Dr. Cavaiola discusses Testosterone Replacement Therapy and Men’s Health with Dr. Ben Weitz.

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Podcast Highlights

3:47  To understand what a low testosterone level is, we need to look both at lab tests and at patient symptoms. The symptoms that a male patient with low testosterone may present with are fatigue, libido problems, difficulties putting on muscle mass or losing body fat, sleep disruptions, as well as a variety of others. Then serum total and free testosterone levels are run and we look first at total testosterone levels. But the lab reference ranges usually huge, with normal being from 150 or 250 to 1100.  Because of this huge range, Dr. Cavaiola feels that many men are undertreated.  If a patient has a total testosterone level of 250 or even 400 and they have many symptoms, then there can still be a justification for treating with bioidentical testosterone replacement therapy.

6:38  Free testosterone may be even more important than total testosterone, since it is the bioavailable proportion of testosterone that can be utilized by the body. The free testosterone is that portion of the testosterone that is not bound up by carrier proteins like Sex Hormone Binding Globulin (SHBG) and albumen or that has not been converted into other substances, like estrogen or dihydrotestosterone (DHT).  Therefore, we need to measure both total and free testosterone and we also need to have adequate levels of free testosterone. But after we put a man on testosterone replacement therapy, it’s not as accurate to measure free testosterone any more, so it is more important at that point to mostly monitor levels of total testosterone.  However, Dr. Cavaiola does still measure free testosterone along with total testosterone, as well as estrogen, DHT, and SHBG.

9:58  Dr. Cavaiola monitors estrogen levels in men because of the negative side effects that can result from higher levels of estrogen. He usually focuses mostly on total estrogen levels (combination of estrone (E1), estradiol (E2), and estriol (E3)) and he wants to see that level below 100 but above 30.  In fact, a small amount of estrogen is important for bone protective effects, for libido, and even for erectile function.  Dr. Cavaiola pointed out that estrone is partially a measure of exogenous estrogen exposure from pthalates in plastic and other environmental toxins that have an estrogenic effect.  He does not focus as much on progesterone levels in men.

14:40  Let’s take the case of a young man, say 35 years old, who comes to see Dr. Cavaiola complaining of symptoms characteristic of low testosterone levels but does not want to take testosterone.  After taking his history, examining him, and measuring all his hormones, Dr. Cavaiola will start with diet and lifestyle and usually wants to clean up the gut first.  He will often run a complete stool analysis through Genova and food sensitivity testing through Great Plains Lab. Leaky gut and dysbiosis of the microbiome can have a negative impact on hormone levels.  From a lifestyle perspective, men should not smoke, not drink to excess, and minimize exposure to environmental toxins.  Smoking marijuana is not favorable for testosterone levels, so you should minimize this. Exercise is beneficial for raising testosterone levels, esp. strength training.  Dr. Cavaiola also recommends such men follow an anti-inflammatory diet, which avoids dairy, gluten, sugar, corn, and soy.

23:05  Dr. Cavaiola has found that some of the commonly recommended nutritional supplements, like tribulus and maca, do not appreciably raise testosterone levels.  However,

Dr. Alejandro Junger discusses Detoxification with Dr. Ben Weitz.

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Podcast Highlights

4:23  The term detoxification has started to be accepted by mainstream America, though not so much by mainstream medicine, who tend to think of it as quackery.  This is because the term detoxification has been hijacked and misused by so many people who have no idea what they are talking about that the Institute of Functional Medicine has changed the name to biotransformation. The body is bio-transforming these exogenous chemicals from toxic to non-toxic and from lipophilic in to water-soluble so that the body can eliminate them.  This happens more intensely in the liver, but it happens in every cell in the body, and also it happens in the intestines through your intestinal flora, which detoxify about 40% of these toxins that we are exposed to through our diet and water.  Whether you call it biotransformation or detox, which Dr. Junger still likes to use, you are not turning on any function of the body that was not turned on before, but you are creating the conditions for this to happen more effectively by supplying all the nutrients that the body needs in order to attach to the toxic molecules to convert them into non-toxic and water-soluble.

8:00  Some of the most important toxins that are impacting our health are the preservatives in food that prolong shelf life. These preservatives prevent bacteria and fungus from growing on the product, so they will kill the bacteria in our gut. Dr. Junger likes to tell people that the longer the shelf life the shorter your life. We need to avoid eating these chemicals found in processed foods because they will eventually promote chronic disease.  These toxic chemicals are everywhere and they are cumulative. Just like how the big fish eat the smaller fish and accumulate mercury and they will eventually cause chronic diseases.  The good news is that your body knows how to get rid of most of these toxins, especially if you learn how to create the conditions and you support your body nutritionally, you will be able to rid yourself of 90% of these toxins.  There are some toxins that will require some extra effort to get rid of, like heavy metals, which require doing some chelation to help your body detoxify them. 

12:57  Some of the impediments to our bodies being able to clear these toxins is that there are so many chemicals being released into our air, food, water, in our cleaning products, and in our furniture on a regular basis, but our body’s ability to detoxify is impaired for 3 main reasons.

1. One reason our ability to detoxify is that we need specific nutrients to detoxify that are not being found in our food, since much of our food is depleted of nutrients, and you will not have the raw materials that your body needs to do this work. 

2. Also, our intestinal flora has been decimated that is responsible for up to 50% of the detoxification work of the body. 

3. An additional impediment to detoxification is that we are eating constantly and digesting throughout the day, that it is taking so much of our body’s energy.  This goes against nature’s design, which for thousands of years involved periods of fasting until the next time you were able to find food.  Our bodies evolved in a way that it gave the digestive system a lot of importance with a nervous system that has the power to shut off other functions in the body so that the body could shut off everything else (including detoxification) to dedicate itself to being able to digest and absorb the food, since we never knew when the next meal was going to come.