I appreciate everyone showing up today. It's a pretty exciting conversation. Adam's a good friend of mine and he's a really established functional medicine practitioner. He works a lot with acute and chronic disease. He works a lot around autoimmune issues, focuses in on longevity.
He also has some specialties in regards to hormone imbalance, hormone management, as well as weight loss management, pre, post, and operative care, as well as supportive cancer care for thrivers and cognitive. of decline prevention he's got a medical degree as a naturopathic medical doctor out of Bastyr University and he's affiliated with a lot of different affiliations but just to name a few the naturopathic Academy of primary care physicians California naturopathic doctors Association as well as the American Association of naturopathic physicians the list does continue from there but he's got a lot of experience in this realm and I really wanted to bring him in to kind of give some of this knowledge to Smart Fit members and also answer some of your questions. So I've taken a lot of different submissions on questions of what to ask Adam today.
I'm going to ask some of them for you guys. And then after that conversation, we'll head in, we'll kind of open up the floor, and everyone can ask their individual questions off that. So the first question really is, what is a functional medicine practitioner?
And why should someone utilize a functional medicine practitioner rather than a functional medicine practitioner? rather than going the traditional medicine route. What's been your experience with functional medicine?
Yeah. There we go. All right.
So well, I've worked with a few functional medicine practitioners. I went through the regular route. I've dealt with different injuries, different autoimmune diseases. And with getting more into this longevity space and the longevity world, I've worked with a few, and yourself included now. And really, for me, I think it's going.
above just reacting to a situation or a problem and really getting into preventing future issues as well as optimizing. So feeling okay is one thing, but feeling great is a whole other thing. And once you feel great, it's really hard to go back to just feeling okay.
And I feel like functional medicine is a really good way to get you feeling your best and also working around and preventing certain things. A lot of stuff that's come up in my own blood work, I've been able to prevent and get way ahead of it rather than... rather than just kind of reacting to things as they come up to a surface level.
But I know you've worked with a lot of different people, and what would you say are the differences between a functional medicine practitioner? Yeah, absolutely. You know, as a functional medicine physician, we look at the body as a complex system of pieces that work together. So when we take someone in for the first time, we're really diving into every aspect of their physiology in everything we do. For example, when we look at someone's blood work, we look at not only their blood sugar, but also how what they're bringing into their body is actually converting into energy by testing a number of different other sort of lab tests as part of that process.
We dive a lot deeper. And the reality is, is we should all be diving really deep into our health because it's the most important thing that we have. Health. is wealth you know without health we have nothing there's there's a lot of phrases that go in and around that and those that have ever been sick or injured I can can relate to that right even something like sprained ankle and and how it impacts everything that happens in your life so when we think about functional medicine we we look at every aspect of the body in in depth and then integrate it into a comprehensive treatment plan that works with every system. Another area that's interesting about and unique to functional medicine is we take a really deep timeline of a patient's history.
We know that even the circumstances that were happening when you were in utero inside your mom's belly play a significant role in your health and well-being now as well as what could potentially predispose you to certain conditions or illness as you get older. Additionally, we have testing that can look at your genetics and in doing so we can get a deeper understanding as well into what potentially could be contributing to areas of your physiology that could be impacting your maximum potential. Vitamin D is a perfect example. We all are very aware about vitamin D and its role in our immune system. We know that that vitamin D gets converted.
in our skin by exposure to the sun. We also know that on average a typical American spends 80 to 90 percent of their day indoors. We're chronically deficient in vitamin D and we can supplement with vitamin D. However, genetically we have what's called a vitamin D receptor gene. That vitamin D receptor gene gives us an understanding of actually how that vitamin D is going to function inside your body when it binds.
to a cell, right? What does that mean for us? Well, for example, patients that have challenges with their vitamin D receptor sensitivity, they may benefit from higher levels of vitamin D dosing. They may value from really prioritizing sun exposure in their day.
And we might not see the same benefits from vitamin D supplementation at a lower dose for their mood, their immune system, for their bone health, than we would would if we just gave it a little bit more of a higher dosing. So there's a lot of personalization that can come into your care through functional medicine. And we really prioritize that in our patients. Definitely see that. And that's something that I think is when people are traditionally prescribing things, they're looking at a general activity level, a general age range, gender, those kinds of factors, but they're not really going the extra step deeper in testing their genetics.
genetics, getting their blood work, doing urine samples, doing all those things. So in regards to testing, you know, what are some common tests that people should be doing to get a deeper look into their own health and, and maybe some frequency around those tests as well, just, just on a general level. Yeah, absolutely.
So one thing to think about in, in any lab testing that you get is this idea of what would be considered a normal reference range, right? We've all gotten lab tests back. from our doctor and it tells you your number and it gives you this range well what that range is even though they call it a normal and an abnormal there's a there's a very big difference between what is normal and what is optimal and we have guidance from academies of medicine that can tell us through research what is actually optimal however optimal values are not presented on lab work. They're only presenting what's considered a normal value. A normal value is an average of every single test that that lab receives for that particular marker.
So that could be from the sickest of the sick to the healthiest of the healthiest, right? That range is what they get on average and then they do a mathematical equation to break it out. Now just from that explanation alone you can tell that what is considered normal.
normal and what is considered optimal are very different things. And ever since the beginning of my medical career, I don't want anyone normal in my practice. I want everyone optimal in my practice.
So when you work with someone who's a functional medicine provider, you'll get optimal ranges. We will talk about these tests, whatever they may be in the optimal range, which is, which can be very different than what would be a normal range. We also take into account age and certain genetic predispositions to further specify what we want as optimal. When it comes to blood work and what I think everyone should be looking at, right?
First and foremost, we should be looking at blood sugar. We should be looking at what we're putting into our body and how we're using our body influences the level of sugar, glucose, that is inside our body. and how that's working to either benefit or destruct our health. And when we look at sugar, most providers will look at one level, maybe two.
They'll look at a fasting blood sugar, and they'll look at a number called hemoglobin A1c. Now, these numbers are really important to check. So I would certainly recommend everyone get a fasting glucose and a hemoglobin A1c. Okay, fasting glucose is your blood sugar on rising after an entire night.
of being fasted. And that's an important number to know because it can give us some indications on how you're eating during the day, how your body's storing and then releasing sugar overnight. Our bodies do a lot of repair and recovery in the evening and we need an appropriate amount of sugar in the bloodstream overnight in order to have the fuel to repair and recover. Too much can be challenging for the body to manage overnight.
overnight and can result in in dip Hemoglobin A1c is our average blood sugar. It gives us about a 12-week idea of throughout the day with all the spikes and lows after eating and exercise and sleeping, what's the average? right that's the number that we use to determine if someone has diabetes right diabetes pre-diabetes but what's most interesting about blood sugar regulation and in my mind I think it's the most important number is insulin.
Insulin is a hormone that is secreted by our pancreas that helps our body take the sugar that's in our bloodstream and move it into our tissues to be used as fuel. Now, high levels of insulin can be inflammatory to our body, and we are seeing more and more that chronically high levels of insulin are causative for conditions that we're seeing on the rise. Right?
dementia, cognitive decline, as well as diabetes. So I would suggest that whenever you get any type of blood work done by your provider that you get not only glucose and A1C, but also insulin. And you can ask for that, it's a very affordable test and it's gonna give you a really good understanding of what's going on.
I also recommend that people get a look at their hormones. At any age. For women, I recommend that they get their estrogen looked at, specifically estradiol.
They get their progesterone looked at, and they also get their testosterone looked at. And in testosterone, we want to look at total, and we want to look at free testosterone. This is an important thing to do.
If you're a menstruating woman and you're not on birth control, you have a relatively regular cycle, then that's going to be done on day 19 to 21 of your cycle, with day one being the first day of. of menstruation. And this is going to give you a lot of information.
I mean, estrogen, progesterone and testosterone are critical for female cognitive function, for healthy hair, skin and nails, for maintaining muscle mass and body composition, ocular health, eye health. I mean, it's a it's a it must be functioning in concert in the body. For For men, we're going to look at total and free testosterone and a hormone called sex hormone bonding globulin, as well as usually we look at estradiol as well.
The next sort of category that we would look at is kind of how are we going to evaluate the quality of our blood vessels and our heart function through blood work. And we do that through our lipid panels. Most people call it a cholesterol panel.
right but a cholesterol panel actually contains many more items than just cholesterol on its own Typically a cholesterol panel involves a total cholesterol What's called an LDL and what's called an HDL as well as a number called triglycerides now? These are counts of different types of molecules that have different impacts on the your blood vessels right some of these molecules will elicit damage in the vessels, some will support repair and recovery. But it's really just a very small glimpse into what we can learn from blood chemistry. So now what I would suggest people do is, in addition to those, that panel, I would suggest that you add what's called an apolipoprotein B, an apolipoprotein A1, and the associated ratio between the two.
Because what we know now is that risk of cardiovascular disease is much more prognostic when we look at those numbers in combination with the total cholesterol, LDL, HDL, and triglycerides. Without that level of depth, that apolipoprotein evaluation, we don't really know a lot about the results that we're getting and how to utilize them and interpret them. We also want to look at inflammatory markers.
Just a couple inflammatory markers that I think are essential to follow in people's lives are, one is called HSCRP, which is called high sensitivity C-reactive protein. This is a marker of inflammation in the body alongside another marker called homocysteine. And with these two markers alone, we can get an understanding of if your body is activated and reacting to something within you on a daily basis.
that should not be happening. We want a level of inflammation when we're sick. It's inflammation that causes a fever.
It's inflammation that helps us fight a tummy bug. But in our day-to-day life, we want as little inflammatory... process in our body as possible.
And HSCRP and homocysteine are two very available lab tests that can give us a really good understanding of what's going on there. Yeah. So yeah, when you have that whole, I guess.
this kind of picture of where someone's at in regards to, you know, through the testing, what are some, we talk a lot here about physical retirement plan, right? So really creating a better health span. So improving the quality of life that you have for a longer period of time and making investments into that physical retirement plan, whether that's investing in building some muscle, building some bone density, improving your cardiovascular strength, make sure you have good balance posture, all those things. When it comes to the, you know, outside of, just the exercise component, right? When we're talking about on a longevity front, you gather some blood work.
What are some key things people can do to really improve their health span outside of exercise and improve their longevity? Yeah. Well, I'll talk about one exercise thing, if you'll let me first, and then we can talk about some other stuff. But what's an interesting biomarker for women, just seeing the age range in the audience is through the urine, we can actually track change. in the way that your bones are remodeling and growing or degrading on a much more consistent basis than using the DEXA scan which is what most people are familiar with on their own.
We can see changes in how your bone is repairing and degrading much more quickly than with DEXA on its own. I would strongly suggest that anyone who's doing strength training and anyone who's considering hormone replacement therapy have that urine testing done and because you'll be able to see much more quickly how what you're doing is impacting your goal and then when it comes up to that three-year mark that you're gonna get a repeat DEXA scan you'll have an idea that you're that you're moving in the right direction right before without having to wait 36 months and so there's a there's a lot we can do do to improve these markers of insulin sensitivity, hormone optimization, and inflammation. I mean, these are really three key targets that we want to approach from a holistic standpoint.
Probably the most important thing apart from movement is sleep. Sleep is currency. It is essential. I think that the larger communities becoming more interested in sleep we're getting wearables that are much more easy and and able to be used like this aura ring no affiliation to to track how what we're doing is impacting our sleep quality but it is it is well understood in the medical community that if someone is snoring at night right male or female right that will on its own raise people's inflammatory markers it will raise people's cholesterol levels.
It'll worsen those lipid panels that we were talking about as a window into their heart health. Not to mention result in fatigue, difficulty with motivation, can impact mood. I mean, it is critical. It's also, as we all know, so important for maintaining the other activities that we wanna employ as part of our longevity strategy.
In regards to sleep, what are some key things that people can do to improve their sleep quality? Maybe an ideal time that they can sleep or some things they can do before bed, things they can do during the day. Yeah, 100%.
I mean, there is this 12-3-2-1 strategy that some people have heard about and is utilized in a few different ways. But the general idea is that 12 hours before your bedtime should be the last time that you inject. something that has a significant amount of caffeine in it because of the half life of caffeine we we put that 12-hour mark so if you're going to bed at 10 p.m.
that means 10 a.m. is when your last cup of coffee is for the day right um yeah the three two one strategy is the lead up towards bed right and people put different things in these positions at different times based on kind of what is most important to them right for example I have male patient who You know, wakes up three to four times a night to go to the bathroom, right? So we put at the three-hour mark before bed our last sip of water. And it solves the problem. The problem is solved, right?
For me, because I love my job and I love working. and it stimulates my brain, my three is work. So I stop working is work, working.
So I stop working at 7 p.m. I just put it away. I'm like, this is...
there's nothing that is going to be more valuable to me to get done within this three-hour window then my sleep that I can't do again at 8 in the morning or 7 in the morning or whenever I want to pick it up again so that's usually my my three um the other two typically revolve so we have work we have water and we have meals so the idea is that kind of as you count down maybe it's three hours before bed you stop you cut off working two hours before bed is your last meal, one hour before bed is your last glass of water, and then that 60-minute window is for you, right? The screens are away, it's about stretching, reading, snuggling with the kids, you know, connecting in with your partner, but not in a logistics and programming kind of way, but just in a very light and loose way. The lights are down and that's gonna allow you to hit. hit the bed really easily.
Really just down regulating the system at least one hour before bed. Yeah. And, and, and committing to it. I mean, I, I know it's hard, like it's hard for me to do it too. Um, but, uh, every time I break the rule, I think, you know, like whatever it was that I did within that hour, I would have done better the next morning.
And the fact that it got done at nine 30 versus eight 30 the next day, didn't matter to anyone. So why did I why did I choose to put that there when I could really focus on my sleep and give myself that? that value I have that but with like Usually if I'm watching a show or a movie or something like that You know that last hour right before bed if I spill that with watching a movie the next 12 hours of the next day Are sat slightly sacrificed because of that that one hour and just not getting a proper sleep.
So It's not an easy thing to consistently do, but doing it makes a huge difference. One of the things that I've found reinforces my strategy is the fact that I'm tracking it with a wearable. There are wearables that can track your sleep. There's apps on your phone that you can put by your bed.
There's actually mattresses that can also track your sleep quality. And it's just another reinforcing agent for me that I'm on the... on a track that makes the most sense for my health. The other thing that I think is really important or seems to be very important for most people is the temperature of the room.
So it's like the ambient environment where you sleep, right? A lot of sleep experts talk about the bedroom is for sleeping and for other stuff, not for working, right? It's for sleeping and snuggling, right?
Bedroom is for sleeping. and snuggling so that when you go into the bedroom, your brain is trained to know that it's all right. I'm going to sleep and I'm going to snuggle. I'm not going to work. That the room is dark, as dark as it can be, and that it's cool, that it's cool and cold.
And however you can to keep that temperature nice and cool, that helps with your sleep quality as well. Awesome. So we covered sleep a little bit there on one of the key ways.
and what are some other key things that you recommend? Yeah, so looking at, there's research on these areas called blue zones, and it's a zone of the world where people live over 100 years old, and they live for a really long time. And one of the consistent things across every zone is that these individuals that live there have community and connection. They, like the Okinawa... The Nga Wans, for example, have groups of people that they're assigned to that they grow old with.
They're not family members, they're not relatives, they're a group and they meet on a regular basis and they grow old together. That level of community, that feeling of community and connection is what is ubiquitous across all of the Blue Zones. Some of them have different diets. There's similarities. But that's it.
Connection to community is consistent. The other area that's consistent is that they're moving. They're using their body on a daily basis. They're walking, they're hiking to get water, doing some gardening, but they're doing a bit of active movement every day. Yeah, community is important, I think.
Why do you think, I mean, on a health perspective, why do you think community is so important for longevity? Is it because it's lowering people's stress? What do you really think is the reason behind that?
Yeah, physiologically it's impacting your cortisol production and hormone production. There's a lot of data on what is considered, they're called mirror neurons. So we have neuronal activity in our brain right now, you and I, but because we're connected in, if we had MRI imaging looking at what was going on in our brains, there would be certain parts of our brains that were firing in the exact similar way at the exact time because of how we're connected, right?
That impacts hormone production like serotonin, dopamine, GABA, and others that impact. our heart rate, right? They impact the way that our blood vessels are constricting and releasing. They impact our regularity of our bowel movements, right?
So there's a lot of activity that is triggered in the body by us relating to other people throughout the day. And if we're able to nourish a community around us as we grow older together. those physiological actions will become much more regulated and health promoted versus stress inducing. And then you know the other part of it is like there's just something I mean I don't know for those of us that are older than me in the room but there is there is something about passion.
I have a number of patients in my clinic that are in their late 80s, early 90s, my grandfather included, he's 95 years old, and the one thing that he maintains is passion. He has a passion for whatever it is that he's interested in. He continues to have a passion for it, to study it, to read about it, to learn about it.
That's something that I've noticed personally. I don't think it's in a lot of the literature, but it's something that I've noticed personally about every client of mine that is in that age range that's living a vibrant life. Like they come in with research articles.
Oh, Dr. Silverman, have you learned about, have you heard about CoQ10 with PQQ and mitochondrial health? And they put it on my desk and it's highlighted in orange and yellow and pink and it's got writing in the margins. And I'm just like, yes, like you are living a life. of purpose right yeah in regards you know I had a couple of questions to that just gone from other members and and one of the questions you know in terms of living a healthier lifestyles a lot of people are really confused about water intake there's kind of a lot of difference of opinion and it's pretty relative. What are some ways people can figure out what their actual water intake should be throughout the day?
Yeah, that's a good question. I mean, there's honestly there's not a consensus. We don't have a consensus. So what we talk about in the functional medicine community, right, is we want the urine to be clear.
And if you're going to the bathroom every hour and a half to two hours, you're probably in the zone of consistent fluid intake that's appropriate for what you're doing on that day. Yeah. Can I ask a question? Of course.
Sure. Sure. Like vitamin and mineral supplements, it seems to cover the urine.
So that doesn't work anymore. Can you repeat the question? Yeah, yeah. I mean, it was saying that when she started taking certain supplements, right, certain supplements get discarded. in the urine if they're not fully absorbed as they travel through the body, and then that changes the color of the urine.
Similar to like how if someone eats beets, right, the color of the urine is going to change. This protein and your stomach acid breaks down that protein into like little tiny amino acids. Then you're small. Testin absorbs those into your bloodstream and those single or dipeptide amino acids get turned back into muscle in in the body, so there's a direct relationship to protein intake and maintenance of muscle mass and maintenance of muscle mass is one of the most important markers of longevity. We know that As we age, if we can maintain muscle mass, we're more likely to maintain our function as we get older.
We're less likely to fall, we're less likely to fracture or break a bone if we fall, and we're more likely to be able to enjoy the competencies of an active body as we continue to grow older. That's one of the reasons why it's so important. Protein also with meals plays a role in blood sugar regulation as well. And when we think about total amount of protein, there's two main considerations that I think about and one blood marker that I pay attention to.
So age is a big indicator, right? Age and activity status. So younger, Younger members, younger clients who are really focusing on optimizing body composition, building as much muscle mass as possible, they're extremely athletic.
Like we're pushing about 1.2 to 1.5 grams, right, per kilogram of body weight, right? So you know they're eating upwards if they're if they're a couple hundred pounds for example, right? They're eating 250 grams of protein. That's not very achievable for the common person, right? That's sort of the outlier.
I would say for most people that are looking to work out here in the gym, if you're getting about 0.8 to 1 gram per pound of your body weight per pound, then you're in a good spot. So that's if you're 180 pounds and you're getting somewhere between 150 to 180 grams of protein. you're doing an excellent job.
The way you'll know that you're having enough protein is if you're able to maintain your muscle mass and or grow muscle mass at the rate that you feel is appropriate or that we kind of determine should be adequate based on what you're doing. And we use the body scans to evaluate muscle mass. When we get older, We've got to be more cognizant about our kidney function.
Protein, high levels of protein intake can put some pressure on the kidneys. So as we age we pay a lot attention to a blood marker called creatinine which is one of a few different indicators we use to look at kidney function in the body and we appropriately you know pay more attention to that. So we really kind of thread the line of trying out.
optimize protein intake to maintain muscle mass as we age without inadvertently compromising kidney function. Are there some things you can do throughout the day while you're ingesting more protein to not compromise your kidney function? Fluid intake is the most important.
Yeah, absolutely. And getting tested to see how your protein intake is affecting your kidney function. Awesome. Yeah.
On that note with protein, that kind of leads into supplementation. It's kind of an overarching question, but a lot of people ask, you know, diet versus supplements, right? Am I getting enough nutrients through my diet?
How do I know if I'm getting enough nutrients through my diet? And then when should someone supplement? Or do you think most people should supplement? Because most people in today's society are supplementing to some extent. And I think that...
You know, it can be confusing sometimes if people already eat a healthy diet, if they really need or don't need supplements. Yeah. Food first, always. Food, we call a supplement a supplement because it supplements our nutrition and lifestyle programming.
That being said, in... It's sad, but in the environment that we're living in today, we have a significant amount of exposure to organic and metal toxins and other types of compounds that negatively impact how our body works. So that's everything from commonly heard about. Chemicals like Teflon in your cooking ware to the bisphenol A's and B's and C's and D's that are in plastic bottles or on the receipts that you get from the supermarket.
Different types of... xenoestrogens compounds that actually turn into estrogen in the body that are in common creams or makeup different types of fragrances that get inhaled orally through our shampoo or or compounds that get absorbed through our deodorant that we put in our armpits. Now, these are all foreign substances to our body, and they have negative implications and put additional stress on particularly our liver to metabolize them and excrete them. And now we're learning more than ever that long-term exposure to this battery of potential problematic molecules, right?
has to be addressed in a way that nutrition and lifestyle practices alone can't accommodate. We can look at these compounds through urine testing, so we can check your urine and see what you're being exposed to on a regular basis, if that's glyphosate from your food sources, bisphenols, like we were talking about, toxins that are inhaled from exhaust from cars. or otherwise or off-gassing from maybe furniture in your house, mold exposure to metals exposure like mercury from fish if you're eating high levels of fish or arsenic potentially in rice.
Like these are things that 20 years ago, no one was talking about arsenic in rice because it wasn't a problem, right? Very few people were talking about mercury in fish. And if it was, it was swordfish. It was these massive fish, right?
Now it's... it's not uncommon for me to see high levels of of mercury in clients that are even eating very small fish myself i i ate a good i eat mackerel all the time i love mackerel comes in a tin it's a cold water fish it's small the functional medicine community was like this these are the fish you're going to eat if you're going to eat the fish they call them the smash fish salmon mackerel anchovies sardines herring right what's consistent about them all they're all They're all cold water fish. They're little fish, right? But I checked my blood mercury levels and they were high.
I stopped eating mackerel for like 90 days, did a protocol and it was gone. And I was like, oh man, like I got to eat less mackerel. Do I not eat mackerel?
What's happening? So I think that I am a, I am a food and, and lifestyle first physician. It, it is my training and it is what I do for myself and I will never.
stop. And the more I've been in clinical practice, the more I've seen that with supplementation, I can take people to the next level. And I think it's because of this increased burden of exposure that we have on a day-to-day basis and a reduction in nutrient adequacy of some of the foods that we typically get through our traditional sources of acquisition, right?
If you think about it, when a vegetable like a lettuce is cultivated in soil, the nutrients that go into the lettuce are what's in the soil. And if the soil is depleted, which most of our soil is, we're going to get a lettuce that's going to be in the soil. that were in which the liquid, right, the crunchiness and the fluid and the lettuce, it doesn't have as many nutrients and minerals as it would have 20 or 30 years ago.
Or if you would have grown it in your own garden using blood and bone and culture. Cultivating with compost and really diving into your your soil quality. Most of us are unable to to have that in our lives so We use either a whole food supplementation and or other types of compounds to to augment and The way we know what to do and how to do it right is We look at a patient's symptom presentation what they're having struggles with what they're how they're presenting We look at their blood chemistries, we look at their urine, and from there we can ascertain what they could have as a deficiency and what could potentially be a toxicity.
And if we can support the deficiencies and lower the toxicities, we're going to get a better functioning system. So we're doing that on a regular basis with our patients. Awesome. Yeah.
Well, I'm going to open it up to questions from the audience, but real quick, can everyone just give a round of applause for Adam? So yeah, I'd like to open it up for questions, and feel free to ask Adam anything that's on your mind. How would you recommend people about finding these supplements that aren't contaminated with...
Some of the stuff we're trying to avoid, what would you look for? So the question was, how do we source supplements that are high quality and safe? It's a great question because there are two... considerations when we think about supplements, right?
We want to make sure that what we're being told is in the supplement is actually in the supplement at the time we take the supplement. And the other is that we want to make sure that any anything that's in the supplement that we don't know about, we want to make sure that that's not there either. So we all have probably heard that the supplement industry is a self-regulated industry. And that's not necessarily a bad thing.
We're self-regulating organisms. But what it means is that we take the onus on ourselves. So when I think about a supplement that we're going to use, we've got to be self-regulating. got to look at what is called stability testing.
So stability testing is a key differentiation point between supplement brands. It's expensive to do but basically what it means, what a stability test means is that at the time that it says on that label that you can take the supplement up until, you know that what's on that label in the milligram quantities is actually in the supplement, right? So a supplement manufacturer will batch test for stability and then they will package that and off you go, right? The other area to think about is they will test, supplement companies will test the ingredients of a product, but they can check it in a couple of different ways and they can check it at a couple of different times, right?
So the best way to... check for supplement to for supplement sort of strength as well as to make sure there isn't any toxins in there or other stuff is to do what's called a core biopsy so they'll get an ingredient and they'll take a core all the way down the entire mass quantity of magnesium or whatever it may be and then they test that to make sure that every layer is actually magnesium because people are out there sometimes they'll fill the the bucket with 50 magnesium at the top and if someone just checks the top top, they'll think it's all magnesium, but actually at the bottom, they've maybe filled it with psyllium husk or something that's cheaper, right? So doing a core biopsy is really important.
And then they'll also check it at the end. So when you do the stability testing, once the product's completely formulated, you can run a second test to make sure there aren't any metals or organic compounds or otherwise that are in there. Now, that's all good for someone like me who nerds out and goes and asks all these questions and collects all this. this stuff. So one thing you could do is see someone like me and then we could, we could point you to the way, but there are, um, independent agencies that check for, that do their own testing on supplement quality.
I'm drawing a blank on the name right now, but we'll, we'll get it. It's a consumer, it's not consumer reports. It's just what's coming to my mind, but we can look it up. But there is a, yeah, there's a, there is a good company that's going out there and independently testing. It's.
It's funded by people like us. I can look it up on my phone. GWG, Healthy Living?
The Environmental Working Group is a great option for, not necessarily for supplements, but the environmental. Yeah, CGMP. Thank you. So this other one is for food? Yes.
Yeah. So the question is, well, like what can we use for non-supplement products? Like our hair? care, our skin care, our cleaning products, and our water quality.
So yeah, the most comprehensive resource and independent resource consistently over years has been the Environmental Working Group. The Environmental Working Group has resources. One, for example, is called Skin Deep. And you can go onto the website, you can type in your product, be it a sunscreen, a mascara, lotion, and it will tell you.
you all of the ingredients. in the product and it ranks each ingredient individually on a scale of 1 to 10 as to whether it's safe or potentially carcinogenic. That's the 10. And this is all backed up by NIH data and other resources that you can click on to understand where they're making their interpretation of the safety or concern.
with that particular ingredient. I think the Environmental Working Group's an incredible organization. And when it comes to your skincare, your makeup, your cleaning products, and your water quality, it's an amazing resource, absolutely.
It's independent, and it's very well established. Any other questions? I know a lot of people probably Go to the doctor or seek your support because they are having specific symptoms and maybe they come in with certain complaints, but when you have a new patient, are you... giving them a specific questionnaire that helps kind of like get at key issues or, because I guess I'm wondering, sometimes, at least for me, especially in my 40s, I've been noticed that sometimes I'm used to something in my life. I'm used to having brain fog or whatever the case may be.
And I'm not realizing how much of a problem it is in my life. Do you have the ability to help people get at those things that they maybe have become accustomed to but still aren't serving them in their lives so that you can target them and give them their root cause? Yeah, absolutely.
So the question is, what types of interview questions or tools do we use as functional medicine practitioners to fully understand the entirety of someone's case and what they're going through, who they are, in order to really get a comprehensive approach? And that's exactly what the core of functional medicine is. So we use three main tools to accomplish that.
One is called a timeline. So we go through someone's timeline from birth to present. And in doing so, we can really understand kind of like where their mental, emotional, and spiritual growth and development has happened over time. If there's been any individual events that might have been traumatic or game-changing and shifting in their health journey, right? We can also look at what are called antecedents, triggers, and mediators.
throughout their life as well. And these are things that preempted a health challenge or a concern, something that triggered it and potentially something that's mediating it ongoing. So by looking at the timeline, we can get a really good picture of someone's history to present.
We also use what's called a medical symptoms questionnaire, and it's a validated tool that goes head to toe and gives... the most common symptoms per area right like you know dry skin crackly you know lots of infections or like challenges with vision dry eyes and it allows you to rank rank the how you perceive that in your life on a scale of of one to five and it and it and we add it up so we can look from in every part of your your body and and how it's presenting with you know like 30 or 40 questions and we can get these these indicators on key areas of concern and key areas of emphasis that, like you said, that might not be as evident to someone. But when we look at the number, we're like, oh right, your GI symptoms are 20. You don't have diarrhea or constipation or any of this stuff on your intake form.
What's up with that? It's like, oh, it's just been like that my whole life. I go to the bathroom every three days and it strains and whatever and things.
It's just who I am. And you're like, well, you know, like that could be contributing to why you're having chronic headaches, right? Or why you're having trouble maintaining a healthy weight or why you have low mood, why your mood is an issue. So we use the medical symptoms questionnaire. We use the timeline.
And then we also use this tool called the matrix. And what the matrix is, it's you can imagine it's it's a matrix that blends the timeline and the questionnaire. On one side, we have your antecedents, triggers, and mediators that we identified in your timeline as potentially contributing ...into your current health state.
On the bottom, we have a summary of your foundations of health principles. What's going on with your relationships, your nutrition, your movement, your sleep, and your spirituality and relationships and connection. And then in the middle, we have different organ systems, organ systems of elimination, of transportation, of immune function.
And we bring in your symptoms and concerns from the medical symptoms questionnaire. as well as your personal history that you've explained to us. We put it all in the matrix, and now we have this deep picture of you as you've expressed it to us that most people aren't putting together on their own without that support. Now you couple that with a list of your three goals, and we've got a lot to talk about.
We also have a lot of data that we can then convert into doing specific types of work. types of lab testing, imaging, referrals, additional investigation that's going to be very pertinent to you. That's the way that we do it.
And it takes time. But man, does it really reveal a lot about someone? And honestly, going through that process with a trusted partner can be very relieving. It can be gratifying, it can be a beautiful way to connect and form a therapeutic alliance with someone. As we all know, the therapeutic alliance we have with our provider is extremely valuable in and of itself.
To have someone who's trusted in your life, that you can come to in confidence, who can rationally and emotionally and spiritually connect with you. It's something that's really important. I feel like it's been lost in medicine and it is an extremely important thing to have in our lives as we go through the process of aging and everything that comes with it does that answer your question awesome any questions Go back to protein for a minute. So as I'm a member here at the gym, I'm hearing all this stuff about protein and how I need it as I get older. So I'm trying to eat more protein.
Sure. I'm resistant to supplements. So I'm trying to get it from diet.
I believe that you should be able to get away with diet. But I find myself now eating more of the foods that I... that I thought were no-no's, more eggs, more meat products. And I'm wondering what your thoughts are about that and also about statins. Sure, so the first question is.
Like it. Yeah, yeah, of course. The first question is as I'm working towards hitting what is being told to me as my optimal grams of.
protein per day, I'm finding that I'm consuming more animal protein and eggs. Right? And that... Pardon?
It's an animal protein. Eggs are an animal protein. Yeah, eggs. Yeah.
I think about, you know, yeah. More animal protein. And that I've been brought up, I've been educated that increased levels of animal protein negatively impact my cardiovascular health. I would suggest that the answer to that question I think comes in the diagnostics.
So I would suggest that you get a comprehensive blood panel done that looks at not just your total cholesterol, HDL, LDL, and triglycerides, but also your apolipoprotein, what's called your LP little a, that looks at inflammatory markers like homocysteine, HSC. CRP, potentially oxidized LDL, and others, alongside possibly some cardiac imaging to understand what your current risk is. And then based on imaging and blood chemistry... you can make an informed decision about your food choices and how that's impacting your own body. The reason I bring it up that way is that we see, you know, we hear all the time that LDL is bad.
People in the world will say, LDL is bad. LDL results in heart disease. and individuals that eat more animal protein have higher LDL and they have heart disease. I have patients in their 90s that have LDLs in the high 150s, 180s and they haven't had any heart attacks, they've had no strokes, they've had no... cardiovascular implications, nothing, nothing.
Now, I also have patients that have had high LDLs and have had heart attacks and strokes in their 40s and 50s. So what we know is that it matters. But what we also know is that it's not the whole story.
So the question becomes, what do we do with that? What do we do with that? Because you're absolutely right. I think the answer is that for some people, those markers are very prognostic of a heart disease risk. And in others, they're not.
I like to think that by bringing in additional blood biomarkers, we can further personalize that decision to you. And with the advent and accessibility of more higher quality heart imaging, particularly like a CT coronary angiogram, which historically has been only reserved for those who had had a heart attack or being monitored very acutely for cardiovascular disease, now that's a readily available exam. And it gives us such an intricate view of the vessels in the heart, right?
So then you can know. You can know what your cardiovascular status is with a lot more sensitivity and specificity than we ever could before. And then I would use that data to make a decision, particularly with the second question was about.
And then also, like, looking at your creatinine and your body composition and muscle mass. And you. Using that to determine your protein intake, not necessarily just a number.
Like I would want your protein intake to be enough that you're able to consistently on body scans maintain the muscle mass that you currently have, right? Assuming it's adequate for your age and quality of life, which I've seen how you move and how you train and I think it is. So that would be where I would go with you particularly, Emi.
And then, yeah, the question about Statin therapy is the same. It's the same answer. You know, for patients that have plaque and cardiovascular aging, we know that statins can be supportive. For people that have had an infarct or cardiovascular incident, we know that they can help stabilize plaque.
We also know that many people have trouble tolerating statins. And so I think it's a personalized decision. And now more than ever, when we're talking about statins, we're talking about statins.
with cardiovascular imaging, we can help people make that decision that makes the most sense for them. Yeah. I have a question about hormone replacement. Hormone replacement.
And different people say, you know, you might get cancer, so don't do it. And now it's kind of shifting that maybe that's not the case. Yeah. Is it individual? Yeah.
It's a good question. The question is about hormone replacement therapy in perimenopause or menopause. And the considerations we should think about when making that decision specifically is there a risk for cancer when we use hormone replacement therapy that it's a it's a very heavy topic and the the reason that so so the thought process the how should I say this the The answer is that as we, every year that goes by, we learn that hormone replacement therapy does not seem to significantly increase the risk of cancer in most women.
The reason that we're becoming more confident in that is because every year that goes by we are seeing the completion of what are called longitudinal studies. It's a study that looks at a woman, for example, on hormone replacement therapy for certain period of time, right? 10 years, 12 years, 14 years. And they complete, and we compare that group that was on hormone replacement therapy to a matched control that was not.
And we see very similar rates of cancer prevalence in both. We also see very similar The rates in mortality from cancer in both. So from that, we're becoming more confident that there is not necessarily a direct link, as we may have thought in the 90s, to an increased risk of cancer and hormone replacement therapy.
So that's where we're going now, right? But if you would have asked us 20 years ago, it would have been a completely different story, even a few years ago. And I guarantee you that there are, that I probably am still one of the minority in that. that position however I read the data and and I know what I'm seeing and and it is it is the case now give me one section out the other the other piece of that conversation is like the real the real question the real question is is hormone replacement therapy going to be more beneficial for me than than not in terms of my health span and my lifespan that's the that's the real question and the other and my quality of life exactly and and you know alongside this question of of hormone replacement therapy over time has been dramatic advancements in our ability to detect cancers, particularly breast cancer, early stage, and treat it to remission. So, you know, it's argued by physicians like Arnold, like Dr. Blum and others that like four out of five breast cancers in women are now fully, fully treated.
So, 80%. I mean, that's a huge change and it's because we have more targeted therapies and we're really catching things earlier, right? With screening and more advanced screening techniques.
And there are even better screening techniques on the horizon for breast cancer imaging now. There's a thing called a QT image, which is going to come out. It's already available at like Beverly Hills and these other places, but it's going to be much more common.
And it provides such a clear image of the. the breast that we are going to be able to identify suspicious tumors even earlier than we can now. And it's going to further improve the ability for us to fully resolve these breast cancers, right? So not only are we seeing sort of fairly similar prevalences between hormone replacement and non-hormone replacement as we look over an extended period of time, right, we're also at the same time finding that we're able to identify and treat breast cancer more effectively and that's improving year on year what isn't improving year on year is the rate of heart disease and and death from heart disease in women and we know that estrogen replacement and estrogen therapy improves cardiovascular outcomes in women so when we think about a woman where the likelihood of you dying from heart disease versus is cancer is about two to one, right? Yes, heart cancer is a second leading cause of death in women, right?
But it's like a, it's a league away from heart disease. Heart disease is here. Cancer and everything else is here.
So we're in an environment where we're doing a good job and it's gonna get even better in identifying breast cancer early and treating it. We're doing a poor job in cardiovascular outcomes. And we have this tool.
tool that we know improves cardiovascular outcome. So that's the calculus that I think about when considering hormone replacement therapy in women. I'm like, okay, these are our problems.
How are we going to use this tool? And then we run genetic testing, we run urine testing, we run genetic testing and urine testing primarily. to understand like, and look at your family history, right? To understand like, what is your, what is your risk profile, right?
What does your risk profile look from your family history? What does your risk profile look like from a genetic standpoint? And then we can use the urine to understand how your body is metabolizing its estrogen. Because really where estrogen can become problematic in the, in the system is how we take the estrogen as a hormone and run it through the liver to have it be excreted through the kidneys, right? It's through these different metabolic pathways.
That everybody has kind of a unique sort of composition of how they metabolize estrogen, that's where we can we can further help to minimize the risk right of having complications and also dial in dosing strategy. So I think that when we take into consideration a person's genetics and the way that they metabolize hormones, right, as well as their family history. and we dose them in a way that's very acutely monitored, that we're looking at blood work, we're checking your symptom picture, we're making sure you're on the lowest effective dose for you. We dial in the other areas of your physiology that could contribute to something that you wouldn't want, from like heart disease or cancer or otherwise, so we're keeping your blood sugar managed, your inflammatory markers low, we get your liver and kidney functioning optimally, you're not exposed to toxins or other chemicals. I think in doing that we can really minimize the risk and maximize the game.
So yeah, that was a really long answer. But that's how I work with every single woman because that is how I work with my mom. And I love my mom.
Is that fair? Yeah. Janelle had a question. I'm really excited about how my mom has benefited my life, but my friend who had breast cancer, and it was the estrogen positive breast cancer, is having symptoms now that I feel like estrogen would help her, but for someone like that, it's only been in my life.
for like a year or two, would that be contraindicated because it's too much of a risk versus the benefits? Yeah, that's a really good question. So the question was in an estrogen receptor positive breast cancer patient who's currently in remission, however, who's going through menopause most likely and is having the basal motor symptoms that are associated with that, is hormone replacement indicated? And that's a really specific question for someone who's above my pay grade, but I know that in our medical dex reference, right, in our in our medical literature, the way that that is assessed is every other option is tried first and then if symptoms are not able to be managed and quality of life is impacted so significantly these then we then we would go to the operation of hormone replacement therapy with a consent and discussion about risks and benefits and the reality is is we don't we don't know we don't know if a short course of effectively dosed hormone replacement therapy will significantly increase that woman's risk for another bout of cancer, be it estrogen receptor positive, PR positive, HER2. We don't know.
But we take a very different approach in terms of the risk-benefit analysis whenever we'd speak with anyone who's had a history of cancer. cancer of any kind really. But that in itself seems different than more of a traditional. Yeah, I wouldn't talk to my GP about that, no. Like we've got, I have colleagues that are specialists in endocrinology within the medical oncology.
community and they would be the ones that I would recommend that patient talk to because they're the ones that see these cases all day every day and they also know what to screen for and monitor. in order to track to see if things are changing or not, at what frequency do you do MRIs versus ultrasounds and 3D tomos and put them, if they do end up choosing hormone replacement therapy, how vigilant we're gonna be in monitoring, right? Does that make sense? Yeah. It's a good question.
Every case is unique in some degree. Any other questions? I have one more.
Yeah, we're here. With how many trendy diets there are now with the internet, like there's a new one every day, some people seem to really thrive on certain ones, and then the same diet for every person seems like they get sick, or their quality of life really decreases. How would you recommend that a person go?
About finding a diet that works for them, that makes them their lifestyle, their goals, all that kind of stuff. That's a great point. And it kind of dovetails into our conversation too, and me.
The question is, is with the advent and increased awareness of a wide variety of nutrition choices, from vegans, vegetarians, pescetarians, ovo-lacto vegetarians. vegetarians, pesco-ovo-lacto-novo vegetarians, carnivores, ancestrals, paleo, keto, autoimmune paleo, antihistamine, intermittent fasting, SIBO specific, biphasic SIBO specific, low FODMAP and more. How do you choose? What do you choose? So just like my answers to to everything else.
I think that a lot of this is individualized. There are certain core non-negotiables in our diet, right? What are our non-negotiables? Our non-negotiables are no trans fats, right? Trans fats are a oil that has been created by the food system and incorporated into processed foods to extend their lifespan on a shelf, right?
But our body cannot absorb and utilize trans fats. They muck up every system. in our physiology and since the, I wanna say the 50s, maybe even earlier, there's research identifying their negative implications in our body since the 50s.
And they're still being used in our food system in much less frequency now because there's been awareness, but they're still around. Also with, to that point, we can create trans fats in our cooking unnecessarily by, if we heat, our oils too hot. So you can take an olive oil and if you cook with olive oil at too high of a temperature, it will turn into a trans fat.
So, so we can, we can unintentionally make our own trans fats. Um, and, and it's worth kind of looking into, uh, how, which oils are appropriate at which temperatures. Um, so no trans fats. That's our, that's our number one, no trans fats.
Trans fats are bad, right? We want to avoid as much processed food as possible in our diet. And so what does that look like? When you go into the supermarket, typically the processed foods are going to be in the middle.
There are big square of aisles that have, you go back and forth, there's usually eight or 10 or 12 of them. That's where you kind of don't want to hang out. Where you want to hang out is all around the outside of the supermarket, where you've got your fresh pieces of protein, you've got legumes, you've got vegetables. and other fresh pieces of food, right?
If it can last more than four or five days in your kitchen and not start to look a little funky, you probably don't want to be eating it and putting it in your body, right? You know, barring something like a fermented food, like a pickle or a sauerkraut. So those are kind of like two of your key, like, no-nos, right?
Avoid processed food, no trans fats, right? The other thing we want to think about is color. We want to talk about color in our diet. Our colors are where we get our antioxidants. So we want, if people can tolerate it, they don't get GI symptoms or feel funky.
We want people eating every color of the rainbow every day. The other thing that's non-negotiable is your fiber intake. No matter how you get it, we want to be getting 40 to 50 grams of fiber a day into our diet.
That can come from different types of vegetables, it can come from grains. come from protein sources, but we got to get enough fiber in our body so that we're having regular bowel movements and we're moving things through our system, right? This allows for us to remove toxins and really promote a healthy gene.
GI tract, right? So no trans fats, try to avoid our processed foods, every color of the rainbow every day, getting about 45 to 50 grams of fiber. And we're trying to hit our protein intake, right? Our protein levels that allow us to maintain the muscle mass that is appropriate for our age to optimize our longevity. And people, like I was saying, ranges from your physical activity and your age to anywhere from like 0.8 grams per pound all the way up to 1.5 for 1.6 grams per pound.
So it's already a lot. It's already a lot to kind of think about. You're like, alright, so I gotta look at the thing to make sure there's not any trans fats.
I can't eat anything in a box, more or less, right? Which is impossible. But Silberman said so.
I've gotta eat, you know, the stuff on the outside. every color of the rainbow every day. I'm thinking about my protein intake, right?
Like, what else is there? Well, there's sugar, added sugar, right? Our body can accommodate, it ranges, but an adult can can accommodate anywhere from 40 to 60 grams of added sugar in a day, right?
What does that look like? That's like if you take a teaspoon of table sugar and you have about five or six of those, like that's about where your max threshold is for your body to accommodate that, utilize it as fuel. And the next day in the morning, it's all good and done, right?
Like is sugar the enemy? No, sugar's not the enemy. Too much sugar. sugar is the enemy, you know, just like a lot of things, but we're all having too much sugar in our diets.
It is, I think the average consumption of sugar in the American diet is well over a hundred grams of sugar a day, right? Well over, yes, a hundred grams, right? It's like 20 of those teaspoons, right? And we're meant to be eating like four or five. And, you know, the, it's, it's a shame, but the, the, the school breakfast, right?
The, the school breakfast, school breakfast that is provided in in in public school that that I think it's like 30 or 40 percent of of youth in America eat is like fruity pebbles or fruit loops and um like orange juice right with milk and orange juice right so they're alone they're getting 60 plus grams of sugar right like this is a problem like this is a big problem so so we want to look at our sugar intake too so like that's now we're now we're like in this crazy world right so we're like looking at at our sugar, we're avoiding trans fats, we're minimizing our processed food intake, right? We're getting every color of the rainbow every day. We're hitting our fiber and we're trying to hit our protein, right? Plus we're cooking with oils that we're not burning.
Like, shouldn't that be enough for everybody to try to manage? But on top of it, we start to think about like these different types of preferences. And that's where I think things get interesting. right um you know two decades ago two and a half decades ago there was a a naturopathic physician named joe didamo and he wrote this book called the blood type diet and it was looking at different um individuals blood typing and how it related to foods that worked the best for their their nutrition right the idea was that based based on where you came from, your genealogy, where your genes and your family history originated, different types of foods would be more appropriately assimilated into your body. And I think that there's a lot of truth to that.
There's a lot of truth to this anthropologic origin and eating how your ancestors ate. So when I think about what people should be choosing for their nutrition, right, in addition to the foundations that we spoke about, I think looking at your genealogy and then looking at your... like really paying attention to how you feel, how you perform, and how you are as a person with that particular nutrition program. And then we can track things like blood chemistries to see see how your nutrition programming impacts your physiology.
For a long time, there was a physician who would evaluate how your pulse would change when you ate different foods. It's well known that that happens, but there's a lot of other factors in the moment that can impact your pulse. So it's not as sensitive of a tool, but the food you eat certainly impacts how your brain functions. you feel, how your skin looks, right? Like I know a lot of people's introduction into functional medicine in my world comes from something that they're doing that's impacting their guts, that's impacting how they're thinking and feeling, or that's impacting their skin, causing eczema or rashes or otherwise, right?
So we can look at how the food is working with you and then make a decision based on that versus like kind of following. a particular type of dogma or ideology. Now, totally separate to that is the idea that the do no harm concept, right, that many people adopt in their nutrition choices, right?
Not, you know, killing another organism on the planet. And that, I think, is a very sacred thing for people who aspire to that and should be respected and acknowledged and honored in its entirety. The same thing applies to food choices and their impacts on the environment as well. I think that that's a very noble and honorable and appropriate way to live life. And what we can do is we can look at blood chemistries, physiology, and symptoms to make sure that what you're doing is not only impacting your goal of environmental stewardship, of sacredness of life, right?
And is it negatively impacting your health span and lifespan? We're going to wrap it up there. I know we'll be hanging out for a little bit after, so I'm sure you can ask more questions if you want.
There's also cards for Adam up at the front if you're looking at scheduling a consultation with him and maybe learning a bit more about your health. But yeah, thank you, Adam, so much for coming in. It's a pleasure.
Thank you, Connor. Yeah. Thank you guys for coming too.