 Welcome to the Dr. Gundry podcast. Today I'm going to discuss a very important health topic. It's one of the most basic human drives and quite frankly we don't talk about it enough. This episode of the Dr. Gundry podcast is all about sex. In just a moment I'll answer some questions from you about libido and other sexual health issues. I'll also share tips for having a great sex life at any age. So stay tuned this is an episode you won't want to miss. So let's start with some questions about libido. What do you think about Viagra? Is it good or bad for your gut buddies? Well the good news is Viagra has nothing to do with your gut buddies but here's the bad news that I tell anyone of my male patients who's looking for erectile help from one of these medications. If you can't get it up without assistance from Viagra or any of the other compounds you have serious health issues. Serious and it has nothing to do with an erection. It turns out that the same process that's preventing you from getting an erection is happening in your coronary arteries and in the blood vessels to your brain. And countless studies show that the need for Viagra or any of the other medications like Cialis for instance means that your arteries in your heart and in your brain are incapable of dilating properly. And there's an expression in longevity that says you are only as young as your blood vessels are flexible and I couldn't agree more with that assessment. So number one I won't prescribe Viagra or Cialis or any of the other ones without a stress test first to show me that when you possibly can dilate your blood vessels with this medication you won't have a heart attack. But the point is if you need these medications that is probably the best wake up call that what you're doing at any point in your life is really a warning sign that there's something going on with the blood vessels in your heart and brain. And I got news for you if you know Joe won't wake up when he needs to that means your brain won't wake up when it needs to. So this is a huge warning sign and that's the first thing that you should look for. Second many men don't realize that the inability to get an erection has nothing to do with testosterone and I'll get to that in a minute so please stay tuned. Is there a natural Viagra? That's a great question. There are actually many natural compounds that aid in dilatation of blood vessels. There's actually a very good study that suggests having about a half a cup of walnuts will produce more L-Arginine which is the precursor for nitric oxide which believe it or not that's what Viagra does. L-Citraline is the precursor for L-Arginine. I personally think it works much better than L-Arginine. Word of warning with L-Arginine. The herpes virus actually uses L-Arginine to reproduce. So if you have a history of cold sores if you're going to take L-Arginine make sure you supplement with another amino acid called L-Licine which will block herpes ability to use L-Arginine. There are several other compounds that dilate blood vessels. One is Hawthorne and interestingly enough there's recent research that shows that aged garlic extract will actually dilate blood vessels in a totally different mechanism so all of these are options for quote natural Viagra but the important thing is if you're looking for help in the erection department you need to totally examine your diet and change it immediately. It's one of the scariest things that you should be aware of. I have a very good friend in longevity who used to say men no matter what your age if you don't wake up early in the morning with a boner death is on the way and it actually makes an incredibly good point and all you guys who are listening you better be waking up with one or something's radically wrong with your blood vessels. Whoa is that scary or what? Next question I have low testosterone and it's affecting my sex drive how do I improve it? Well first of all are you sure you have low testosterone? The usual test that's available in most doctors offices in most labs is total testosterone but what you actually want is free testosterone. The reason for that is there are a large number of men who make this hilariously sounding compound called sex hormone binding globulin and if you make sex hormone binding globulin a great deal of your testosterone will be bound to this protein and it will not be available. So for instance I see many men who walk through the door with testosterone of a thousand and yet they are weak they have no muscle mass and when we measure their free testosterone their free testosterone is low because they have a very high sex hormone binding globulin which we also measure. On the other hand the vast majority of men who I see with low T with low testosterone actually have a normal free testosterone so you can ignore total testosterone as a useful test. What you want to ask for is free testosterone. Now here's the other important point most men who I see with low testosterone can absolutely positively have a normal free testosterone if they will give up sugars and carbohydrates. Remember those commercials when testosterone was available as prescriptions and you could advertise it? All those guys talking about their low T were sitting around the campfire eating chips and having a beer and it's amazing the number of men that I see who have pre-diabetes high insulin levels or diabetes who have low testosterone and they come in looking for a testosterone prescription and first of all I won't write for it because I have not met a man yet who cannot get a normal free testosterone by changing his diet by getting rid of the sugars and carbohydrates in their diet and these men come back shocked that they now have normal testosterone. The other important thing to realize if you are considering testosterone replacement is that testosterone will suppress your testicle ability to produce testosterone and your testicles will shrink to little bitty tiny balls and if you stop testosterone you in fact will take a very long time to regenerate your own testicles ability to make testosterone. Lastly on the same point the reason you do not see testosterone commercials on TV anymore is that the FDA banned it because most men who take testosterone don't realize that they convert a lot of that topical testosterone into estrogen the female hormone and the reason testosterone commercials are banned is because of this fact and we now know that topical testosterone replacement increased estrogen in men and estrogen is one of the leading causes of heart disease and strokes and that explains why testosterone replacement was causing more heart attacks and more strokes not because of testosterone but because it was converted to estrogen and lastly guys you'll convert the testosterone into estrogen and guess what you'll get in man boobs and that's not what you're looking for with testosterone replacement so lots of good reasons not to look for topical testosterone or those crazy testosterone pellets and I'll have more to say about that so women if you have a low libido what can you do to amp up your sex life so I've been taking care of women and men in my practice for over 20 years now and one of the things I've learned from listening to a great deal of men and women is one of the worst ways to screw up your libido is when you're busy with a project such as a child sex goes way down the line the other thing that you should know is that during lactation and during breastfeeding your child and your interaction actually suppresses your desire to have sex because quite frankly your child wants your undivided attention and there is a really cool hormonal interplay between breastfeeding and not having a desire for sex and this has actually been shown over and over again particularly in societies where breastfeeding is done until three or four years of age and it's actually a very useful way of limiting the population so number one don't feel bad that there's somehow something wrong with you hormonally because you're not very interested in sex your children are keeping you from doing that now one of the interesting things that I see in women particularly in the perimenopause or even the postmenopause period is there is a huge amount of information out there that menopause is going to decrease your sex drive or that perimenopause is going to decrease your sex drive and you need hormonal replacement to get your sex drive back quite frankly there's some very fascinating studies in psychology looking at the effect of a long-term monogamous relationship on sex drive in the women and it has nothing to do with hormones and this is going to shock a lot of people but check with Dr. Google you'll find the studies women in a long-term monogamous relationship tend to lose their libido their sex drive and it appears to have a psychological reason to drive the long-term sexual partner usually the husband absolutely crazy as to why you're not interested and it actually keeps the husband fascinated with trying to get sex from you now one of two things happen either the husband finds an affair a mistress and can't take it anymore and can frequently leave the marriage over that but what's fascinating is and I see this with a lot of my patients let's suppose either the husband dies or the husband does go off and they get a divorce the woman who supposedly has no sexual desire no libido then meets a new partner and that woman universally I've not seen it otherwise becomes phenomenally interested in sex again her libido goes crazy even though she's had no change in hormone status so there's really good psychology behind all this now how about hormonal replacement in females so I do use hormone therapy in females but it's not for often the reasons you think there are about five percent of women who are very vascularly sensitive to the effects of estrogen and those women as they go into perimenopause menopause they notice a distinct difference in the way their thought processes work and I was taught by an excellent gynecologist on our staff that a small dose of estrogen preferably topical please folks do not swallow an estrogen containing substance a small dose of estrogen will do dramatic changes in the way women feel and I can see that very small dose of estrogen on their labs but what amazing is the women without knowing their estrogen level will automatically say that was it that's what's missing and sometimes they'll actually forget the patch or change the patch and we'll see it on their labs and they'll come in and say something's not right and I'll I'll go what's with your patch oh that's right I you know I forgot it or I ran out and I didn't refill it so that's number one number two there are a number of women who as their progesterone levels drop as they enter menopause have great deal of difficulty sleeping now the nice thing about progesterone is that it is absorbable orally and it's easy to obtain from a compounding pharmacy and usually the dose of progesterone that works is about a hundred milligrams a day now the third thing I'll mention about hormone replacement is my good friend and colleague Dale Bredesen who wrote the end of Alzheimer's and it's probably I think one of the greatest neurologists in dementia there is told me a number of years ago now that one of the missing links is a another hormone called pregnant alone pregnant alone is sometimes called the queen of all hormones the master of all hormones because when we're young pregnant alone is made in our adrenal glands and quite frankly it's the precursor for estrogen progesterone testosterone DHEA you name it it comes from pregnant alone but what's fascinating is that as we get older our adrenal glands for most of us stop making pregnant alone in any amount whatsoever about 95 percent of adults don't make pregnant alone and Dr. Bredesen has shown and others as well that pregnant alone is probably very important in keeping neurons in your brain active and alive as we get older so what what Dr. Bredesen has shown is that he thinks and I certainly have come to agree with him that much of what we assume is forgetfulness as we get older is actually the effect of falling levels of pregnant alone now the good news is pregnant alone is over the counter in general and you know everybody's different because I measure the effects of these doses every three months of my patients in general 50 milligrams a day for women is usually the right dose 100 milligrams a day and men is usually the right dose now I'm not prescribing that to you I'm not suggesting it I've just found through the last few years of using this compound that that usually works out to the to the level that Dr. Bredesen likes but everybody's different and if you're going to take a supplement a hormonal supplement you've got to measure what it's going to do and it's actually easy to do with simple blood tests now the last big misconception about women's libido is that somehow testosterone either with creams or with pellets is going to drive women crazy wild about having sex about 85 percent of women will not respond to testosterone with sex drive and as my colleague in gynecology has reminded me through the years and I've certainly seen it in the last 20 years that if a woman is complaining about libido about sex drive then he wants to talk about their marriage rather than giving her testosterone because 85 percent of women in general will not respond to testosterone replacement with a sex drive 15 percent will and I have certainly seen this in my practice but it doesn't happen very much and I live in two communities where we have what are called doctor feel goods that all they do is a large amount of hormone replacement usually with pellets and what happens to these women is they will keep giving these women testosterone until I kid you not these women are shaving their arms they're shaving their beards and they still don't have a sex drive even though their testosterone levels approach that or exceed that of their husbands so I can assure you that testosterone is not the cure for a relationship issue and so talk to your family counselor if that's what you need okay so here's some more instagram questions partner less sex can you masturbate too much you know this is actually getting a lot of attention from mass media the idea of is partner less sex the new in thing and in quite frankly partner less sex is on the rise whether it is internet porn based whether it's subscription service or whether it's now AI models that use have replaced the old inflatable dolls there are now lifelike mannequins that can be purchased on the internet and the interesting thing about can you masturbate too much no you won't go blind that's the good news it turns out that the problem with porn in general is that what we're finding with men and women is that what happens with porn is you actually get this huge burst of dopamine and what you're actually looking for is this dopamine hit in your brain and what happens with more and more porn as was shown in a very famous call for is that you have to have more and more and you have to have more and more for lack of a better word erotic or kinky porn to have the same dopamine effect and eventually it really fails to work because you flooded your dopamine receptors and you no longer get the hit you're looking for so that's the danger of too much of a good thing there's nothing you know obviously it's big business but the problem is it's addictive in the same way any other addiction is addictive isn't that you have to have more and more to get the same result and that's the slippery slope now here's another great question is celibacy healthier than being sexually active or vice versa a few years ago a colleague of mine who's well known in health suggested and he's a male suggested that as you get older men should stop having sex and they should stop masturbating because he believes that your sperm your semen is your life force and that as you get older you have to conserve your life force and so the natural thing to do is to stop having sex and stop masturbating now quite frankly that goes against everything we know from an evolutionary perspective particularly for men and that is if you are sexually active or if you are ejaculating that tells your genes guess what i'm still in the business of recreating myself of making or at least attempting to make a new copy and from a genetic standpoint the more you demonstrate that you're capable of doing that the more your genes keep you around the interesting thing is we know that sexual activity particularly among couples is one of the best ways to promote a healthy lifespan now here's the other thing that's been fascinating to me for the last 20 years and that is listening to women in their late 70s their early 80s their mid 80s their late 80s begging me to get them some help for their husband to get an erection because they want it and they can't believe that hubby isn't willing to help out in that department so no there's i think evolutionary the the deal is the more you are sexually active or act like you're sexually active from masturbation the better your genes think that you're still involved in recreation so great question all right let's get some more questions from instagram can oral sex give you bad bacteria well the vaginal microbiome is actually very interesting and replete with its own set of microbiome that's actually different than the oral microbiome but here's the deal a few years ago a very famous actor got throat cancer and went through thankfully successful treatment for that throat cancer now i got a lot of talk in the tabloids but in fact we now know that about 75 percent of all oral and throat head and neck cancers are caused by the hpv virus the human papilloma virus and we all hear about hpv injection shots vaccines for young kids and prepubescent females and we're now actually finding that men can contract the human papilloma virus from oral sex now here's i guess the good news is that if you have a head neck cancer that tests positive for hpv and about 75 percent of them now test positive for hpv that the treatment the chemotherapy treatment the radiation treatment is incredibly effective at curing that problem quite frankly my long-term partner at loma linda dr glennon bailey eventually passed away this past year from recurrent head cancer and i am no way saying that was hpv because we didn't test for that back then but the point is that used to be a lethal disease almost no cures but now are incredibly successful at treating that disease if you're positive for hpv but be careful and that is a real consideration we now know that if you are infected with hpv that that's a consideration the same thing we know about anal sex number one please use protection in my community of palm springs a huge number of my patients are gay or lesbian and anal sex is a huge part of their lifestyle but just as you can get the hpv virus transmitted orally you can also transmit the hpv virus annually but we also see a large number of men get anal and rectal cancers from viral transmission so let's be careful out there that's all i'm going to say on the subject all right finally can you fix peronese disease with electon-free diet so peronese disease is where your penis is not straight but it's got a curve like a banana just like the things you see believe it or not peronese disease is an autoimmune disease caused by lectins and i have a number of men who've come to you with that problem and then we get electon-free diet and guess what willy straightens right back up so peronese disease is curable with electon-free diet i've seen it in my own practice okay time for the audience question following my lecture on hydration john hall on youtube asked i've been drinking distilled water for 30 years what about collecting fresh rainwater for drinking uh that's a great question and believe it or not there are a number of island countries particularly bermuda comes to mind where their entire source of drinking water is collecting rainwater off of their roofs and that's what they've been living on for generations and generations so yeah go collect rainwater it's a really great way of getting your water so that's a great question okay so that wraps it up for today i tell you we got so many questions on this subject that i promise you will have a part two in the foreseeable future so thanks for listening to the dr gunnery podcast before you go i just wanted to remind you that you can find the show on itunes google play stitcher or wherever you get your podcast because i'm dr gunnery and i'm always looking out for you