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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.
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Is there any natural ways for men 30 or 40 year old,
how they can improve their testosterone naturally?
Yeah. Vitamin D.
Welcome to Next Phase Human,
where medicine meets performance and science meets longevity.
I'm your host, Dr. Ashem Sandhu,
a cardiologist, an educator, and a lifelong student of
human potential.
My guest today is Dr. Hugh Beatty.
When we talk about wellness,
I believe
that's right up his alley. He's had a career across multiple
phases, so lots of experience.
I believe started as an anesthesiologist?
Yes, I did.
And then pain management, then primary care, and
now you are the wellness doctor.
Yes.
Does that sum it up?
That sums it up right there.
All right. So what made you transition into wellness? Let's start with that.
It really boiled down to a sales rep, and he was really riding me
about that I wasn't really getting patients healthy.
That I was keeping them just as sick as the next doctor.
And so he said, "Why should I come to you?
If I have asthma, why should I come to you?
What are you going to do for me with asthma?
You going to do anything differently than the other doctor would do?" And I didn't
know what he was getting at, so he kind of rolled me a little bit for about three
or four months, and then one day he just said, "Hey, I want you to go to this
conference. And it's a functional medicine conference." I didn't even know what
functional medicine was. And the American Academy of Anti-Aging
Medicine, I know you're very familiar with it.
And so I went to my first one in 2013, December, and I was hooked after
that. And I said, "Whoa, this is what I need to do.
This is real medicine here." So...
No, absolutely. And there's a lot of people that need it.
Oh, yes.
So lots of help. And we are going to dive into multiple topics.
So just to kind of sum up what this will entail, we'll talk about men's and
women's hormones. I understand you delve a lot into it.
Yes.
You help a lot of people with that. Then how
professionals deal with symptoms of tired but wired.
What's the hormonal physiology there, how that can be helped.
And then you do a lot of regenerative medicine-
Yes
... coming up with your pain management background.
You do PRP and ozone. So we'll touch up on those topics
also.
Yes.
So let's dive in. So starting with hormones.
So there is general thought, men's testosterone levels across the
board are declining.
Mm.
Is that the truth? Is there truth to it?
That's true.
Why is that?
That's what I'm definitely seeing.
Well, I think it's probably multifactorial, but I think the main thing is the
environment and probably the stress.
It has a lot to do with our diet as well.
So I would put it probably in those three categories.
There's a lot of
estrogen-related
reasons for our decline, because estrogen can oppose testosterone in men.
Mm-hmm.
And so
you look at phytoestrogen, plant estrogens, and then you look at the plastics and
the BPAs and stuff like that, all those things start to affect us.
So we essentially live in a toxic soup-
Yeah.
... of chemicals and that affects, and then lack of sleep and stress doesn't help.
No, it does not help.
Everything comes together.
Does not help.
So I understand some of us have testosterone
levels compared to our
parents or grandparents-
Mm-hmm
... significantly lower-
Yeah
... same age group.
Well, they say a 50-year-old from 20 years ago had the same
testosterone as a 20-year-old today.
Oh, wow.
And so because it's a significant drop worldwide, it's not just in the United
States. And
the thing that I'm concerned about is not just the drop, but why did it
drop and what are we going to do about it?
And is it important to replace the testosterone, and when should we replace it?
Those are the kind of things I focus on, and those are the kind of things I deal
with with my patients on a regular basis.
And just to clarify, testosterone is not just about
sexuality. It is about overall wellness.
Whenever you talk about testosterone, you get some people looking at you sideways.
It's not just about that. It is about
overall wellness, how you feel, how do you go about your day.
Yes. I think men really want the testosterone for two
main reasons. They want to develop that muscle tone.
Mm-hmm.
And they also want it for better libido.
In my experience, testosterone really doesn't improve erectile dysfunction
by itself.
So I know that patients sometimes seek it for that.
It can make erections better if you don't have significant erectile dysfunction,
but it doesn't correct it if there's a problem.
Got it. And we
talked about testosterone, what are some of the other big hormone problems you see
day to day?
Estrogen dominance in women, for sure.
I think that's the main problem that women have is estrogen dominance.
It leads to a myriad of problems.
The weight, potential cancer, infertility, just so many different things
that women are suffering with estrogen dominance.
And stress, cortisol. Stress is a major problem.
And then I think melatonin's a big one, too, because stress
and cortisol and melatonin oppose one another.
They're in a circadian rhythm with one another.
And so, whenever I test for those, I find a lot of
abnormality.
With cortisol, I know we're going to probably talk about that a little bit more
later, but cortisol I look at on almost every patient
because when the patients come in, they're having hormone imbalance, I start
thinking about their sleep.
Mm-hmm.
And I want to see. And because they're stressed, I want to look at that cortisol
curve. And there's different ways you can measure it.
You could do an AM cortisol. I don't think that's the most accurate.
I like to do the 24-hour saliva cortisol.
Also, I will also look at the urinary cortisol, too.
So the blood cortisol may actually
not be very useful. That's the most commonly checked test I understand-
Yeah, it is
... for cortisol.
I think you'll get some misinterpretations from it, and
then you'll make decisions on it. I don't ever check blood cortisol
without checking ACTH, because I want to know what's going on with the ACTH as well
as the cortisol.
How often do you see people come in, they think it's just age, "I'm just
getting older"?
And they don't know they are feeling poorly till they actually start feeling
better.
Not too many of my patients, because usually by the time they come to me, they're
looking to get healthy.
Mm-hmm.
And they
refuse that it's age.
Mm-hmm.
They think it's something else, okay?
But I had patients who have just already resolved to the fact they're just
older and nothing they can do about it, and I've helped turn those patients around,
and now they see that it's not just age.
So I think it's two different types of patients that might approach me.
I tell them, say, "Look, you are just as healthy as your cell.
If we can regenerate the cell, let's see how much better you can do." And that's
where my focus-- I always give people hope, because of the fact that
if you're breathing, there's a chance that we can get you better. How much better?
I don't know, but let's try.
Absolutely. That makes sense. So talking about testosterone, let's dive
into it-
Yes
... a little more in detail.
So low testosterone, it's a problem of feeling or it's a
medical problem?
I truly believe it's a medical problem because it can lead to all kind of metabolic
imbalance.
But then also it's going to how you feel, too.
Because if your testosterone is low, you're going to be grumpy, you're going to be
fatigued, you're going to have trouble sleeping, for men.
So I think it's a mixture of both. And then you're going to age faster
because testosterone is linked to inflammation and there's a concept called
inflammaging. And the more inflammation you have, the faster you age.
Just recently I kind of noticed-- This a little bit, I guess, different than
hormones, but I've been struggling with my back, lower back pain, for probably
about a good year, and I had an idea what it was.
And so I said, "I think it's my SI joint." And I end up having a SI joint
injection, a little bit of steroid placed there, and my back hasn't
felt better. And the steroid is cortisone, and
it's an anti-inflammatory, but that's what testosterone will do, too.
Testosterone is anti-inflammatory.
It all comes from cholesterol. It just depends on which
steroid you're looking at. So every one that we use so far as when you start
talking about testosterone, estrogen, progesterone, is all steroid.
They're anabolic steroids, and cortisone is a catabolic steroid, which means it
breaks the tissue down. But sometimes you have to use cortisone
immediately just to get the relief you need, and then you can set up a long-term
program to try to stay less inflamed.
That's what I'm trying to do now, stretching, exercising, stuff like that.
Right. The rehab part.
Yeah.
And just to clarify, the anabolic steroids is we're
not talking about-- Whenever you listened about anabolic steroids, people think
about sports people using steroids inappropriately.
That's not what we are talking about.
We are talking about medically needed right doses to get people to their
optimal functionality.
Yes, totally.
And
so testosterone replacement therapy,
who's the ideal candidate?
The one who needs it.
Let's define who needs it.
Okay. Well, I think the ideal candidate, usually for men,
probably after age 50.
Mm-hmm.
But a lot of time there's a reason why they have low testosterone.
So I'm kind of thinking that it's not just the person who's just
given up on being healthy, the guy who won't work out, who doesn't want to eat
right, and then he walks in and says, "Give me testosterone."
I know that that's very prevalent, and a lot of patients will
need testosterone because they let themselves go in that way.
But the ideal candidate is a person that no matter what he has done, he's not at
his optimal. For me, it's the guy who is eating right, he's
exercising, he's trying to get proper sleep, but he's not all the way there where
he wants to be, and he knows it. He's doing his proper reading, and he
knows that he's not getting the same performance out of his workouts.
He doesn't have the same endurance. Maybe he can't handle stress the same way.
He's not sleeping as well. That to me is the ideal candidate.
The guy who just says, "Give me testosterone" but don't want to put the work in,
he's not for me. You see, I will work with him, but he's not the ideal
candidate.
And what are some of the potential downsides?
Is it more like once you are on testosterone, is it a lifelong commitment?
Yes, because once it suppresses the axis it is, and the axis we're talking about,
of course, I know you know, is the hypothalamic pituitary axis, the HPA axis.
That once you suppress it, and you follow in the blood test.
In fact, one of my patients today, he was showing me a trend of his
LH levels, okay? And I was telling him, because he's under replacement therapy, not
testosterone, and I'm saying, "We haven't suppressed it yet." So he said, "I don't
feel optimal." I said, "Yeah, because look at your LH.
It's still around six." I said, "Most of my patients who get it down
to around one or two, they feel much better." So he said, "Well, I have a
trend." He showed me his trend. And it was interesting.
His LH were around eight a couple years ago.
He wasn't working out then, and he was under a lot of stress. He's a professional.
And then now he's trending around four to six.
And I said, "Well, ideally, maybe you want to suppress it down to around one or
two." But that's not the only marker you look at.
Of course, you're going to have to follow the hemoglobin, hematocrit.
You're going to have to follow his estrogen levels and stuff like that.
I also follow urine testosterone levels.
But I say that just a quick glance from the blood test, LH for me
to look at for men.
So just to clarify for our listeners, LH is the luteinizing
hormone, and that's something your
brain secretes-
Yes
... to tell the body to produce more testosterone.
So if I'm getting it from outside-
Mm-hmm
... then the brain is going to get the message, we don't need it.
Yeah.
So that'll be suppressed.
That's exactly what happens.
So if you do it for long enough time on testosterone
from outside, the chances are your body is going to get the message, we don't need
to make it, and that is why we'll end up needing it.
Yes.
And how do you give it? We hear all about either gels
or pellets or what's the right way to do it in your mind?
Well, I use all those modes. In men, most men, they are
on cream.
Mm-hmm.
But I have some men do pellets. The ones who do pellets, they don't want
to do the injections, but they also don't want to expose their wives to
testosterone with the cream. I don't use any gel.
So I would say probably 80% of my patients are on the cream and
probably 10, 15% on the injections, and a few are on the
pellets. And I've gotten great results with all of them because I
monitor their urine. I use something called a DUTCH test, dried urine test and
comprehensive hormones. And when I look at the DUTCH test, I look at their
testosterone levels. Are they in the optimal range?
If they're in optimal range, then I look at their sex hormone binding in the
blood. I look at their LH levels. I look at their total testosterone, but more
importantly, I look at the free testosterone, and I see what's going on there.
And in terms of the-- So in pellets, when you give it,
there is more of a spike-
Mm-hmm
... early on.
Yes.
And then it falls. So it's not really physiologic testosterone.
Do you find that men who use it twice a
week injections and whatnot is better?
Yeah, I think so. Today, I had an interaction with a patient.
He wants to do microdosing of testosterone now.
He wants to inject every day.
Mm-hmm.
And so we were talking about the range, seven to 10 milligrams is what they
recommend. And I have a patient, he kind of started doing that on his own a few
months ago. I had written him for a twice-a-week injection of 50
milligrams, and he started doing 12.5 milligrams,
I think five days a week he was doing. And he's got great results.
He's not suppressing the LH as much.
He doesn't have the metabolites that I was seeing before with the estrogen and
things like that. So I said, "Let's give it a shot and try." Because there is
information out there about microdosing testosterone that you have fewer side
effects, you have fewer fluctuations in how you feel.
You don't feel really well for a few days, then crash a week later.
Right. So that would be a daily injection, right?
Yes.
It's not a small syringe.
No.
No.
Yeah.
So when you see the numbers, someone comes into your office, you see a testosterone
number.
Yes.
What's the number that worries you?
Anything under 300, but I like to confirm it.
I don't want to just look at the blood because it depends when was the
testosterone checked. I ideally tell patients to do it between 7:00 and 9:00
a.m.
And so if I see their testosterone is under 300, and
they have elevated sex hormone binding, and I see their LH is
elevated, then I'm concerned that, hey, it might be dealing with low testosterone
here. Then I want to look at the person. Is this person young?
Is he, quote-unquote, in andropause stage?
Is there a reason-
Andropause, sorry to interrupt.
Yeah.
But andropause, we talk about menopause all the time.
Yes.
So I caught that word when you said it. What is andropause? How do you define it?
Well, it's trying to be consistent with menopause for women.
I don't think men really can technically go into andropause because they
aren't cycling.
Mm-hmm.
But
andropause is the past age of 40, where you have low
testosterone, and you have the symptoms of low testosterone, and then we'll use the
term andropause.
So if they in andropause already, I want to look to see what their levels are.
But for me, I always like to confirm it.
I always like to look at their urine because I believe the urine doesn't lie,
because the body doesn't let go of what it needs.
So if the testosterone low in the urine, and you also have the markers
in the blood that show you have low T, if you're younger than 40, I want to deal
with that. One of the things I look at in all patients,
whether male or female, is their prolactin level.
You can actually have a prolactinoma because prolactin can actually lower
testosterone. It opposes testosterone.
So also stress, cortisol hormone opposes testosterone
release, and also the impact testosterone has on the body, it directly
opposes it. So you can have symptoms of low T and not be actually low
testosterone levels. It's
kind of similar, a patient who has
hypothyroidism. Their thyroid levels are normal, but if their thyroid
hormone's being blocked at the receptor level because of antibodies or some other
reason, you can have hypothyroidism for that, even though your thyroid levels can
look normal. So similar.
So in testosterone, you're going to fix the factors that we
can modify, which is sleep-
Yes
... which is exercise, which is controlling the body fat percentage,
and
insulin levels, of course.
Definitely.
The blood sugar spikes that happen.
Definitely.
Are all those things add up? Am I missing anything?
All of them. No, you're not missing that at all.
Insulin resistance could definitely impact testosterone levels.
The thing is, and you're taking the right approach.
When patients come to me, it's not just, "I want to do a quick fix." "Hey,
doc, my testosterone level's low.
Can you start me on testosterone therapy?" I say, "Well, let's work you up and see
if it truly is low and why it's low, and let's fix the cause."
So men under 40, I can't think of any of my patients who are on
testosterone under 40. They have come to me with on testosterone, but
then what I do, I evaluate them, and I start recommending other things we can do.
I'm a big proponent of progesterone, as you know.
And so I think men need progesterone.
I don't care if they're in their 30s, 40s, or 50s because progesterone is-- It's
like the unisex hormone in a way. Men and women both need it.
It protects you from the effects of estrogen.
Men's estrogen could be higher than women's estrogen, depending on what age they
are. And I saw the other day, I have a 60-year-old male.
His estrogen level in the blood was 1,100, and he's not on
testosterone.
But he had a large belly, and so whatever testosterone he's
making, he's converting over to estrogen.
And his wife is on hormone replacement therapy.
Before I started her on hormone replacement therapy with estrogen, her total
estrogen was down in the 30 range. It was very low.
So I see that men can have higher estrogen levels than women when they get to a
certain age.
So you want to treat the high estrogen first, even in men,
before you dive into the low testosterone-
Oh, yeah
... scenario.
Definitely.
And part of that is progesterone, just to recap, and part of that is the
lifestyle.
Well, progesterone protects you from estrogen. It definitely do.
It's a direct impact. It balances it out.
And then sometime I have to give them something to block the aromatase
enzyme because testosterone gets converted to estrogen and
belly fat. And the bigger the belly, the more aromatase.
Alcohol also induces the enzyme aromatase, especially
beer. Beer has more effect on aromatase than, say, wine does.
But if you induce that enzyme to convert testosterone to estrogen, your estrogen
levels just get higher. And I'm concerned there's three different types of
estrogen you make. The body makes estrone, estradiol, and
estriol. The estrone has the cancer metabolites, like
4-hydroxyestrone, 16-hydroxyestrone, and so I measure
those. So that's why men's risk of cancer goes up with
age, because they're making more estrone.
Just like women's risk of cancer go up with age, estrone.
I truly believe that prostate cancer is linked to estrogen.
I know they say DHT, but I've seen some studies say that it was estrone.
As well as colon cancer is linked to estrogen, too.
And that's why in females, hormone replacement helps with those.
Definitely. And when you start replacing the healthy, youthful
estrogens like estradiol and estriol in women, I see consistently, almost
every time, the estrone gets suppressed.
I've never seen it rise by giving estradiol. Now, you can over-treat patients.
You can make a patient estrogen-dominant, and I see that.
If I were to take a patient who is, say, late perimenopause,
about to be going to menopause or post-menopause, and I only put her on
estrogen, what state did I put her in? I put her in the estrogen-dominant state.
So we can iatrogenically cause estrogen dominance.
But most women become estrogen-dominant for two reasons.
Either because of stress when they're in their reproductive years, like their 20s
and 30s, or because of the fact that their progesterone starts dropping in
earnest. That's what perimenopause means, lowering progesterone.
And the estrogen usually doesn't start dropping until the mid-40s.
So you have this period, maybe five, 10 years of estrogen dominance.
Then the women start gaining weight. They get the fibroid uterus.
They get the cyst on their ovaries, cyst in their breasts.
And so they don't know why this is happening.
And the frustrating thing I have, they go to the traditional physician,
and he tells them what's wrong, but not why.
He'll tell them, "Hey, you're bleeding.
You have all this uterine bleeding, irregular periods, because you have fibroids,"
but not why you have the fibroids. And so that's a whole another discussion, and
the treatment they do after that actually put the patient ultimately in a worse
state than when the patient first came to him.
Because once you take her uterus out and her ovaries out, she has
terrible hormone imbalance. She feels worse than when she was just bleeding all the
time. I see that a lot.
So the treatment-- We'll kind of dive into that.
I know. I'm kind of all over the place.
No, absolutely. This is fun.
Yeah.
So if a 30-year-old comes to you, one of the issues with testosterone treatment
is, of course, it decreases the sperm count in someone who
still wants to be a parent. And
so 30-year-old comes to you, has low testosterone on your blood
test and urine test, and you diagnose, okay, it could
be hypogonadism, true. Not lifestyle.
He's doing all the things right. How do you address that?
Well, let's say, for instance, we worked him all up.
He clearly has low T, and it's a primary cause, not a
secondary. Okay? Then at that point, I would think of HCG,
because it has an FSH-like effect.
It can stimulate the testicles to release sperm.
It
has a regenerative effect on the testicles. Okay?
So I would think to do that, and you can use HCG
with testosterone and preserve fertility, preserve
testicular size and volume.
And so I've done that. I've had several men who have come to me in their
mid-30s, not at age 30, and their wife had some
infertility. They also had infertility because they had low sperm
count. They had non-motile sperm.
And I can think of one in particular who came to me, and I
was able to work with both. And they actually had two children.
And I just noticed, because I'm concierge now, so he's no longer my patient,
but I got a report from another physician, and it said
incidental on the report that one of his procedures he's had done was a
vasectomy.
Mm-hmm.
So it's kind of like, oh, look at that.
He struggled with getting
his wife pregnant. Now he had a vasectomy.
So it just goes to show you how people can turn it around.
That is rewarding, definitely.
Yes.
And so
we talked about fertility preservation, but is there any
natural ways for men 30 or 40 year old,
how they can improve their testosterone naturally?
Yeah. Vitamin D.
Really?
Vitamin D itself can increase testosterone up to 25%,
if you're deficient in vitamin D. And the thing is, I don't think we take
enough vitamin D. There's studies that show that vitamin D protects the bones
800 to 1,000 IUs a day. But that's not
the therapeutic range for your heart
and for
the other organs. They say it's 8,000 to 10,000 IUs a day.
So I take up to 15,000 IUs. But I follow it.
I follow in blood, stuff to make sure where I'm at.
I also have intraoperative scan. I look at that, too, and see what the tissue level
of vitamin D is. But I found since I've been taking higher dose
of vitamin D3, even though people are getting sick all the time, not.
If I
can feel an illness trying to come on, like a little scratchy throat, it doesn't
come through. But yeah, studies show that adequate vitamin
D3 can increase your testosterone up to 25%. And you already know about zinc.
The Leydig cells need zinc-
Right
... in order to make testosterone.
The other thing you can do is just a good night's sleep.
Get that good circadian rhythm. When you go to sleep at night, growth hormone
gets released first, and once it get released between-- It's critical to be
asleep probably around 11:00, between that window of 11:00 to 1:00.
Growth hormone gets released, and that stimulates the release of testosterone, so
when you wake up. So your testosterone levels on waking should be
highest in the day. But of course, during activities, testosterone spikes.
But I'm just talking about the natural circadian rhythm.
Testosterone's higher in the morning than any other time in the day.
So I would work on the sleep. Definitely building
muscle will raise testosterone levels.
So exercise, building muscle, sleep, vitamin D, zinc, those kind of things you can
talk to the patient about. They're going to be-
And just to clarify, vitamin D should always come with vitamin K
combined.
K2, for sure.
K2, for sure.
Yeah, for sure.
And why is that?
K2 helps. It directs where the calcium should go. It takes it out.
It can actually revascularize blood vessels that have a calcium
plaque. So it sends it to the bones.
If you take vitamin D3 and calcium, it comes into the body.
It can deposit in the kidneys and cause kidney stones, in the heart, tissues
all throughout the whole body. Studies show that people who take vitamin D3 and
calcium will have a higher calcium score. Now I'm getting in your realm.
That's where you live. But taking K2
will take the calcium and put it on the bone, so you have healthier bones, too.
And does it go with the other fat-soluble vitamins the same, A and E?
Do all four fat-soluble vitamins go together, A, D, E, and
K, or-
So far as taking them?
Yeah.
Yeah. I'm really a proponent of measuring things.
Okay?
Mm-hmm.
I want things to be optimal, so I don't want to over-treat, and fat-soluble
vitamins can have their problems.
So I will test first. One of my mantras is that I can test
or I can guess, but if I guess, be ready for a big mess.
And so I don't like guessing. In fact, I had a new one that came with the-- today,
a patient of mine, she's a cancer survivor.
And so we were doing ozone therapy on her.
I know we're going to talk about that in a second.
And I said, "You know what? I'm into healing things, not just
killing things." And so she had been through the process of chemotherapy, where
they're trying to kill cancer cells.
I said, "Yeah, but I want to heal the other cells." And so we can get the
double whammy, where we can have an impact on the cancer cells, kill them, make
them more prone to chemotherapy while healing the rest of the tissues, and so.
So, in terms of lifestyle interventions, we went through
these. Any supplements that can help?
Does ashwagandha work?
Oh, yeah.
Does it help?
Ashwagandha's good, but you need to limit it.
I think it's like they say that up to about two months, because you can suppress
the cortisol too much. Ashwagandha, because it's suppressing
cortisol, can actually help increase your testosterone levels naturally.
So that's the only thing. You just have to be careful not to use it
indefinitely.
So it's cyclical.
It's cyclical.
You will use it, and you'll go off it.
Yeah. I tell patients to do it for two months and then stop.
And then you can cycle back on later.
Does it go with some of the other supplements for stress that people use,
rhodiola, and does it go the same way with them?
Yeah. It goes with the other adaptogens, yeah, for sure.
I tell patients--
I usually use it a lot in people who have prominent insomnia, especially
because of cortisol and stress. Ashwagandha can really help them sleep.
It can have an immediate effect on suppressing cortisol release.
And so I'll tell them to go ahead. Of course, I already give them
hormone therapy if they need it. I'll tell them to do the progesterone, the
magnesium, the ashwagandha, and a lot of time I can get them sleeping.
And
we hear about this tongkat ali. Does that help?
Is there-
I hate to say this, I'm not familiar with that one.
All right.
Help me out, doc. What is that one?
It's a natural supplement.
Okay.
Southeast Asian-
Okay
... it's a plant.
Okay.
And people there chew it quite a bit, so I do believe it works through sex hormone
binding globulin.
Oh, okay. I'm going to have to look that one up.
And are we under-treating or over-prescribing testosterone
replacement?
What do you think?
Because I have a lot of people come to me, and I'm kind of biased, I think we're
definitely over-treating, especially men when it comes to testosterone replacement
therapy. I think we under-treat women, though.
I hear a lot of women who are on hormone replacement therapy that are not on
testosterone. They need it. Sometimes women oppose testosterone.
They don't want to be on it for a lot of different reasons.
"I don't want to get a deep voice. I don't want to break out in acne.
I don't want to lose my hair. I don't want to
grow facial hair." These are all the concerns I hear.
Does it happen?
Not on my patients, because I test them. I get the levels where they need to be.
I've not one patient ever develop a deepened voice,
loss of hair, acne, any of the signs of virilizing in men,
because I follow it. Testosterone replacement therapy in women should be about
a tenth of what we give men. So I stay in that range, but
there's nothing like clinical signs as well as laboratory
testing. And I confirm it, not just with blood, because you can get some erroneous
results with blood. I confirm it with the urine, I confirm it with the
saliva. But no, women do really well. In fact, it's amazing.
When you get the women's testosterone where it needs to be, not only do they have
more energy, they sleep better, and their libido goes up. Yeah.
Even the husbands like the higher libido.
So, women do really well on testosterone.
Where does alcohol stand in all of this?
You mentioned that the beer increases aromatase-
Aromatase
... activity. So
beer belly-
Mm-hmm
... and drinking beer. Beer is a very manly drink, right?
Yes, it is.
So the beer belly actually is going to make you less manly. Is that the truth?
Well, it's going to give you those man boobs.
Because breast formation is stimulated
by the estrogen. So, if you notice,
men who have large bellies tend to have gynecomastia.
And it actually is getting worse. You're seeing younger and younger people with it
because of this estrogen dominance.
Men are estrogen dominant just like women can be estrogen dominant.
And
so when a man has a belly on him, and he has gynecomastia, he's definitely estrogen
dominant. And where does that estrogen come from? We're not giving men estrogen.
Of course, there's some environmental things, like toxins they're exposed to.
But mostly it's coming because he's converting his testosterone to estrogen.
And the bigger the belly, as I've been saying for years, the lower the
testosterone, because he's converting more and more testosterone to estrogen.
And
what is the best exercise? We talked about weight training and whatnot for
testosterone increasing in men.
What is the best form of exercise?
Anything in particular in weight training or cardio, or what should
men target?
Well, I think resistance training, for sure.
I'm really struggling to try to build more muscle in my lower extremities because
I'm 67 years old, and you know Jake, the trainer.
Mm-hmm.
And I started working out with him, and he's definitely pointed some things out to
me. And one of the things that I really was able to really
quickly understand what he was doing, he's showing me what I can't do.
And that's my baseline. Just like when a patient comes in, you show them their
baseline labs.
Mm-hmm.
So this is where you're starting. So I can now look and see I'm
improving from where he first started working with me.
But there's a lot of information out there.
A lot of studies show that when you build muscle below the waistline,
you actually can improve cognition. And so I think about that, too.
So for me, I'm like, no, I need to do this because I want to
lower my fall risk. I want to be able to
travel and function like I want to.
I love playing golf. But also, I want to keep my health, and
muscle is the organ of longevity. So I think lifting weights
trumps Or resistance training, even isometric training,
trumps anything that you're going to do aerobically.
I know a lot of people like doing aerobic exercise, walking, and all this
other stuff, but for me, I think it raises cortisol and that
opposes muscle development. There's nothing like suppressing
cortisol with weightlifting and having the testosterone to
build muscle. So that I would say definitely resistance training.
So if you want to be smarter, lift weight?
Yes, definitely.
That's a good one.
What's the most underrated habit that you see that can help people, but they just
don't do it when it comes to hormonal health?
Sleep. A good night's sleep. No matter what age you are, if you are
sleep-deprived, it's going to affect your hormones.
It's going to raise cortisol initially, and that cortisol is going
to cause a pregnenolone steal. I know you're familiar with pregnenolone.
Pregnenolone is the mother hormone.
It makes progesterone, it makes DHEA, and those things go on to make your
testosterone estrogen. So lack of sleep is going to
cause hormone imbalance. So when you are young, I tell young people all the time,
just because you should have great hormones in your 20s, especially reproductive
years for women, doesn't mean you will.
And if you're stressed out, you're going to cause hormone imbalance.
One of my employees, when she was in high school, she used to run cross country,
and that was stressful for her. So she went 10 months without a
period, and it was because of hormone imbalance.
She was making the estrogen, but she wasn't making the progesterone.
And so that led to eventually she had, she told me, the period from hell.
One day she had her cycle, and she said she bled heavily and she bled longer than
she had wanted to bleed,
but it was all hormone-related.
So for all the young people out there, if you're not getting quality sleep at
night and partying and drinking,
you're lowering your testosterone.
Is that-
Terrible combination. That's a terrible combination.
This past week I was seeing some friends down South and one of my friends said,
"Hey," he said, "Doc, you don't drink anymore?" And
I said, they knew I never really drank much, but I said, "No, I want to protect my
brain." I think about what Dr. Daniel Amen says about alcohol.
But also, for me, I get some indigestion, especially if
I drink white wine.
And so I'm just like, "Why am I doing this?
I don't need to do this." And so I don't.
So there is some data now that even-
Mm
... one drink a week is detrimental when it comes to dementia risk.
Oh, yes. I can accept that.
Well, let's switch courses a little bit. Talk about women.
So you see a lot of females, they'll come to you, and they just don't feel
well. It's in that 40 to 50 age. The labs look relatively
normal, so to speak. They're not clearly into
menopause at that time, but something is not right, and they can feel it.
What do you typically see in that age?
Well, let's say they're in their reproductive years, and they don't feel-- Usually,
it's fatigue.
They might relate to, they have irritability, mood swings,
some stress, some anxiety.
They just don't feel themselves. But the cycle is
off. Generally, when women have hormone issues, it's going to
show up in the cycle. I tell women all the time, "You want to have
healthy cycles until you're 55." I said, studies show that it's
linked to longevity, lower risk of cancer, lower risk of other health issues.
Most women don't want to have periods that long. Why not?
Because either they're having pain with their periods,
cramps, or they're having heavy bleeding.
But the focus, if your hormones are balanced, guess what?
You can have a normal cycle without all those discomforts.
I tell women that it's common for women to have pain with their periods,
but that's not normal. What's normal is that you don't even know your period is
about to start, and I have women who have done that if you balance their hormones
correctly. So, it depends on what they present with.
But one of the things I ask
all women, are you still cycling? Some women aren't.
In fact, I had a patient newly established, and she's
43, hasn't had a cycle for 15 years.
Oh.
Okay? But the thing that's interesting, she has a eating disorder, too.
Okay? And so there's a link there.
But my focus is to correct multiple things.
One of the things I find that's really fun for me in functional medicine right now,
I'm not
scared off by challenging patients.
Because think about some of the most difficult patients you've ever had, okay?
If you have nothing else you can do, say, you inherit a patient from another
doctor, a cardiologist, and he's done everything you would try,
you're like, "Well, I could continue to manage you."
But in functional medicine, I get patients all the time who have multiple
problems. They're inflamed. They have inflammatory illnesses, but no
functional medicine tools were used on them.
No techniques. Nothing was done, and I look and say, "Well, okay.
Let's look at your hormones. Look at your gut health.
Let's get your minerals and vitamins right." You see?
And so then you start doing that, giving the body what it needs to get better.
So it just depends on how they present to me, what I would do.
And what are the typical, if you were to do a hormone profile on someone in that
age, what would you typically expect to see?
How would you start your workup?
Well, I would still order their blood because I can get some information on blood I
can't get from other type of special tests.
But women who are in their reproductive years, so this is before perimenopause,
they need to have saliva testing. I do a 28-day saliva test
because I want to see what their hormone levels, the estrogen and progesterone, is
doing during their cycle. I want to see if they're ovulating.
I want to see if the progesterone will rise during the luteal phase.
I want to look at those different things. I want to see what the testosterone does.
Testosterone doesn't vary during the cycle, but I want to see what the testosterone
levels are. I've helped a lot of women who have had problems with
their cycle to even get pregnant. They have problems with infertility
just by looking at a 28-day cycle and correcting the imbalance.
So, we talked about this perimenopause.
When does it actually begin?
Perimenopause
A hard age, most women 35, but it can happen sooner.
35. Oh.
Yeah, it can happen sooner,
because progesterone starts dropping around 35.
The thing that's interesting about progesterone is that women love their
progesterone.
It is the hormone that makes them feel youthful and alive, okay?
It has to oppose estrogen. People don't realize that estrogen is an
anti-inflammatory, but it has some inflammatory effects when progesterone is not
there. It has to be opposed by progesterone.
And so,
progesterone is the last hormone to mature, of the sex hormones,
and it's the first one to go away. So, the peak years for
progesterone balance is between 20 and 35, and that's where their
most fertile years are also, if you look at it from that
perspective. So, it's easy to follow.
You just do a 28-day saliva test on women, and you can see what happens with the
progesterone during their cycle.
If you try to do a spot progesterone level,
no. Where are you going to check it?
Right.
If they're cycling, you're going to check it on day 21?
Well, the progesterone's high, but the estrogen's low.
You're going to check on when she's ovulating, day 14, progesterone's supposed to
be low, estrogen's high. So, I see that a lot.
I see women misdiagnosed because doctors will send them for blood
tests, which I don't think is always the most accurate way to test for hormones,
and which day are you going to check it on?
Are you going to send the woman for 11 blood draws during their cycle?
So, I just feel the reason why there is a saliva testing so that we can really look
at the woman's cycle.
So anyone in the less than 45 age, you would prefer a
saliva test to make a diagnosis?
If they still cycle, I would like to even do it even if they're over
45. But most women,
it's not a fun test, so if I don't use it and just do a
24-hour saliva test, I will do it generally on women over
45. But I also will combine it with the urine hormone test and
the blood hormone. I try to get as much information.
Women who are over 45, one of the tests that I really love to
look at in the blood is the FSH, because FSH starts
rising when estrogen starts to drop.
And if I see that FSH is rising, then I say maybe it's time for
estrogen replacement therapy.
And
so we beat up on estrogen a little bit-
Mm
... that all the things that it does negatively.
Yes.
And it's obviously needed.
Yes.
And it has a good positive role also.
Yes.
What's the biggest misconceptions that you see when people talk about estrogen?
I think a lot of women are scared of estrogen because they've been
inundated with the fact that estrogen causes cancer.
So, I have these women say, "Oh, I don't want to be on hormone replacement therapy.
I don't want to be on estrogen, it causes cancer." Plus,
unfortunately, GYNs tend to only give estrogen
for hormone replacement therapy. They still do.
They don't combine it with progesterone.
One of the things that I see that's real frustrating, that's why I put it in my
book, that's why I talk about it in my consultation, that's why whenever I'm
interviewed or do videos or anything like that, I talk about
the importance of combining progesterone with estrogen.
Never give a woman estrogen without progesterone.
You can give women progesterone without estrogen because it depends on where they
are in their,
so far as their aging. Are they perimenopause? Are they menopause?
Are postmenopause? But to give a woman estrogen without progesterone, I think that
borderlines on, I wouldn't want to say malpractice, but it's bad practice.
Okay?
So, the things you need to test for. Estrogen is definitely beneficial.
When women
get to the point where the progesterone is no longer keeping them feeling well,
energized, and their estrogen levels are dropping, you need to give it to them.
In fact, in the past few months, I put at least three women who had not been on
estrogen, had been only receiving the hormone therapy with DHEA
and progesterone, testosterone.
They were having hot flashes. They weren't going away anymore.
They had trouble sleeping. Their hair was getting thinner.
I put them on estrogen replacement therapy.
Within three to six months, they were just blown away how much better they feel.
But it was the proper timing. If I had done it earlier, they would have breast
tenderness, they might have had heavy periods, it would've been a whole different
story. So, the timing of when it should come in, and that's why you have to know
what to look at. If you don't know what to look at, you're just going to be
guessing, and you're going to cause the problems.
So, it's horses for courses. You'll see who needs it, and there's a timing for it.
Oh, yes.
So estrogen, is it a friend or a foe?
If it's done poorly, it's a foe for sure.
Weight gain,
breast tenderness, irregular periods, it's a foe.
But the thing is, you got to be careful that the gut can
also make estrogen dominance because
one of the tests I do right now is the GI map test, and it looks at
an enzyme called beta-glucuronidase.
And that enzyme will
deconjugate estrogen. Estrogen is cleared in
the liver. The liver conjugates estrogen to clear it, and it gets dumped
into the stool. And in the stool, if you have that
beta-glucuronidase enzyme, it will just cleave the conjugation, and
then it'll recycle back into the blood.
So, it'll essentially put back more estrogen in the blood.
Yes. And I tell women all the time, say constipation leads to estrogen
dominance. It's one way you can get estrogen dominance.
Stress can lead to estrogen dominance.
Iatrogenic, people giving you estrogen only, can lead to estrogen dominance.
And so estrogen by itself causes problems.
Estrogen paired with progesterone is a thing of beauty.
So, it's a friend at that time-
Yes
... if it's the right company.
Yes.
So, there was an era in which everyone used to be on hormone replacement
therapy.
Yes.
Then came a time when no one was on it.
Yes.
And now we are swinging a little bit back.
Yes.
So, let's talk a little bit about that.
Do you see a lot of that? Is every woman a
candidate for hormone replacement therapy?
I think at some point, all women will need hormones.
I'm shocked when women are in their 40s and they don't need hormones.
After proper testing. It's rare, but I do see it.
But
when a woman's post-menopausal, she has no estrogen, no progesterone.
That's the sign of post-menopause. And they're going to age.
And some women, they say, "Well, you know what?
My mother was not on hormones, my grandmother's not on hormones, so I'm going to
age like them." But they're not satisfied with the fact they now have high
blood pressure. They have heart disease. They have diabetes.
They're gaining weight. And I say, "Okay, you don't want to do hormone therapy, but
the hormone therapy is the very thing that's going to lower your inflammation so we
can combat these illnesses that are developing." So sometime I have to convince
them and point out to them, you're developing these adult illnesses because
of inflammation. Okay? And then there's things you can say, like HSCRP, you know
about the inflammatory marker. I look at
insulin levels. Those are the two most important biomarkers that I follow,
and those come down with hormone therapy. It's amazing.
I don't know of anything else you can give short of hormones to bring down
HSCRP. There's nothing else. If the person is lacking hormones,
you're going to have inflammation.
I have a patient I just started today on hormone therapy. She's 81.
Her CRP was 6.9. And
so we're going to see. She had insulin resistance.
Her insulin levels were, I think, 19.
I believe in optimal levels of insulin, four to seven.
Quest Labs will say up to 18 is okay, but I don't believe-- I
think any insulin above the optimal stores
fat, causes inflammation, it's just not good.
Insulin resistance linked to dementia, so many different things.
So I want to optimize.
So just to clarify, that's a blood test you'll check.
Yes.
And is there a particular time in the day when you should check insulin levels?
Well, usually I do it in the morning, between 7:00 and 9:00, when they get in the
cortisol check.
Fasting?
So do it fasting, yes.
Got it. So
what about cancer risk with hormone replacement therapy?
Well,
of course, recently, thank God, they removed the black box warning from
bioidentical or compounded hormones, but I still think it remains for
synthetic. I would never give synthetic hormones to
a patient, and definitely I wouldn't give horse estrogen.
A woman's not a horse. But I think that it's,
how can I say? It's overdone right now.
And the concern is not
something that women should really put too much weight on
because I haven't seen balanced hormone therapy cause
cancer, and I've been doing it now for a good 12 years.
I have women who are in remission from breast cancer who
are on hormone therapy doing really well, and the cancer did not come back.
There's an author I'm reading right now, her name is Jen Simmons.
Actually, I was going to bring her book to show you.
She has a book talking about breast cancer.
She's an integrative oncological surgeon, breast
surgeon. And
she initially was not a functional medicine doctor, she is now, until
she had her issue. She developed Graves' disease.
And the first person she went to a lecture to learn something about
how to deal with her Graves' disease was Dr. Mark Hyman.
And when she saw him, she initially said, "Who is this quack?" But she'd come to
find out who he is. So now she's a big proponent of functional medicine, and
so that's what she does. She does an integrative approach to breast cancer.
And she makes it clear early in the book, I've already seen, she
said, "Healthy breasts comes because the person's healthy." If
you get the breast healthy, you can't do that without getting the patient healthy.
So I think that
now we do
need to understand that hormone therapy is critical for the health of the
patient, but it has to be in the right.
What I'm starting to hear, because in fact, one of my
coworkers, Nurse Candy, she had brought up
that she's hearing more and more doctors
are starting to put women on birth control for hormone therapy.
And that they're doing, because now they're saying that the risk
of cancer from hormones is less, so now they're doing things they
shouldn't be doing. Just like I see a lot of men being placed on testosterone
inappropriately, and I'm concerned about women taking hormones who
might not need it, might not get the right dose, might not get the right
mode of therapy. They might be given something they don't need just yet.
So that's what I'm concerned about.
Because, hey, the black box warning been removed.
Patients ask you about hormones, and if you don't know how to do it, what are you
going to do? Either you're going to tell them to go to another doctor, or you're
going to try to wing it. And unfortunately, I think that's going to start
happening.
So it still should be done with caution-
Yes
... and respect, and with appropriate follow-up with the clinicians who are
involved in your care. Just because black box warning is removed-
Yes
... does not mean we can wing it, does not mean we can take it lightly.
No. I totally agree.
There's still a right time, and place, and expertise for it.
I agree totally.
So let's talk about professionals a little bit.
Mm-hmm.
You hear this a lot and you see it.
They're tired-
Mm-hmm
... but they can't rest properly. The tired but wired feeling.
Yes.
What is going on hormonally there, physiologically?
I'm like an anesthesiologist.
Yeah.
Well, you've seen that life.
Yeah. I remember that life.
Yeah. I think it's a cortisol effect because what is
happening, your circadian rhythm is so thrown off that when you should be
sleeping, you can't go to sleep. So that's the wired part.
And then in the morning, because you didn't sleep, you feel tired,
and
you have to get them back on the circadian rhythm.
You have to reprogram that cortisol.
You have to get the cortisol high in the morning when they first wake up, and
lowest part of the cortisol is when they try to sleep.
And if not, you're going to have that tired and wired feeling.
So how do you do that? Where would you start?
DHEA.
DHEA is--
Because DHEA opposes cortisol.
So it's a hormone that you can take.
Yeah, it's a hormone. Well, of course, you got to You got to try to start working
on sleep hygiene. On every patient who said they can't sleep, I
always want to rule out sleep apnea as an issue.
There's other things I do, but eventually, it gets down to I'm giving them
supplements, but I'm thinking about the DHEA, too.
Because if you look at it, when you check saliva cortisol
curve, they're looking at the DHEA-cortisol ratio.
And
what causes the cortisol to be suppressed is chronic stress.
And so the body is smarter sometimes than we are.
It says, "You are so stressed out, you won't calm down." So they start
suppressing it. And so what happens, you got that feedback
loop with elevated cortisol then suppresses the release of
ACTH. It suppresses from the hypothalamus, the release of
corticotropin-releasing factor.
So you get
less stimulation for cortisol to come out.
So now cortisol's suppressed. But guess what happened?
Way before cortisol is finally suppressed, DHEA has
been down. Okay, and so then I look at it from this perspective.
I haven't done much study on it, but the cortisol will not rise again
if DHEA is too low. So what I found is that I start working on getting the
patient's DHEA levels where it needs to be.
I look at their urine DHEA, I look at their blood DHEA, and once I bring the
DHEA where it should be, the cortisol, I noticed, starts to rise
again. So you can correct a flat cortisol curve sometimes as short as
six months. Most of the time, it can take a year.
But if they still are doing shift work, you can't correct them.
If you're trying to get them a circadian rhythm where
they're waking up in the morning with high cortisol, and then it's low at
bedtime, but they're doing that when they're
going to work at 1:00 in the morning and they're trying to sleep at 10:00 in
the morning, then that's not going to work. How are you going to really do that?
Several years back, I heard this functional medicine instructor say, she was
lecturing to us, she says, "You can't help people doing shift work.
If they continue doing the shift work, there's not much you can do for their
hormones. They have to start going to work and sleeping when
everybody else is working and sleeping."
So obviously, society still needs people who work at
night.
Mm-hmm.
I've been there. You have worked nights as a physician, and then there are nurses
who work at nights, and
they're needed. Obviously, we can't-- So what is your
suggestion to them? How can we help them?
Well, this suggestion I actually had years ago to my anesthesia group when I was in
Los Angeles. I was on call,
there was a group of nine of us,
and we were on call at least three days out of the week.
So we did something called second call and then first call.
So you were pretty much up after midnight when you're on second call.
So you work all day, and then first call, you're up all night.
And then you would have the day of recovery, and then you come in with the
eighth position, the seventh position, now you're on OB for 24 hours.
So we were up a lot during the week. And I
said, "With
enough of us here,
let's just assign once a month, you just work
nights." You see two people working nights.
One, at least
so far is covering OB. We can cover OB
where maybe three people are covering OB during the week,
somebody's on 24 hours, so that we can get this pattern where we're sleeping.
We have day shift people, and we have night shift people.
They didn't want to go with it. They said, "No, I'm going to get my call over so I
can enjoy the rest of my time." So I think you need to do more of that.
I think that we need to cycle it around.
I don't think that no one should consistently be on night shift.
I think that maybe if you do nights for a month, maybe have two or three months
off where you're not doing night shift.
So give the body time to recover.
Yeah, recover, but what do we have set up?
Who gets the night shift duty? The most inexperienced and the
youngest, right? Not the experienced people.
I had patients who worked in the prison system, and they had great
hours because they had been there 20 years, and so they were working, what,
during the week, 8:00 to what, probably when they first came in, 7:00 in the
morning to 7:00 in the evening. And then the guys newly hired were working the
night shifts, the weekends. But we do that to nurses, too.
We also do that to young physicians, too. We give them all the call.
Mm-hmm.
And the more experienced people in the group, they don't have to do the night
shifts or the calls anymore. So I think that you have to
get people off of doing
graveyard shifts and night shift work.
But it's hard to do when we need police, we need firefighters, we
need people working in the hospital.
But I think we need to be a little bit more cognizant of the fact that we need to
rotate it around more and not just having one group always working
nights. I don't think that's healthy.
So we appreciate all the first responders who stay up the nights-
Yes
... be it the police, the firefighters, the nurses.
But if possible, a rotation,
maybe in a month, someone else takes on the night-
Oh, yeah
... so they get two or three months of normal cycle to recover their body.
Oh, yes. Yes. I think it can happen. I think it can work.
But it has to be proposed, and there has to be a strong motivation to get it
done. But if you think about it, how many people see the link between
lack of sleep and hormone imbalance?
I didn't think that link.
Not many people talk about it.
But in functional medicine, we know it.
Yeah. See, we live in a society where
sleep,
if you can tell someone, "I'm sleep deprived," it's considered a sign
of weakness.
Yes.
So I think we have glamorized staying up, working through the
night a bit much.
Mm-hmm.
And there is a bill to pay.
Yes.
So
seven hours or less of sleep, I was in that camp where
if I could function with four hours, that was great.
Mm-hmm.
But my wake-up call was insulin resistance and pre-diabetes,
after which I started turning this around.
But-
Yes
... a lot of people don't get that wake-up call early enough.
So yes, sleep is something which is
underappreciated labor of health-
Mm-hmm
... both hormonal and physical. I agree with you on that.
So you threw this name around, DHEA.
A lot of our listeners don't know what DHEA is, what it
does. Can we just go through that briefly?
Well, they call it the biological clock of aging.
DHEA stands for dehydroepiandrosterone, and that's why we
don't call it that. We call it DHEA.
But it falls in the category of an androgen
or anabolic steroid. So it comes from cholesterol.
A lot of patients don't realize, or people don't realize that these steroids come
from cholesterol. Cholesterol makes pregnenolone, and pregnenolone is the mother
hormone that makes the other sex hormones, progesterone, estrogen, testosterone,
DHEA. And DHEA opposes cortisol. That's one of the
main functions of DHEA. And like pretty much
everything in our bodies, it declines with age.
The rule of thumb so far as replacement, if it needs to be replaced, it's one
milligram per age of life. That's the rule of thumb.
So a person who's 25 years old maybe needs 25 milligrams of DHEA, 50,
50 milligrams.
So if they have it in their body, normally that'll be the levels, correct?
Yeah, that's the levels. The thing is that's interesting, when you look at
Quest or LabCorp, they have different ranges for
DHEA. So a young man, they will have DHEA is appropriate for him
up to 450. So if you go in there and you're past 50, they say that
it's normal up to 237, 240. I
still target the 450 in men because I want to get them
at the optimal levels of age 25. I was taught that years ago.
In functional medicine, we treat to the level of age 25, where
you're optimal, whether it's male or female.
So you want them to feel like they are 25-
Oh, yeah
... all the time, right?
Oh, yeah.
Fair enough.
They might not look 25, but they'll look better than their age.
Absolutely.
I tell one of the things, Doc, is that when I have patients, they say,
"Well, Doc, I feel better and I look better, but I don't look like I'm
25 or I look younger." I say, "You're looking younger than you used to look.
And don't compare yourself to a 25-year-old when you're 50.
Compare yourself to other 50-year-olds." At my age, I don't compare myself to
people in their 50s like you, okay, Doc, or 40s.
I compare myself to people who are 67, and I say, "I'm doing pretty good." You
see what I'm saying? So that's what I try to encourage people to do.
How are you doing compared to your age group?
That's fair.
We talk about
fatigue a lot in our practices. You have an epidemic of fatigue here.
Oh, yes.
So
what is the most overlooked cause-- So we talked about sleep-
Mm
... but what is the most overlooked cause after that for fatigue that you
see?
Stress. Because stress will use up your
B vitamins. It
opposes your hormones. It's just so many things. I think stress.
Because until you get rid of the stress, you're going to be fatigued.
Because think about it, chronic stress will lead to a flattened cortisol
curve. Cortisol is what we need in the morning to energize us.
So if we have low cortisol curves, we're going to have fatigue.
So we got to deal with the
cause of low cortisol. I tell people all the time, I say, "Cortisol is
life-threatening. If it's too high, it's going to cause risk of death.
And if it's too low," like if you're looking at Addison's.
So I had a patient I diagnosed with Addison.
I picked it up because I check ACTH, not just cortisol.
She had a low, flat cortisol curve.
Her ACTH level is like in-- I think I checked it several times, but one
time it was like 25,000. And that was way too high when her
cortisol level was close to zero. And I picked it up.
I sent her over to one of the endocrinologists in time, and she said, "How'd you
pick that up?" I said, "Because I looked for it." If you look for things, you'll
find it. But what was her complaints? Extreme fatigue.
She never wanted to do anything. She was losing weight.
And she had all the classical signs of Addison's.
And her doctor prior to that never considered it, so.
But you will see some electrolyte abnormalities in that also.
Oh, yeah.
So when you talk about stress, the things that you can do to mitigate stress,
it'll come under
meditation or mindfulness-
Yes
...
breathwork, and supplements. So let's go through that.
Mm-hmm.
So meditation or mindfulness, that of course we know helps.
Yes.
Breathwork, does that work?
Yeah. I don't know much about breathwork.
I did do it with Anna Frank once and Kyle Jones. I think, were you there that day?
And I haven't really studied it, but yeah, some of the things I looked at, they
said breathwork is really good at rebalancing you and helping you to deal with
stress.
Because there's a lot of information out there.
You can do cleansing breath when you feel stressed out.
Like I have patients come in, and they say, "Oh, Doc, I have white coat high blood
pressure." And I tell them, "Look, take some deep breath and blow out slowly.
Do that for a couple of cycles, and you'd be amazed blood pressure does come down."
So I think breathwork is definitely good.
And in terms of supplements,
we talked about ashwagandha, if done cyclically.
Yes.
Is there anything else?
L-theanine, rhodiola, for stress for sure.
Magnesium goes a long way, especially at bedtime.
What kind of magnesium?
It just depends on what you're dealing with.
Some patients, it's a price issue, because they're buying so many different
supplements by the time they see me.
So I try to steer them away from oxide, magnesium oxide, because of its poor
absorption. But if they're struggling with constipation, of course, we're trying to
work on the cause of the constipation, but I tell them to do mag citrate for that.
If it's something for bones, I have them think about threonate or malate.
If it's brain, glycinate. So it just kind of depends.
And there are supplements out there that have several different types of magnesium
salts for them to get, so at one time.
So there's no downside to taking something which has several different
magnesium salts in it?
No. I tell people way before you have respiratory depression from magnesium,
you're going to have a lot of loose stool. Okay.
So that comes way before. Because when I used to be an anesthesiologist and I was
doing labor and delivery,
because women had preeclampsia, we would put them on IV magnesium drips.
They're checking deep tendon reflexes.
And so some of those women's magnesium levels in the blood was getting up to eight,
nine, ten. And you know as well as I do that magnesium in the blood's around two.
Mm-hmm.
And so you have a big safety window with it.
One caution that I always say is that kidney function, if you have poor kidney
function, you got to watch the magnesium.
You'll accumulate it that quickly.
Yes.
So it's still best to do it
in the appropriate therapeutic dose, but you can use something which has multiple
magnesium compounds all in one.
Oh, yeah. A rule of thumb is 5 milligrams to 10 milligrams per kilo.
Okay.
So because patients ask me, say, "Doc, how much should I take?" Like even kids, I
follow that same. I put kids on magnesium all the time,
especially if they're suffering with allergies and have trouble sleeping.
I tell them, "Add on the magnesium." So...
So let's switch courses a little bit here now, talking about regenerative medicine.
Mm.
I know you do-
Yeah
... PRP therapy. So tell us what PRP is first.
It's platelet-rich plasma,
and I've been doing it since 2014.
And the technique is just drawing blood from the patient, so it's
autologous. It's your own blood. And the reason why I like,
because studies show it's effective, and I've seen it.
Because I've done pain management for a number of years, since at
least I moved here in Bakersfield in '98, that
I used to use a lot of steroids. I would inject a joint with steroids.
And it has, as we mentioned, the term catabolic, it breaks
tissues down, soft tissues down. So I rarely inject
steroids in joints now, only if the patient can't afford PRP or
ozone, and it's a one-time use. I tell them, "Look, we'll do this one time,
calm everything down, but I really wouldn't recommend you do it over." And
especially if I think it's not going to cause further damage.
I'm a little reluctant if they have a rotator cuff tear, and you're putting
steroids there, and they go out and work out the next week, it might be making
a full, complete tear. So,
I found that it's a great replacement for steroids, for sure,
and it actually regenerates the joint.
It's not like steroids that calm the inflammation down but could possibly further
degenerate the joint. The other beauty about it is that I've
never had an infection from PRP. In fact, you use PRP
to treat infection. So I find that it's a great tool
to have in your
toolbox to help with joint pain. So...
And why does it help? It's your own plasma.
You already have it in your body, so why does it help?
Because the PRP has growth factors, and those growth factors activate the stem
cells.
And those stem cells can differentiate to be the
tissue that it needed to be. And so if you're
trying to repair soft tissue meniscus or tendon
injuries, then those cells become the cells they need to be.
They become tendons, become meniscus, cartilage, whatever else, and it does
heal. I haven't done stem cells lately
because, one, stem cells are very expensive.
I've never been a fan of doing
donor stem cells because you're getting it-- In order for the stem cells to
have to be effective, they have to be alive,
which means that you increase the risk of infection because you're getting these
donor stem cells from other people.
And so I've never really been a big fan of exosomes, and also you hear
about cord blood and things like that, which might be a little bit safer,
okay? But it really depends on who's the donor.
So I always like autologous. And since I started doing ozone, I mix
ozone with the PRP, and that ozone, these cells will not
survive without oxygen. So you give that extra oxygen in the
ozone with the growth factors of PRP, the patients do really well.
So I haven't had a need to do the stem cells as much.
What are some of the places you use PRP therapy?
What would be the indication?
Routinely, I do it for joint injections, like shoulder, hips,
elbows, knees. I pretty much have done it every joint.
Tendon injuries.
Fingers, tendons, especially Achilles tendons.
Yeah.
So there's a lot of talk, you hear about women also doing it for
skin.
Oh, yeah.
The vampire facials and whatnot.
Mm-hmm.
Does it have the same effect?
Oh, it definitely does. I've seen it really help with cystic acne,
with potted scars from cystic acne,
acute breakout acne. It really is really good for that.
But yeah, it can make the skin so smooth and soft.
I've seen it do that.
If you do a chemical peel just before you do the PRP, I think that's the best
results, get them a light little chemical peel.
Not the harsh one you get where the face gets red and inflamed.
If you think about the chemical peel, what is it doing? It's doing the same thing.
It's trying to kill the bacteria on the skin.
Mm-hmm.
It's inflaming the skin, which brings blood flow.
But why do all that when you just do the PRP facial or the vampire facial?
And you mentioned a little bit about ozone therapy.
Yes.
Now, most people don't know about it.
So what is ozone therapy, and why do you do it?
If I had to take one tool out of my office, it's the ozone.
I could do so many things-
Oh, really?
... with ozone. Yeah. And there's different things I like in that office.
Let's say, for instance, I have a woman who I truly believe is very
inflamed. She can't sleep. She has hormone imbalance.
She's fatigued and all this stuff.
I've seen where I can do what we call IV major
autohemotherapy, MAH therapy, ozone, and she'll
feel better at least for a few days from that.
It can just turn the brain back on. That's what it's known for.
So if you're having a lot of brain fog, it can just clear your head.
It can give you energy. Let's say if you're anemic and you need a blood
transfusion,
but you're right at the borderline, it can help with the symptoms of
poor tissue perfusion.
It's just so many beneficial things with ozone. It can treat infection.
Some of the things I've seen ozone do, I had one patient in particular, he's
diabetic,
severe diabetic, and he
suffers with a mental disability, so I think his IQ probably is around
maybe under 70, 60 or so. And so even though you
tell him he needs to eat properly and exercise, it doesn't come
through. And so he's on insulin because you can't
manage his diabetes without it. And I'm not a big fan of insulin.
That's another whole story. I would like to kind of delve into that if we can,
because I don't want people to get the wrong impression.
Because type 1, you definitely need insulin, so I don't put that out.
Yeah, right.
I think that too many people are on insulin are a type 2, and we haven't dealt with
the insulin resistance. And that extra insulin is causing them to
gain more weight. It's causing more inflammation.
That's the kind of person I'm talking about.
But in his particular case, so he's on insulin, what I would wish I could get him
off by doing some of the regenerative work that I do, right?
And I've helped people get off insulin.
I've helped
put patients in type 2 diabetes in remission.
So what I have-- In this particular young man, he had
a diabetic foot, and the podiatrist was thinking
about starting to cut tissue back, as you know, amputate the big
toe and maybe the forefoot. And it
looked really bad. It was gangrenous, didn't have very much circulation at all.
So I said, "Okay, before they do it, can I see him?" So the
mom brought him to me, and I injected his foot with ozone.
I did IV ozone. And you could tell by the next day it looked much
better. A week later, the podiatrist said, "I can't believe this.
I've never seen this before." "What did he... Oh, Dr.
B did IV ozone on him and ozone on the foot." And this is the
second diabetic I've done that on. He came in about a month later.
He had a big gash on one of his knees, and of course,
the infection, diabetes. And so I did ozone
around the wound. Within a week or so, it was totally healed.
And so I've seen ozone. Ozone is good for fighting infection.
It's good for joints. I
was very successful in going a long way to reverse Bell's palsy in a patient
of mine. She had Bell palsy for a number of years, and I said, "It's
not going to hurt. Let's see." Ozone can help with
regenerating nerves.
Just recently, I had a patient who-- It's amazing.
This is a reason why you should be reading reports from other doctors.
One of my patients had fallen, fractured her wrist, went and had
wrist surgery, and then the surgeon reported, "I'm at the center for pain
doctor because she has complex regional pain syndrome, CRPS." I said, "Oh." So
I called her. I said, "I'm sorry you had CRPS." I said, "Look, I've dealt
with that before. I recommend ozone.
Look it up."
So I told her what the alternative was.
I said, "When you go to the pain doctor, he's going to recommend steroid blocks,
steroid gang block." She said, "I don't want needles in my neck."
Because I've done that with patients in pain management, where you keep giving
injections once a week, and you send them physical therapy.
Because they're in so much pain, you can't do anything with the
RSD,
and because the joint is so painful and stiff.
So what I did, I injected ozone
at the wrist, and we did IV ozone. She felt better when she left that
day. She continued to do it. Now,
the orthopedic surgeon wasn't familiar with ozone, so he said, "Don't do that."
She wanted to continue. So I didn't inject the wrist anymore, but we continued to
do the IV ozone. The thing that's interesting,
he just saw her recently, and after probably about six months of care and
following her, that he said, "You don't have complex regional pain syndrome
anymore." Okay? And she told him, she said, "Yeah, but I think the
ozone did it." Because she never did steroid gang blocks. You see?
And she was going to physical therapy.
And if you look it up, there's
case reports of people using ozone for complex regional pain syndrome.
Because what is complex regional pain syndrome?
You get
nerve ischemia, right? Because the blood
is narrowed down. The nerve is replenished by the blood
flow. And so what is ozone doing? Just bringing the oxygen in there to
regenerate the tissue, and it's amazing, so.
Why does it work with the infections? You mentioned that. So why would it do that?
Because it turbocharges the white cells.
Okay.
Because the mitochondria needs oxygen, right?
So
now these white cells have the oxygen it needs to make more
ATP, and so they're a lot more effective as killer cells, so.
Would oxygen do the same thing?
Yeah, it would, but
it's a third oxygen.
I think it's probably something to do
with the fact that
ozone is kind of counterintuitive because its oxidative stress increases,
but it makes these super
antioxidants-
Mm-hmm
... okay, that will eventually have an antioxidant effect.
But the main thing is just you're giving the extra oxygen for the electron
transport chain, and so you make more ATP, and now the white
cells can be more vigorous. But yeah, one of the concerns that the
orthopedist had about the complex regional pain syndrome, the
patient, he had put hardware in there, and he said, "I don't want that to get
infected. We don't want the doc..." Yeah, I would never inject steroid in a
joint that had hardware in it, but it wasn't.
I knew that it wouldn't cause an infection.
But you don't want to override specialists, so I said, "Okay, I won't inject it
anymore, but you can still do the IV ozone." You can do the IV ozone
for a lot of reasons. We don't even need to think about complex regional pain.
She can do it because she wants to feel better, you see? And that's why we do it.
Right. So why does the orthopedics guys, why do they not like?
Lack of knowledge. Because she asked us a question, he said he didn't know anything
about it
So you think there is a future in which this is used for more-
Yes, definitely. I've had doctors who were aware
of ozone. They hadn't had it done, and they said, "Oh, no, I think it's great." I
can think of a patient in particular, he had
prostate cancer, and so they end up doing
radiation therapy, and he developed severe bladder inflammation, and he was
having blood clots in his urine. And so he went for
hyperbaric oxygen therapy, and they had to go higher and higher
pressures before him, and it got to the point where it started causing visual
problems in his eyes, so he couldn't do it anymore after about 20-something
treatments. And it really hadn't resolved the bladder
inflammation. He still was having some bleeding.
So someone who knew me said, "Hey, why don't you go see Dr. Beatty?
He does IV ozone." So we started doing that.
He eventually, I think probably after about six treatments, had no more signs of
bleeding. He eventually had another cystoscopy by his urologist.
Urologist put the scope in and came right back.
He said,
"I can't believe this. It's totally normal in there." He said, "I don't know what
you're doing, but it looks..." Said, "I'm doing ozone therapy with Dr.
Beatty." He said, "Oh, that's great." He said, "Keep doing it." So,
the thing that's frustrating about ozone, when people go to
research ozone, they see immediately it's not FDA-approved. Okay?
So that's why it's called therapy. I don't ever call it treatment.
Anything that's not FDA-approved, I don't use the term treatment.
I don't tell people I give cancer treatment.
There's therapy, there's adjunctive therapy you can do with patients, so I want to
make that real clear. But when it comes to ozone, it's
additive. If a patient has problem
with their sinuses, I'll do nasal ozone because it's additive to the
antibiotics. You'll get better results.
And you can also
use less antibiotics. You'll be amazed.
In addition to that, it's additive when somebody has
infection. Say, for instance,
I use it for a
ganglion cyst, where you inject ozone into the cyst, it ruptures.
Some people say what? Hit it with a book. Right?
No, we won't recommend that to patients.
But I went online, I looked up ozone for ganglion cysts.
It will cause it to rupture, right in front of-- before your eyes.
It won't come back. So I've seen ozone do a lot of things, but I've never seen a
patient become infected from any of my PRPs or
ozone therapies or combined therapy, because it's very effective in treating
infection.
Is there evidence for ozone? Is there...
Limited. Most of it is just kind of, I wouldn't say anecdotal,
just maybe small studies that people have done.
But nothing on a large scale, because who's going to pay for the study?
And how can you really-- I guess you can do a placebo. Ozone does have an effect.
If you inject ozone, you can tell that it's
ozone inject, because it's inflaming. It burns.
I guess you can probably mix it with some lidocaine to try to-- You can do
a shot with lidocaine on both sides, and they won't know that you've injected
ozone. You see what I'm saying?
Yeah.
But
yeah, where's the funding for it?
It's used universally throughout the world.
Probably 95% of all countries use ozone.
Cuba, it's the mainstay of Cuba. It's a country, they don't have very much
money for healthcare. They use it for all kind of different
reasons. It's been around since the 1890s.
It was discovered in Germany as medical indicator.
The thing is, when you go online and Google it, it says there's no medical
indication for ozone therapy. And in fact, it's toxic to lungs.
Well, I'm not telling people to breathe ozone.
I never have patients breathing ozone.
It's done safely in the IV. And the biggest
concern that people have is embolism.
It can cause
air embolism. Well, how does that happen?
Well, if you do a direct vein injection, take a big, huge syringe of
ozone, inject it directly in the vein, yeah, you're going to cause the air
embolism. But if you do it properly, like I've been trained, Dr.
Frank Shallenberger trained me. He's been doing them for 40 years, since the '80s.
He went to Germany to learn how to do it.
And he has courses on it. I got certified in it.
But the way we do, we start an IV,
we hydrate the patient, then drop the empty bag on the ground.
It's just like when you go to the blood bank, get phlebotomized, and the blood
leaves your arm, goes in a bag. We put ozone gas into the bag of blood,
never directly to the patient. And then we put some heparin in there, so it won't
coagulate the blood, and then we give it back to the patient.
So I've done hundreds of these since October 2022, with
great results.
So the
right way to put it would be, it can be an adjunct or
a helping hand to-
Yes
... some of your standard therapies you're doing.
Definitely.
It may help with that-
Yes
... but is not a standalone therapy. Is that a fair statement?
I've done it standalone, but it definitely is great with
adjunctive therapy, for sure.
So it's more of a helper?
Yeah.
Perfect.
Let's say, for instance, somebody has an infection, and they want to be on
antibiotic therapy, and they submit also to ozone.
They get much better results. I did it before I had surgery.
I had surgery last year, a hernia repair,
done robotically, and I'm glad I did it that way, and I had IV ozone and
glutathione the day before surgery, and then I followed it with
glutathione injection the day after surgery, and I was driving the next day.
I felt great. I recovered. I just had a patient, in fact, I had to throw this out,
Doc. She
had her second
cervical fusion, okay? She had one done before,
a few years back, probably 10 years ago.
And she had told me, she said, "Doc, I really need this done because I'm in so much
pain." And she was. So she went down to Cedars-Sinai, and I know Dr.
Michael Kroft, great guy, and so he did the surgery.
And the thing is, when she had the surgery done the first time, even her husband
was there because he was there both times when she came to do the ozone after
surgery.
And she said, "Yeah, my wife was wiped out when she had surgery last time.
She was in bed for three days. I mean, for three months.
She didn't move very much."
He said, "After surgery, when you did the ozone on her
That I couldn't believe how active she was.
Her pain had dropped dramatically.
So she came back for a second treatment last week,
and I did trigger points because he took the hard collar off.
And so with the trigger points in her neck,
and I gave her the IV ozone,
she looked, she thought, "My pain is zero right now." She said, "I have so much
energy, I feel great." But look at it, that's adjunctive
therapy to what he had done the surgery. She already had some pain meds.
He wanted to put her on muscle relaxer.
I'm not a big fan of mixing muscle relaxants with opiates, okay, for respiratory
depression. And I said, "No, no. I got something better.
Let's do the trigger points, and let's do the IV ozone." She left feeling great.
Awesome. So just a little muscle relaxant directly into the muscle.
That's it.
So if we go back into future 10 years from now-
Yes
... what would seem very primitive about
today's medicine and hormone replacement therapy that we are talking about?
What would seem, you would think-
I think the trend is definitely going toward getting rid of inflammation.
Doctors who are not focused on getting patient
less inflamed is going to appear archaic. That's just my hope.
Mm-hmm.
Because if the vast majority of our illnesses are
inflammatory, a doctor who is just managing your sickness...
Bless you.
Sorry. I was trying to hold off on it.
Yeah.
But I think that a doctor who's only managing sickness is going to
be considered archaic. But here's the problem.
The problem is there's tools that
are not very expensive, that can be used. Ozone is not that costly.
Vitamins and minerals are not that costly. Hormone therapy is not that costly.
What is costly is prolonged hospitalizations and surgeries.
And I've seen too many patients get better by just focusing on inflammation.
And patients are starting to demand it.
Look at all the health influencers out there, social media influencers.
Are they
always helpful in telling people the right thing? No.
That's why we have to be careful of them.
But the thing is, they're influencing people to do what?
Be your own doctor. Ask questions. Do your research.
Look what's going on right now. Everybody's on peptides.
That's not doctor-directed. These people are getting them online.
They're coming from all kinds of different sources because why?
Patients want to be well.
I've never asked a patient, "Do you want to be well?" And they said, "No."
Never. Have you?
No, it's doing the right thing.
Yeah.
So it's lifestyle-
Yeah
... and some of the adjunctive therapies that hopefully will see more data in
coming time and be able to help people live healthier
lives.
Yeah.
Are there any emerging therapies in the world of functional medicine that excite
you?
Sorry about that. I can't think of any, and that's the
frustrating thing. I go to conferences, I'm looking for things.
There's a lot of stuff in aesthetics that are coming out, and I don't do a lot of
aesthetics because it's kind of not my wheelhouse.
I'm a man first, okay? Women like to go to women and stuff for that
kind of stuff. But I don't really see anything
major coming down the pipeline. I hear about biologics and
things like that, but if you think about it, it's really not anything new about it.
It's just being more applied. I think that there's some things that are kind of
gimmicky that people are talking about, but is it really going to make a
difference? No, I don't really see anything major that I'm overly
excited about.
And what's the most important biomarker that you would track if you, like
yearly tracking a patient, what would you want to, on your
must list
that you would-
Well, they talk about telomeres, but that's not-
No
... easy to set.
In terms of blood testing, you-
Just insulin, HSCRP, and insulin
levels. Fasting insulins is the two most important
because insulin resistance leads to so many problems.
If a patient has optimal insulin levels and they have low
CRPs, like less than one, then I think those are critical ones to
follow.
So they are very likely
going to live a disease-free life if you can-
Oh, yeah
... control that.
Well, fatty liver causes insulin resistance, too.
Right.
So let's go through a few
short answers with you-
Mm-hmm
... as pertains to your life.
Okay.
What's a morning routine that you would never skip?
My morning
devotional. When I get up, I
have a devotional book I read, and every day is a daily devotion,
and then I pray. I definitely won't skip that.
And prayer is great for mental health.
Oh, yeah. Definitely.
One supplement you personally take.
I take a lot of supplements, but-
But if you had to pick top three, what would you pick?
Oh, magnesium, for sure, at night, and potassium.
I do the potassium, magnesium every night.
Melatonin.
So you're a big fan of melatonin?
Yes.
Why do you think it works?
Well, it's a powerful antioxidant.
It has
pro-inflammatory, but also anti-inflammatory.
Depends on what's going on with you.
I think because it helps reset the circadian rhythm.
It can lower oxidative stress. It's
just so many different things that I've read and learned about it.
I'm not taking as much as I initially was planning to do.
I take 10 to 20 milligrams every night.
I found that it's kind of my sweet spot.
But those three.
I don't go to bed pretty much without those.
I do take progesterone, but that's more of a hormone thing.
So my nightly routine is progesterone, magnesium, potassium every
night, and melatonin.
So my understanding of melatonin always is, this
is not the guy that'll keep the race running.
It's the guy who shoots the gun at the beginning of the race. The race has started.
So at night, it'll tell you it's dark now.
Yes.
So some interesting data comes from nocturnal animals.
Mm-hmm.
The animals which their natural cycle is to stay up at night-
Okay
... and sleep during the day.
Mm-hmm.
So if we give them melatonin, it almost effect is like caffeine.
Yeah.
They become more active.
Yeah.
Right? So-
In terms of
when people talk about sleep, there is some data in
jet lag-
Mm-hmm
... for melatonin
that may help with that. But beyond that-
Mm-hmm
... why do you think it really-- If I can fall asleep okay, would
melatonin still help me?
I don't take melatonin for sleep, though.
Okay.
I take it because of antioxidant effect.
Okay.
And in fact,
I was reading some things not too long ago where people are taking melatonin up to
1,000 milligrams. They take it all throughout the day, and it's not making them
sleep. So the dose that I take, if it's going to
cause me to feel drowsy, I don't want to take it in the morning.
So it's just that I take it at night because if it does
cause some sedation to help me sleep, then fine.
But I'm taking it mostly for antioxidant effects.
So not for sleep?
Not for sleep.
Okay.
Because I'm doing the progesterone magnesium for the sleep.
Yeah. That was just to clarify-
Yeah
... that melatonin is not a sleep aid for everyone.
Yes.
What's the most over-hyped wellness trend that you see?
I think right now it's peptides, and everybody wants to be on peptides, and they're
not understanding whether they should be on them and which ones.
I
think the reason why I'm saying it's over-hyped is because I'm frustrated by
peptides right now.
I love peptides, don't get me wrong.
But I just wish they can be in the hands of
physicians in California without
you feeling that you shouldn't be doing it-
Right
... you see? Because there's concerns.
Yeah, if I was in Nevada, or if I was in Florida, in Idaho, I wouldn't have a
problem.
But there's concern because you hear so much misinformation that you shouldn't be
given any injectable peptides because they're not FDA-approved, other
than the GLP-1s. So what do you do? Should you
inject
Semaglutide if you have access to it?
And so these are the kind of things I'm concerned-- I wish to just get some clarity
so I can then decide because I think there's a lot of benefits to
peptides, BPC 157 and so many other ones that I
would love to do. But-
It's just done-
Kind of frustrating
... done right
... that you're seeing people-- All these patients are doing it.
My patients are asking me about it.
I'm going to go to a big course in September in Nashville about it, and I saw
the other day that RFK Jr. was saying some things.
They're working on trying to get this resolved, and I hope it does.
Supposed to be a meeting in July. I just don't want there to be any
type of legal ramifications because you're trying to help people with peptides.
Right.
That's all I'm saying. And that the states don't have all these different rules and
laws, that everybody's on board, that the FDA does not have a
ban on it. You see what I'm saying? You're not going to get in trouble for
prescribing it. And then now you can apply, you can give
peptides to those who really need it.
And one of the things I try to tell patients to caution them about peptides is
this, that insulin is a peptide. It has disulfide bonds, but it's a
peptide. It's one amino acid above, what they say, 50
amino acid sequence or less is a peptide.
But does everyone need insulin? No, they don't.
You better not give everybody insulin.
Right.
So we're out there doing stuff, and there's people who don't know anything about
medicine. I'm hearing that there's police officers and butchers
and everybody's giving out peptides.
And in fact, a friend of mine, his son-in-law
is doing peptides. He had a conversation, he's in Arizona, and we had a
conversation about peptides. He said, "Doc, do you do peptides?" I said, "Well,
I'm not really in a position to." He said, "Do you have a problem with peptides?"
"No, I don't have a problem with peptides." It's just that you have to be
concerned about, are you able to
prescribe it? Just like growth hormones.
Can we give everybody growth hormones like they do in Florida?
No.
No, we can't. There's ramifications of that.
Can people benefit from growth hormones? Yes, if you know what you're doing.
I wasn't aware. I want to throw this out real quick, Doc.
I didn't know that
in aesthetics, some states there's doctors who are using growth
hormones in the face. But it ends up causing some
horrible deformities where-- Think about it.
If you inject growth hormone in a syringe in the face
as a filler, and then it stimulates the growth of cells, and
so now you can't stop the growth. And so there's some horrendous-looking
facial
features that people develop from that.
And so it's banned, but they try to get around it by calling it different
things. So if you're not familiar with it, you should look it up, and I wasn't
aware. So that's the kind of things I'm talking about.
Social media influencers are out there saying you should try this and try that.
And so the doctors are kind of being left behind, especially in California, because
it makes functional medicine doctors look like we are against it or we don't know
how to use it, or we don't think it's effective. It is, okay?
But done right-
But done right
... there is a dose. So the difference between medicine and poison is the dose.
There is.
So done right when you need it.
I love that.
So one lab that every adult should know,
if I could only test one thing for myself,
what should that be?
So far as determine your health?
Yes.
I would just probably look at the HSCRP.
So C-reactive protein.
Yeah.
That's an inflammation marker.
Yeah. I would look at that.
So if you see someone with high C-reactive protein-
Yes
... now C-reactive protein
is a useful tool, but it's very non-specific.
Yes.
Everything from a cold to arthritis to pain can raise it.
So
how do you go about helping someone who comes to you with high
level of high C-reactive protein?
Let's say I had a 22-year-old with a high CRP.
I'm like, I'm shocked by that. But a person post-menopausal or
someone that's 67 with a high CRP, eh, it's kind of--
And I know it can be in-- Let's say you have a high CRP, and the person doesn't
have an infection. They're 25 years old. What's going on with this person?
Right.
And so I want to try to find out why. So
CRP is a
good starting marker. Let's say they don't have inflammation Should I
relax? No, because there could be something that might eventually
lead to that inflammatory problem.
So I think CRP is a good place to start, but that's the starting point,
that's not the ending point.
Fair.
What's the biggest longevity mistake that you see people make?
Inappropriate use of hormone placement therapy.
I see it all the time.
I've seen some things that just shake my head. It's just sad.
I have patients that come to me and say, "Doc, I
really wish you could see a family member or friend. They're on hormone therapy.
They're only getting estrogen from their doctor," and I'm trying to explain to them
that estrogen can cause problems all by itself. They aren't getting proper testing.
What I see a lot is young men in their 20s more and more getting on testosterone
placement therapy without an adequate workup.
They're not looking at why do you need testosterone. So I think it's a hormone.
The hormone issue, I'm working-- peptides I think is a lot more safer than
inappropriate use of hormones, and that's where I see the problem.
So hormones is not something to be taken trivially.
No, it's definitely-
One thing that everyone listening can start tomorrow to be in better
health.
Good night's sleep.
Seven hours?
Seven, eight. Well, wake up feeling refreshed.
I sleep about six and a half hours a night, seven.
Usually, I wake up consistent. I go to bed at the same time pretty much, and I wake
up consistently at the same time. I would have to force myself to sleep longer.
But I wake up refreshed and ready to go.
Like during the day, I'm at work, I don't feel fatigue.
If I don't get a good night's sleep for whatever reason, then I might.
But if I sleep six and a half, seven hours a night, I can go all day long.
I'll be fine.
Perfect. This has been
fun and very informative. Thank you so much for taking the
time.
Is there anything else you'd like to add before we close?
Yeah. I would like to just mention that if anyone would want to follow me,
my Instagram handle is docnbak, D-O-C-N-B-A-K.
Also, I have a website, hubedmd.com.
The last thing is I have a book that is on Amazon.
I didn't bring it with me to show.
It's "5 Pillars of Health: Do You Want to Be Well?" And you can find it on
Amazon.
Perfect. Thank you so much, Dr. Beatty.
All right.
This has been a real pleasure.
Thanks for having me, Doc.
Thank you.