Dr. Robert Rountree:

This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Dr. Robert Rountree:

Hi, everyone, and welcome back to the Thorne Podcast. Joining me this week, we have a special returning guest, Dr. Mark Holthouse, who was with us awhile back. He's a physician that specializes in men's health, in cardiovascular disease prevention, in cognitive illnesses and dysfunction, and gastrointestinal disorders. He's taught hormone health for the Institute of Functional Medicine since 2014. So he’s got a lot of expertise in hormones. I'm so excited he's here to share some of his insights with us today. So Mark, how are things going? It's great to have you back.

Dr. Mark Holthouse:

Really well, Bob. Thanks, it's a pleasure. The exciting thing is that we get to talk about lifestyle and making some lever points that can make huge differences in people's lives really simple. And it just takes understanding a few of these basic tools to get there.

Dr. Robert Rountree:

So let me paraphrase that and say, a lot of people get the idea that functional medicine is this really complicated approach to health care and reading between the lines, I'm hearing you say, “It doesn't have to be that at all. It's more about lifestyle modification and simple things.”

Dr. Mark Holthouse:

It's pretty foundational. You know, and it's not rocket science, we get into the weeds on the biochemistry and kinda geek out when we go to conferences and talk to each other. But at the end of the road, when you get behind closed doors with a real person in the room, who's got real problems, it becomes very real, very quickly. And the simplicity of the model, the simplicity of the lifestyle, foundational tools is really what makes it come alive. That's the fun part of what we get to do.

Dr. Robert Rountree:

Great. Well, I think what we can do today is actually even walk people through what your thinking process might be for somebody with a typical problem. So let's get right into the main discussion this week, which is going to be testosterone deficiency, you know, which people are seeing advertisements all the time [for] now. “Do you have low T? What does it mean to have low T?” And what does that have to do with metabolic syndrome, blood sugar disorders, and insulin resistance? So before we dive in, can we just break those terms down for our non-physician listeners? What does it mean when we talk about low T, exactly? And what is metabolic syndrome? And then we'll talk about how all those things kind of interact with each other.

Dr. Mark Holthouse:

Absolutely. You know, it's almost comical to see the marketing jockeying for position in any market with TRT clinics popping up right and left and peptides and all of these kinds of things, which are great and often necessary. But what a lot of the clinics are missing out on are these associations, these lifestyle associations, which have not only associative, but probably causative relationships now with low T. We don't know why. We have some suspicions guys are having profound decreases in sperm counts, and why the prevalence, depending on whose study you're reading in testosterone deficiency is as high as 38 percent in the average 40-year-old in the United States.

Dr. Robert Rountree:

Wow.

Dr. Mark Holthouse:

You know, we don't really understand all of the in’s and out’s of the causes there. But what we have been able to really clearly kind of tease out are a few key associations. And at the top of that list is obesity — having extra tummy fat in particular. This thing about metabolic syndrome really is just incorporating the idea of having high blood sugars, having difficulty with some of the elements of your cholesterol panel, and again, some of the abdominal fat. And it's commensurate with having more inflammation and what we're talking about today, lower T levels.

Dr. Mark Holthouse:

So metabolic syndrome is just a fancy doctor word that we made up, and it had all kinds of other names, syndrome X, and it sounded like you know, Racer X on Speed Racer, which was my favorite cartoon when I was little. You know, it's very, “Ooh.” “Ahh.” Really all it's doing is saying, "Hey, this is much more than just having high glucose. There's these other body things that happen to us." And, oh, by the way, we can throw in there that low T is really, really common with this metabolic syndrome that so many people have now.

Dr. Robert Rountree:

Well, let's talk about a typical patient, and this is probably somebody you see all the time. And I know I see a lot of this type of patient in my practice. We're talking about a guy who's say in his late 40s, his early 50s, busy business executive, works out a little bit. More of a weekend warrior, feeling kind of run down, thinks that he gets enough sleep, but you know, wakes up not well rested in the morning. His libido is declining. He just doesn't have that same kind of interest you know, and maybe this is a guy that's been married for 20 years. And so he says, "I don't know, maybe I'm just with the same partner and we've lost some of our spark. But I just don't have that same kind of drive and it seems like my muscles are harder to maintain." Right? He's not pumping iron every day, but he feels like he's doing enough. And yet, he can see his muscles kind of melting away and turning into fat.

Dr. Robert Rountree:

And so he saw an ad for low T and he measured his level and they're not out of the normal range, but they're in the lowest say 10 percent, right? Which is a critical kind of question here. So he's got somewhat low testosterone. He's tired. His libido's gone. He can't maintain his muscle mass. And you know, seems to be a little bit heavy in the waist. He wouldn't call himself fat, but he says, "You know, my pants don't fit me as well." So the first question is, do all of these things fit together, right? Is this a, quote, “syndrome,” you know, or is it all just part of having low testosterone? So we just give this guy testosterone shots and send him out the door, is that the end of the story? Or is there a whole picture that's developing in your mind with this kind of person? You ever seen anybody like this?

Dr. Mark Holthouse:

Yes, it's my daily routine. I have a steady parade of gentlemen like this. And sometimes it's the wife that's turning their elbow to get them to come in, right? But it's the classic case that you presented. And you're right to set the stage with this dichotomy of, do we just do [what] a lot of the TRT clinics, testosterone replacement clinics, are doing and saying, "Hey, your labs are funny. You've got these symptoms. Here you go." You feel better, out the door. That's certainly an option. And in some of the guys that are really, really bad off, we do start initiation with prescriptions sooner than later.

Dr. Mark Holthouse:

However, it's really unfortunate because there's a huge group of guys that we're seeing, probably 60-70 percent of those type of gentlemen that present that way, who are able to do things like work on a good eight hours of sleep, change the way they're eating, manage their stress, look at specific toxins that might be affecting their endocrine system, evaluate their prediabetes, so their high glucose numbers. And those things are all these knobs that you can turn. And often, when you recheck them three months later, their levels that they've presented with initially that were subpar or 10 percent, like you said, are suddenly up [in the] 30, 40, 50-percentile.

Dr. Mark Holthouse:

And you know, they get all excited because you haven't then committed them to essentially a lifetime of testosterone, or Clomid, or some of these other prescription options that are available for guys. So that's the fun part of what we get to do. And it's not unlike what we do with the women and hormones, where we start there with gut health, with diet, with stress, with sleep, with toxic burden. But these are all the things that kind of just get leapfrogged over and ignored often. And so, it's exciting to be able to offer a more complete package for these folks.

Dr. Robert Rountree:

Let me ask you a question: Is there a direct relationship between the amount of exercise one does and testosterone levels? And I bring this up because I remember back in the Lance Armstrong days, and I can't remember the other guy that got nailed for having super high testosterone metabolites, and he said up and down, "Well, my testosterone's up just because I was vigorously exercising." What kind of relationship is there between the amount of exercise you do? What kind of exercise? Does it matter whether you're weight-lifting or riding in the Tour de France? Is this a direct relationship or what is it?

Dr. Mark Holthouse:

Yeah, yeah. It matters what type of movement you do. And I love the word “movement” because exercise kind of sounds like “diet” to me. I immediately get rebellious thoughts, and as do my patients. But exactly. There's a way to go about this that seems to be more tightly correlated. So we know there's several different types of testosterone in the body. It exists in several different forms. One of them is the total, which is bound up to proteins that chaperone them in the blood. The other one is unbound, it's called the free T, free testosterone. Come to find out that he and one other, called dihydrotestosterone, do most of the heavy lifting. And there are certain activities that seem to go after raising the free, more active version, than the total.

Dr. Mark Holthouse:

But we know both cardiovascular, aerobic-type exercises can help in addition to strength training and resistance-type training. What I tell my guys, when I do a prescription for exercise or for a movement, I'll say, "Look, there's two things that will really help move the needle for you. And one of them, is if you're going to do aerobic exercise or cardiovascular stuff, do it in shorter bursts. This thing of getting on a treadmill or a stair stepper and slogging away with a 45 to 60 minute suffer fest is really promoting more oxidative [stress] and inflammation and not as much help with T as if you were to do these, well they call them Tabata drills or HIIT, high intensity interval...yeah, exactly. And you know, so that can be seven minutes.”

Dr. Robert Rountree:

HIIT me! HIIT me, for seven minutes.

Dr. Mark Holthouse:

HIIT me hard. And so they'll do that maybe twice a week because that's a all-out effort for a minute or so and recovering for a minute or two, and then you're doing this on and off for seven, eight, 15 minutes, something like this, just a couple times a week, because that takes a lot out of you to recover. What they're really going to want to focus on is the strength training. And I have them do that four days a week. Again, you don't have to spend two hours, you know, looking at your biceps with the Gold's Gym crowd, a day. You can basically go and get in with a group of folks. I recommend groups training where there's a trainer, that's kind of working with several folks. It's most cost-effective that way.

Dr. Mark Holthouse:

But more importantly, they're going to say, "Mark, stop lifting that way. Your form is awful. You're going to end up with a lumbar disc herniation if you keep doing that." So having someone that's going through battle ropes, kettle bells, good old-fashioned push-ups, working on core, doing things in the gym, on the floor where someone's observing you, that's what I usually recommend. And these are the guys that get into shape and a fitness level that is really complementary to making this T safe.

Dr. Robert Rountree:

And so when you've seen people really stick with the program, have their free testosterone levels gone up as a result of that?

Dr. Mark Holthouse:

Absolutely. You know, it's one of those things that you kind of learn about and you teach about and you talk about, but you're not really sure until you see it in action. And I'm always amazed, when I recheck their labs, you know, I'm having them sign their consent for testosterone therapy in my mind. And they come back and it's like a different person. And I saw somebody this week whose initial testosterones were in the 200s who came back in the 500s. And I honestly had thought I'd started them on T, and no.

Dr. Robert Rountree:

You're responding really well to the shots! Yeah. Except you haven't started them.

Dr. Mark Holthouse:

You have to read the chart before you go in, because some of these people have that good of results with just lifestyle.

Dr. Robert Rountree:

Wow. Now, what is the relationship between insulin and testosterone, if there is one? Can you talk about that? And if there is a relationship, what are the factors that make your insulin go up or go down?

Dr. Mark Holthouse:

Right. So we know that as we age, in guys in particular, but this is true in both men and women, that we become more fat and less muscular, just to put it bluntly.

Dr. Robert Rountree:

It's just the way it is.

Dr. Mark Holthouse:

It's kind of the way it is. And we have this fancy name we give it so we can bill insurance called sarcopenia, which just means we're losing muscle. And associated with this are things like increases in certain enzymes in our body, aromatase being one of them, that makes our testosterone become estrogen.

Dr. Robert Rountree:

It's bad.

Dr. Mark Holthouse:

That's a bad thing. We like a little bit of it. We need enough around to keep our bones and there are some good cardiovascular things that it does for us. But it's like oxygen, you know, you need enough to survive and be healthy, but too much can kill you. So we try to look at these relationships of things that are changing physiologically, some of them prematurely because we've eaten poorly or we've made poor choices with lifestyle.

Dr. Mark Holthouse:

And so, you start seeing these symptoms of premature aging. One of them is this gradual increase in body fat, tummy fat, in particular, which tends to upregulate — not just this aromatase and this hormone dysregulation — what we call estrogen dominance in guys in middle age. But also we have a pro-inflammatory state that starts to occur as we increase in girth. And when this happens, the insulin that the pancreas makes stops working as well at the level of the cell, in particular at the skeletal muscles, but all over the body. I mean, in the brain and in the ovaries, and there's things with polycystic ovarian that we won't get into today, that are affected this way, in addition to the liver. And the liver is this huge furnace, if you will, that kind of decides what to do with fat and with energy. And insulin is this cruel general, who's overseeing everything and saying who can go to the liver to be a contributor to the party of making energy.

Dr. Mark Holthouse:

And so when he's around, that's very, very difficult to do, having a high insulin state. So we've got data now that's mostly associative data. There are some early studies, the one in particular in January 21 out in Australia, two-year trial that looked at giving testosterone to guys that were either prediabetic or already diabetic. In other words, they had high insulin levels versus folks that didn't receive the testosterone therapy. So they were comparing against these controls. And what we found is that we were able to, at the end of the two-year period, see a significant difference in the number of cases of type 2 diabetes, the number of cases of prediabetes that progressed to full-on type 2 diabetes. And this is some of the earliest data now, that's showing that there's certainly an association, a negative one between having prediabetes or too much insulin around and having low T.

Dr. Mark Holthouse:

So yeah, it's a body of literature that's exploding. And we see that there's about a 30 to 50 percent prevalence in diabetic folks having low T. It's unbelievably high. Now, that's an association, it's a correlation, it's not a causation. We're looking at studies that aren't of the makeup that necessarily tell us to that degree. But my goodness, there's a lot of smoke here. I think there's also, we're going to find that there's causation someday.

Dr. Robert Rountree:

Yeah. I've actually been a little surprised in that I've had patients who were prediabetic and they were seeing an endocrinologist, or they had low testosterone andthey were seeing reproductive hormone specialists. And it seemed like they're two different silos, right?

Dr. Mark Holthouse

Exactly.

Dr. Robert Rountree

This one group of specialists that look at your reproductive hormones, your testosterone, your estrogen, and they don't even really talk about your blood sugar and how that could be influencing all of this.

Dr. Mark Holthouse:

Exactly. They don't make the connection. Even as a family practitioner, historically, I never talked about the two. I was more involved with the statins and the ACE inhibitor and the blood pressure drugs that they were supposed to be on. So it's largely something that... it's not a connection that's made. And it's huge. I mean, if you think about that, nearly half of all type 2 diabetics have low T.

Dr. Robert Rountree:

Really? Half?

Dr. Mark Holthouse:

Yeah, 30 to 50 percent of them, the prevalence of a low T is that high. And these are not the guys that have testicular failure, this is a type of low testosterone where the brain is not getting the message to the testicles to make the product, make T. So it's this secondary type that's 85 percent of all low T that seems to be associated with lifestyle, diabetes and obesity leading the pack at about 50 percent prevalence rate for both those problems.

Dr. Robert Rountree:

So the solution is to lower the blood sugar, to decrease the belly fat, decrease that unseen muscle fat — the marbling in the tissue that tastes so good in a steak — that is not what you want in your thigh muscles or your biceps. That's hidden sarcopenia, really, is the marbling where it's like your muscles look okay, but if you did a MRI, your muscles are going to go, “Wow, that looks like a T-bone there.”

Dr. Mark Holthouse:

A tasty steak.

Dr. Robert Rountree:

A tasty steak.!So lowering the belly fat, increasing exercise, really revving up metabolism.

Dr. Mark Holthouse:

Exactly. And I always tell folks, you know,they're terrified that I'm going to take their T-bone, their steak, their, here in Idaho— their elk — away from them. And I say, "Absolutely not. What I might take away from you though, is your bagels and your burrito, you know, your bread and your pasta and all of the stuff that we know we give geese to make fatty liver that we feed them dextrose with a funnel down their poor little throats."

Dr. Robert Rountree:

Yeah, we know how to make foie gras, as they say. We know how to make foie gras. We just give them grains.

Dr. Mark Holthouse:

Right. So I always say, “It's going to be high insulin and tummy fat along with a lot of stress, cortisol.” Those are my three legs of the kryptonite stool, if you will, for lowering testosterone and just doing away with it. So we reverse-engineer those three areas and voila! They come back with these big changes. And they're happy because they don't have to shoot themselves twice a week or spend a lot of money on pellets or things like that.

Dr. Robert Rountree:

So the really interesting thing that I want to reiterate before we take a break is that somebody can show up in your office with low testosterone. And you may say, “Well, rather than treating that, let's go deeper and let's do something to make your insulin work better. You know, let's improve your blood sugar. Let's improve your diet and voila! Your testosterone level goes up and all the things you were concerned about — the fatigue, the low libido — all those things start to reverse themselves on their own.

Dr. Mark Holthouse:

That's exactly right. And it's step one of every client that comes to the clinic. We always start there. You know, some of these guys will get an initial lab that's below 200 for their total testosterone.

Dr. Robert Rountree:

And you're like, "Oh boy, okay."

Dr. Mark Holthouse:

Yeah, exactly. They're suffering. And you know, we always will treat them individually and sometimes we get them rolling on a prescription sooner than later. But it doesn't, I always tell them, get them off the hook for doing all these other things.

Dr. Robert Rountree:

Great. Well, let's take a break. And then when we come back, we're going to be answering some questions that have come in from our listeners.

Dr. Robert Rountree:

Hello, this is Dr. Robert Rountree, your host of the Thorne Podcast. Do you have a health topic you want covered or a question you want answered on the show? Then reach out to us on Instagram and we'll try and cover it in a future episode. Also, don't forget to subscribe to the show through your favorite podcast app. Subscribing to the show enables you to stay up to date on the latest in medical research, follow the next big ideas in health and technology, and get insights from experts on common health concerns. Subscribe today through the podcast app of your choice. Thanks for listening. Now, let's get back to the show.

Dr. Robert Rountree:

And we're back. So now it's time to answer some questions that have been submitted by our community. The first question this week comes from a listener who asks, “Are there supplements that are good for testosterone?” And I assume this person is, you know, talking about your typical herbal product. You certainly see a lot of those advertised on the internet. And this kind of ties in with what we were talking about before the break. Do you focus on those supplements to raise your testosterone or do you instead, focus on things like berberine, just to throw in a little plug? Would you work more on the insulin resistance part of the problem? Which direction do you go in?

Dr. Mark Holthouse:

Yeah, that's a great question. I always preface this part of the plan and the planning with saying, "Look, the supplements are great. They can really help move things along, but don't think they're magic pills over and above the lifestyle changes." The things that we've been talking about earlier. My rock stars, my workhorses, if you will, for naturally raising testosterone might seem misdirected to some, but it hopefully will make sense when we make these connections. Berberine, you mentioned Bob, is one of the best things we've got going, because it helps not only with controlling glucose, but also with lipids. And it can help with something that we've not talked about, leptin resistance. It can help with indirectly raising T by improving this insulin resistance and improving glycemic control, which is the actual glucose in the blood itself.

Dr. Mark Holthouse:

The other one I love to use is the trace mineral, chromium. Chromium's great because it will help with utilization of glucose and the whole process of insulin and glucose regulation. It's one of those kind of magic trace minerals. Magnesium, what doesn't magnesium work for? It catalyzes 300 enzymes we know about. It's an amazing thing in the Kreb cycle. It's absolutely necessary for energy metabolism and therefore, insulin resistance and therefore, T. So you kind of follow the bouncing ball with these chemical pathways. Along with that is your Bs, your B complexes. B3 and B2 in particular, when we're talking about mitochondrial health and where are the hormones made, but in the mitochondria. So we're also supporting mitochondria in addition to healthy blood sugar and insulin when we're talking about trying to raise T naturally. So Mg, Bs, berberine, chromium, these are kind of your rock stars with nutritional micronutrients, in addition to some botanicals.

Dr. Mark Holthouse:

One of the other ones that I just can't forget because it's one of these things that I almost think should be in the water, and that's curcumin. Curcumin has so much benefit, kind of like omega-3 fish oil. I think pretty much everyone in my practice, the joke is if you've seen Holthouse and you're not on magnesium, fish oil and curcumin, we don't think you've actually been in the room with him. So it is that much of an emphasis.

Dr. Robert Rountree:

So that's why you have that yellow stain on your hands.

Dr. Mark Holthouse:

Exactly. My teeth are completely yellow and I have yellow hands at all times because of curcumin. No, it's one of my go-to's for sure. And specifically, when you're talking about botanicals and micronutrients helping with raising T, you can't miss zinc. Zinc is one of those things, like vitamin D, that's very, very important in making testosterone. So it's always in most men's health formulations. We know that it's Tribulus terrestris, which is a mouthful, not something you want to take if you've had more than a couple of drinks, because people might misunderstand you.

Dr. Robert Rountree:

Yeah, yeah, yeah!

Dr. Mark Holthouse:

But Tribulus [terrestris] is interesting because it's historically been used anecdotally for helping testosterone. In the actual medical literature, when you look at these great big systematic Cochrane reviews and these databases we all look at, there's not as much support in the literature for actually raising T as there is for improving sperm quality. And so we use that. We use another product called maca, either black or yellow maca. It's this...

Dr. Robert Rountree:

Peruvian stuff.

Dr. Mark Holthouse:

Yeah. Peruvian ginseng, we call it. Grows at 4,000 meters and this stuff comes in different colors. The red one supposedly shrinks the prostates in rodents. Doesn't do a whole lot for humans that we've seen in trials. But the black and the yellow maca are known to really help with sperm quality and things like that, and things like adaptogens and energy and mood and things like that.

Dr. Mark Holthouse:

What really tends to, in the literature, be supported mostly for raising T in the botanical world is ashwagandha. Ashwagandha — usually 500 milligrams, a minimum of three a day, 1,500 milligrams in the studies that I've seen — along with something called Mucuna [pruriens].

Dr. Robert Rountree:

Mucuna pruriens.

Dr. Mark Holthouse:

Yes, yes. We affectionately call it “Mucuna Matata.” And you're going to feel better. There's data sets that show after as little as 12 weeks, three months, using doses of these, they're both roots, products that you can see significant increases in total and free T. So most of my guys that are trying to avoid prescriptions, we've got them on those two. The other that is out there is black... let's see, not [inaudible 00:29:29], but it's a black-

Dr. Robert Rountree:

Black cumin?

Dr. Mark Holthouse:

Black cumin, yeah. Nigella sativa. And this has been shown in the studies as well as fenugreek. Fenugreek, the black seed, and ashwagandha and Mucuna [pruriens], these are the ones that have the best literature, if you look at meta-Cochrane review database kinds of things.

Dr. Robert Rountree:

Wow. So there are actually a lot of options out there.

Dr. Mark Holthouse:

There are, there are. They’re additive to the lifestyle. In and of themselves, you know, they have smaller leverage points. That's been my experience.

Dr. Robert Rountree:

Well, I see, I'm looking at the next three questions and I think I might roll them all together, because I think they're all part of the same general question. So the first one is, “What are the warning signs of insulin resistance?” So how do you know you have it? Part B is, “Well, if you do have it, how should you change your diet? What food should you avoid, or maybe what food should you include?” And then kind of a corollary, “How do I fix this, naturally?” Person is saying, "Well, I went to my mainstream doctor who said, 'Well, take metformin.'" Or maybe even, “Take insulin, you've got insulin resistance, so let's give you more of the thing you're resistant to, right?”Which is probably going to make the person fatter. But that's a different aside. So all of these things kind of roll together. “How do I know I have it?” “What do I do about it dietarily?” “And what else can I take?” Which kind of overlaps with what we're saying before with the berberine and the chromium. But if you have anything else you want to add there, would be great.

Dr. Mark Holthouse:

Right, right. You could add [Coenzyme Q10] (CoQ10), you could add alpha-lipoic acid. You could add several other kinds of supplements. The way you know you've got it is usually based on lab. You're going to go in and they're going to say, "Hey, your glucose is over 100, but you don't need to worry because you're not diabetic till it's 126.” Which is very arbitrary.

Dr. Robert Rountree:

Right. “If you're not diabetic now, don't worry about it.See you later.”

Dr. Mark Holthouse:

That's right. You've run 22 miles of the marathon, so you haven't begun running yet, right? The logic there escapes me. So labs, you're going to see high fasting sugars. He might even say you've got this lab result called a hemoglobin A1C that's off, that's not quite normal, or you might have him... he might take something where you drink this awful hummingbird sweet stuff and then they check your sugars, oral glucose tolerance. There's several ways to kind of get at insulin resistance.

Dr. Mark Holthouse:

High uric acid levels, these are things that are traditionally looked at as gout risk. There's lots of ways. Looking at the cholesterol panel. If the triglyceride divided by your HDL cholesterol is two and a half or higher, you have insulin resistance. You don't even need to look at a blood sugar if you've got a basic lipid panel, cholesterol panel. So that's how we know. You can kind of guess you’re insulin-resistant if you've got these abnormal labs, if you've got that increasing tummy fat going on. Some people have this velvety brown kinds of skin changes that can occur that's associated with prediabetes. There are a lot of physical findings that can be there. As far as treating it, metformin has been the classic prescription drug to really initiate things that way to try to reverse the whole process. We do know that there's data saying that things like NAC, N-acetylcysteine —

Dr. Robert Rountree:

N-acetylcysteine.

Dr. Mark Holthouse:

Yes, yes, can do as much or even better with some of these folks. So I'll usually try things like N-acetylcysteine. It's getting a little harder to find it, but it's still around. But in addition to all of the supplements we've laid out earlier, that's certainly one that you can consider. And metformin is not the end of the world. There's a lot of people taking it for other reasons now.

Dr. Robert Rountree:

Yeah. Anti-aging.

Dr. Mark Holthouse:

Anti-aging being huge. Regenerative medicine has really grabbed ahold of this medication, and rapamycin and some other more obscure-sounding chemicals. But the point being intermittent fasting, time-restricted eating, is the ace in the hole as far as how to treat insulin resistance. If we say that high insulin and tummy fat are two of the three legs of that stool that are kryptonite to low T, then what's the antecedent to that? Well, it's intermittent fasting. Intermittent fasting, if done right, reverses all of that stuff. And it's free. You don't have to buy anyone's cuisine. The biggest frustration I see is that a lot of folks, even who’ve thought they've tried it, haven't really done it correctly. You know, they've kind of gotten half the information or they've done it partially right. Or they've been too aggressive, they've been too calorically restricted. And we know what happens with the eight television season premieres of “The Biggest Loser,” one person kept their weight off.

Dr. Robert Rountree:

Yeah. When you talk about intermittent fasting, are you talking about the typical 16 hours overnight and restricting your time of eating to about eight hours? Or, there's other variations on that, but I'm wondering if that's the one.

Dr. Mark Holthouse:

There are. Valter Longo’s — out of USC — fasting mimicking diet is a variation getting the same results. But anything that's pushing breakfast out, even an hour or two will be effective. I always tell folks, "Hey, if you're going without putting anything that's going to pop your insulin up by eating for 12 hours, you're going to get some benefit." 14's better, 16's probably a little better. But we do it slowly. We push it out maybe by an hour breakfast, your first meal, breaking that fast by an hour a week. So at five weeks, you might be at noon, assuming your last meal was at 7:30. But a lot of folks can't do the 16. And I say, "Hey, don't sweat it. If you can do 12 or 14, you're going to be making ketones, you're going to be doing things to your mitochondria that will help you make heat instead of storing calories as energy.” Which can be called fat.

Dr. Robert Rountree:

Yeah.

Dr. Mark Holthouse:

That's the ace in the hole.

Dr. Robert Rountree:

I think maybe we have time for one last question, which is kind of a way to wrap all this up, is somebody asked, “What about processing foods?” Is there a problem with processed foods that could be creating all of this stuff that we're talking about? So, I know we could probably go for hours about that, but I wonder if it's just one thing you want to leave our clients with because it kind of leads to this simple recommendation, like what if you just cut them out? So why would you want to cut out processed foods? What is it that's bad about them?

Dr. Mark Holthouse:

Yeah, so the processed foods are, are going to be calorically dense and nutritionally poor, meaning our bodies are starving yet, they're full. And this is our culture right now where we have basically filler. It's the consummate Eggo Waffle with peanut butter. I used to tell my boys, you could just put peanut butter on the Dixie paper plate and eat the plate and get the same amount of nourishment. Right?

Dr. Robert Rountree:

Yeah, yeah.

Dr. Mark Holthouse:

It's the refined grains that are devoid of fiber, that are devoid of meaningful micronutrients that we've been talking about, that have no B vitamins, that are, you know, missing so many of these seemingly unimportant trace molecules that are important at making these hormones. So we have people avoiding them, not just because they don't have much in them, but because the stuff they do have in them, which is these bad fats and simple carbohydrates. Unlike broccoli, the cookie is going to have the form of sugars that are going to promote insulin resistance, promote inflammation at many different levels in the body — the brain, the gut, the heart, everything we're talking about in the endocrine system — leading to these dysfunctional hormone levels. So I tell people, get rid of the bread sticks, and the bagels, and the tortillas.

Dr. Robert Rountree:

Pizza.

Dr. Mark Holthouse:

Yeah, you know, just make it kind of the cold cereal. Have it be when you're on vacation. You know, when you go on vacation, the Lucky Charms or whatever, that's almost too bad, I'm sorry. But yeah, you get the idea. We talk about the 80/ 20 rule where you do 20 percent of the time you can cheat a little bit, 80 percent of the time, you do the right thing. You're probably going to get the right goal and you can fake your doctor out when he does these labs. And I say, “Great, we don't want fanatics, we want sustainable lifestyle change.”

Dr. Robert Rountree:

Things you can do!

Dr. Mark Holthouse:

Change, man!

Dr. Robert Rountree

Things you can do.

Dr. Mark Holthouse:

You don't want to be that guy at the birthday party that won't have cake, you know, — ever.

Dr. Robert Rountree:

So let's be practical. Yeah.

Dr. Mark Holthouse:

Yes.

Dr. Robert Rountree:

Let's be practical.

Dr. Mark Holthouse:

Absolutely.

Dr. Robert Rountree:

So I think that's all we have time for this week. That has been actually a wonderful discussion. We've got this huge epidemic going on, that's a combination of low testosterone with all the symptoms that go with it. The low sperm counts, low stamina, fatigue, and it's totally overlapping with the belly fat, the prediabetes, etc. And you've given us some really practical ideas about how to address that. It's not just about hormones, although we're not saying hormones might not be appropriate, but there's a lot of other things that we can do. So I really want to thank you for your insights and looking forward to having you back on the show in the future. Meanwhile, if people want to follow more of your work, how do they get in touch with you? How do they want to make an appointment or that sort of thing, how do they find you?

Dr. Mark Holthouse:

Yeah, best way to go is to use our website, which is info@funmedidaho, which is kind of a fun thing.

Dr. Robert Rountree:

That's a great thing, fun med.

Dr. Mark Holthouse:

Info@funmedidaho, and that'll get you to our patient navigators that will find me.

Dr. Robert Rountree:

And they don't have to fly to Idaho to see you necessarily.

Dr. Mark Holthouse:

Not necessarily. You know, if we're talking about where the patient is at the time of the visit, we can do TeleMed. And if it's place I've got a license which currently, let's see, we've got California, Nevada, Idaho, and Oregon. So I can do TeleMed visits for folks that are in those states currently.

Dr. Robert Rountree:

Terrific. All right. Well, thanks everyone for listening and looking forward to having you listen to us next time. Bye bye now.

Dr. Robert Rountree:

Thanks for listening to the Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thornehealth. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news, videos, and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of the Thorne Podcast.

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