Today we discuss adrenal testing, mitochondrial health, testosterone, stress, calories, body comp, and much more with Dr. Ben House. Dr. House knows his stuff, and this conversation was extremely insightful.
Dr. R’s Fast Facts
Most common way people deal with stress?
Why is that a problem?
• Exercise is not a problem necessarily; it is, however, another form of stress. More tools are needed to relieve stress
How to mitigate stress
• Find ways to unplug, remove yourself from your environment to gain some perspective.
• Try working in short spurts, about 50-90 min then taking a 7-20 min break.
• Listen to your body.
What testing or assessments can be used to measure Cortisol?
• ASI and Dutch testing… but Dr. House does not recommend it.
How much stress is too much stress?
• Listen to your body, it knows. This is highly dependent on the individual
How to treat low or high cortisol
• Find a clinician that can help you master the fundamentals, eliminate or remove the stressors, and find the driving underlying cause, likely something at the level of the brain and or some source of inflammation
What is a good baseline workout and can it be applied to weight loss?
- 10,000 steps per day and 2 to 3 days of lifting per week, in the 6 to 15 rep range
- Steps help with metabolism and lifting helps to maintain muscle mass
- Yes, good protocol for weight loss, stay consistent and make it enjoyable
Devices for tracking steps?
• A pedometer is fine. No device is 100% accurate, good enough for baseline
• 1 in 4 American men over the age of 30 have clinically low testosterone
Why is low testosterone problematic?
• 40% higher risk of all-cause mortality independent of age, lifestyle, and adiposity
○ 2.4 times more likely to be obese
○ 3 times more likely to have diabetes
○ 2 times greater risk of stroke or heart attack
○ 1.8 times more likely to have high blood pressure
○ 1.99 times greater risk of depression
What are the contributing factors?
• High stress
• Horrible sleep
• Dietary habits
• Issues with mitochondrial function
- Are Pregnenolone and DHEA helpful?
- They can provide support but not necessarily the answer to the problem
- How about Testosterone Replacement Therapy?
- TRT can help some, many men still feel horrible after a while
- Improve lifestyle measures first before resorting to hormone replacement therapy
How to optimize Testosterone
• Lower stress factors in your life
• Get enough sleep (you know how much is enough for you)
• Exercise but don’t over-train
• Lower inflammation
• Good Thyroid function
• Eat a nutritious diet
• Good Mitochondrial function (all of the above assist in mitochondrial function)
• Laugh often
• HCG can help support but won’t fix the problem
What knocks down mitochondrial function?
• Energy surplus
• Not exercising enough and exercise beyond one’s limits
• Too much iron
• Infections and inflammation
• Toxins – heavy Metals anything that depletes glutathione. Tylenol
• Not having what they need to function – Carnitine, glutathione, Zn, Se. Mg, B1, B2, B3, B5, vitamin c and E, chromium, iron, protein
What increases mitochondrial function?
• Not doing all of the above and optimizing nutrient status, autonomics, fundamentals
• *Lower Carbohydrate Diets
• The right amount of exercise
• Supplements like NAC, Alpha Lipoic Acid, Carnitine, CoQ10
*If fasting and low carb improve mitochondria but antagonize testosterone – how do we balance this?
• Depends on the individual
• When fasting, make sure to eat enough calories
• Carb cycling can help some folks
What testing or assessments can you use?
• Insulin being high is a good biomarker
Any standard goals for rough caloric intake?
• Depends on the individual – everyone adapts differently to caloric intake
• Most people are going to be around 15 calories/lb
• Check out my course Moving Beyond Macros
• Eat To Perform has a good calculator
• Alan Aragon has some good info
Research, Case studies, Clinical trials mentioned in this episode
• Dahlgren et al 2009
• Araujo et al 2004
• Travison et al
• Camacho et al
• Trexler et al
In This Episode
Episode Intro … 00:01:55
Our Relationship with Work … 00:04:13
Coping with Stress … 00:06:21
Dr. House’s Research … 00:07:37
The Peer Review Process … 00:09:55
A Simple Exercise Protocol … 00:12:15
Tracking and Consistency … 00:17:29
Different Types of Stressors … 00:19:17
Stress and Recovery … 00:21:45
Adrenal Stress and ASI Testing … 00:24:42
Gut Health, Assessments, and Interventions … 00:30:24
“Knowing What You Don’t Know” … 00:33:45
Testosterone Decline … 00:36:41
Testosterone Replacement Therapy … 00:38:32
Mitochondrial Health and Testosterone Production … 00:44:12
Mercury and Toxic Buildup … 00:46:36
Optimizing Mitochondrial Health … 00:52:10
Supporting the Right Companies … 00:56:09
Fasting, Carbs, and Testosterone … 00:59:56
Nutrition and Libido … 01:05:09
Caloric Intake Recommendations … 01:08:51
Intermittent Fasting and Hunger Signals … 01:17:54
Exercise and Cycling Carbs … 01:21:57
Assessing Mitochondrial Dysfunction … 01:24:52
Episode Wrap-up … 01:26:57
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Dr. Michael Ruscio: What a great conversation with Dr. Ben House. If you were to take me and instead of having my focus be the gut and thyroid, but rather instead someone who focused on metabolism, body composition, exercise, stress, macronutrients, and how to use all these things collectively for optimum energy, vitality, and body composition, you would have Dr. Ben House. Very impressed by this young man.
He’s published a number of papers. He also has a clinic in Costa Rica where he practices functional medicine with an emphasis on kind of health and fitness as I outlined a moment ago. Evidence-based, conservative. Really knows his stuff. And he did a great job of kind of tearing down some sacred cows.
Unfortunately, they’re incorrect sacred cows in functional medicine, similar to what we’ve talked about before, but really picked apart some aspects of adrenal testing, but also had some very interesting stuff to say about mitochondrial function and how important that is for overall health and brought it back to practical things that you can do to test and to treat these imbalances.
And I think everyone will really enjoy this conversation. So please check it out. It will be well worth the listen. It was a little bit of a long one. We went about an hour and a half. But there was just so much to get into. And again, I really think you guys will enjoy it. So here we go.
Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Dr. Ben House who, gosh, I have been really impressed with your work, Ben. He has published a number of research papers himself. He is also a functional medicine clinician. He’s got a cool gig of being down in the jungle of Costa Rica. I’m hoping to get down there and hang out with him at some point, hopefully next year.
But just really been impressed with both the progressive nature of a lot of Ben’s work but also the kind of conservative, practical, evidence-based way of looking at things and, to be frank with you, cutting through a lot of the BS that circulates in functional medicine, his area predominantly being health and fitness. And we’re definitely going to dig into a lot of different topics and, I think, dispel some myths that may be sacred cows in functional medicine. So, super excited for this call, and, Ben, welcome to the show.
Dr. Ben House: Yeah. Thanks for having me. The feeling’s definitely mutual. I respect the content you put out and just the overall depth of your knowledge—it really does help the field more forward. And I’m thankful for people like you because it’s an honor. There’s no other way to say it. So thank you.
DrMR: Well, thank you, sir. And like I said, I look forward to hopefully getting down to Costa Rica one of these years and hanging out with you. Because if you haven’t seen what Ben’s doing down in Costa Rica, it’s pretty cool. They look like fitness retreats, I guess. You lift and you hang out in the jungle.
And, gosh, I love woods to begin with. I grew up in western Massachusetts, and we had lots of rivers and woods. So I spent a lot of time in that environment. So I love that environment at baseline. And then, looking at some of the videos and such that you post on Facebook, it looks like a really, really fun time.
DrBH: Yeah, I live on the side of a cliff in the middle of the jungle. I can see one house from our property. We have about 20 acres and it’s up a mountain in Novita, which is in the southern zone. I learned very quickly the best way to kind of promote change is almost to supplant people. Take them out of their normal environment and just put them in this environment and they have this top-of-the-mountain type experience. And then they go back to their life and they figure out what works and what doesn’t work.
So that’s why I wanted to build this place. We talk so much and I think there’s so much power in just showing people what this life can be like and how good they can feel.
Our Relationship with Work
DrMR: Yeah. Well said. It’s funny, because I have a buddy right now who’s on honeymoon in Hawaii, and it got me thinking about the last time that I went to Hawaii. It was probably about maybe a year and a half, maybe two years ago. And when I got back, it just felt like the world was moving so fast. That was the way that I used to live every day. I just felt like I was kind of like—to use a super nerdy example—if you’ve ever seen like a space movie, you have people just cruising through space. And then people can zip into warp drive and everything starts screaming by them.
That’s how I felt—like the world was in warp drive, and I was just kind of coasting when I got back from Hawaii. And I said to myself, Holy cow, if I was feeling like this is normal, then I was feeling like a sprint was normal. So you’re right. Getting out of your daily routine into a different environment can help you see through contrast if you’re maybe overextending, which is definitely a line that I’ve flirted with and crossed numerous times in my life.
DrBH: Yeah, and I don’t know that that’s bad. I think if we want to get something done we have to pay attention for long periods of time. What I see is this incessant hustle, like the inability to unplug. And that’s what I despise more than anything because our goal—like you produce so much content. It’s not to out-work people. It’s to out-produce people. And those are not synonymous.
And I think a lot of people have been fed that story that those are one in the same, and they’re not.
DrMR: Yeah, and I totally agree. Not to get too off-topic, but just one more thought on this I guess, which is I work hard but I’m not the type of person’s that addicted to working or hiding from a bad relationship or a bad situation and kind of hiding in my work. I’m working hard with the goal of working less.
So I do think you can work hard in a healthy way, as long as you have the endpoint in mind of getting yourself to a reasonable position, which is a contrast for some people that work hard I think out of addiction. Perhaps, they’re addicted to work and they’re hiding. Or they’re addicted to material things, and they have to keep working hard to feed this lifestyle that they can’t keep up with. Yeah, it’s definitely an important issue.
Coping with Stress
DrBH: I think that’s a good really jump into overall exercise, because that’s where most of our people are coming to us from. If we think about their stress bucket, their stress bucket’s overflowing with non-exercise stressors. And so, if we don’t take care of those, if we don’t try to limit those stressors, because the body only has one way to deal with stress, and that’s the sympathetic nervous system.
And human beings are meant to be more parasympathetic. And any time we’re on these podcasts, we’re going to go sympathetic. Any time we’re turning it on, so to speak, and I work with a lot of strength coaches and they can kind of vibe with this. They essentially have to turn it on, however many sessions they have. And you do it with consults. I do it with consults. You turn it on. I’m a natural introvert, but I have to kind of go into this extraverted state in order to almost survive in this economy.
And not to say that I couldn’t be some dusty professor somewhere, but I love my job. But I just can’t keep doing it all the time. I have to do what refills me. So I’m constantly asking people, “How do you cope with stress?” And the number one answer I get is exercise. And I’m sure you get it too.
It’s ironic, because your way to deal with stress is a stressor, and that’s not a recipe for success, at least long term.
Dr. House’s Research
DrMR: I 1000% agree, and that’s definitely one point I want to dig into. Before we do that though, because there’s something that you do that I think should be just kind of emphasized, which is you’ve published a number of papers. And it’s great to kind of see clinician scientists. And I consider myself as one of those, having produced one study and working on a second. And I think that’s a very unique perspective, because it shows that you have one foot in academia and you understand science, how to interpret science, how to use science to learn.
But you’re not, with all due respect, what is sometimes termed a talking head, where you’re just in academics and you don’t have that real-world plug-in to keep you grounded or to help you have an intuition for when maybe the science is a bit misrepresentative of what actually happens in the real world, which can happen.
So can you tell us briefly about some of the research that you’ve done?
DrBH: Yeah, so I’m a PhD. I’m not a DC, MD, DO, or ND. I went to the University of Texas out of Austin, which is one of the top five nutrition schools. And it’s crazy even to think about how I got in and my past. There’s plenty of podcasts where I talk about that, and there’s no need to talk about it.
I was essentially taught how to learn. I cannot really just say enough about that because now I have the tools. I was taught how to learn and I had to publish papers, and I know that process. So it’s easy to publish a blog post. You might get like two reviews from your friends maybe. And they’re like, “Yeah, that was great, dude.”
If you’ve ever tried to publish—I have one study published in Obesity Research, which is like one of the top-end journals in nutrition. That paper got reviewed over 100 times before it was even submitted. And like just that process, you have a respect for that peer review process.
And I get a lot of questions, like why is science so important? Like, yeah, it’s slow, but we have a responsibility, an ethical responsibility, to make sure that what we do is reliable, that it is what it says it is, and that we have to measure that this stuff actually works. And that’s why I love that you’re doing research and you’re getting it published and putting it out there. I think we’re going to see more and more of that.
Crowdsourcing, like Andy Galpin’s great about that. And research has to be for the people. And I think it’s been paid for by prescription drug companies and NIH for so long, and it’s not necessarily research that a lot of people can relate to. And I think that’s going to change as we move forward, at least I hope it is.
The Peer Review Process
DrMR: Yeah, and that’s a great point, because some people I think with a good intentions say, “Well, you can’t trust research because it’s funded by pharmaceutical companies,” which in some respects is true. But that’s such a broad brush. And it’s really unfortunate, because there’s so much research in natural medicine that’s pretty well done and can teach you a lot. And on the other side of the coin, the reason why I think the peer review process is so important amongst other things is because it prevents you from just saying whatever you want.
And I can’t tell you how many lectures I’ve walked out on of “health gurus” who are just saying whatever they want, and as someone who understands the science, I get infuriated. And sometimes I have to leave because clearly this person has no respect for the truth or for being representative of the facts. And they’re just saying whatever they want. And that’s why the peer review process, in part, is important, because it prevents you from being a jerk and just saying whatever you want to say. And it chains you to have to be somewhat representative of the science and prevents you from just being a zealot and saying whatever you want.
DrBH: Yeah. I entered that PhD program probably one of the cockiest little kids on this earth. And I was humbled every day. What about the other end of that research? If you cherry-pick in a study, you’re going to get called out. The reviewers are going to say, “Why didn’t you quote this paper which found the opposite finding?” So that’s important.
DrMR: Yeah. And that’s really where I think the field of complementary alternative medicine, functional medicine, natural medicine, whatever you want to call it, that’s where I think the future is, because we have to be more well informed to have information that’s really going to help people.
In my experience, the less informed someone is, usually the worse their recommendations are. And usually the more over-zealous and dogmatic they are about those recommendations, because all they’re doing, like you said, is cherry-picking.
And the problem with that is when you cherry-pick you miss things that may contradict your point. If there’s enough evidence that contradicts your point, for example, using an example I’ve used 1000 times, using high levels of prebiotics in those with IBS and IBD. You have a higher probability of hurting that person than helping that person. And that’s important. Anyway, not getting us too on the topic of peer review. I think the audience is pretty understanding of that.
A Simple Exercise Protocol
There’s a number of notes that you sent over to me, which I thought were brilliant. You make one point that I wanted maybe to get a little bit of an elaboration on, which was a simple way of looking at exercise. I believe you said 10,000 steps and two to three days of lifting and kind of how we can start very simply. And we don’t need this highly-meticulous and detailed program.
I’d like to get your expansion on that, because there does seem to be this recurring theme both in the kind of health medical side of functional medicine and more so the health fitness side, which is a pull away from these highly individual, highly prescriptive, highly assessment or highly test-based recommendations and the movement toward more kind of practical interventions. And it sounds like you’re kind of in step with that. So can you expand on that point?
DrBH: Yeah, I think the number one rule for all of us is do no harm. It has to be. And even personal trainers, strength coaches, they have that same rule. So we have a large population that doesn’t move right now. They just have to accumulate work. They have to accumulate volume.
If your goal is weight loss, exercise is not going to make up for not moving throughout the day. It’s pretty clear. You’re not going to be able to regulate your energy intake if you don’t get 8000 steps a day. If you have one thing, do 10,000 steps a day.
DrMR: So let’s go into that actually. That’s a really interesting one. So is there research showing that it’s hard to regulate your appetite if you’re not moving enough? Is that kind of what you’re saying?
DrBH: Yeah, there’s a study—I think it was 7800 and something steps and they were able to regulate their intake a little bit better. That makes sense to me. Because as humans, we moved a ton. If I put a pedometer on one of our construction workers, like God knows how many steps he’s going to get in a day. And then I started training those guys. So they have this huge base of essentially what we would call GPP or general physical preparation in the strength and conditioning world.
So they have this huge GPP. And I’ve been training them for four months, and it’s kind of this interesting case study. Two of them have really gravitated, and they probably average like two days of lifting a week. And the guy—he’s never back squatted before, and he back squatted last week. And the only thing we’ve done is like kettlebell front squats. He’s done some front squats with a barbell. I put 205 on the barbell and it looked amazing. And he did it for 10 reps.
DrBH: It was insane to me. And so, we put the cart before the horse. Like everybody wants to lift this insane amount of weights. But have you accrued—is your collagen system ready for that? Can your nervous system even take that? So we have to respect volume over time. That’s the name of the game with all of this stuff.
The common denominator’s always time. And so, if you don’t move well, if you have pain, see somebody who’s really good. Find somebody who will help you move. And then, just knock out the fundamentals, just how we do in functional medicine. Knock them out for long periods of time. And I’ll get off my soapbox, but that’s just how I feel.
DrMR: I think it makes a lot of sense. And so, you think a good starting point and I guess long-term foundation even is 10,000 steps and then two to three days a week of lifting. I know you said within the six to 15 rep range. Do you have any more specifics in terms of you should be weight training for this amount of time or maybe you should be doing this many sets in total? Any other granular details to help people kind of step into this?
DrBH: You’re going to get a depreciating return for like every set you do. When we talk about exercise, just like eating, it’s all about adherence. So number one, it has to be fun. People have to like to do it. But why I don’t have essentially “cardio” in there… If you like to do cardio, great. I don’t care. Do it.
But the reason lifting weights is so important is that human beings are going to lose muscle mass as we age. So after the age of 30-40, you’re going to lose 1-2% of your muscle mass every year. But not so if you lift. There’s kind of this minimum effective dose. And Dr. Mike Israetel has a lot of like volume-based stuff. And I think we don’t need paralysis by analysis.
I would just have two days a week where you do… It’s all based on time. So if you can run a split protocol where you do upper body/lower body, great. But if you don’t have a ton of time, spend 45 minutes in the gym. Three sets of 10 works for a reason. You can period it out. You can go two weeks, three sets of 10. Two weeks, three sets of eight. Whatever you want to do.
Dr. Pat Davidson’s one of my best friends, and we use a 20/40 protocol, which is essentially 20 seconds on, 40 seconds off. And then we pick five simple exercises and then they get three minutes of rest in between each round. So that’s kind of a baseline protocol that I would use. And then I might run three sets with someone once they know how to lift well. That’s going to allow them to accrue a lot of volume in a short period of time.
And one of the other tenets of strength and conditioning is that you don’t ever want to go up more than 10% in a week. So like CrossFit, like you never worked out? Okay, do all this stuff the first day. That’s not going to go well. So you want to have this progressive overload-type system.
I have clients that have fat free mass indexes of 28. Like, we’re talking guys who are 220 pounds and they’re less than 10% body fat. That guy needs to accrue a lot of volume. Now, if you’re 220 pounds and you’re 50% body fat, you do not need that much volume. You just need to move and accumulate some work.
Tracking and Consistency
DrMR: Sure. Now, you mentioned steps. Is there a couple good devices you could recommend? And I’m guessing it would be ideal to have a device that can track your steps and also kind of like your calories burned during a session if people are tracking that. Are there any good devices that you like for that?
DrBH: Yeah, I don’t really care honestly. Most of them are probably going to be not very accurate. You can buy whatever you’re going to do and you’re going to do consistently. All this stuff, just like nutrition, you’re after consistent imperfection. You’re just trying to watch it. You’re not after perfect.
And so, I just have a pedometer in my pocket. You can argue whether I’m getting free steps when I drive my motorcycle up the mountain. But overall, it’s going to probably equate over the long term. Does that make sense?
DrMR: Yeah, that makes perfect sense. And I think you make a good point, which is some of these devices we don’t necessarily have to use for the most insanely accurate accounting, but rather just to kind of get a baseline of, “Oh, geez. I didn’t realize that my daily grind I only get 2000 steps. And Dr. Ben said I should be striving for 10,000. So I’ve got to plan a couple breaks in here where I get some walking in.” That’s where I really think they have the most utility.
DrBH: Yeah, I’ve had a ton of clients I’m like, “Hey, just buy this pedometer for $12.” And they buy the pedometer and I’m like, “Hey, how many steps you get?” They’re like, “I got 2500.” I’m like, “Yeah, that’s a problem.” You need to move.
DrMR: And again, coming back to this simple theme. We don’t have to be incredibly detailed or analytical in our measures. There are some simple fundamental measures that tend to yield the best results.
DrBH: Yeah, I completely agree. The fundamentals… I’ve had clients and it just boggles my mind. They’re overweight. They’re stressed out of their mind. And they go to a functional med doc and they get $5000 worth of lab work. I’m like, “Really? You needed $5000 worth of lab work to tell that person that they’re screwed up?”
DrMR: Yeah, you’re preaching to the choir.
Different Types of Stressors
So you were saying a few minutes ago their only way of dealing with stress is exercise. And of course, this speaks to the bigger issue of not having an excessive allostatic load or just not having too much stress, which I think is really important for people to bear in mind, because exercise, as you said, and as I think the audience understands, is a stressor. And stressors are healthy, but only if the stress load is enough for the body to overcome it.
And I always remember—actually, it was Dr. Chris Keroack who was on the show a while ago. And I think I’ve told this story before. But back when I was kind of a snot-nosed college kid. I think I was a sophomore, and I wanted to get into medicine so I shadowed him at his office. And I was on kind of like this anti-stress kick. And I was all about reducing stress, reducing stress. And he looked at me and he said, “You know, Michael, stress is to life as tension is to the strings on a violin. You need to have the right amount of stress. Too much and the strings will snap, but not enough stress and you will have an instrument that is out of tune and doesn’t play.”
So probably for most people, we’re more toward the strings snapping, but balance, I guess, is a key aspect there. And I want to get into your thoughts on the ASI and DUTCH testing in a second, Ben. But any thoughts on that before we jump into the ASI and DUTCH?
DrBH: Yeah, most people are kind of at their wit’s end. But that’s not to say that stress is bad. Stress is great. It’s needed. And I hate the word balance. I hate it. For some people, for my high-level CEOs, balance might be them working straight 10-hour days for a week and then taking a week vacation. So I don’t think we need to think about balance in the terms of everything has to be super “balanced.”
But we have to have some time where we—we have to have rhythms. We have to have time off, time on. And to me, from a stress physiology side, when I think about it, I think about mitochondria. And so, mitochondria, you look at what’s bad for mitochondria, it’s stress. But then you look at all the things that are good for mitochondria, like fasting, exercise—those are stressors too.
And so, stress is good and it’s bad. Like you said, it’s an overall load issue. And that load’s going to be individual for everyone. If you feel like you’re fatigued and you have all the symptomatology and your sweat is salty and you have frequent urination, you have all the telltale signs of “adrenal fatigue,” yeah, you probably have a problem with stress.
Stress and Recovery
DrMR: Now, the mitochondria thing is definitely something I want to dig into in a little bit. And I’ve got some notes from what you sent over that will elaborate on that. So we’re definitely coming to some details on mitochondria in a few minutes, guys.
But before that, do you have any kind of recommendation in terms of how people can look at their day-to-day stress load? Because you said something very interesting, the CEO that does 10-hour days straight for a week and then takes a week off. I’m assuming that that’s probably not the best oscillation between stress and recovery.
And it gets me wondering, what is kind of like the max ratio you can go between stress and then getting some rest? Do you need to have a period every day? Or can you do a 12-hour workday as long as your next day is a little bit of an unloading day? And I know that’s kind of a broad question, but are there a few simple kind of takeaways that people can try to shoot for to help prevent them from being overstressed without enough corresponding recovery time?
DrBH: One of the things that I use with clients a lot, if I have a CEO like that or someone who’s really high… And people that come to us, we do get these kind of high-functioning, high-level, super-productive people and they don’t want to necessarily take time off. And so, the stress research even shows if you have a super stressful week or your life is super stressful, even if you have just one hour in the week that’s yours that you can look forward to, that does help.
And as far as like—I don’t know numbers. Everybody’s going to be different in their genetic ability to take stress. And you also have to think about this contextually. Like, what’s people’s buy-in? And so, I would say our buy-in is high. Some days I might work 10 hours if I’m in the zone. If I had a flow state, I don’t want to really mess that up.
And then, the other part is people can only focus for so long. So like 50-90 minutes seems to be the end of our natural ability to run our brains in sympathetic, like dopamine to remember stuff. And so, then taking like a 15-minute break or the research is like 7-20. I think that’s important. So, work in small bursts. I like to answer when someone asks, “How much sleep do I need?” I’m like, “You know. You know how much sleep you need. When you feel your best.” It’s the same with stress. You know how much stress you can handle.
DrMR: I think that’s a good point. It reminds me of the conversation we had with Kevin Geary and actually a few different guests. But essentially, just like someone who potentially has had a lot of gut insults early in their life and now they have a hand that they’ve been dealt, that they have to be a little bit more careful with their gut. Maybe they can’t have a lot of gluten or they have to be somewhat careful with FODMAPs or whatever it is. They have to make some adjustments because of their gut.
If people have had a lot of emotional trauma early in their life, they may be more amenable to the negative effects of stress. So they may have to be a little bit more cautious with that. So just kind of listen to your body, find your own truth. I think that makes a ton of sense.
Adrenal Stress and ASI Testing
Now, in your notes, Ben, you also said something about ASI and DUTCH testing and kind of this note about why try to quantify chaos. And you also made some pretty interesting remarks about intra-individual variations. So I would love for you to go into some detail about that.
DrBH: I got my first ASI I think when I was 22. We all make mistakes. I probably ran 12 or 13 of these. My patients were paying for them. They all came back crazy weird, and they didn’t really change what I was doing. Yeah, they probably changed my supplement protocol a little bit. But I was like, man, everybody’s screwed up. Why am I having these guys pay for this test? Can I convince them that they’re screwed up without these values?
And then I started looking into these ASI markers, and there’s a great study from Dahlgren et al. in 2009. What they did was they had 14 people and they grabbed four-point ASIs on them for 28 days. And you look at the chart. They published their individual data, which was amazing. And you look at the intra-individuals. So within each subject, you look at their variation, and it’s absolutely insane.
Someone’s waking cortisol was anywhere from 1-40 over that 28-day period. And that makes sense to me. So really, if we only get a 24-hour ASI, what are we really getting? And I don’t think we know. And then, are we going to dose supplements off that for three or six months? What’s the game plan there?
And then the other aspect of it is, if it comes back weird, well, what do we do? We have to master the fundamentals, and then we have to respect this ideology that maybe high cortisol or low cortisol, maybe the body wants that. In terms of low cortisol, it could be all in your realm. Maybe this is all GI related. Maybe the GI is just pounding out lipopolysaccharide and IL6. And it’s turning the brain into the sympathetic state because we know that’s going to act on the midbrain reticular formation, which is attached to your vestibular system. And it’s that reflexively sympathetic system.
Maybe this stuff—it’s not that cookie-cutter and it can’t be. So that’s just how I feel. Get to the underlying point.
DrMR: Yeah, I think you make a great point. I love the study that you referenced. I wasn’t aware of that study, but it makes complete sense to me. When I initially got the feeling that ASIs were probably not really worth the cost of the paper that they were printed on was actually pretty early in my career, but it took me a little while to be fully confident in that observation, because the dogma suggesting the adrenals is important—I felt like I was an idiot. Like, I must be dumb because every seminar I go to, every post-doc training course I do, everyone I talk to it’s “adrenals, adrenals, adrenals.”
You’re at a conference—and this is when I’m a student—and there’s like there’s doctors next to me. And they’re talking about, “Oh, my adrenals are going to be shot after today. Ha, ha, ha.”
DrMR: It’s just like everyone. It’s so ingrained. But I remember I would test a patient from during my internship who was really sick, and her cortisol’s normal. And then I’d test a buddy of mine who can deadlift like 405 and is super vital, and his cortisol looks like he should be dead. There were numerous observations like that.
And I said to myself, How can this be effective? And it took me a few years to get kind of the confidence to question the dogma in the field. But, yeah, they are certainly, in my opinion, not accurate. There’s been a number of researchers who have come out against them. And I’m planning on having one of them on the podcast in the near future. There is a test called the cortisol awakening response that’s probably more accurate. But, again, you’re still quantifying a symptom of the problem and not the problem itself.
DrBH: Yeah, I think adrenals… No one’s going to have a primary adrenal issue, unless you have Addison’s disease, which you wouldn’t even use a cortisol rhythm test to diagnose anyways. You’d use an ACTH challenge test. Addison’s disease is going to be very, very rare.
DrMR: Right, and just for the audience, if you’re not familiar, primary just means there’s an actual disease like Addison’s or Cushing’s, which are extremely rare in the adrenal gland. And that wouldn’t even be tested by one of these assessments.
DrBH: Yeah, you’d just see low cortisol and that would be essentially your check engine light for another test.
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Gut Health, Assessments, and Interventions
I also really like your remark about the cortisol, the changes in cortisol. First of all, they’re probably not representative of physiology because, as you just mentioned, they change from day to day to day to day within the same person and aren’t really representative of physiology. But perhaps, we’re seeing something that’s adaptive.
And I’ve made this remark oftentimes about the gut. We see skewing of the microbiota. And we want to rush in there and blast the microbiota with prebiotics. And also in cases, my suspicion is that, especially in IBS and IBD and probably other like functional gastrointestinal disorders, the skewing that you’re seeing in the microbiota is adaptive due to a malformed immune system, which is fairly common in westernized countries due to sanitation, early antibiotic use, Cesarean birth, lack of breastfeeding, and overall hygienic society.
So you’re looking at a symptom of the problem, and when you treat the symptom, you’re not going to get great results. So it’s very possible that we’re seeing the same sort of phenomenon or similar phenomenon with cortisol.
DrBH: Yeah, we always like to blame something else, but we never like to look at the overall host. I think that’s what we need to come back to is, like why is this happening in this person. What’s going on in the micro and the macro that this is present? And the GI tract is so huge. And I didn’t necessarily want to believe that in the beginning. 80% percent of our immune system’s there. It is our window into health.
Any time you’ve got those inflammatory responses coming off the GI tract, I think you’re going to be in a world of trouble.
DrMR: Yeah, 1000%. And for me, a lot of the reason why I’ve really settled into the gut being my primary area of focus is simply reflecting on what works best in the clinic and what doesn’t work as good. And the interventions that make the most impact in my observation, hands down, are interventions for the gut.
Now, I should also say that I haven’t done a lot of work with Lyme. I haven’t done a lot of work with mold or CIRS, so I’m open to that. But certainly, in my experience, the gut interventions are the most powerful. Again, not to say that it’s a panacea or a cure-all, but I really try to focus on the things that are going to help people the most. And that’s why I put so much emphasis on the gut.
DrBH: Well, there’s so many loops in the human body. If the GI tract is off, it’s going to spin so many of those other loops out of whack. And the other big loop for me, and I think one of the things that you and I do really well is we respect what we don’t know. I get a lot of pro athlete clients. So one of the big questions I’m asking is concussions. You know that’s going to have—within 24 hours, you’re going to have the blood-brain barrier’s going to open up. The intestines are going to open up, so you’re going to have leaky gut.
So, not to say that working on the gut isn’t going to help that person, and also using it like preventatively because they know concussions—the more inflammation you have onboard, the worse you’re going to be if you do have a concussion. But is it the primary? I’m always trying to find, is this the primary?
Same with testosterone. So if you got hit in the head, right in the front, and your pituitary gland got knocked off, like whoa. I think assessing what you don’t know and knowing when it’s outside of your scope. But then also helping people manage all the fundamental things that are going to help them if it is something else.
“Knowing What You Don’t Know”
DrMR: 1000% agreed. And testosterone’s actually the next thing I wanted to ask you about, so that’s a great segue. But just a quick note before we go there. Gosh, it’s so important knowing what you don’t know. And there’s an old quote by one of my history professors, when I was actually a freshman in high school, that I’ve never forgotten and I’ve probably used it before. But it essentially reads that “he who knows what he does not know is the mark of one who truly knows.”
I think one of the things that as a patient you want to look for is a doctor who doesn’t have an answer for everything. Because if your doctor has an answer for everything, they’re either the smartest guy in the world or they’re not telling you when they don’t know something. And that’s really important, because we want to have our box and we want to do what we do well. But we also want to have a respect for where we’re not really expert in an area and not try to be the expert to everyone.
And sometimes that happens out of good intention but a little bit of, I guess, fear of—you have the expectation that you should know everything for your patients. And it’s very freeing, I think, as a clinician just saying, “Listen, that’s not my area. Here’s what I think, but that’s really not my area. I would seek someone out who can give you a better opinion on that.” Or even not giving your opinion at all if you don’t even think you have enough information to have a well-formed opinion.
Just another quick tangent here. There was a patient that came in just yesterday actually. It was the same day that the podcast with Dr. Satish Rao aired, and we talked about dyssynergic constipation, which I was so happy that he had that dialogue about dyssynergic constipation. For many patients I think in the natural medicine community, when they have constipation, it’s magnesium, vitamin C, methane SIBO, fiber, and there’s not a whole lot of consideration of maybe it’s not an IBS, SIBO, lack of fiber, or a laxative-driven problem. Maybe there’s something that requires a different intervention.
And for dyssynergic constipation, these are patients that aren’t helped by anything. They get treated for SIBO. They get treated with magnesium and vitamin C and other laxatives, and they still have a very hard time going to the bathroom. And this particular patient came in after she had a partial colectomy, her cecum was removed, and ever since then, she had constipation.
And it’s the constipation that sounds like it’s dyssynergic constipation, meaning this is someone who’s in the bathroom for 10, 20, 30, 40, 50 minutes having a very hard time moving her bowels and still doesn’t feel like she has complete evacuation afterward. And so, she may be a great candidate for biofeedback therapy, which is essentially retraining the muscles in the colon and rectum.
The first thing I wanted to do was get her to a motility center that offers biofeedback for a workup and for that therapy. And I don’t want to sit there trying to cram her into my box of SIBO, magnesium, vitamin C, fiber, what have you. So definitely, knowing when you don’t know is super important.
Now, testosterone, you sent me a note about testosterone kind of being the canary in the coal mine. And I loved what you had to say about testosterone. So let’s jump into that topic.
DrBH: Such a hot topic right now. Like TRT prescriptions are up God knows how much percentage the last 10 years. So like, everyone under the sun seems to have a problem with testosterone. At least males and females, I guess. I work primarily with males. It’s my population that I love to work with.
But you look at the research and it’s related to everything. Like 40% higher all-cause mortality. You’re more likely to be obese. You’re more likely to be diabetic. You’re more likely to have a stroke. You’re more likely to be depressed. Like all these things are related to low testosterone.
But then, you see a lot of guys who are on—and TRT can help with that. But then you see a lot of guys who are on TRT and they still feel horrible. And so, it’s like maybe that Band-Aid wasn’t the answer. The first step is acknowledging that we have a problem. So one in four American men over the age of 30 have clinically low testosterone and then one in two have low normal.
I think the big broad scope question is like how are we aging? How are men aging in our current society? And we’re not aging well. And we would expect that, given our lifestyles, given our diets, given that we try to outwork the system.
And it doesn’t look like it’s getting better. Traveson et al. has these cool graphs of like testosterone decline from like 60-year-old men. And then the same men 10, 20 years later and then the same men 20 years later at the same age, and we’re just progressively getting worse. And so how do we kind of revert back is the big question.
To really understand that, we have to dive very—we can’t make it this pregnenolone steal, like this oversimplified kind of concept. We have to really dive deep into testicular function, the HPG axis. And so that’s where I thrive. And let’s go as deep as you want to go.
Testosterone Replacement Therapy
DrMR: I agree with you completely that it does… And of course, this is what the data shows, that male hormones are on the decline. And it’s probably no huge secret. We have a lot of things working against us: stress, food, environment, sleep, lifestyle. So it’s not surprising that we would see this occurring. And I also agree with your comments that it may not be as easy as pregnenolone steal.
Now, I do think pregnenolone and DHEA can be helpful. It’s a little bit of support, but I don’t necessarily think it’s the answer to the problem. Now, I know that you’ve said that lifestyle measures are one of the most important things to help to increase testosterone. I’d really like to get your elaboration on this, because there’s two things that kind of go back and forth in my head in this regard.
One is that lifestyle and these basic interventions like stress, sleep, gut health are the foundation, 1000% agreed. But then I also wonder on the other side, just like many women seem to be benefited from a small amount of herbal support for their female hormones or maybe a little bit of birth control or maybe a little bit of HRT, might there be a population of men that can benefit from this?
But I also have seen—if I’m being honest and objective—men who’ve gone on testosterone replacement therapy and there’s maybe a short honeymoon period where they feel great at first. But then, they feel about the same or even worse after a while. So it does make me question how much utility there may be for males. Perhaps HCG, which is something that kind of stimulates testosterone production, is the better go. But I know you said there’s a lot that can be done with lifestyle factors.
And maybe going beyond just some of the simple and having some more kind of definitive lifestyle factor goals to achieve and nutrient support to help optimize that. So as someone who’s as objective as you are, I’m super curious to hear more about things that you can do for testosterone. And I guess before we jump into that, does this apply to women? Because I know for women, testosterone can be very helpful for sex drive, for drive, also slightly for body comp. So are these things going to apply mostly to men or do they apply for women also?
DrBH: Yes. So from the women aspect, we have to address that women are just insanely more—at least menstruating females are insanely more complicated than men. And so, they’re actually easier to disrupt physiologically. It’s interesting—women are way more likely than men to survive a famine, so they’re more resilient than us.
But you think about like what’s the most expensive thing to have as an ancestral culture, it’s to produce a baby. So you can imagine the body’s going to shut that down in times of famine, in times of war. So if there’s stress or if there’s low energy availability, I think women are going to get screwed. And then you think about like how, all of a sudden, women in our culture they had to not only take care of the family, but now they also have to have an income. So they’re getting hit from both sides.
But I think the fundamentals are definitely going to apply to women. I think that you just have to be a little bit more careful with their training stress. There’s a really, really, really cool paper that just came out in 2016, and they looked at when they took female bodybuilders—and it’s one of my favorite papers. They took female bodybuilders, and they brought them down into these lower percentages of body fat. And then they tracked them.
They tracked them for a really long time, which isn’t normal for a study. Three to four months later, these females’ T3 and their testosterone still wasn’t back. So they brought them back to their previous weight and then they brought them to maintenance calories. But three to four months, their hormones still weren’t back.
And so, I have a lot of ex-female bodybuilding clients and a lot of track athletes. And so, who knows? You’ve been underfeeding and like very, very lean for a really, really long period of time. I don’t know that we have the research to support that. Yes, women are going to do probably better with pregnenolone and DHEA than men are. Men aren’t going to androgenize DHEA. It’s not to say that they don’t need DHEA, but they’re not going to turn DHEA into testosterone. Maybe if you get into intracrinology they might, like at the level of the cell. But as far as DHEA supplementation making people more androgenic… It’s why it’s over-the-counter, because it doesn’t necessarily do that.
So if we think about men, like what can we do to “optimize” testosterone, I think we really need to focus on a few things. Stress is going to be huge. Stress inhibits testosterone production at the level of the brain and the level of the testicles. We have sleep. The fastest way to drop somebody’s testosterone is to over-drain them and sleep-deprive them and dehydrate them. And then, we have inflammation. And the next one’s mitochondrial function, and those are intimately related. And then, thyroid function which, again, comes into play there too. And then nutrient deficiencies.
But why mitochondrial function is so important to testicular function is that when we make steroid hormones, we actually produce a lot of reactive oxygen species. And there’s even a paper by Ciccone et al. which says that this aging effect of lower testosterone is even related to mitochondrial deficiency.
Then another bullet, the rate-limiting enzyme of testosterone synthesis—no, it’s not pregnenolone. No, it’s not cholesterol. There’s 350,000 times more cholesterol in the blood than there is testosterone. So it’s not like a substrate availability issue. The rate-limiting status of testosterone production is bringing—it’s called a steroidogenic acute regulatory protein.
And so, what this thing does is it brings testosterone into the mitochondria. So how crazy is that? We have to have mitochondrial function.
Mitochondrial Health and Testosterone Production
DrMR: The question then, I guess, of looking to your mitochondria health as potentially a way to help bolster your testosterone production. So then, I guess, what are some of the best things that people can do to keep their mitochondria healthy? Because I’m assuming, and please correct me if I’m wrong, that maybe what you’re taking is a semi kind of mitochondria first approach to try to increase testosterone.
DrBH: Yeah. When we think about thyroid or we think about the gut or we think about mitochondria, I think we’re generally going to come back to the same place. We’re going to have to get to all of those systems. If we think about what knocks down mitochondrial function, it’s going to be this hypercaloric, sedentary lifestyle, where your cells all of a sudden are like, “No…” Your mitochondria’s spewing out too many reactive oxygen species and there’s just like no more energy. No more party. They’re shutting the doors.
And then, you have inflammatory stress. So too much iron, we know that’s going to oxidize, and it’s going to create mitochondrial stress. And then, the biggest one is infections and inflammation, which we know just wreak havoc on mitochondrial function. And then, toxins too. Anything that’s going to deplete glutathione. So like acetaminophen within hours depletes glutathione. So that’s going to knock you out.
And then, you think about the average American diet. What are they going to be deficient in? Are they vegan and they’re not eating enough protein so they can’t make glutathione? Maybe they’re not getting zinc. They’re not getting selenium. They’re not getting magnesium, B vitamins, vitamin C. There’s so many things. And so, I think we have to be able to dive deep, but then we also have to be able to expand out.
And if we look at mitochondria, we all of a sudden get into all those other systems. And I think the biggest one is like finding that underlying source of inflammation. One of my favorite quotes isn’t from a functional medicine practitioner or even a scientist. It’s from a stand-up comedian named Ali Wong, and she says, “If you don’t have HPV, you’re a loser.”
One of the things I ask in consults is when’s the last time you laughed. I want people to laugh often. That’s very, very important. So that’s true to me. If you don’t catch something in this world, what are you doing? Are you living in some stupid bubble? I don’t think of infections as something wrong with the human. I just think of it as a product of living on this earth and doing cool stuff.
DrMR: I love that. And I agree. You have to have fun, and we’ve talked about that a lot on the podcast. And that’ll be good for when I ask you later what is the least healthy, most fun thing that you’ve done lately. I’m suspicious you’re going to have a great answer to that, but that’ll be the last question that I ask you.
Mercury and Toxic Buildup
I do want to ask you how common do you think toxin issues are? Because certainly things with diet, with maybe having an anemia or iron overload or infections or dysbiosis, gut inflammation, those things are I think easier to pin down, fairly straightforward in assessment.
Those are all things that I feel like I have a pretty good handle on. It’s the things like mercury that I’m much more skeptical of, and I did do a pretty comprehensive review of the literature on mercury. And I know I’ve been saying this probably now for like two years. At some point, I’ll release—it’s just all this other stuff has been more important, so I haven’t taken the time to kind of organize that and get that ready to be published.
But really based upon that data, it looks like the potential detriment or perils of mercury, lead, what have you, have been very, very overstated. Yes, there’s a time and a place. But at least from what I’ve seen, it seems to be quite a bit overstated. But I’m totally open. So I’m wondering is that something that you’ve found to be a big hindrance to many people, Ben?
DrBH: I always think of like risk for reward. So if you’re like bathing in chemicals, it’s not a good idea. You don’t need to wait for the research to come out on that. Since World War II, like 80,000 chemicals have been added—some crazy amount of chemicals have been added to our environment. In the US, they don’t even have to test for this stuff; they just put it in there.
And so, you have to be somewhat cognizant, but then on the other end, you don’t want to let that run your life. As far as mercury, I think, yeah, if it’s bound to selenium, like there’s so much stuff there. And I think that we’re going to find there’s genetically susceptible individuals. I know we’re finding that for like sick building syndrome and mold toxicity. We’ll probably find it for a lot of this stuff. There’s just some humans that can’t handle… Like maybe you have a PON1 SNP where you can’t get rid of organopesticides very well.
We’re not there yet, but I think we’re going to get better and better on who needs to be super anal about this. And I would say—I’m the same way. I think of chemicals as I think of gluten. If you don’t have a problem… My wife has zero problem with gluten. She’s eliminated gluten for two years. She puts it back in, she feels no difference.
And so, for her, avoiding gluten is probably a bigger deal than actually eating it. Now, me, everyone in my family has an autoimmune disease. I get immediate diarrhea if I have gluten. So it’s like, for me, whether that’s placebo or not anymore, it doesn’t really matter because it’s there. But for me, I have to avoid it.
If you’re a very not robust human, then you probably want to be pretty wary of that stuff, because you’re not going to be able to take it. But, yeah, I don’t think everybody needs to go on some crazy-ass detox. That’s stupid.
DrMR: Right, and I agree with you that fundamentally you want to create a lifestyle that as reasonably as possible avoids toxins. And there’s a lot of things that are simple: your cookware, what you keep your food and your water in, what you eat, the things that you put on your skin, your home cleaning and cosmetics. There’s a lot that can be done with just some simple changes there.
I guess what I’m more so curious of is doing some sort of urine or blood test, detecting these things in the blood, doing corresponding detox therapy. Have you found for many people that’s like a huge cathartic intervention?
DrBH: I’ve never done it. I have no desire to do it. If someone needs that, I’m probably going to refer them out. Even if they think that’s their problem, I’m not going to be the guy. I’m going to be like, “Hey, you probably need to see somebody else.” Just because that’s not something I necessarily want—I don’t want to deal with mercury toxicity.
This is my wheelhouse: I prefer to work with like jacked gorillas who are trying to do crazy stuff. And that’s not bad or good. That’s just what I love to do.
DrMR: I really would like to interview someone that does a lot with detox, especially metal detox, who is also objective. Just my main challenge is I don’t feel like I’ve come across someone—and they could be out there. And if you know someone, Ben, or anyone in the audience knows someone who seems to be objective and conservative, kind of the way Ben and I are, who’s doing a lot with detox, especially metal detox, I’d be more than happy to have them on the podcast to talk. It’s just, unfortunately, everyone that I’ve seen who’s big into that seems… I just question their objectivity. So I’ll throw that out there if anyone has a recommendation.
DrBH: Yeah, I think Chris Shade—I’m sure you’ve heard the name. But then you get into like so many of these practitioners, they’re attached to lab companies and supplement companies. That’s like the biggest red flag to me because now you’re all of a sudden making money on these people having problems.
DrMR: Yeah, I agree. The podcast allows sponsors. And the way I handle this is I only allow sponsors for companies that I already use and like. Doing it that way is very important than doing it the other way. And unfortunately, I think that happens to some clinicians.
And I think in some cases it’s probably kind of a tough situation where someone may be having a hard time making a living. And they’re good at the academics, and they find a company that’s looking for someone to help them educate people with these marketing materials.
And you kind of have this whole thing that I’ve been critical of, which is just searching for data to support a test or a treatment rather than looking to be objective and craft a well-informed opinion. So I 1000% hear what you’re saying.
DrBH: Yeah, confirmation bias is going to get all of us in trouble. It’s the bane of social media right now. What you believe just gets thrown back in your face. So we have to have this evidence-based mindset and this constant skepticism of what’s going on.
Optimizing Mitochondrial Health
DrMR: Exactly. So, Ben, what are some things that you would recommend people do to try to optimize their mitochondria health?
DrBH: Yeah, so don’t do any of that stuff that we mentioned above. Clean up infections. Don’t have iron overload. Get a ferritin measurement. Don’t be sedentary. I think the biggest thing that people can do that’s like underutilized—like if we think about testosterone. Body composition is a big deal. It’s a big deal. So losing weight.
And then, you think about will TRT help people lose weight? Yeah, the research is very, very clear that it does. You know it breaks that loop. I’m not against TRT. It’s a hammer, and I want us to be more careful with how we use it. And the same thing, I don’t want people to have any money on it.
The fact that TRT clinics make—once you sign up, they make gobs of money based on you getting that prescription every month. And that, to me, is wrong, because if they put you on that, they’re looking for ways to put you on that because it gives them money. And I’m always against that.
So I always have exit plans for supplements. I’d prefer it if the practitioners didn’t even make money on supplements. And maybe people don’t want to talk about that. That seems like this black hole of the industry, “Oh, we don’t want to talk about that.” Are the supplements just like prescription drugs? And I’ll get off my tangent and back to mitochondria here.
So I would say for mitochondria: optimizing nutrient status. This is going to be huge. We’ve got to make sure your glutathione’s okay, your zinc’s all right, your selenium. But that comes down to the diet. So if you eat a whole food, plant-based diet based on what you like, you’re probably going to be all right.
And then the other things that are going to optimize mitochondria function are going to be fasting. I think that’s tried and true. But that’s going to be completely contextual too. If you’re an athlete… So I have athletes who need to eat legitimately 4500-5000 calories a day. They cannot get that in in an eight-hour block. It’s not going to work. They’re going to have huge glucose variability. So fasting’s a tool. So we need to be careful with how we use it, and it’s a powerful tool.
And then, the other things like tried-and-true supplements that are going to help mitochondria function are like n-acetylcysteine, alpha-lipoic acid, carnitine, CoQ10. All those things have been proven to work. So you’ve got to take away the stress from the mitochondria, and then you’ve got to give them what they need.
I think we’re going to see some cool stuff come out of the exercise realm that could find its way into the functional medicine realm and that’s near infrared spectrometry or NIRS. So these are called Moxy Monitors. And so, what they measure is they measure the oxygenation of the blood or hemoglobin and myoglobin.
How we use them in exercise is once oxygen’s depleted you’re probably done. So if I’ve put that on you and you squat and you run out of oxygen, I can tell you when you’re going to fail. But how it’s used in mitochondrial medicine is they clamp people up. So they essentially use like a blood pressure cuff, and then they…
DrMR: Oh, I’ve seen this.
DrBH: Yeah, they blood pressure cuff people. Some of my colleagues actually do it, like Brandon Evans and Aaron Davis are just insanely crazy sports performance physiologists. And so they cuff people’s legs and then they see how fast they re-oxygenate. So they look at that over time. And Carl Valle also has a bunch of stuff on this.
So that’s something that may find its way in office from a mitochondrial standpoint that we can use.
And then, you could also think about what’s another easy marker for mitochondrial function. Insulin. If you have high insulin, you probably have mitochondrial dysfunction because that means that your cells are saying no to energy, specifically it’s a ball of worms. And so that’s actually probably via an alpha cell in the pancreas that is resistant to insulin, so it’s not secreting glucagon and the lymphatic cells aren’t making glucose. But that’s a long story short.
C-peptide or just this overall lack of either our first phase or second phase insulin or insulin resistance is probably a great marker for mitochondrial function.
Supporting the Right Companies
DrMR: Awesome. And I do want to ask you about mitochondria testing in a second. Just a couple quick thoughts on the economic comments that you made. I think that’s an important thing to talk about. And I think it is good to talk about these things, because unless we do talk about them, we just kind of leave them as these taboos and people will kind of flounder to decide what they think.
There’s a few things that I think are important to take into consideration. One is I do think it’s important for healthcare consumers to support the people that are providing them information. An example of this is if you are educated about, let’s say, a product, a Squatty Potty, a supplement, or a book, and you can buy that kind of through your educator’s channel or just go right to Amazon and buy it. If you go right to Amazon and if you don’t support financially the people that are helping you, you really make it much more difficult for them to continue to exist.
I’ve always been a firm believer in this that there are some political podcasts that I’ve found to be very, very valuable. And they have certain things—like there’s one that I follow that has a mug club. And I could give a crap about the mug, but I bought it to support the outfit because I know that they require listener funding to maintain their operation.
So it is important I think for people, if there’s a provider or an educator that you respect and that you trust, to support them financially. Because if you don’t and they’re not able to cover their costs and make a living, then they can’t continue to give you that free information, because no information is really free. It’s just maybe you’re not charged for the information to access it, but then there’s another way of supporting that person.
So I think it’s really important that we all keep in mind that if there’s people that you like and that you trust that it’s better for you to support them, even if it’s $2 more than it is on Amazon and you don’t get free shipping. Because if you cease to do that, then this person may cease to exist, and all you’re going to get is whatever biased information is being funded by like a pharmaceutical company or a big supplement company on the internet.
So if you want to not have the information consolidated to kind of a monopoly, it’s important to support other people outside of that monopoly. And sometimes, it’s a harder pill to swallow because it costs you maybe a few dollars more, but I think for most it would be an invaluable investment.
Now, the other side of that coin is this is I think highly contingent upon funding and supporting people that you trust, because there are clearly people in the movement who are just, in my opinion, violating or exploiting someone’s will to get better. And they will take you to the cleaners. They will have you do $5000 worth of lab work. Or they will create this self-help book for you with a program in there that is just based on absolute garbage science, and they’re just trying to sell supplements.
You have to really have your feelers out and have a BS meter. And when that BS meter goes off, walk away. But also realize if it’s someone that you like, you trust, you respect, and has really helped you, then I would say definitely support that person as much as you can.
DrBH: Yeah, I always use the analogy of a restaurant. So if you’ve got a farm-to-table restaurant in your area and you never go there, how long do you think that thing’s going to stay in business?
DrBH: Not very long. So you have to pay for the things that you believe in. So I’m constantly buying courses. I’m constantly supporting other people. I tell young coaches—this is a Mike Boyle-ism—you should be spending, if you can…I spent 50% of everything I made on con eds for like the first five years, and I don’t regret any of that money. And I still spend an ungodly amount of money on con ed, because otherwise, it’s going to cease to exist, and that’s why it’s important to me.
DrMR: Exactly. And I have some colleagues who have courses, and sometimes they’ll say, “Oh, I’ll get you a free ticket.” And I actually buy a ticket, because it’s like, geez, if I’m not going to support you, who else is going? So, yeah, I agree with you 1000%.
Fasting, Carbs, and Testosterone
Coming back to mitochondria, I wanted to ask you a couple things. And of course, I think it’s pretty well agreed upon that fasting and lower carb can be helpful for mitochondria, but they can also antagonize testosterone if you fast too much and if you’re too low carb. So I’m assuming there’s kind of a happy middle ground, but do you have any comments for kind of how we reconcile those seemingly contradictory approaches?
DrBH: Yeah, that’s a phenomenal question. I love that question. From my standpoint, this is my wheelhouse. Nutrition is my wheelhouse. So think of fat and carbohydrates as a teeter-totter and then protein’s kind of—if you’re an athlete, protein is stationary.
You can argue whether it’s a gram per pound or even higher than that if you’re chasing hypertrophy. But then, your fat and your carbohydrates, they’re going to ride this seesaw. So if you take carbohydrates too low and then you’re doing like glycolytic-type exercise, you’re going to run into problems. If you’re trying to do CrossFit, eating 100 grams of carbs, you’re going to get into trouble.
So that’s, in turn—so if your goal is weight loss, we know that lower carbohydrate diets are going to be the most effective, at least in the short term. But what’s effective most in the long term is whatever diet you can adhere to. So I think that’s most important as far as weight loss science.
If we’re just thinking about testosterone, I think males, you don’t want to play the fast game. I think that’s most important. So you don’t ever decrease your—I wouldn’t do like crazy hypo-caloric diets, because that’s going to knock your testosterone off a cliff. And I think this is really big for… It’s great for lean body mass. So you don’t want to do that either because you’re going to lose muscle.
But just playing the long game, which is just unsexy. Nobody wants to play it. But I think that’s what you have to—you’ve got to chase adherence. I think this is a Chris Masterjohn-ism. Losing weight is like trying to fly a plane and the calories-in/ calories-out is gravity. So a lot of functional med people want to get rid of calories-in and calories-out. They want to just like throw away food quantity. And let me tell you, that is a huge no-no. You can go paleo and gain a lot of weight. You can OD on coconut oil very easily.
So I think just assessing… What we do know is the hypocaloric thing in terms of health and weight loss is the trump card. So if you look at diabetes trials like where they have really high carbohydrate intake, like 275 grams in fairly overweight people versus like really low carbohydrates and they equate them calorie-wise, there’s really not a huge significant difference in like a 52-week trial between glucose measurements and the change in their lipid panel.
And so, I think finding what works for people is going to be super, super, super, super helpful. And then, I think Dr. Walsh—I’m going to plug him because he’s a lot like us. And he has this great course on blood glucose regulation. And I think that might be the… It just came out. And I think that might really be the future of how we fine-tune this stuff as functional med practitioners.
I’ve had the opportunity to put like 20 CGMs in people. And a CGM is a continuous glucose monitor. And I think one of the things that we really need to pay attention to is individuality. And so, glucose variability or like people flying too high in their blood glucose is probably worse than just having overall high glucose. Does that make sense?
DrMR: Yeah. The surges?
DrBH: Yeah, the surges. And that’s probably indicative of a loss of a first phase insulin response. And so, if you see that in people, if you take a glucometer reading after you eat a meal and you’re all of a sudden at 250, I think you want to look again at digestion. And this is directly from that Brian Walsh course. Because if you don’t have GLP-1, you’re not going to get that first phase insulin response.
And so, you’re going to have that crazy blood sugar surge because your pancreas, your beta cells have like 15 minutes worth of insulin just stored in these vesicles. And when they get GLP-1, they secrete all the insulin they have and then that’s their first phase insulin response.
I think as we get more and more metrics on this and we get away from like hemoglobin A1c… Granted, that’s important and there’s a lot of research on it. But I think we’re going to find individualizing this situation is the best-case scenario.
Dr. Ruscio Resources
Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.
For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.
And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.
Fasting, Carbs, and Testosterone continued…
Okay, so maybe there’s a further discussion to be had on kind of blood sugar and blood sugar regulation. And maybe I’ll have you connect me with Walsh because he sounds like he might be a good guy to pick his brain.
DrBH: Oh, yeah.
DrMR: There was one thing there that… Okay, good. So there’s one thing there that I think you were pretty clear on, which was fasting for testosterone is a bad idea. And I’ve kind of discovered that myself where I think I told the story on a recent podcast where I was exercising and then fasting post workout. And I would also exercise, do a steam bath, and then fast for like an hour to two post workout.
And I noticed when I would do that, I would have a lot of energy, probably, of course, stress hormone response. But my libido would just tank. I may well have been like a 13-year-old girl because I had just like zero libido.
So if guys are having a hard time with libido, is one of the tenets that you’re recommending maybe not intermittent fasting and making sure they get at least three meals in, in a day?
DrBH: I’m glad you hit on this, because when we think about testosterone a lot of us think about behaviors. And testosterone really has a permissive effect on behaviors. Testosterone’s not the driver of behaviors; it just accentuates behaviors. And so, libido to me—I love the book Come as You Are. I think we need to respect other fields, and Emily Nagoski, she’s a PhD and a sex physiologist.
And so, when I think of libido, the best analogy I’ve ever heard is there’s this flock of birds. And so, if your libido drops and it’s like you got hit in the spine and, all of a sudden, your autonomics don’t work and your actual apparatus doesn’t function. So you have this flock of birds, and so it’s called turning on the ons and turn off the offs.
So if you want to have sex, all of your birds have to be flying towards having sex, especially for women. Guys, we’re easier to activate. For dudes, if you’ve got three birds that are thinking about your workout and then another four birds that are thinking about the paper that you’re writing and then another seven birds are like, “Oh my God, I’ve got to buy stuff on the internet or whatever,” or, “Oh my God, Ruscio’s and House’s podcast blew my mind. I’ve got to do all this stuff,” you’re going to have one little bird like chomping at you to go have sex by the end of the day.
And I think that’s the most important thing for libido, because they’ve castrated monkeys, which is a horrible thing to do from a study standpoint. And then they inject like 10% of the original testosterone, and those monkeys have just as much sex. This is stuff from Zimpalski, so if you want to learn more about testosterone behavior, that’s the man as far as… He’s a Stanford researcher.
So I would say there’s probably actually some research to show that fasting increases testosterone. I’ve seen that research; I’m not sure how great it is. It’s also probably not post workout, because now you’re not throwing 17 different variables in the situation. So I would say you felt that, so I would avoid that situation, like anecdotally. But everybody may be different.
One of my really good friends is the director of sports performance for an NBA team, and he used intermittent fasting for a guy to lose incredible… Like a player who was overweight, to lose weight. That was the primary mechanism with which he did it. And the testosterone stayed pretty similar. So that’s pretty cool.
Just collect data on yourself and do what works. But eat enough calories. I think that’s the biggest thing I see with fasting. Strength coaches will start intermittent fasting because it fits their day. I see this a lot. They wake up. They don’t want to eat because they’ve got to get to training people, and then it’s two o’clock by the time they have their first meal. And they’re just running on stress hormones. And they walk 10 miles a day and then they only eat 2500 calories, and they’re wondering why they feel like crap.
Caloric Intake Recommendations
DrMR: Gotcha. So do you think using an app like MyFitnessPal where you can punch in your age, your weight, your body composition, your activity level, and then, of course, you can track your daily dietary, caloric intake—do you think that’s something that’s decent at giving you a calorie guideline to follow? Or do you have kind of different calorie guidelines for people to shoot for?
Because I’m sure that there’s probably two camps of people. Some people that are going way over—and I didn’t realize this until I started tracking my calories. And what I learned really quickly was my occasional eating out splurges were way more bad than I thought they were. A salad, a chicken—or I think it was a salmon salad from the Cheesecake Factory had like 1500 calories in it. Just crazy. So that was a big eye-opener for me. And I kind of figured out I was going way too high on some days and then too low on other days.
So I guess two questions there. Do you like the MyFitnessPal? And maybe if not, do you have a few kind of standard goals people should be shooting for, for like a rough caloric intake to try to come out at?
DrBH: I absolutely love this question. I’m glad that you threw it out there. Hopefully, this will be an alley-oop. So I have a course called Moving Beyond Macros. I hate to plug myself, but it goes into all this stuff. I think it’s very individual. So figuring out calories, the first thing I want to do with an athlete is I want to figure out how much I can have them eat and stay weight stable.
So you asked about tracking. I would use MyFitnessPal very contextually. If someone has any history of an eating disorder, I’m not going to have them touch it. I’m after adherence. So I’ll give people meal plans. I’ll have them weigh and measure their food for like seven days, and then I’ll see if we can do intuitive type eating. Some people can.
And it’s all going to be dependent on your goal. I have guys who want to deadlift 600 pounds. The amount of tracking that they’re probably going to have to do is going to be way higher than someone who wants to deadlift 400 pounds. To me, it’s all contextual based.
I think if you’re looking for like hard numbers, most people are going to be somewhere around 15 calories per pound. Like Eat to Perform has a good calculator. There’s a SuperTracker from the government which is fairly good. I use Alan Aragon’s work. And I use all of them just to check. I use all of them just to check. And so usually, I’ll be pretty spot on. So I’ll use all the like Harris Benedict—I’ll use all these nerd equations to find like a rough calorie number. And then I’ll break it down into macros to kind of meet what they want to do.
And I teach people how to do this. It’s actually not that difficult, and I think it’s something that a lot of functional medicine practitioners would get a lot out of, is being able to assess food quantity. We do a lot of work with food quality, which is your main tenet. That’s the bottom of your pyramid. But I think the next thing we need to look at is food quantity, because a lot of those paleo foods are fairly dense.
To me, those are the basics. But in my own research, like in working with people who are super fit, all of a sudden, they’re at like 17 calories per pound or 18 calories per pound. If I have a 200-pound guy, that’s like 4000… I’ve had 200-pound guys who can eat 4600 calories and stay weight stable. And if they don’t eat 4600 calories, you’ve got to think like what sacrifices is their body making to make that happen?
There’s a great guy out of Australia, Luke Lehman. He’s a body comp coach. Super into functional med, which is not… Super, super well-read. And so what he’ll do with his clients is he’ll have an onboarding process of about two weeks, and he’ll have them weigh and measure and figure out what they need to stay weight stable. And then he’ll use that time to figure out what they need for a deficit. And then he’ll use that deficit.
And then the other thing to think about from the deficit side is everybody going to adapt differently to both caloric excess and caloric lowering. So some people, like we know who they are, if you up their calories, their need’s going to go through the roof. They’re just going to start pounding their foot on the ground. You could ramp them up by 600 calories and they might not gain a single pound.
And then, there’s other people where if they look at a banana, they gain two pounds. They’ve done some cool research with twins. And they have these sets of twins, and they put them on what do you need to gain 30 pounds in a month. And some of them gain seven pounds in the month. They’re all eating the calories where you’d get 30 pounds. And then nobody gains 30 pounds, but some of them gain like 27. Some of them only gain seven.
And the same thing—it’s called metabolic adaptation. Trexler et al. has a great paper if you want a summary paper about this. All the things the body’s going to do to counter that calorie deficit. So I think that’s why we think about re-feeds. And so, if you’re a functional med practitioner, you’re probably dealing with weight loss. So this is a really good thing for you to look into. And there’s a ton of people who are really, really good at it. And I may be one of those people.
DrMR: It sounds like you are. And you’re definitely one of the guys I would go to. And this is where I’m going to ask a somewhat selfish question now. I’ve been kind of tinkering with MyFitnessPal just to start tracking my calories because I’ve kind of gotten away from it. I think I’ve gotten maybe a little bit too lax with my diet. So I’m trying to kind of reign things in a little bit.
And I’m about 210-215. I’m fairly lean. I think I could probably drop about five to seven pounds and get back to being like really lean like I was maybe five years ago. I work out three to five days a week. And other than that, I’m somewhat sedentary because most of my stuff is at a desk, either at the clinic or at my home office on reading research days.
So MyFitnessPal tells me that I should be doing about 1950 calories per day.
DrBH: Sorry, that’s very low.
DrMR: I’m guess that that’s probably way under.
DrBH: Yeah. For sure. How tall are you?
DrMR: I’m about 6’1”.
DrBH: So I would say like low end—I’m in calculators right now. What are you 12%, 14% body fat? What do you think you are?
DrMR: I would guess right now I’m probably about 14%.
DrBH: I always tell guys this when I’m talking to them too. If you survey women, what they like, it’s always generally like 12-15%. If you survey guys what they like in women, it’s generally 20-25%, which are the healthy ranges. So if people get down under that, it’s generally for performance or it’s for their own ego, which isn’t bad. I don’t really care.
I think that’s where we want to get with all men is somewhere in that 12-15% range. And so, I would say if you’re 210, 6’1”, I think you’ve probably got a good amount of lean tissue on you, probably like 175 pounds of lean, somewhere around there. If your goal is to lose five pounds, like if you wanted to drop like 2% body fat, I’d have you probably somewhere around… So just you maintaining weight, let’s throw that in that.
So just you maintaining weight, I’d have you somewhere around 3000 just to start. I can put it in another calculator too. And then to lose weight, we’d have to see what you needed from a deficit. I think the first step would like get you moving and then look at what is your actual exercise protocol. Do you have this progressive overload type system? And then overall, what is your stress physiology?
My goal right now would be just to figure out how much you can eat and stay weight stable and then drop it from there. And you might find that—we have this great… It’s an Eric Helms-ism. It’s called “gaintaining.” It’s what I would probably do with you.
DrMR: That just appeals to the meathead in me, the way that that’s phrased.
DrBH: Yeah, it’s a great word. It’s “gaintaining.” So your goal is to actually stay—because 6’1”, 210 sounds great to me. That sounds like a great weight. I know a lot of guys who are…
DrMR: Yeah, I really can’t complain. I’d say at least once a week some kid in the locker room comes up to me and is like, “What can I do to look like you?” So it’s not like I feel bad about myself. But you always compare yourself to kind of your best self, which I feel like I was probably at about four years ago, so that’s why I’m working toward that maybe five-pound loss.
DrBH: Five pounds is nothing. I wouldn’t even put a weight goal on it. I would put just a body composition goal. I would go get a DEXA and I would do it that way. And then I would set—how I usually work with clients is like, “Okay, you have a body comp goal. Let’s set some metrics in the weight room that are body comp related,” which would probably be pull ups. Not obviously back squats for weight, which is going to be the opposite, not that that’s not important.
But I would set goals related to that, and then I would get a metric. And then, for you, I would try to “gaintain” or just like not lose that much that fast. So I would figure out how much you can eat. I’m in the camp of eat more, move more. I love that the most. People are going to feel better generally if they eat more food and they move more. So that’s what I would do with you, and we can talk online. I’ll build you a meal plan, whatever you want, man.
DrMR: Yeah, I may have to take you up on that because I think I’m at the point where I need to take the training wheels off and kind of get into this.
Intermittent Fasting and Hunger Signals
But let me ask you one other thing, because something I noticed, and hopefully this will be helpful for the audience, when I started doing intermittent fasting, it actually really helped regulate my appetite.
I think for a little while there I was maybe overeating, and I think it may have just been a combination of stress, too much caffeine, and bad food. And I think you can easily throw off your metabolism and some of your satiation signaling.
So when I started doing intermittent fasting, it actually kind of re-regulated my appetite. And I noticed that cravings really abated. Also, I probably decreased my carbohydrate intake a little bit, which I think, for my metabolism, if I start eating too much carbs, I kind of fall into that carb-craving syndrome.
The question I’m driving at is how important do you think hunger is? And I’m assuming in this case it’s someone who’s gotten any major metabolic problems out of the way, so they’re not like a hungry, hungry hippo, just craving, craving, craving because their metabolism is imbalanced.
But for someone who is fairly healthy, do you find that eating to hunger is the way to go? Or might people want to be a little bit hungry so as to have their body go into that fasting state for losing weight? Is there something to follow if people don’t maybe want to count a lot but maybe use their hunger as a barometer that you could provide for a guideline or a gauge?
DrBH: If your goal is weight loss, I think the research is very, very clear that you need to have some form of tracking. It doesn’t have to be MyFitnessPal, but you need to have a diet diary, some form of tracking. As far as hunger cues, I think that we are so hedonic from our cultural standpoint, just like the amount of ads that you see for food. I don’t think that we’re going to have the ability to necessarily regulate hunger very well.
That’s not to say that you chewing your food, being with your food, being mindful is not going to reduce your caloric consumption. But we know it takes about 20 minutes for hunger to really hit the brain.
If you’re trying to lose weight, you’re probably going to be a little bit hungry. But what I see is the opposite side of this, is I see like underfueling—this is super prevalent in athletes. They underfuel during the week and they just blow it out on the weekends. Your body’s going to get what it wants.
So, to me, it’s always surprising to people how if they—for you, you’d probably be somewhere around… I’d put you at 200 grams of protein, 125 grams of fat (which is a lot), and then 225 to 250 grams of carbs. That is a lot of food, and I don’t think people respect that enough. If you put that into real food…
DrMR: That is a lot.
DrBH: That’s a lot of food.
DrMR: I can tell you from my tracking and looking at those numbers, relative to what I’m doing now it feels like a whole lot more.
DrBH: One of my favorite guys—I’m going to throw him under the bus here—his name’s Michael Lexner. He’s an absolute beast. And so, he came down to the jungle. He had a coach from Precision Nutrition—I’m not hating on Precision Nutrition. Precision Nutrition is great. It’s John Berardi’s group. And they use a lot of the thumbs and the palms and like the deck of cards. They don’t actually have people track macros, which isn’t bad. Again, you’re after inconsistent perfection. Consistent imperfection, sorry.
He told me he was eating 2600 calories. I was like there’s no way you’re eating 2600 calories. You’re 6’4”, 240, and you deadlift 650 pounds. There’s no way you’re eating 2600 calories and not losing weight. So then he emailed me like two days later. He’s like, “Yeah, I tracked my food. I was eating like 4600.” And I’m like, “Yeah. That makes more sense to me.”
The thing is like we probably all underreport. The research is fairly clear on that that we probably all underreport. I have been tracking my food—I’m part of a longitudinal study for like 16 weeks with 20 other dudes who all squat double bodyweight. And it’s just a great time. Just a bunch of meatheads just doing meathead stuff.
I’ve tracked every value, and I just posted on Facebook. So I’ve been averaging about 3300 calories a day, and I’ve gained like one to two pounds. My body composition, I guarantee I’m the same body fat. It’s crazy once you rev the body on all cylinders is kind of what you’re after.
Exercise and Cycling Carbs
DrMR: So speaking of revving, I’ve heard more coming out about macro cycling where maybe someone spends several days low carb and then they do a couple days high carb. Do you think that there is utility in that approach?
DrBH: Yeah, so again… So you’re talking about carb cycling. Even from a weight loss standpoint, I think we need re-feeds, which is going back to maintenance, even once a week or like multiple weeks in the month because that’s a long-term gain. From your question, I’ll just kind of throw it out. I always think of everything in case studies.
If I have you on the board right now, if I have you do four carb-ups a week. Say you have four workouts in a week, and I was going to put all your carbohydrates on your workout days. Well, not all of them but most of them. So I would essentially put you somewhere around like 350 carbs on your workout days. And then 80 grams of carbs on your off days. I think that would work great for you. It’s called carb bunching. I put all your carbs around your workouts because that’s when you’re going to need them. And then, that’s when you’re most insulin sensitive. That’s where you’re going to get the most non-insulin mediated glucose uptake.
And so, from that standpoint, I think carb cycling can apply. Now, I take a guy like James Sherby, and you can look him up on Instagram. The guy’s an absolute behemoth. I put a CGM in him. He’s jacked to the nines. He’s 5’10”, 205 pounds, and like maybe 7% body fat just walking around.
And so, I put a CGM in him, and I gave him 500 grams of carbohydrates, which is insane. He never went above 110 mg per deciliter. So like, talk about just breaking rules. Don’t put baby in a corner. I think we really need to think about this individually. So maybe I give you 350. I plug a CGM in you, and you go crazy high. I’m like, “Oh, that wasn’t a good idea. I’ve got to go back down. The carb cycling didn’t work for him.” Or maybe I put you at 350 and you can take that easy on a carb day.
I think we just really have to think about this contextually. And as CGMs get more and more affordable, I think this data’s just going to get… And you can buy them over-the-counter in the UK and Australia. It’s just the AMA is super tightlipped about it in the US. I can get them. One of my friends is an MD and we work together.
DrMR: These are constant glucose monitors. That’s what the acronym stands for?
DrBH: Yeah, continuous glucose monitoring. Right now the FreeStyle Libre is probably the most applicable for what we do. And it stays in their arm for 14 days, and it measures blood glucose every 15 minutes. So you get a look at what’s happening when they’re sleeping. You get all their postprandial stuff. It’s pretty cool.
There’s a great paper by Zerva et al. which shows people’s glucose responses to individual foods are crazy different. You might go crazy high from pineapple, but mango’s fine. And someone else might have the exact opposite effect. So I think we’re going to be able to individualize this more and more as we go forward.
DrBH: Does that help?
DrMR: Yeah. Super helpful.
Assessing Mitochondrial Dysfunction
So the last question I want to ask you—I want to get into testosterone and behavior, but maybe we’ll do that in a subsequent follow-up call. But I know people are probably wondering if you recommend any testing for mitochondrial health. Now, I know you said insulin, and I think that’s great.
Running a fasting insulin is something I do as part of my baseline panel. It’s a simple measure. I’m sure there’s some simple things people can look at, like we talked before like are they fasting? Are they sleeping well? Are they getting some exercise? Are they eating the appropriate amount of carbs?
But there’s also these more advanced like organic acid mitochondrial assays. So I’m wondering if you have any thoughts or experience with those.
DrBH: What was it again? I’m not going to pay to measure chaos. I’m going to ask, “Are you overweight? Okay. Good. You’re overweight. You have mitochondrial dysfunction.”
DrBH: What percentage of the population’s overweight? 66%. And then of the third that is of normal weight, how many are over-fat? Another third. Okay, if you’re not in that camp, maybe run that test. But how many people aren’t in that camp?
And then, if I’m thinking about an athlete, I’m probably going to be more apt to use NIRS. I have this super aversion to urine just because it’s so volatile. And I just hate so many of those tests because they give you these cookie-cutter… Somehow you pee in a cup and they give you how many milligrams of CoQ10 you need. And I’m like, “Dude, there’s no way that can happen.”
So that’s my overall physiology. I don’t run those tests. They’re very expensive. I always come back to the tenets of like what am I going to do anyways? So I’m going to try to do all that stuff. I’m going to try to optimize nuclear function.
DrMR: Right. Exactly.
DrBH: I’m going to try to get people to exercise the right amount. I’m going to look for those. I’d rather pay to run a stool sample, to be completely honest. If I’ve got $300, I’m buying a stool sample 99% of the time.
DrMR: Yep. I completely agree. I’m biased, but I agree.
So where can people track you down, Ben, if they wanted to connect with you, follow you, hear more from you?
DrBH: Yeah, my website is FunctionalMedicineCostaRica.com. Instagram’s kind of nonsense. If you like funny stuff and like people lifting, like dudes dancing with their shirts off, you’ll maybe like that. But if you want super-science-y stuff, that’s going to all be on my Facebook. I tend to put out like 300-500 pages of content a year. I’ve been doing that for a really long time.
DrMR: On your Facebook mostly?
DrMR: You do put a lot of good stuff on Facebook. I could give you a credit for that.
DrBH: Appreciate it. Appreciate it. I try to write every morning. I love to write. This is a Kharrazian-ism. So a lot of people will always ask me how do you learn? And I think that’s a very unique way to think about it. But Kharrazian has this ideology, and you do this too. You have your podcast. You create something. And so, we can’t really learn unless we go from left brain to right brain.
And so, for me, I take all this super intellectual stuff and then I write about it, which is creative and more right brain. And I think that’s really, really important if you’re trying to master these very, very complex topics. You’re not going to retain it if you just go to a couple seminars. You’ve got to take this stuff, and you’ve got to make it your own.
DrMR: Yeah. Well said. Well said. And definitely check out Ben’s work, guys. He’s one of the few people that I really respect their work, and I just am refreshed by kind of this nonsensical approach, which I think this is what our audience has come to expect. And I think Ben, as you can probably tell from our conversation, is doing a terrific job with that.
And so, Ben, the final question for you now. What is maybe one of the least healthy but most fun things that you’ve done lately?
DrBH: Oh, definitely the last trial that we did where I think we lifted God knows how many pounds of weight. So we trained eight days. Out of 10 days on the last retreat, we trained eight days. I probably averaged every training day somewhere around 60,000 pounds lifted. Yeah, and I was like the fourth biggest guy. Just some behemoth dudes.
Dr. Pat Davidson’s one of my best friends, and no one would tell you that was a good idea. But it was still a good idea. We all survived. It was kind of this top-of-the-mountain type experience. I’m not sure that we adapted from that. But I think it definitely upped our work capacity. But it also lit a fire for a lot of us. And so, that’s definitely the most unhealthy thing.
I’m the most dopaminergic human being there is. I was addicted to gambling when I was 20. I was alcoholic. I’m crazy. And so, the fact that the worst thing I do is exercise with my friends is probably a good idea. And there’s a reason I moved myself to the jungle, guys. You put me in Las Vegas, there’s no way I’m going to avoid that environment.
DrMR: Straight to the bottom.
DrBH: Yeah. I’m going to be drunk in a gutter within four hours. I just don’t go there. Luckily, I found my wife, and she holds me accountable. And I send her an email every week, not like it’s AA or anything. All my goals. I’m just thankful that that is the worst thing that I do.
DrMR: If you don’t mind me asking, do you completely avoid alcohol now or are you able to have some?
DrBH: Yeah, so if we think about like my family, my grandpa was an alcoholic. He died an alcoholic when he was 79. He lived a crazy life. He was an electrician. He was a Marine. He was in the Korean war. I understand why he drank. His entire battalion was killed.
And then my dad, who obviously had a pretty rough childhood with that kind of father, he was an alcoholic and really bad. Then, when I was 3-years-old, I asked him to stop. I said, in my little kid voice, “Hey, Dad. I don’t like it when you drink.” And he hasn’t had a drop since. I don’t know how many years that’s been. Probably 28.
And then when I was 25, maybe 26, I got really just drunk. It was Halloween. Me and my buddies were dressed up as wrestlers. So you can imagine it was—
DrMR: That must’ve been fun.
DrBH: Bunch of jacked dudes. I was Rey Mysterio Jr. Junior, junior. And I jumped off a table and punched some guy 10 times in the face. My wife woke up the next morning, she’s like, “Hey, I don’t really like it when you drink.” I was like, “Yeah, I don’t really like it when I drink either.” I haven’t really drank since.
DrMR: Geez, man. I wish I was there for that night, though. Sounds like it was pretty wild.
DrBH: Yeah, all my friends are like, “Oh, my God, that’s amazing.” And my wife just looks at me like, “What just happened? You never do that again. That’s not the man I married.” And I was like, “Hey, touché. Touché. You’re right.”
DrMR: Well, thank you for sharing, Ben. And thank you for what’s been a great and very informative discussion. I’m sure people got a lot out of it. And I’m sure at some point we’ll have you back on the show. And also, keep me in the loop with stuff going on in Costa Rica. I’d love to get down there at some point if my schedule permits.
DrBH: Yeah, we have a retreat—it’s crazy. It’s been up for a week, and it’s 50% sold out. There’s a functional medicine retreat with Brian Walsh and myself which is March 7th to the 14th. And then, there’s a nutrition retreat with Mike T. Nelson, who you’ve also had on, who’s just a nutrition genius. We’re running a nutritional week.
At the end of that week, we’re going to do the CISSN exam, so that people can call themselves a certified sports nutritionist. So if you’re interested in all this macro speak and like body composition, we’re going to be going all over that. And then, Brian Walsh and I are going to be talking super nerd functional medicine.
I don’t really need to hype that up because it’s going to sell out pretty quick. Not to toot my own horn. It just seems to happen. I say Costa Rica and people buy stuff.
DrMR: Yeah, it’s not a hard sell. That’s for sure.
DrBH: Yeah, come to the jungle. Eat all organic food. And lift and jump in the ocean and go to bed at 8:30 pm and have a blast. It’s important for all of us in the functional medicine realm. What is our party? What is our fun? And we need that.
DrMR: Cool. Yeah. Completely agree. All right, man. Well, thank you again for taking the time. Guys, check out his work. I think you’ll be really happy. And, Ben, thank you for doing your work. It’s refreshing and it’s really great stuff. So keep it up.
DrBH: Yeah, I listen to your podcast, and I’m thankful for it every day. So thank you for everything you do as well.