Dr. Rick Cohen has had 15 years of functional medicine practice and 10 years of nutritional product development. His area of expertise is men’s hormone, athletic performance, targeted nutritional supplements, optimizing key biochemical markers.
Today we’re going to be diving into the topic of testing via saliva, blood and other methods, discussing some of the best options out there and what to look for including:
- How Hormonal Problems may not be in the Hormones by the Cells
- The Role of Sex Hormone Binding Globulin
- Hormones Working Like a Symphony
- Anabolic vs. Androgenic
- What is Better for Hormone Testing, Blood or Saliva?
- The Best Way to Test Cortisol Levels
- Beware of Labs that Only Calculate Free Testosterone
- The Big 3 for Proper Cell Communication instead of Becoming Plastic on the Inside
- 3 Methods Nitric Oxide is Produced (#3 is Amazing and Little Known)
- Measuring Toxic Load with Urine
- The Liver as an Endocrine Organ and How to Test its Function
- And Much More
Find out more about Dr. Rick and his services at https://core4nutrition.com/
Click the link below to access the complete transcript.
Logan: Welcome to The Vital Way podcast. I’m Logan Christopher from Super Man Herbs here with you today. At Super Man Herbs, we really try to marry the sort of western scientific approach with eastern traditions and ancient wisdom of using the herbs. Really, I do like to focus on both of these things, although at times I may lean more towards the eastern more holistic approach. That’s because one, it’s holistic and also most people are coming from that western scientific paradigm so I feel we can help to even that out. That being said, I love science. I love getting down to the data. I like being able to look at things but it’s all just information. It all needs to be looked at in light of the bigger picture.
So on that note, today we’re going to be looking in depth about testing, different forms of it so you can see blood markers, hormone levels and all kinds of different things. Today with me to help me on this subject, we have Dr. Rick Cohen, who’s had 15 years of functional medicine practice as well as ten years of nutritional product development. His expertise is men’s hormones, athletic performance, targeted nutritional supplements and optimizing key biochemical markers. So thank for joining us, Rick.
Rick: My pleasure and happy holidays.
Rick: Absolutely. Good. Well, I’m excited. The science of hormonal assessments, I guess, as a primary point of view is something that’s a little bit of an art. It’s a little bit of, like you say, a science but it’s art and there seems to be, having done this for a good period of time now, a disconnect between what the average person understands and then even what the in-the-trenches doctor gets. Somewhere in there, there’s a place and hopefully we’ll be able to educate people on what the most important things are they should be aware of.
Logan: Absolutely. I like that you say there’s an art to it even though it’s scientific testing. A lot of people think oh, you get these markers and it’s clear as night as day but as we both know, that’s not quite the case when it comes to testing.
Rick: No. Here’s an important point. It’s a good place to start so let’s talk laboratory testing. We think it’s gold standard and yes, it’s very, very helpful. But having done enough labs, you can sometimes see one lab differ from another lab. You can see one type of assessment such as let’s say hormones, serum which gives you a certain viewpoint, versus saliva which gives you another viewpoint, versus urine which gives you another viewpoint. So depending on how you’re used to looking at things and depending on what’s going on, you can have a different perspective on the results. That’s important. That gets back to the art form.
Hopefully, we’ll educate people to understand what some numbers mean and what some key markers to pay attention to are but at the end of the day, it’s how are you feeling? When I work with people, it’s like yes, we want to improve numbers and do you have a low T but it’s really about do you have passion? Do you have motivation? Do you have energy? Do you have drive? Those are the most important and if you have those, the numbers are not so important. Even if the numbers are low, if those key markers of hormonal health are there, who cares? The numbers are numbers and while you can pay attention to them, they’re not as relevant. You can have another person whose numbers may even look better than yours but they’re having all sorts of issues. Well, that’s the person you want to be more concerned about. That’s sort of where the art form comes into play because it’s not only the numbers and this is a part that’s really missed by the non-functional medicine. The separation we call holistic or nutritional to me is functional. Western medicine takes a disease approach so if you go to your doctor for a low T, they might do one or two parameters. If you’re within that 95% bell curve, two standard—
Logan: Which is large range, right? Testosterone, yeah, like 200 to 1,000 is normal or something like that.
Rick: Yeah, and it’s only one marker, total testosterone. So if you’re within that range then you’re not considered to have a disease. You are considered normal. So that’s where the art is. What’s normal, what marker did they look at and so forth. If you’re not within that range, it’s a diagnostic illness. It used to be there was no chance in heck you were going to get testosterone and now it’s become a little bit more commercialized and there are testosterone clinics everywhere. They’ll be more willing to treat you because it becomes more of a financial decision for them. That line has grayed but from a traditional sense, if you’re not within that range you’re not going to get testosterone because you don’t have a disease.
Now as we know, people start to have issues and what I was referring back to, what’s good for one is not good for another. That’s where the art is. What do you need? Where is your imbalance? Maybe the problem—here’s another sort of key point to keep in mind—isn’t necessarily the hormone levels; it’s what those hormones are doing at the cellular level. If you think of hormones as messengers—that’s a key component: a hormone is a messenger that the brain uses to send a message to the cell for the cell to have an action then the cell’s receptors are responsible for translating that message into action; testosterone has a number of actions—there could be plenty of messengers out there but for some reason the cell, due to nutritional imbalances or cell membrane deficiencies of essential fatty acids to vitamin D, doesn’t get that message. So you need to turn up the message really loud. You need to have a much higher hormone level to get that across where if that cell is really healthy, then you don’t need as loud a message.
So the analogy I used to use for—and I still do—for clients is hey, you’re trying to talk to your teenage child before when they used to blare the stereos. I don’t know if that happens anymore but it used to be that hey, you’re playing—gosh, am I that old?—album really loud, my Led Zeppelin form the ‘80s.
Logan: You put the record on the thing, right?
Rick: I put the record on and my mom’s trying to knock at the door and she can’t just and eventually someone’s got to knock really, really loud and I finally hear them and maybe I’ll turn down the music. If I’m just zoning out or just playing something nice and light, it doesn’t take a loud knock at the door for me to make a change. That’s a real simplistic analogy but it can be true. We’ve seen people whose levels of hormones are high and they have all the symptoms that you would say are low T and those who are not so high and they’re doing great. And also, they will fluctuate.
We work with a lot of athletes, if you take an athlete who’s in the middle of their triathlon season and they’re pushing really hard and you start measuring testosterone, they’re going to be low. Now that’s not a good thing but we know the cause. We know they’re either training too hard or they’re pushing too hard but they’re still doing okay. So it’s almost their reserve, their bank of hormones and they know they can go so far, they kept going hard for a period of time, they’re going to start to notice it. So they can push so far but then they need a break to recover. This is where recovery comes in. Whether it’s recovery after a workout or recovery after a season, you need to recharge. As we get older, it’s harder to do that.
So if I took a one point in time in that person, and we’ve seen these, the guy’s testosterone, we’ll just use total testosterone because there’s total testosterone, there’s free testosterone and there’s bioavailable testosterone and they’re all a little bit different. I guess just a corollary, total testosterone is how much your testicles, which is production facility, make. Now that doesn’t mean how much is actually getting to the cell so that’s another scenario. But this guy who’s under stress, in this case physically, their total testosterone instead of being on the higher range—we mentioned before 350 to say 1,000, depending on the lab—they might be 700 or 800 off season but now they’re 400. That’s not good but is it something of major concern? Depending on how they’re doing, depending on what you’re supporting them, depending if they can come back and recover.
I know we just went through a lot of information but I think it gives people who listen to this the opportunity to say whoa, this is not as simple as I could check this number and I’m good or bad. No. That’s where the art for it comes in and that’s where having some experience—I think experience is knowing when to do something; experience is knowing when not to do something, like this is not an issue, don’t worry about it, you should pay attention to it—I just spoke with someone this week. He’s an older gentlemen. His testosterone is low but he’s doing well. He’s in his mid-70s and he doesn’t have major issues. He’s almost in that hypogonadal issue but he has other things going on. He has a low vitamin D and a low omega-3. He’s got some inflammation. So it’s much better to address those issues first and that’s where the functional comes in. We’re going to address why and address issues that could be causing the problem because a low vitamin D is definitely related to low free testosterone or a low or poor omega-3/omega-6 balance is going to affect the cell membrane. That cell membrane is really the brain of the cell and that’s the component that the hormones need to connect up with. So he’d be much better off, and that’s what we decided, if we’re going to work on that and sort of see what happens with him. There’s no reason for him to start throwing it—he might be someone for some pine pollen, right?
Rick: Supportive, adaptogen—
Logan: But the pine pollen won’t help if you really don’t have those critical nutrients in the first place. It may help but you’re not going to really fix a problem that’s caused by lack of things like vitamin D and omega-3, as you mentioned.
Rick: Right. That’s where you get sort of the synergism. It works together really well. You can go and here’s the caveat, it’s sort of again the art form, at what point do you in functional medicine, and it’s the thing that’s sometimes frustrating for me because sometimes it’s really easy because you know what to look for. It’s like the plumber coming in and he knows what to look for. Anyone who has a skill—what I do is sort of an experiential skill set based on knowledge, right—you know what to look for. You know what the patterns are and 80% to 90% of the time, some patterns are a pretty easy fix. The cool thing is the body sort of knows what to do if you do the right things to it, if you rest, you recover, you eat well and you do the right physical activity. So if it’s generally healthy, it’ll figure it out. It knows a lot better than we do.
So the challenge though is that you really get stuck with it and those are the hard ones at some point, depending on the person’s age, depending on how bad they feel, that’s the person that may consider hey, I’m just going to go to a replacement. Because when you go into replacement, you’re buying something for your life, for the most part. You’re not fixing anything. It’s very much a symptomatic therapy. In fact, there’s a place for it sometimes. For injury, we’ve used hormonal replacement for people coming off of or going through surgery. You say okay, we’re going to do this for three months because you’d be getting that anabolic reserve. You’re just going to keep that high and it’s going to help the body recover quicker. It’s one of the reasons that when you’re 20, 23 or 25, athlete, you recover quicker. The next day you’re back up and around where if you’re 45 or 50, you’re out for three weeks. So again there’s a place for that but for someone with a low testosterone at 30, if they haven’t had any injury or an infection, do you really want to be on testosterone?
Logan: Yeah, that’s not the first thing to go to, kind of like surgery tends to be the first-go to for many people.
Rick: So let’s see now from a medical western, but what other choices do you have? You go to your doctor, anyone out there, what other choice is he going to give you? It’s like either you’re normal, or maybe you need to relax, or get some exercise, or lose some weight or okay, here’s some testosterone and maybe a more sophisticated doc would try some HCG, which is human chorionic gonadotropin which actually stimulates the testes to produce testosterone. That’s more sophisticated and that’s what a more educated and experienced guy will do. But a traditional internist, even an endocrinologist, it’s testosterone or nothing. That’s where functional health and the use of some herbs that can be tailored to someone’s particular need can be really powerful.
Circling back, what is that need? Where does the problem lie? Is it a low total testosterone or you’re not producing enough? Is it too much estrogen because you’re exposed to receipts or chemicals or plastics and BPA, cosmetic lotions or things that you’re using, or you have extra body fat, or you’re taking meds that are affecting your liver? So high estrogen can be an issue as a primary cause for people. Or is it you’re making enough testosterone but there’s something going on that’s raising the protein called sex hormone-binding globulin. It’s a marker that you can check and what that protein does it’s it holds onto testosterone. I guess the backdrop is your testes which we mentioned produced testosterone under a signal from your brain and the two hormones, one is luteinizing hormone, the main hormone, that your brain like a thermostat does sends a signal to your testes when it senses total testosterone is low. It’ll get turned off and on but it can also get turned off by estrogen as well. That’s one of the negative feedback that the body uses as how much estrogen. So it can be a problem. That’s why high estrogen can drive down testosterone and if you block estrogen or you can fix that problem, testosterone can bounce up.
So testosterone is signaled to be produced in the testes by the brain and then you get this total testosterone. You get it released. Well, your body knows better than to have this flood of testosterone floating around in the serum. It uses a protein and what that protein does, which is produced in the liver—and the liver can have issues—it’s a blinding globulin. It actually holds to anywhere from 97% to 99% of the testosterone in your body. It just sort of keeps it in reserve and it’ll fluctuate and release. Here’s the important point – that amount that’s sort of in reserve and maybe is on the bus or is in storage or in your military reserves, however you want to think of it, is not on call for duty. It’s not active. It’s your inactive reserves. It’s the other 1% to 3% that are out there sort of telling your cell what to do. If the amount of that protein is too high, it’s going to keep all those much higher percent of your total testosterone inactive and that’s where the problem is. So you can see a good total testosterone, high numbers, but you have very little active. That’s what we call the free testosterone.
Logan: I have a question around that, regarding the sex hormone-binding globulin because obviously it has a positive function in the body but largely people have been focusing on it and because it does get too high and we may have a good total testosterone but our free testosterone is not good. Is the function of the sex hormone-binding globulin just to transport testosterone around the body? I know it binds to the other sex hormones as well, hence the name.
Rick: Correct. That’s right. It’s a transport. I view it is a transport and a regulator. So yes, it’s taking it to where it needs to go so you’re not just having free testosterone. So it can more directly control that and also can regulate it by increasing or decreasing There are certain mechanisms that will trigger to produce more of this protein and I think it does that to control how much testosterone the body has. Sometimes, there are some of the physiological reactions that honestly I haven’t quite—I’ve sort of said, why is the body doing?
Logan: It’s complex, right? That brings me to another question. Part of this art form of looking at the testing, one thing you’re saying like if a normal doctor will just like measure your testosterone, maybe your estradiol, like one in—
Rick: I would say 1 in 100 will look actually at estradiol.
Logan: So really, the hormones, it’s more like a symphony, right? There are way more hormones that we even talk about. You have all these precursors and different steps going on. Does having many more of the markers give you a better idea of how the endocrine system is functioning overall so when you have not just testosterone but DHT, estradiol, estrone, DHEA, cortisol levels, prolactin, FSH, luteinizing hormone, all this stuff, does that give you a much fuller picture with which you can then get better snapshot of what people are?
Rick: Totally. Absolutely. Throw in thyroid there, too because they’re all going to interact. Let’s say no one ever bothered to look at a functional thyroid marker. Let’s say your thyroid’s off or it’s trending slugging, well maybe that’s a core foundation. Maybe that’s where the issue lies and if we never bothered to look at it, how do you know? Like you say, maybe DHEA is depleted and that will give us an indicator of stress and sort of the body just churning things up. DHEA is a precursor to testosterone or DHEA becomes androstenedione which then becomes testosterone and testosterone becomes DHT, which can be a feedback. That’s called dihydrotestosterone and DHT is very androgenic. It’s very powerful in sort of the sexual traits where testosterone is more of a mix.
Just to give you the flip side, the anabolic hormones which are some of the synthetic ones, have very little androgen and that’s why they were pharmaceutically developed. It’s because you didn’t want the excess hair or male pattern baldness or effects on the prostate, anything that would be the secondary sexual characteristics. The idea is to use the anabolics which had more of the strong, positive strength recovery gains that are present in testosterone, which are great. They really have tremendous use in cancer, AIDS and recovery. Unfortunately—and this is my political hat—they were abused by some people and because of abuse per se in sports, it became politically bad. That doesn’t mean that they’re not good for you when they’re done properly in right situation. Anything can be harmful to the body. We tend to demonize. I don’t know if it’s our American way. We pick something, we say that’s bad and forget everything about it that probably is good.
Rick: So anabolic hormones are what? Testosterone. Testosterone is anabolic and androgenic. DHT is more androgenic and certain other forms of testosterone are more anabolic. That’s one way to do that.
Logan: A question regarding the hormones, before you talked about the different types of tests and I know there is no clear answer to what is best, saliva, blood or urine but how do you look at which test it’s going to be the most appropriate for?
Rick: It comes down to practicality. It’s depending on where a person is. If you wanted a full evaluation, the full serum because there are certain markers that you can’t see in saliva and urine because they’re protein-bound. So while there can be some things you might miss in serum that you would find in saliva, doing a serum first firsthand and even better would be a simple saliva to correlate the testosterone and estradiol to make sure that there’s a safe line, they’re in same range, I guess. There’s a translation. Because sometimes, serum and saliva don’t jive and that’s another part of the art form. Doing a full serum assessment to look at the thyroid and those other brain markers such as FSH, SHBG and so forth is the best way to go.
Logan: And just for people that don’t go, serum refers to blood. I’m not sure everyone is familiar with that term.
Rick: Right. Correct. Now at the same time, if you really wanted a full and there were signs of some adrenal or stress, you want to do a saliva because the ideal way to do adrenal is through four saliva samples throughout the day. So you want to see that full circadian rhythm. You want to check one in the morning, you want to check one at noon, mid-afternoon and then at bedtime. You can’t do that with serum. It’s not practical and actually sometimes the actual blood draw has a stress effect.
Logan: That brings up a question. Is the blood test really just a snapshot in time versus a longer term picture? Is cortisol one of these more unique cases and that’s why we’re looking at it four times throughout the day? But don’t all these hormones kind of have some sort of rhythm?
Rick: They do. We know that testosterone, for example, is higher in the morning than it is later during the day and there is actually one lab which we’ll use occasionally that will take that four-saliva sample and give an average. They feel that it gives you a better overall marker of testosterone throughout the day as opposed to just the morning. I’m not sure if that’s always the case but in general. So yes, testosterone can vary day to day. Testosterone can vary after a race. It can vary if your team won at a sporting event. It would go down if you lose.
Logan: Right. So on that note, because testing is somewhat expensive and not everyone can afford to do it hundreds of times or anything like that so they go and get a serum test. They get their testosterone. The numbers are looking a little low but they don’t realize that maybe it’s because it’s later in the day or they had some issues last night, which tanked their testosterone. So they go and get this test and then they base things they do in their lifestyle off of that, does that happen? Is that a problem?
Rick: Less so. If you’re going to do a serum, the other markers are not going to change. So if you’re looking at serum prolactin or LH and the HSBG, the binding proteins, they’re not going to change that much. Total testosterone is just a little more stable so that’s a good thing about it but it doesn’t have the flexibility of the saliva. That’s sort of where the art form comes in.
And yes, cost is a role. If someone wanted to just check things quickly, they can do a saliva, just looking at testosterone and estradiol. The thing to be aware of when you do saliva, because proteins don’t filtrate into the saliva from the serum, you don’t look at total. It’s always the bioavailable and that’s why certain protein-bound markers or larger markers can’t be assessed in saliva. That’s why they’re not exactly the same. You’re seeing what correlates. That’s just something to be aware of. So you can never compare total testosterone in the blood to what you’ll see in the saliva. But you can, and we’ve seen that regularly, most of the time if you take the range of where someone’s saliva comes in, let’s say their saliva range might be, depending on the lab, anywhere from 30 to 90 and let’s say they come smack dab in the middle at 60 or 55 so it’s 50% and then you go to see where their free testosterone comes up in serum, typically that’ll be right smack dab in the middle. The units are different because you’re looking at a slightly different hormone with slightly different total amounts so you can’t compare them exactly.
The other thing, not to confuse us but just to understand how important it is to have experience and knowing this, is certain serum labs or certain diagnostic laboratories, when you’re doing a blood test—like we said, before most of the time they’re just looking at total testosterone—you can go to a lab and even if you’re a doctor, if you’re lucky we’ll do a free testosterone, sometimes that lab is actually not measuring it. They’re doing a calculation and that can be inaccurate at times.
So typically, and this is what I say getting back to it’s good to have a marker, you could start with a simple testosterone and estradiol, just to be curious where you are especially if you’re having issues. If nothing’s severe or you really want to check in, a more comprehensive saliva exam or evaluation that will tell your testosterone, estradiol, DHEA, DHT and androstenedione will give you a more complete picture. That’s a good place to start for someone that’s concerned and wants to get a better idea of what’s going on. That’s more affordable, somewhere in mid-hundreds cost. Then if there’s an issue, after that you could do a more comprehensive serum to sort of get a sense of thyroid or adrenal and so forth. That’s sort of the approach that we’ll take.
Logan: So is that the good starting place for most people?
Rick: That’s a good starting place for most people, that mid-range saliva because also you can add in a cortisol to that. Since you’re already doing four examples, you just throw in the cortisol so it gives you an adrenal picture. It doesn’t give the thyroid picture which you would need a blood test for. But if the test comes back good and it’s not an issue and you don’t have classic thyroid signs, sluggishness, constipation, dry skin, things of that sort then it’s probably not something you need to look at right away. These are all sort of good functional assessments to evaluate and it sort of gets back to the difference between looking for disease, we’re going to pick out if something’s really wrong or functionally looking for trends and then taking those functional imbalances and say, well how can I track what I’m doing?
What’s nice though once you’ve done that serum or mid-range saliva and you pick up the markers that are off, you don’t need to check everything all the time. You could just track, you could use the saliva if you know it’s correlating well for you and someone could say all right, I’m going to start taking—maybe I’ll take my D and omega-three because I’ve checked that and I’m taking tongkat ali and I’m taking pine pollen or some fenugreek or nettles or whatever it might be to work on doing some botanical herbal support. You can do a quick saliva for testosterone and estradiol relatively inexpensively. If you track that with hey, how am I feeling, how am I doing in the morning, what’s my passion and libido and ultimately at the end of the day, that’s helpful. That’s not helpful; it’s most important. But knowing the numbers can help guide you. And vice versa, most people are going to just start taking stuff and then you wind up taking things and maybe you’re not taking what you need. Like you said, maybe pine pollen’s great. I love it but if you’re missing certain factors, it’s not going to give you the results where all you needed to do was do a few other little things and then it’s going to work really well. So to say that it was a failure isn’t really a correct statement. It just wasn’t sequenced properly.
Logan: Right. Yeah, you really need to focus on all the different micronutrients. I guess we’re going to go back to talking about the cell membrane a little bit. You mentioned that the omega fatty acids are important for sort of the cell signaling at that level. What are some other things people might do to make sure that their cell membranes are communicating properly, that these receptor sites are working so that the hormones are docking and the cells are listening?
Rick: There are lots of things you can do but the big three are sufficient omega-3 fatty acids so really optimizing, getting away from the unrefined processed fats, using some coconut oil or some grass-fed butter. The cell membrane has saturated fat.
Logan: It’s largely made of that, right?
Rick: It’s actually made of cholesterol essentially. Well, we need that and when we start to decrease that or not have enough, we get unhealthy cell membranes. Actually, if we’re using trans-fats or processed fats or heated fats, that gets incorporated into the cell membrane.
Logan: Right. We’re plastic on the inside.
Rick: There is that.
Logan: America basically is what is happening so it’s no wonder that cells aren’t communicating so well.
Rick: That is probably far and away the biggest thing that someone could do is to really nail that.
Logan: I’ve heard it described as an oil change and it takes some time, like two years for your body to really be switching out some of these cells.
Rick: Correct. You can monitor that, too. There’s an old saying you can’t fix what you don’t measure. With essential fats, everyone’s a little bit different. The absorption is a little bit different so you can start to track and you can do it through a simple finger stick. Relatively inexpensively sort of track okay, I’m going to take a couple of grams of an EPA/DHEA combination. I’m going to really watch, having eliminated as much processed fats as possible. I’m going to eat good and healthy. I’m not going to worry about some clean butter. I’m not going to worry about eating eggs. Those are the common—
Logan: Your cells are made of fat and your hormones are made of cholesterol.
Rick: You got it. So we were fed something that was incorrect. But then you could do a whole blood stick and it’ll look at your red cell membrane and it’ll say hey, your omega-3 percent is 10% to 12% and that’s where we want it to be. The ratio of omega-3 to omega-6 in your blood is 3:1. Great. The inflammatory ratio of something called arachidonic acid to the EPA, which is the healthy omega-3 that we want is 3:1 and that’s great. A typical American population we’ll see an arachidonic acid of 15 to 20:1, we’ll see omega-6 to omega-3 ratio 10:1, we’ll see an omega-3 index or percent probably 4%. So we’re significantly depleted in omega-3 fat so that’s a powerful thing to focus on.
The other two for me is vitamin D and K because those are just part of the genome. Whether it’s sun, and again it’s fat-driven—vitamin D is not a vitamin, necessarily; it’s sort of a misnomer. It’s required but we make it through getting sunlight and how it reacts to cholesterol in our body. So ideally sun is really critical. We can’t get enough and whether we need to support it, and most people have to default to that, it’s useful and it’s part of the whole picture. Where I get upset and where we sort of missed the boat is vitamin D became very “in vogue.” We tend to be in vogue in this country. So it became very much in a lot of studies so you have people, oh, your D is low; now you’ve got 20,000 a day. So we’re going to give you an injection.
Logan: Like anything, it can be overdone.
Rick: Correct. And you need D and K and fats and magnesium. If they’re not altogether, you can cause problems.
Logan: Imagine that.
Rick: Yeah, how about that? So when we overload on anything, it’s a problem. If you overload on coconut oil, for some people that’s a problem so balance and moderation. So D, omega-3 and the big trifecta for me is looking at nitric oxide. That’s a powerful cell communicator.
Logan: Right. Let’s go into that a bit more detail.
Logan: Can you explain what nitric oxide is doing?
Rick: Sure. Nitric oxide is a gas. Actually, there were Nobel Prize winners when it was first discovered. It was understood for years and years. We gave people nitroglycerin and heart pain went away. It’s like whoa. They didn’t know how that worked and there were actually three different researchers working at three different times that sort of tied this whole picture together but it turned out that it caused the release of this gas in the cell, this gas that lasted maybe one to two seconds and it communicated cell to cell. And what this gas does—there’s a whole variety of things—but it opens up blood vessels and improve tissue oxygenation. In the tissue, it supports immunity. It keeps the platelets slippery. It’s really powerful. It’s involved in our gut.
We actually produce it three main ways. There are certain sites in our body that produce it, depending on where the enzyme is. One of those is the lining of our arteries. That’s sort of originally the most well-known pathway. It’s called ENOS, endothelial nitric oxide synthetase. The whole idea is like loading up with arginine, the bodybuilder would to try and power that pathway to produce more nitric oxide. Now if you’re young and your arteries are healthy, you can do that pretty wall. But if you’re not, and they’re not, it’s sort of like dumping a gallon of water and trying to get it down a little pinhole. Again, you can overload. So taking 10 grams of arginine to push nitric oxide is inefficient and has problems associated with it.
We also have learned recently that another pathway is actually from nitrates. This is a whole podcast but there’s a nitrogen cycle in life. You have nitrogen in the air and it goes into the soil and the plants fixate it. We eat it and we excrete it and it just cycles around. We’re part of that nitrogen cycle but not only are we are part of the global nitrogen cycle but there’s a nitrogen cycle in our body. When we consume nitrates which are sort of fixated nitrogen from the air and plants, our body through the bacteria in our mouth actually converts those nitrates to nitrate and then nitric oxide. It sort of goes through our saliva and back into our mouths and it sort of gets recycled. Those nitrates that we eat produce nitric oxide and it turns out that’s a really powerful way to produce nitric oxide in our body and keep our health.
Well, guess what? Where are those found? All these really healthy vegetables and fruits that we’re supposed to eat, beets and kale, arugula and spinach and then they’re supported by flavonoids in pomegranate and blueberries and dark chocolate. You look at the Mediterranean diet or healthful diet, they’re rich in nitrates. You can actually assess using a little saliva strip and determine two things: one, if there’s a block in your pathway to convert the nitrates that you’re eating in your diet and two, are you getting enough. Most people just don’t get enough.
Logan: Is this the same as sodium nitrates used in cured meat?
Rick: Well, yeah. Those will affect nitric oxide. They’re synthetic as opposed to naturally vegetable-based.
Logan: Well, all the natural stuff uses the nitrates from celery instead, right?
Rick: Right. It’s a fermented celery. That’s actually celery. Celery, if you go look on folk remedies for erectile dysfunction, two of the things that you’ll see are celery juice and watermelon rind. Watermelon rind is high in citrulline. Citrulline is what arginine converted into to make nitric oxide at the cellular level. The other good one is hawthorn. There are some ones that are specifically helpful but citrulline in celery is a high source of nitrates. I try correct. Beets are better. Kale, spinach, those are even better. That’s where the whole beet trend came in, to understand how athletic performance improved with beet, or blood flow to the brain improves with beet, or blood pressure decreases with beet, or erectile dysfunction can improve using beet and other sort of blends to do that so nitric oxide. And the third pathway which sort of is the sun, it turns out that when we eat nitrates, our body cycles them into our skin when we get sun. Not only does that sun activate D but it converts to nitric oxide.
Logan: Wow. I haven’t heard that one.
Rick: Yeah, I know. It’s a relatively new one for me. It’s like wow.
Logan: Everyone is on the supplement with vitamin D and that’s good but you’re getting other things with the sun that you should be getting obviously. It’s a bit tougher to go sit in the sun with our busy lives and
Rick: Right. And that’s another. Honestly, it has to do with photons and energy and it’s something that I’m not as—it gets into quantum mechanics and ultimately if you go to a level deeper then I understand. We’re talking biochemistry but ultimately we’re all energy. Vitamin D winds up being a transporter of that energy. So if we’re not providing that energy with the sun effectively, we’re not transporting it across. So just adding D can miss the boat. If you think about magnesium—we’re talking theoretical. Anyone who understands some chemistry, if we understand where magnesium is in plant life, it’s in photosynthesis, right? Magnesium is a transfer of energy as well, the same way that the heme in the body, which is where the iron is, acts in a similar way to our system. But if you imagine magnesium playing the key role in how plants take energy, we say well, how can we transfer energy? Well, plants do it. They take photons, all this energy of light and convert it into biochemical energy. We do the same thing.
Logan: Yeah, it’s our form of photosynthesis.
Rick: We do it a little bit different but we do the same thing. It’s not where western medicine is focused. It’s knowledge-based. That’s a whole other—
Logan: Yeah, I’ve always been quite pale and never gotten the habit of getting a tan so that’s like my main health goal for 2016. Obviously, it’s the dead of winter right now and it’s pouring as we speak so I can’t start right this moment but when the sun comes out, that’s my mission. That’s my goal, get that natural sun in there.
Rick: Right, into your eyes and .
Logan: Right, those effects with melatonin and all that, too.
Rick: Correct. So if you think about how we make the cell healthier, those are some of the things that are really, really powerful to do. We’re talking a lot of theoretical and for most, we’re excited about this and maybe certain—if someone says I don’t feel so good, I want to feel better, it’s real easy to take a testosterone and check ultimately if that is. But remember that that doesn’t make you healthier and that it may make you feel better. Certainly, having a higher testosterone can reduce certain illnesses and keep signaling but ultimately, and here’s a really important point for people to realize, why the heck are testosterone levels in men 25% lower now than 30 years ago? Why is this a huge issue? Obviously, we could go into the changes in society but something or a lot of things have changed and we’re affected by them. The more you can sort of reduce that load on the body or pay attention to it sooner than later, then that’s going to be helpful. So anyone who’s younger, know your testosterone in your 20s.
Here’s another take-home that’s interesting but makes sense. Testosterone is drive, passion, fight in a high testosterone guy. There is a high testosterone, the warrior guy and women have testosterone but at a much lower level. There’s a spectrum of women with higher testosterone. There’s a spectrum of men who just naturally produce less and as it turns out, guys with higher testosterone tend to be in professions, skills or activities that are related to those, whether it’s a pro football player to the orthopedic surgeon versus the guy playing chess and the pediatrician. There is a link and there’s a link to that dominance, which is what testosterone drives and affects our brain, the actual structure of the brain. Some of that is changing with the high estrogen world.
Logan: Yeah. I feel like I’m not one of those people that was naturally born with a high testosterone. A quote we often get with some our herbs is older guys saying like I feel like I’m 18 again. I’ve heard that both framed positively as well as negatively people.
Rick: And I’ll tell you, and you don’t hear this often; it’s sort of political but there’s a large—and it’s an awareness and this is not any—but if you look at there’s a large trans gender movement now more. It’s an awareness but also we’re in a high estrogen world and a—
Logan: As a question on that, what I heard a long time ago—I forget the original source—even if we’re testing estradiol, estrone, estriol, sort of the main three estrogens in the body, what’s not going to show on those tests are things like xenoestrogens. Is that the case?
Rick: No. You could do that now. Yeah, there’s another lab. It just came out. There’s a lab I use through urine that will look at toxic load and it will look at BPA. Obviously, the easiest thing to see is if estradiol is up. But if their testosterone is lower and they really wanted to say hey, do I have a high exposure, you can do a urinary toxic load for other estrogenic and then also very specifically BPA. Actually, you can look at glyphosate now, too. I don’t know how estrogenic glyphosate is but pesticides are.
Logan: Well, people tend to throw around the word xenoestrogen and some of them act like that but many are just endocrine disrupting. In some way, they may be anti-androgenic but not be an estrogen so all kinds of different ways that they can play havoc.
Rick: Correct. And they could just be affecting the liver and that can be driving—
Logan: Yeah, you mentioned the liver before. It’s not thought of as part of the endocrine system but it pretty much is. It does so many different things as well as detoxing all of these things that have a role. Is there any sort of test that looks specifically at the liver function?
Rick: Yeah, I think in two different ways. Sorry, I was just thinking like glyphosate and drives breast cancer so not a surprise there. So the traditional liver to look at liver, and again we’ll go to western disease orientation, you look at enzymes. You look at something called AST and ALT or these GGT. Their enzymes of injury so if the liver is damaged. You’ll see with hepatitis, I’ll tend to see them when someone is really pushed hard and you’ll see enzymes elevated. There’s a similar muscle breakdown but you’ll see that in people drinking too much who tend to have slightly higher than normal liver enzymes. We’re talking not about someone with liver disease but someone who drinks a bit too much. A couple of people who are healthy, oriented but one’s a recording artist and when he goes on tour, this is sort of what they do. It was affecting him.
But that doesn’t tell us how the liver is detoxifying. To do that, you really need to look at a more sophisticated—you can look at again something called organic acids which are sort of metabolic products. That can give us a sense of the overall efficiency of the body in a variety of ways. I liken it to sort of looking at your web browser and sort of your search history. So you know what you like to look at and where you’re spending too much time and what you’re doing. Looking at organic acids can tell us a cell energy. It can tell us GI health. It can tell us detoxification in certain areas, how your liver is doing. It could tell us a variety of other factors. The most specific way though is you can actually sort of challenge your liver.
Logan: You’re not talking about binge drinking.
Rick: Yeah, but you could do. The way the liver breaks things down, it knocks some molecules. It takes this chemical and it attacks it and it makes it very reactive. But in that process, it has a step two. It tags another molecule onto it. Sulfur is one but there’s a variety of others that will tag onto it. So it becomes water-soluble.
Logan: Right. This is phase 1 and phase 2.
Rick: So each of these phases can be challenged. You can actually take some caffeine or you can take some Tylenol, small doses, that you can measure the excretion potential through urine what these molecules and what’s coming out based on the standard load that you’re giving them. It’ll tell you if there’s a block in phase 2 so if you don’t have enough of the conjugation molecules, enough sulfur specifically then you’re not going to be able to tag on and excrete those that they’re going to build up, or if the liver is under oxidative stress it can’t convert very well that first step or if there’s a nutritional depletion. That’s really the way you functionally challenge it. There are certain people with Parkinson’s, and there’s definitely a link to toxicity in Parkinson’s, what they tend to have is a very rapid phase 1 and then a slow phase 2. So they wanted to put this intermediary, very free and active free radical molecule that we can’t get rid of.
Logan: Right. Phase 1 actually makes the molecule more damaging.
Rick: Correct so it’d be better to have a slow phase 1 and not just get rid of it and put it in the fat than someone who’s breaking it down really rapidly and then doesn’t know what to do with it.
Rick: So that’s the way to sort of assess. It’s a relatively easy test to do because we’re really talking about the tenets of functional medicine and how that plays into your overall health. As you can see, it’s a process to do, to go through each of these steps but ultimately your interest is in health and wellbeing. If there’s a weak chain link, that’s what’s going to come and bite you in the butt. You can test forever and that’s the art. It’s like where do you stop?
Rick: When does it become too much? And then the other challenge is not doing too much upfront because you get too much information. Then how do you react? Someone isn’t going to do 20 different things. It’s just not practical. So the goal is to sort of start with the basics, make changes, address some of the key issues. You might assess some hormones, see where you are. First, assess how you feel and truly what the issue might be. Assess some hormones. Consider doing a more comprehensive serum level. Target the key factors – vitamin D, omega-3 and nitric oxide. Clean up your lifestyle. Add in some supportive botanicals that fit into maybe your patterns of imbalance, whatever that may be and then see how things go. At that point if you’re not getting where you need to go, that’s when you can look a little deeper into, am I being exposed to estrogenic chemicals, how my liver is doing, looking at organic acids. That’s sort of either a step down the road when you’re stuck or I want to dig deeper to make sure that everything is good and I’m not missing anything that’s going to come up and bite me later on.
Logan: Yeah. Well, that was a lot of information. People may need to listen to this or read the transcript another time over to get it but I think this really gave some solid information, a lot of stuff people can look at as well sort of those places to start. So thank so much, Rick. Where should people go to find out more about you and your services?
Rick: Core for Nutrition is our company. We do sort of targeted nutritional support based on a lot of assessments that we do on high level athletes. What we’re able to do is sort of offer these assessments in combination with nutritional formulas that actually work. Some we wound up private labeling and some we just source from unique companies. That’s sort of the idea. It’s to give people the ability to track their health. So there are some programs. There are some individual nutritional formulas and then there’s a whole wide range of assessments to look into. We’re trying to be sort of an intermediary between a health practitioner, because this is all done for optimizing your nutritional health, and then just a store where you’re just buying stuff, guessing what you need and trying to do it with wisdom.
Logan: Right. That’s definitely a tough thing to do, give people enough information that they can make their own choices but without actually guiding them, especially in the complex world of health. It would be tough to do.
Logan: Well, thanks so much, Rick. This was great information and we didn’t even get to some of my questions. Maybe we can do another.
Rick: I’m sorry. Yeah.
Logan: That’s great. I like going in-depth. Maybe we’ll do another call next time and talk about telomeres and some of the genetic testing that is available because that is a whole other area that can be focused on.
Logan: All right. Well, thanks everyone for listening. I hope you enjoyed this call. If you have any questions, you can head to the website and ask them over there. You’ll find links to Rick’s site, the transcript and all that available on our website so be sure to check that out. Thanks everyone for listening.
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