Dr. Myles Spar discusses Men’s Health with Dr. Ben Weitz.

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Podcast Highlights

1:22  Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women.  According to the Harvard Health Blog, the reasons why men die younger are that: 1. men tend to take bigger risks, 2. have more dangerous jobs, 3. die of heart disease more often, 4. are larger than women, 5. commit suicide more often than women, 6. are less socially connected, and 7. tend to avoid doctors.

3:45  Dr. Spar said it appears to be masculinity that results in men dying younger than women. In countries where the masculine machismo is more prevalent and they engage even less in the behaviors we know contribute to longer life and healthier living, are countries where men’s health is actually worse.  Dr. Spar said that we need to figure out how to message wellness to men so that they respond, which is what his professional mission has been about.

4:31  Dr. Spar said that the five factors that most contribute to premature death in men are 1. lack of exercise, 2. drinking too much, 3. engaging in risky behaviors, 4. smoking, and 5. being overweight.

5:29  We need to message in a way that men will tend to respond. Talking about a prevention and wellness approach means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, while guys tend to be more specific results oriented. Dr. Spar explained that we need to message to what matters to that person, such as performance at work, losing weight, getting cholesterol down, sexual function, etc. Men tend to respond to a more performance oriented message. but there are also lots of women who also think in this goal oriented way of thinking. 

7:11  When working with men to lose weight it is important to measure not just weight but bodyfat percentage and setting goals and holding men accountable.  Dr. Spar finds that apps like Strava are helpful in using technology that helps with accountability and tracking improvement or not. 

9:25  Dr. Spar prefers to look at genetics to see if his patients have trouble with detoxification. He uses either Pathway Genomics or PureGenomics from Pure Encapsulations that allows you to put your 23and me raw data through. But he is concerned about a report that such programs that analyse genetic data tend to have up to 20% errors when reporting on the SNPs of these genes.

12:17  To help men reduce their risk of heart disease, men need to have an advanced lipid profile, since the tests that are run with the annual physical exam are inadeguate in assessing the risk for heart disease. Dr. Spar likes to use the Cardiometabolic Profile from Spectracell, which looks at LDL particle size and number and also at inflammatory markers like CRP. We also need to look at Lp(a), which is a huge risk factor for heart disease.  Take the case of Bob Harper, the trainer from Biggest Loser who appears to be in great shape, and had no risk factors except that he had a high Lp(a) and had a near fatal heart attack.  It will also look at homocysteine, which is a risk factor for heart disease and is easy to lower with the right supplements. And homocysteine is also an indication that you don’t methylate well, if you haven’t had genetic testing. Your primary MD will usually not order such an advanced lipid profile because it’s usually not covered by insurance and they usually avoi...

Emma Ferris discusses proper breathing with Dr. Ben Weitz.

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Podcast Highlights

5:20  Most of us come out as belly breathing babies, but then either trauma or infections or stress lead to bad breathing habits that we get stuck with.  So then we need to retrain these people to use proper breathing techniques. 

6:17  Emma explains that when you feel stress, your sympathetic nervous system takes over and results in faster, shallower breathing through our mouth, rather than slower, deeper, belly breathing.  This shallow, fast breathing tends to recruit our neck muscles, like our scalenes, SCMs, and our upper trapezius muscles and can contribute to neck pain.  We should be using our diaphragm as our primary breathing muscle.  Activating our diaphragm helps to support our back. Taking a longer exhale will tend to activate the parasympathetic system, that teaches the body that it can go into the rest, digest, and recovery mode.

10:11 When you’re breathing too fast, you breath out too much carbon dioxide and your blood chemistry shifts, making your body more alkaline.  When your body becomes more alkaline, you get more anxious and you may have trouble sleeping.  This reduces blood flow to the brain and also to the fingers and toes. 

13:45  The importance of deep, belly breathing is that you use your diaphragm to breath. If you breath fast and shallow through your chest, you’ll end with tightness and trigger points in your scalene, SCM, upper trapezius and your other neck muscles. Your diaphragm on the other hand has several roles, including respiration, speech, and stability. Using your diaphragm helps to stabilize your lower back by building up the intra-abdominal pressure. Manual therapy and chiropractic manipulation can be helpful for reducing trigger points in these neck muscles, the ribcage, and the diaphragm. 

18:40  When you are in sympathetic, stress mode it tends to shut down three systems in the body: 1. Hormones, which results in more infertility, 2. Immune system, so you tend to get more colds and flus, etc., 3. Digestion, so IBS is more common. If you are running away from a lion, it is no time for digestion.  This is a result of our inability to handle stress. Breathing is a strategy that can help.

29:30  When Emma works with athletes she will often have them use a device called a PowerBreathe, which is an inspiratory muscle training device. It is like dumbbells for your diaphragm and it makes it harder to take a breath in.

 

 

Emma Ferris is a physical therapist and acupuncturist from New Zealand who created an online breathing hub called The Butterfly Effect and The Big Exhale breathing course to help patients recover from dysfunctional breathing patterns.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free...

Dr. Norm Robillard discusses what is the best diet for patients with Irritable Bowel Syndrome with Dr. Ben Weitz.

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Podcast Highlights

6:47  When you look at studies on IBS, there is a wide range as to what percentage of patients are caused by Small Intestinal Bacterial Overgrowth (SIBO), in one meta-analysis from 4 up to 78%.  This has made some doctors and researchers to question what relationship SIBO has to IBS. Dr. Robillard explained that there are some issues with test methodology, including whether you use lactulose or glucose as the substrate and glucose is less sensitive since it will miss SIBO in the distal part of the small intestine, since it is absorbed in the proximal portion of the small intestine. Lactulose should be a preferred substrate, since it is not digested by humans. There are some potential issues with the 24 hour test preparation, which requires strictly following essentially an intervention diet and then an overnight fast and if these procedures are not strictly followed, it can affect the test results.  Also, this test is only one snapshot in time and there is a constantly changing situation in your gut where if you eat a lot of fermentable carbohydrates, the likelihood of SIBO will go up, while there are a number of mechanisms that work to prevent it from developing, including the Migrating Motor Complex, bile, hydrochloric acid from the stomach, digestive enzymes, and your Gastrointestinal Associated Lymphoid Tissue (GALT), the immune system clustered around your digestive tract. Dr. Robillard thinks the correct number is somewhere in the range of 45-65% of people with IBS who have SIBO. 

11:48  Dr. Robillard has coined the term LIBO for large intestinal bacterial overgrowth because he believes that some of the time the gastrointestinal symptoms are coming from an overgrowth of bacteria or archaea in the large intestine. When bacteria ferment carbohydrates they produce short-chain fatty acids, which are acidic. They did a study at John’s Hopkins that looked at 47 patients with IBS and they had them swallow a SmartPill that could detect pH changes.  They did not see any pH changes till they got to the large intestine, which they interpreted as bacteria in the large intestine, not the small intestine.  Dr. Robillard believes that when you have methane SIBO it is likely caused by archaea not in the small intestine but the large intestine, because the methane gas slows down motility, which causes constipation. This is why you get methane showing an elevated methane even in the zero time point in the breath test. He thinks that the archaea in the large intestine can overgrow and produces so much gas that if forces open the ileocecal valve leading to the gas getting into the small intestine. Evidence has shown that when researchers placed a pressure sensitive instrument in the ileocecal valve it was weaker, which could be because it is being forced open by back pressure from gas being produced in the colon.  Dr. Robillard also mentioned that he has written a book about reflux and his theory that reflux is caused by pressure from the gases being produced by the overgrown bacteria pushing up into the stomach pushing the acid up into the throat.  He found that a low carb diet made his reflux go away. 

25:37  If the archaea are really overgrown in the large intestine instead of the small intestine, this might explain why treating methane SIBO is more difficult and why Rifaximin is not as effective for the archaea, since it acts mainly in the small intestine.

27:18  The causes of SIBO can include the motility of the intestinal tract related to the migrating motor complex and the i...

Dr. Mona Morstein discusses how to overcome Diabetes with Dr. Ben Weitz.

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Podcast Highlights

2:57  There are four or five main types of Diabetes:

* Type I is an autoimmune disease where a person’s own immune system attacks their pancreatic beta cells, and destroys it enough so that they cannot produce the insulin that the person needs to live. 

* Type II is the most common type and it is due to insulin resistance.

* Type 1.5 is Latent Autoimmune Diabetes of the Adult (LADA), which is type I that happens in people over 35, say generally 35 to 60 is where we see people getting a less intense type of type I, but can lead to the need for insulin.

* Gestational Diabetes, which is when a nondiabetic woman enters pregnancy, and then becomes a type II diabetic, generally due to gaining too much weight during the pregnancy

* MODY, mature onset diabetes of youth, which is diabetes because of gene defects, like when the beta cell produces insulin, but lacks a good gene to secrete it, or a cell doesn’t genetically have a good receptor.

5:34  Type II diabetics if poorly controlled or poorly managed, the high blood sugars cause oxidative damage that can destroy their pancreatic beta cells and these patients end up needing insulin, like type I diabetics.  And most diabetics are not properly controlled. 75% of type II diabetics do not get their HgA1c below 7 as recommended by the American Diabetic Association. And type I diabetics, if they end up injecting too much insulin in order to try to control their blood sugar–say 100 to 200 units a day–can develop insulin resistance like type II diabetics. Normally our bodies secrete between 30 and 40 units of insulin per day, so 100 units is a lot. The reason so many diabetics are poorly controlled is that we are only using a big pharma approach based around medications.  We need to use diet, exercise and lifestyle approaches to control blood sugar.  And most of the drugs do not directly affect insulin resistance, except for Metformin, which deals a little with insulin resistance. But Metformin’s main job is to decrease the liver’s production of glucose. The TZDs like Actos and Avandia were directly affecting insulin resistance, but they are not in broad usage because of all their side effects. The 2nd most common category of drugs for diabetes are the sulfonylureas, like Glyburide and Glipizide, which can cause weight gain, hypoglycemia, and they can aggravate insulin resistance. They also don’t significantly reduce the HgA1c. The DPP4s like Januvia lower the HgA1c at the highest dose say 0.5%, but a low carb diet can take someone who’s at 10 and lower them down to 6 in 3 months. There is no drug that can do what diet, exercise and lifestyle changes can do, what a Functional Medicine approach can do.

13:30  With type I Diabetes you have a gene that can turn on and give you type I Diabetes and then we have to look at what factors might turn this gene on.  These could include gluten, dairy, vaccine, environmental toxins, family stress and nutrient deficiencies.  Finland has the highest rate of type I Diabetes and they have done studies showing that giving newborns vitamin D and fish oils reduces the onset of type I.  Celiac disease can lead to type I diabetes.  Leaky gut seems to precede type I diabetes in many kids, so the gut is an important factor. 

26:16  When it comes to type II Diabetes, eating refined sugar, refined grains, junk food, and fast food and lack of exercise are important causative factors.  But Dr. Morstein also believes that saturated fat intake can play a role in worsening insulin resistance. If you are getting too much saturated fat without omega 3 fats to offset it, this will make diabetes worse.