
Got it.
So if you're somebody who gets hives, and we say idiopathic, there's a
reason. We just don't have the tools typically to find it, but
this test I think is pretty helpful for identifying
those subcategories.
And it tells you the percentage of certainty for each of those.
Where does mold come in all this?
Oh my gosh. Mold, it grosses me out.
Have you ever looked at the cap under your water bottle?
Don't, it'll ruin you.
I'm ruined.
I'm avoiding plastic, and I'm drinking out of these tin things, and then I look at
it, and it has mold.
Well,
I don't know, I guess if you look at it every day-
... you'll keep it clean, right?
I'm just going to use this glass cup.
That's perfect.
Right? No, I think we're supposed to be robust enough
to tolerate mold.
And any
mold that weakens or affects our
system
is a gut health problem. So if somebody has a
high mold load, which there's tests for that,
that would definitely need to be treated.
But then I would focus on the gut health after that in
a stepwise approach.
And typically, if someone has a high mold load or is
sensitive to it, how would they present to you?
Hypersensitivities in general, if you're somebody who's
just saying, "Okay, I'm just so allergic," and they have that crazy
list of all their allergies, almost proud of it
Right
... and all of these food sensitivities, and they're getting more sensitive to
other things, that is an immune system problem.
Because they didn't start there, and that's a sign of aging.
So an allergist, honestly, would be a great place
for that person because they need a higher level
of intervention. So I would see an allergist,
get the shots
three times per week, two years, and then drop down to one.
That would be my recommendation for that person.
And then also
there's stress, like what is your home environment?
It
always is so relevant. You cannot be well and healthy
in a toxic space.
Right, if there's mold in the house.
Well, mold, but then also just a chaotic,
negative, if you're in an abusive relationship.
Those are easy to overlook when we just think medical goggles, but the
reality is people,
they're not sleeping, they're not
regulated because they're in these bad
relationships.
So you can't separate mental from physical.
You can't separate it. I try to, I always try to, and it just
circles back to this person's crying all the time, and they just feel so
heavy on their chest, and their breathing is off.
Their vagal tone is wrong, and it's a
snowball. It's so related.
But if there is mold exposure-
Mm-hmm
... and they have hypersensitivities, you have to address that.
You have to. Yeah.
The reason I kind of came to it, because that also affects the histamine in the
gut.
Yes. Yes, it does.
Yeah. And
how is your body supposed to heal if it's in a constant state
of inflammation? Getting that down, allowing the healing
cells to do what they do, rebuild the structure, make it strong.
Maybe the next wave, it doesn't fall down.
You don't get as much damage.
Got it. So we're going to go through a few quick questions before we finish.
Okay.
Easy, short questions.
So what do you think, true or false?
Menopause
equals weight gain.
False.
Does not equal weight gain.
See it all the time, but
does not have to equal weight gain.
It does not have to equal that.
What can you do so it doesn't equal? How do you prepare yourself for it?
As the symptoms come up, if you're like, "Hey, I'm having more trouble
balancing my weight," you start your hormones.
Start your hormones, a low-dose semaglutide, maybe?
Maybe. Yeah.
For the right person.
Absolutely.
Is fasting
as good for women as it is for men?
Ooh, you're asking me and I would do a DNA Intellex test.
Okay.
Because you can tell exactly based on the genetics, the
alleles. This is not my opinion, it's just
what the test offers, and so you can see who it will benefit,
who it will not, just as well as you can see which antidepressants will
help somebody or not.
So there may be women where fasting is good-
Yes
... and there may be some where it's not.
It's harmful. Yep.
Okay, so you can separate it out mostly-
Yes
... with a simple test?
A simple test.
What is that test called?
DNA Intellex with three Xs.
And it's a blood test? It's a-
Well, so it's a finger p***k, which honestly, at this
point, I'm tired of pricking my fingers, so I pull it from here, and I drip it onto
the little swatch. And a buccal swab
and spit.
Okay. So all three.
Mm-hmm.
And how expensive is that?
I think if you just did one category,
there's a women's panel that's about 4 or 500.
Okay.
If you did the full thing, it's about 2,000.
Got it.
And it shows you the Alzheimer's gene, the ApoE, shows your
cardiac profile. Very insightful.
So it'll give you a lot of data-
So much
... how that impacts your decisions-
I think-
... is what'll define it.
Yeah, like the roadmap to your body.
Got it. Is it well-validated?
Yeah. Yeah, it is.
Can too much cardio damage your hormones?
Yes, it can.
And it's actually a problem if you look at people who
are the long-distance runners, you can just burn, you
stay catabolic.
So what is too much cardio?
Too much cardio, you feel depleted. You'll feel it.
So how do you define it? Okay, what's the right amount of cardio?
What would you tell your patients?
I would probably go with what your board says
that it should be.
150 minutes-
Yeah
... a week.
Yeah, of active-
Zone 2
... intentional, yeah.
What is the most overrated supplement?
Oh, gosh, there's so many.
Let's go top three that come to mind.
Man.
Okay.
Black cohosh, because I hear it a lot.
Oh, this is a really interesting question.
I guess what I'm getting at is that patients give you the list and you go, "Oh,
God. Why?"
Gosh. Okay. There's so many.
I think I can't think of any right now.
Magnesium, does it help?
Magnesium, I usually mark that one off because I don't think it helps enough.
Okay. Which one? There are several kinds of magnesium. Does any of them help?
Yeah. I think the threonate is really good.
The threonate?
Yeah.
And glycinate, maybe?
Glycinate, yeah.
But the other ones, I'm like, "Why are you taking this?"
So-
Melatonin?
Melatonin.
Whenever it's a gummy anything, I'm like, "Sorry, you're eating candy."
Right.
So
But if it's not a gummy melatonin, are you a believer, not a believer?
It's anti-inflammatory. So, I'm a believer in low dose.
If you want to take it,
it helps with the onset apparently of-
Right. So it's the guy that tells you the race has started, that's it.
Yeah. Do you believe in it?
I don't.
Okay.
I know
it's kind of a divided camp, but I personally-
I don't know what to think, really
... yeah, I personally feel that it's the guy that shoots a gun at the start of a
race, and then the job is done.
Yeah.
Because the interesting part is if you look at the animals which stay awake at
night-
Mm
... the nocturnal animals,
you give them melatonin, they become more alert.
So this is a chemical that tells you it's night or day.
Interesting.
I feel that's what the purpose is.
Yeah.
So it tells you darkness.
Because for those animals, darkness is day.
So when you give them melatonin, they're like, okay, that's their coffee.
That's funny. I wonder if a night shift worker would have the same
experience.
Because we are not wired that way. I don't think so.
Yeah.
We are not built that way.
But if you flip your circadian pattern
You'll have to do it for your entire life, and then the evolution has to do its
job. Your cells have to get used to it. It's too hard.
10,000 years of work is not going to happen in two.
Okay. Yeah, I like that. That's really good.
Right?
That's helpful. Yeah. I don't take melatonin.
I don't either.
Yeah.
What is the wellness trend that you see that it
makes you cringe, like, "God, why?"
All of these lower level, cheaper
machines, and
it's the illusion of access to these great
interventions that are shown to work, but not at the
nanometers like the red light therapy. You have to have higher nanometers.
Right.
So when you're buying a cheaper device and you don't know the
wavelength, you're probably wasting your money.
And you're like, "It doesn't work." Well...
So that's definitely one.
There's some that if it's not hot enough or cold enough,
I think you're really not getting those heat shock proteins that are really
beneficial.
God, there's so many.
Yeah. Medical grade is important.
So-
So for the sauna, you want to go past 140, 150 at the very least?
If it makes you sweat. If you're sitting in there and you're not sweating, then
it's not enough for you.
It's not doing anything.
Yeah.
And
what is the biggest longevity prediction over the next 10 years that you see?
How's the healthcare going to change in terms of longevity?
Ooh. I never even thought of that. Where is the whole
thing going? And I'm in it.
I think-
That's why you haven't thought of it. You're in it.
Yeah. I think it's the only way. There's no going back.
So, I think it's not going away. People are
living longer, but they're in bad shape.
So, I think it's a must. I think it's going to switch
into more
science behind it. So we can either myth bust things that we're doing that
are not legitimate.
So if it's shaped up a little better, that'd be wonderful.
A little more structure.
A little more structure.
A little more mainstream.
Yeah.
Right now, there's a little bit of Wild West in it.
Yes. So it makes people that are
trusting somebody like us in a physician position,
if we get it wrong,
I don't want to speak on things that are not science-backed.
Right.
So, getting more
evidence behind the things that we're doing to have a stronger,
I don't know, level of endorsing whatever we see
or believe to be true.
All right. So I'll close out with Next Phase Human.
That's where we are talking about.
But to you, what does Next Phase Human mean?
Oh, interesting. Like the term?
Like the term, what would define next phase of human evolution to you?
What are we going to look like?
What are we going to look like, or what are we going to feel like, or what-
Ooh. I think we won't need words to talk.
I think we'll just read,
maybe it's the headers, which would be lovely.
Uh-huh.
But I think our brains, our heads are going to be really big, and our bodies
smaller for efficiency, and almost
alien-esque.
So that's 1,000 years from now or-
Yeah
... 10,000? Or maybe not.
Maybe sooner,
because I think our brains are getting bigger.
Let's hope so.
Mine is.
Well, thank you so much for taking the time. This was a lot of fun.
It really was. Thank you so much.
Until next time.
Yep.