 Welcome to the Dr. Gundry podcast. One in every nine men develop prostate cancer during their lifetime. One in nine guys listen up. And unfortunately, prostate cancer is the second leading cause of cancer deaths for men in the United States. So whether you're a man or a woman, pay attention. What we're about to share could help save someone you love, maybe even you. That's right. Today says that there are plenty of ways for men to take charge of their prostate health now and greatly reduce their chance of facing serious health issues down the line. He's Dr. Mark Stengler, a naturopathic medical doctor who was recently named Doctor of the Decade by the International Association of Top Professionals. Dr. Stengler is also the author of many bestselling books, including his latest release, Healing the Prostate, The Best Holistic Methods to Treat the Prostate and Other Common Male Related Conditions. Today Dr. Stengler and I are going to discuss the root causes behind some of the most common men's health issues and share how you, or the men in your life, can use diet, supplements, and lifestyle choices to support a healthy prostate. Before we dive into all things prostate health, I want to make it clear that the natural methods that Dr. Stengler and I are going to share today are not to be used in place of other protocols recommended by your health care practitioner. It's important to first communicate with your doctor regarding any of the information you wish to put into practice, especially for serious issues like cancer. Okay, let's get started. Mark, welcome to the show. Hey, great to be on with you. All right, you've studied many areas of health in your career. So why did you decide to write a book on prostate health? Well, it's one of those things where we see a lot of women in our clinic, but we also see the men, and the men tend to come in, as you've probably seen, when they've had serious events occur. They've had a heart attack, they have had a certain cancer, but other than that, the men tend to come in usually over the age of 50 when they're having urinary problems. So a lot of men have urinary problems related to enlarged prostate. And so I found over the years, integrative medicine is very effective in helping these men. The millions of men who have prostate problems, prostate enlargement, certainly get a lot of men who have prostate cancer, who are receiving conventional care or are being monitored, and we work to help those men as well. So just a lot of men coming into clinic over my 26 years of practice with male-related problems, prostate problems, and then probably secondary to that, the things with the hormone imbalance, like the testosterone deficiency, adrenal dysfunction, things of that nature. All right. So for our audience who might not know, what is the function of the prostate gland anyhow? Yeah. So the prostate gland, which is located below the bladder and the pelvis, its main function is to produce prostatic fluid, which is involved in fertility. So there's different fluids that are released when a man ejaculates, having sexual relations, and the prostatic fluid is one of the main fluids, which basically enhances fertility, provides an environment for the sperm to thrive, so to speak, and be more efficient in its function. So that's why a female doesn't need a prostate, is that right? Correct. Correct. There's a second function they think as well, and that's just a structural issue where, again, being below the bladder, it has somewhat of a supportive structural effect for the bladder as well. Gotcha. So it may sound obvious, but I think it's worth spending a second or more talking about it. So why is prostate health so important? I mean, okay, it's just there to improve your fertility. Okay, so what, I'm now 50, and I don't really care about that so much anymore. Right. Well, I think the problem or the reason why it's so important is because most men experience prostate issues at some point in their life. So for example, benign prostatic hyperplasia, which is fancy way of saying enlarged prostate, it's just extremely common. If you're 50 years old, you've got a 50% likelihood your prostate's enlarged. If you're 90 years old, there's an 85%, and so then these men experience symptoms. Urination problems. They're getting up during the night after urinate, frequent urination during the day, dribbling, more prone to urinary tract infections, and of course, the more dreaded one is the prostate cancer, which you said's very common. One in nine men in America get prostate cancer. It's the second most common type of cancer in men behind skin cancer. It's the second most common reason of cancer death in men behind lung cancer. So, you know, these are just common issues men typically have to face. All right. Well, let's go back to BPH, prostatic enlargement. So many regular doctors, when a guy comes in at 50 and says, you know, I'm getting up at night, well, that's just your prostate. That's normal. You're now 50. That's normal. Is that normal? Well, in America, it could be normal. I wouldn't say it's normal necessarily in terms of health. I mean, most men in America aren't healthy. So, it's not normal in the fact that, look, I mean, you certainly have men in their 80s and 90s who don't have major issues with prostate enlargement. So, it's not inevitable. And there's good research and I talk about in the book where if you're doing the right diet and lifestyle approaches can greatly reduce your risk of prostate enlargement. So, no, I don't think it's inevitable and I don't think it's healthy. Studies show that it's a very small percent of men where they have prostate enlargement where it's strongly genetically related. That's a very small percent. So, I think what the research is showing is through your diet, your exercise, the chemicals you're exposed to, the body weight that you have, making sure you don't have other conditions like diabetes, you can greatly reduce the risk of having prostate enlargement. Or if you have it, you can improve your symptoms and to some degree even reduce the size of the prostate. Yeah. So, let's break that down. Most men I think would be flabbergasted or when I tell them it's your diet that's causing your big prostate, where does, in your opinion, diet fit into making a prostate bigger or smaller? Right. Right. Well, in my approach, I think similar to yours, been an integrative doctor. I mean, diet for most people is the foundation of their health and so I think it's huge. I mean, you can either promote healthy tissue or you can promote unhealthy tissue in large part by how your diet is. Our body doesn't work by magic, so it's affected by the foods we eat. So, I think it's a huge factor and actually they have studied this. In men where they follow and improve diet and lifestyle, they actually improve their prostate symptoms so we know it can have an effect. So, I think diet is the number one factor and of course diet ties into weight. In men, they're overweight as with many conditions. That increases the risk of prostate enlargement, BPH, as well as prostate cancer. So, I think there's a very direct correlation and as you know, unfortunately, most doctors in America don't fundamentally focus on diet, whatever the health condition that includes prostate. Most men I talk to, they've been to the family doctor, maybe they're a urologist and they have mild symptoms, maybe moderate symptoms of prostate enlargement with your urination. They may be offered some drugs, they may be told to just wait for things to get worse, then they'll offer drugs or certain procedures to treat the prostate, but most men, and this is I think the key point, we find, and this is what the studies show, we talk about in the book, men with mild to moderate prostate enlargement can be helped tremendously through diet, lifestyle changes, and targeted nutritional supplements. So, men can be and should be proactive so they don't end up having to use medications with side effects or need more invasive therapies like surgical procedures. So in my practice, I quite frankly have never seen a man with an enlarged prostate that doesn't have an elevated fasting insulin level or what we call insulin resistance, never. And as I tell my patients, insulin, among other things, is a growth hormone, and as you and I know, there is nothing in us that we want to grow once we get older. So, and do you see that in your practice as well that insulin resistance or an elevated insulin level is a big piece of this puzzle? Absolutely, because, you know, the men that come in with the prostate issues, I mean, 75 to 80 percent of them are overweight and the majority of those men, they have the insulin resistance. So, I'd agree with that and, you know, literature is very clear in terms of creating the growth of cells, more well studied in prostate cancer, but we do talk about in our book how there have been studies showing that men, for example, with insulin resistance with diabetes are much more likely to have prostate enlargement and prostate cancer. So, there is a direct correlation because this insulin resistance and the stimulation of the hormone insulin, high levels, prolonged periods of time, creates an inflammatory response, and also a direct growth response on those prostate cells. So, I believe that's very accurate. Now, you're in the San Diego area and I have always been impressed by the University of California San Diego work on vitamin D and prostate health and health in general and prostate cancer. Can you, for those of our listeners who don't know about vitamin D and the prostate, can you tell us what you talk about in the book? Yeah, well, the interesting thing is they have identified vitamin D receptors on the prostate cells, which, you know, like most other cells in the body, vitamin D has so many far-ranging effects. So, they have shown in studies that men that are vitamin D deficient are more likely to have BPH or prostate enlargement. Now, we've known for a long time, as with other cancers, men who are vitamin D deficient are more likely to get prostate cancer. There's many reasons for this. Vitamin D helps to control inflammation. Vitamin D is directly involved in cell division, cell replication. Vitamin D is directly involved in how well your immune system is functioning, your good immune cells, which are constantly gobbling up cancer cells, circulating throughout the body, and other mechanisms as well. So, vitamin D ties directly into prostate health and, as I'm sure you do, it's always shocking how many, you know, men and women we see in the clinic who have vitamin D deficiency, even here in Southern California, it's just very, very common and, of course, more common in other areas. And they have done studies of men who have enlarged prostate. It is more common in men in northern latitudes, for example, where they're not getting as much sunshine in vitamin D, but, you know, it's even common in areas like ours. Yeah, in my clinics, 80% of my initial patients are vitamin D deficient. And people are shocked, you know, well, wait a minute, you're in Southern California, and how can that be? But unfortunately, most of our patients are wearing sunscreen. People are not going out as much outside as people assume we all do. And yeah, it's even in sunny Southern California, we have vitamin D deficiency, severe. Yeah, and that's true. And there have been some good population studies with blood vitamin D levels and a man's risk of prostate cancer. And depending which study you look at, let's just say, you know, most labs use a range of about 30 to 100 units. And these studies, the most protective level was generally above 41, some show above 44, around 50. So I think it's critical for, you know, providing you serious conditions like prostate cancer, other cancers, even prostate enlargement, know what your vitamin D level is and get it optimized. So I guess one of the things that a guy who's listening to this or the wife of the guy listening to this, can you, or the husband of the guy listening to this, can you actually shrink a prostate by changing diet by getting your vitamin D level up, by getting insulin resistance taken care of, and supplements. So that's a big subject, but can it be reversed? Well, it's a good question. Certainly we can definitively say that when you follow the integrative or natural protocols, the diet improvements, targeted nutritional supplements, losing weight, improving that insulin resistance, you know, addressing nutritional deficiencies, certainly it's been very well shown you can improve your symptoms. So you, the most common issues are the urinary symptoms. So you can definitely improve those, especially if you're in that mild to moderate category of prostate enlargement, which is most men. So that part we know for a fact, but recent research, which I talk about in the book, they actually have done some studies, for example, with the common herb supplemental, when used at the right concentration of dose, they did show a mild decrease in prostate size based on ultrasound studies before and after. So yes, you can to some degree, now I wouldn't, you know, exaggerate it. It's not like if your prostate is 50% larger than what it should, I'll shrink it by 50%, but yes, studies have shown, using ultrasound, you can mildly decrease the size of the prostate with these nutritional approaches. Okay, so let's go, obviously it's one thing to get up in the middle of the night to have to pee, but it's another thing to get the diagnosis of prostate cancer, which certainly the diagnosis of prostate cancer seems to be going up and up. And is there a correlation between BPH and enlarged prostate and developing prostate cancer? First of all. Yeah, it's a very good question. And no, if you look at medical literature, there is no question between having BPH or prostate enlargement and prostate cancer. However, the tricky thing is, is when you look at the symptoms of both conditions, at least initially, they're very similar. The number one symptom would be changes in urination for both conditions. So they kind of mask one another. So, unfortunately a lot of men with the prostate cancer, till they have more serious symptoms, blood in the urine or semen, they're getting pain in their spine, their back, their hips or pelvis when prostate cancer is spread, or perhaps their doctor's been screening them either with physical exams, a digital rectal exam or using blood work, getting a sensor might be something going on where they do further testing. That's the problem with prostate cancer. It's kind of this quiet disease that rears its head. Usually, unfortunately, a lot of men when it's already spread and it's more serious. So just because you're getting up in the middle of the night doesn't mean that you're developing prostate cancer, but is that in itself an indication, hey, this isn't actually normal. This isn't just what happens as you get older. Do we need to look under the hood a bit more? I think so. Anytime you're getting symptoms, I mean, you'd want to know what the root causes are. So if you're a man and you're starting to get up one, two, three times a night or more, yeah, you should find out. Is this prostate enlargement? Do you have a low grade urinary tract infection? Is it prostate cancer? Although, less likely, of course, it's still possible. So we want to know what's going on because as doctors, we want to treat the condition and the root causes of the condition. So you and I, we would treat patients differently. Obviously, if they have prostate enlargement versus prostate cancer versus something like a prostatitis where they have an inflammation and infection possibly going on in the prostate gland. So better treatments knowing what's going off the patient. Now I know a lot, I have many friends who are urologists and they are not so interested in the dietary treatment of prostate enlargement or even prostate cancer, but they'll certainly agree that many times you can get a false elevation in PSA levels, prostatic specific antigen, if there's a prostate infection. And they like to give a round of antibiotics and then repeat a PSA. Have you found that useful in your practice or where do you go with, say, an elevated PSA? Right, yeah, well, first of all, if a man has an elevated PSA out, first would ask him some questions. I would ask him, you know, had he been riding his bike before he had his blood test done? Did he have sexual relations within 48 hours? That can elevate the PSA. Those things can elevate it. What I do with patients typically is I will just rerun the PSA. Before everyone gets all stressed out, I rerun it. You know, a lot of time you rerun it and then the test is back to normal. So there was nothing going on. If it's still an issue, then I'll do a urinalysis, try and I'll screen for urinary infection in the prostate or urinary tract, see if something's going on there. I do not routinely just give antibiotics if the PSA is elevated. And the reason I say that is most cases of an elevated PSA are not related to a bacterial infection of the prostate. You look at the literature, it's actually a small percent. Most cases of prostatitis or prostate inflammation infection are not bacterial in origin. They're either viral, they're or fungal related is what the literature shows. So I don't just give an antibiotic unless I'm somewhat convinced there is a bacterial infection going on. But you're right, that is kind of the standard that's done in urology. I was hoping you were gonna say that. Yeah, I'm not a big fan of whatever walks through the door giving them a dose of antibiotics as the first thing I try. I'm not a big fan of wiping out the gut microbiome, but. Right, right. In fact, I don't, don't do that people. Okay. All right. And of course, Dr. Gundry, as you know, I mean, it goes beyond the gut microbiome. Of course, we have this, you know, healthy immune protective floor everywhere, including, you know, in the prostate and urinary tract as well. So. Exactly. You start giving that a box out and you don't need them. You're making a patient more susceptible in those areas. Yeah, absolutely. Okay, since I have friends who are urologists, does every man who develops BPH or have prostate cancer need surgery or conventional treatment or radiation therapy? What say you? Well, with the benign prostate hyperplasia or prostate enlargement, I mean, most men don't. If you have mild or moderate symptoms and, you know, the prostate isn't, you know, so large, you know, it's stopping urination. Most men don't. I mean, most of the men I treat, we can treat them nutritionally, holistically, no problem. There are some men, the prostate's gotten so large. Yeah, they need procedures. They need procedures like the urolift. We put clips up there and take pressure off the urethra, which would be compressed by the prostate gland, the tube that drains the bladder. There's all sorts of different procedures with lasers and kind of rototillar type treatments like the terp treatment. So there are a percent of men, a small percent of men, they need more advanced invasive treatments because they're beyond the point where we can shrink the prostate enough. But the majority of men out there, the holistic treatments work just fine to control their symptoms, improve their urination. I find, for example, let's say a man comes in and he tells me he's getting up three to five times a night. And it's because of his prostate enlargement. Normally, I find with the dietary changes with the nutritional supplements, we can at least cut that by 50%, if not more, up to 80% with the things I talk about in the book. So most men, we can manage it just fine without drugs or surgical procedures. Now you talk about supplementation in the book and you've already mentioned one and that's vitamin D. What are your other go-to choices in your practice? Well, usually in my practice, I use combination formulas. I've found if we just use one herb or supplement, it can help, but we get much better if we use kind of a combination type approach because they can have different effects. Most people are familiar with supplemental. Now it's interesting if you start doing a kind of a scan on Google, if you will, by law, the conventional medical sites, and I won't give their names, but they're pretty well-known brand names. A lot of them are very negative to supplements like supplemental. They just come out and basically say they don't work, which is quite interesting because I think people didn't do their homework. When you look at the actual published research, we know that studies show that supplemental works for 90% of men, and here's the key with mild to moderate symptoms. The other thing to know is when you look at the studies, the ones that worked well used very specific standardized extracts, very specific doses. Those studies were very, very positive, very effective. When you start using studies where they didn't look at that information in the study, then yeah, sometimes they're not effective. I mean, there's a meta-analysis of 27 studies published in 2018, and they found salpametto was just as effective as the common drug, Tamsulocin, which is used to relax the bladder and the prostate to help improve urinary symptoms. So that's what the literature shows, if you want to be scientific, I also use nettles root, which is very effective, reducing urinary symptoms. That's been well-studied, helps about 81% of men. And it's interesting, you look at these herbs, Dr. Gundry, salpametto, nettles root, other common ones that we use, when you really look at them in detail down to the cellular level, how do they work? Well, they mainly work by blocking hormonal stimulation of the prostate gland, hormones like dihydrotestosterone, a metabolite of testosterone, blocking estrogen. And so as men get older, what happens is our testosterone drops, our estrogen levels tend to go up, especially for overweight or have insulin resistance. And the dihydrotestosterone, the DHT levels tend to go up, and these hormone, the tablates stimulate prostate growth. So in the end, when we change diet, when we lose weight, we improve insulin resistance, we address nutritional deficiencies. You're actually creating better hormone balance for the men and less stimulation of the prostate gland. And that's working at a deeper level. Where does exercise fit into this? Are there studies that show exercise can help? Yes, we actually cite some studies showing that exercise helps men with BPH, helps to urinary symptoms. There's been some really fascinating studies done on men with prostate cancer. And actually what they found was men that were involved in moderate to vigorous regular exercise, it significantly reduced mortality from prostate cancer by about 25%, I mean, very, very significant. So exercise is very important. It's probably many mechanisms, helps the immune system, obviously helps people with insulin resistance, helps people lose weight. You lose weight, you get less estrogen, better hormone balance, so many, many different factors involved with the exercise. So it's gotta be part of a program, in my opinion. Diet's important, the supplements are important, but it should be well-rounded with the exercise. So let's suppose you have a patient who's diagnosed with prostate cancer, biopsy proven or perhaps MRI specific. Take us through the steps of what your counseling is. Where do you go with that? Sure, I get a lot of men in that situation. There's a couple of things I look at, excuse me. So they've had their biopsy done. We know they have prostate cancer. You know, we know if it's in the lymph nodes or it's spread at all. So if a man has more serious cancer, where there's metastasis, it's outside the capsule, the prostate, it's spread, they need conventional care, I give supportive care. Our clinic, we would work with their diet. We would work with supplements to support them with the side effects during their treatments. We do a lot of intravenous vitamin C therapy at our clinic to support men during these treatments. Now for the men where they have what's called the Gleason score, which is the grading of their prostate cancer. If they're 65 and older and they don't have a bad score, a bad grading, it's very normal now, even in oncology, to do the active surveillance. And that's where basically, at least from the conventional viewpoint, they just mod to a man. Because statistically, we know that most prostate cancers are slow growing. Men statistically are likely to die of something else as they age. However, if you have a more aggressive prostate cancer, it's very, very serious, it can kill you quite rapidly. So these men need conventional care. But if they don't have, if they have good grading, they don't have the more aggressive type of prostate cancer, we certainly can treat them. And we do with diet, nutritional supplements and intravenous therapy. And what I do with patients, I have them continue their care with usually their oncologist monitoring them. And we also monitor them as well, just looking at certain blood levels, PSA and things like that. And as long as a patient's doing well, their lab parameters are looking good. They are getting occasional imaging done, making sure things are getting worse. A lot of men are able to do that. And that's kind of changed the last five to 10 years in terms of prostate cancer. Yeah, so let me put it another way. Should someone who has a diagnosis of prostate cancer, should they always investigate alternatives or should they always get a second opinion about their options? Oh, absolutely. In my opinion, absolutely. And I would say that for all types of cancers. And then the reason is in the last 10 to 15 years, there's really been an explosion in the scientific validation, a lot of the therapies that we do, in terms of being able to support people with cancer with proper nutrition, in terms of there's been some studies including with prostate cancer, where men have had conventional care or getting it and then they integrate dietary approaches, things like intravenous vitamin C. Studies have shown they have better outcomes. They have better quality of life scores, better length of life scores, compared to men who just do conventional care alone. I talk a bit about that in the book and actually wrote a book called Outside the Box Cancer Therapy. So we get into that in more detail, but most people are surprised. There's actually one NIH funded study who actually looked at this question and included prostate cancer. So in my opinion, yes, every person that has cancer, including men with prostate cancer, should be working with integrative doctors with nutritional therapies. Number one, you can reduce side effects from chemotherapy and radiation with the right approach. Number two, you can enhance their immune function. And like I said, we now have the studies and have had for a few years now showing that you're more likely to live longer as well. Yeah, I see a number and care for a number of men who either have metastatic prostate cancer after a procedure, or who are in this category that they for whatever reason don't want conventional therapy, whether it's radiation or prostatectomy, and want to manage this with, I call it restorative medicine, but we'll call it functional medicine, whichever term we want to use, integrative medicine. And we've had some very good results, but when they go to their practitioners, they're oncologists, and we follow them with their oncologists. Their oncologist said, this is silly, food has nothing to do with this, and eat what you want. So why don't we talk about diet and where this plays in? Are there certain high risk foods and are there great foods that we should be adding to the diet? Yeah, in terms of prostate cancer, I mean, there has been research suggesting that diets that are high in animal fat, especially dairy products, increase risk. I wouldn't say it's definitive. The problem with these studies, in my opinion, they have not teased out the types of meats, how they're prepared. So I wouldn't just come out and say, all animal products are bad. They haven't teased out part out, but it's a matter of balance. On opposite, we know plant foods are very protective for the prostate. We know there's been studies for example, in the Mediterranean diet, showing it's protective and reducing your risk of prostate cancer. There's been several studies demonstrating that. Personally, myself, I use a diet called the modified Mediterranean diet. I've been kind of developing for years because as you've been telling your listeners for a long time, grains in America just aren't very healthy. They could create net insulin resistance during inflammatory, they're carcinogenic. So we use a modified Mediterranean diet. We've got the olive oil, you've got lots of fruits and vegetables, maybe some nuts and seeds. Yeah, in a traditional Mediterranean diet, obviously you have the cold water fish and lower amounts of poultry and red meat. So that's kind of a general diet. We use a patient. So if a patient comes in, they're very obese, they're more interested in just more of a straight plant-based diet. That's something that could be used as well. So yeah, we know that that type of diet is protective against prostate cancer. It's good for the insulin resistance as well. Those are the types of things we focus on. There is research showing that the prostate gland, the prostate tissue is very sensitive or very much aided by certain polyphenols that you get in a diet can be very effective in reducing inflammation of the prostate. And fatty acid balance is important. Having a good ratio of omega-3 to omega-6, saturated fat, I do test blood levels of patients. Fatty acid levels as well as other nutrients. And quite commonly we just find their omega-3s are low relative to the more potentially inflammation-promoting omega-6 and saturated fats. Yeah, there was a study a number of years ago looking at serum omega-3s in men who were about to undergo prostate surgery. And it got a lot of buzz that higher serum omega-3s correlated with a higher chance of prostate cancer. And I rather than read abstracts, read papers. And what was rather funny was they were measuring serum omega-3, which really looks at whether you had a piece of fish the night before, not an omega-3 index, which I use, which looks at two months. And when you actually break down the breakdown of all these people, if you actually ate a lot of fish, had a glass of red wine and took a baby aspirin, these people were actually immune from prostate cancer in this study group. And that, of course, didn't make the news because that isn't very exciting. But that was actually what should have been the conclusion of that study. So yeah, we have to be careful with what the news media thinks is interesting about a study. Yeah, very, very good point. Yeah, I used omega-3 index too with Quest Labs. So probably like you, it's amazing. It's kind of like vitamin D, how many people come out low on the omega-3 index? Yeah, no, very true. One other thing that I think you ought to bring up, where do you think Lignans fall into all of this? Yes, thank you for asking. I'm a big fan of ground-up flaxseeds and the Lignans, you get in flaxseeds. There's some preliminary, not conclusive evidence that they do have a protective effect against prostate cancer. Lignans are converted into certain compounds in the body by the gut, which help the body to detoxify bad estrogens. And as I talked about, high estrogen or certain estrogen metabolites are more associated with prostate cancer and prostate enlargement. Of course, ground flaxseeds have omega-3s to some degree too. So it is kind of an interesting thing in terms of just specific to prostate health. I do like the ground organic flaxseeds. We used to have our head of oncology at our hospital in the desert who trained at Wayne State in Detroit. And they had a big prostate cancer practice, particularly metastases. And they found that there were some men who didn't have aggressive metastases compared to other men. And when they actually started looking, these men lived primarily in a community north of Detroit where the chickens were being fed ground-up flaxseeds. And they found that these guys, chicken consumption and egg consumption correlated very strongly to less aggressive metastatic prostate cancer compared to men from other districts of Michigan. And I remember talking to him about this and he said, well, we just figured that that was just kind of silly. And I said, no, it was the flaxseeds. It was the omega-3 fats and the lignins that they were actually eating by eating these chickens. Fascinating, observational study. Have some flaxseed eggs, folks. All right, testosterone. Give us an overview. Men are told, well, as you get older, your testosterone falls. And the old joke was eventually, a man, you're gonna be more female than your wife because your estrogen level is gonna be higher than your wife's. And that's normal, that's part of getting old. What do you think? Well, in general, I mean, it is true men's testosterone level drops as men get older. I think there's actually some protective mechanisms to that. I don't think it's all negative necessarily as men age or liver's ability to metabolize hormones and so forth decreases as we age too, as do our kidneys. So if you think about it from a protective mechanism, it's not bad in and of itself because you don't want high levels of hormone metabolites. Testosterone gets converted, like I said, into estrogens. It gets converted into dihydrotestosterone, which are much more powerful in their stimulation of the prostate gland. But that being said, testosterone deficiency is actually quite a big problem in American men. We know, depending on what study you look at, anywhere from 25 to 45% of men, 45 years and older, have low testosterone. And testosterone is important for many essential functions. We need it for proper brain and cognitive function. Most people know about it for muscle mass. It's important for bone mass. As a cardiologist, you know, there's good studies showing it's important for cardiovascular health because your heart is made of muscle too. It's important for mental function health, such as it's antidepressive. It helps with cognitive function and focus. And it helps even with things like erectile function. So it has many wide-ranging activities in the body. So if you have testosterone deficiency, you know, you're more apt to have one or more of these problems. So we do see it pretty calmly in men. I think there's many reasons why a lot of men in America are deficient testosterone. Well, it goes back to diet, lifestyle, nutritional deficiencies, exposure to certain toxins. They get in their food supply and from the environment. And use of certain medications can be a factor. So we see it, I see it quite a bit in my practice. And for the men that are mildly low, we just work with diet and lifestyle and nutrients, sometimes supplements. Men that are mild, like between mild to moderate, depending on what the patient wants to do, we could still use that approach, be more aggressive with supplements. And I do have a fair amount of men I have on bioidentical testosterone replacement as well. Yeah, I certainly see a very strong correlation with free testosterone levels and men's insulin levels with their triglycerides, which indicate to me their sugar and starch consumption. And we actually see very impressive dramatic elevation in free testosterone when we reduce their simple sugar consumption, when we drop their insulin levels. It actually impresses a great number of men who are convinced that their low T is just because they've gotten older. And when we convince them by the numbers that a dietary change made their testosterone go up, they're pretty impressed. Do you, we make it a habit of measuring both total and free testosterone because so many men that I see have excessive levels of sex hormone binding globulin. And I think a lot of practitioners are fooled by looking at just total testosterone, which may actually be normal or even high. But when we look at free testosterone and sex hormone binding globulin, many of these men actually have very low levels of active circulating testosterone because it's all bound up. And their local practitioner has no idea despite the men complaining of low energy and low libido that, no, no, your testosterone is great. Do you see that in your practice? Oh, absolutely. Yes, I do. So that's why I run panels. I always run panels on men. I don't just run like just like a total testosterone. I run panel. Usually it would have the total and free testosterone. Have the sex hormone binding globulin. It would have the estrogens as well. Sometimes there are other hormones too, like progesterone and other hormones as well. Thyroid. Thyroid can affect testosterone function as well. So usually I run panels at least initially. But yes, when I'm doing fall-up testing, I will run the total and free testosterone for sure. And you make a good point because look, I mean, only about one to 2% of your testosterone's unbound or free, so to speak, having activity in your cells. And for your viewers and listeners, I mean, hormones are very interesting because really how do they have their effects? Well, they have their effects on your DNA inside your cell nucleus. So it's that free portion, which is having the activity. So yes, I see men where the total looks, you know, kind of like mid-range or maybe even a little bit high. And then their free level's low, but their symptoms, their signs and symptoms correlate with having a low testosterone. So other doctors have not picked up on it. Now the nice thing about when the free, just the free testosterone's low, especially in those men, when we work with a diet, the nutrients or the supplements, it responds very, very well. It's more of a challenge when men have extremely deficient total testosterone levels. It could be more involved with that. All right, I'm sure a lot of our listeners see ads on the internet or even on TV for testosterone boosters and you're gonna become the biggest, you know, manly man that ever existed by sending us $49 today. What do you think? Yeah, it seems to be a lot of baseball players, ex-baseball players promoting that, but my experience has been throughout the years. Most of these products are very disappointing. I mean, just because patients have come on, they've been using them at the recommended doses. They've been on for months. We're checking their levels. They're usually not very impressive. That being said, what I do in practice and what I review in the book, there are a couple which I think are credible. There's a very specific type of ashwagand extract I talk about. It has two good studies on it done in men. Actually, one also included women. And it did show in the studies that it did increase testosterone levels significantly as they're tracking blood levels over time using a certain type of ashwagand extract. There's another one called uricoma, longifolia with a column named Tonkat Ali, which actually has been very well studied by the Malaysian government. They have quite an industry there with that herbal extract. It's kind of a hot water extract they use. They've done a lot of published research at the universities with it. That also has been shown to increase both the total and free testosterone in men and in women as well as improve symptoms of low testosterone. So I think there are some supplements when you use very specific ones at the right doses. They can be credible, but my experience, what I've seen on the market, a 90% plasma or just, you know, I'd say that I call them like semi-placibos. They're not a whole lot better than placebo, I think. Oh, great advice. Yeah, because we're seeing that increasingly almost like you say a lot of ex-baseball players seem to be pitching these. All right. Well, there's a lot of great information. And it's been great having you on the show. So where can listeners find the book? And if you'll be kind enough to put it up so we can see it, tell us where to get it and find out more about your work. Yeah, thank you. So feeling the prostate, if you can see it there. Yep. That's the name of the book. Yeah. And you know, Amazon, Barnes & Noble, the typical places people can access it. And, you know, I do cover more than prostate, like you said. I cover the testosterone deficiency, common male problems like erectile dysfunction, low libido, things of that nature. So, you know, it's pretty, it goes beyond the prostate, but obviously a big focus on prostate enlargement and prostate cancer. And you also have a serious XM show that people can find you. That's right. Every Saturday, we're on Saturday mornings for two hours and then about a hundred other stations around the country. And people can learn more about it at my website, americasnaturaldoctor.com, americasnaturaldoctor.com, all the listings of the stations, the times it plays. And, you know, we turn into a podcast too and hope to have you on there soon as well. Well, we'd be thankful to come on your show. And again, we thank you for coming on our show today. And good luck with this book. It's important information that everybody needs to know. Now, thank you so much. All right, take care. Now it's time for our audience question. This week's question comes from C. Wakely12 on YouTube, who says, does water interrupt the mitochondrial resting period? When I fast, I still drink a ton of water. Should I not do that? You may have already covered this in another podcast that I just haven't gotten to yet. Well, C. Wakely12, thanks for that question. It's a great question. I've never been asked that question, so that's good. No, water actually does not interrupt your fast. It does not count against you. But since we're recording this during the month of Ramadan, in my new book, The Energy Paradox, I do talk about the Ramadan-like fast, which you may know. And since you asked the question in Ramadan, you eat your breakfast before sunrise and then you do not eat or drink even water until after sunset when you again eat and drink. And the Ramadan fast, which lasts for 30 days, has been extensively studied, and I talk about it in The Energy Paradox. And the fascinating thing is that for 30 days, you literally go out without any liquid for 12 hours every day without any difficulty whatsoever. In fact, athletes have participated on Ramadan fasting in professional competition. So, but the answer to your question in specific is no water does not break your fast. So have all the water you want, but similarly, don't be worried that you need to drink a lot of water during the time you're going between meals. So, and that's been proven in Ramadan. Great question. Now it's time for the review of the week. This week's review comes from Fast Savannah on YouTube, who watched my Energy Paradox sneak peek and wrote, what have you done to me, Dr. Gundra? You've turned me into this high energy, high enthusiasm, long life, extremely productive. I can work even after lunch during otherwise siesta time, and I feel great and manic individual. I'm always in a high. This day this ceases to be the case. The day this ceases to be the case, I may crash big time. But wait, crashing is not even a possibility because of this lifestyle stabilizes your mind too. Well, thank you, Doc. Well, thank you, Fast Savannah. And it looks like you're in the fast lane for good health. And glad this energized you. And please tell your friends, please tell your friends to listen to that podcast and all the others. And when they listen, please have them drop us a review just like you did, rate us on iTunes because this is how we're gonna reach a bigger audience and give them the chance to have the energy you're now experiencing. And remember, we're always doing this because I'm Dr. Gundry and I'm always looking out for you. See you next time and thanks, Savannah, Fast Savannah. 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 podcasts because I'm Dr. Gundry and I'm always looking out for you.