Health, Fitness & Personal Growth Tips for Women in Midlife: Asking for a Friend

Ep.195 “Normal Isn’t Optimal”: Hormones, Heart Disease, Thyroid & Midlife Lab Blind Spots

• Michele Henning Folan • Episode 195

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Have you ever been told your labs are “normal” — but you don’t feel normal?

In this episode, I sit down with integrative and functional medicine physician Aaron Hartman, author of Uncurable, to unpack the dangerous gap between normal and optimal — especially for women in midlife.

We cover:

  • What lab reference ranges really mean
  • The cardiovascular markers every woman should know (hs-CRP, LDL particle number, Lp(a), ApoB, homocysteine)
  • Why LDL alone is outdated thinking
  • Thyroid testing beyond TSH (free T3, free T4, reverse T3, antibodies)
  • Ferritin, B12, iodine & nutrient blind spots
  • Estrogen, progesterone & testosterone — when to start and what actually protects your brain and heart
  • Statins, diabetes risk, and mitochondrial health
  • Gut health, inflammation & autoimmune triggers
  • Why lifestyle is foundational — and where advanced longevity tools fit in

Dr. Hartman explains how heart disease begins decades before symptoms appear, why hormone replacement therapy dramatically reduces risk when used appropriately, and how women can advocate for themselves in a system that often dismisses midlife symptoms.

If you care about your brain, your bones, your heart — and living strong into your 80s and 90s — this conversation is essential.

Did you miss something? Check out the transcripts of the episode!

You can find Aaron Hartman, MD at https://richmondfunctionalmedicine.com/

Instagram https://www.instagram.com/aaronhartmanmd/

His book, Uncurable: From Hopeless Diagnosis to Defying All Odds, is available where you buy books. 

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If you’re doing “all the right things” and still feel stuck, adding a layer of support may be an option. I’ve partnered with a trusted telehealth platform offering modern solutions for women in midlife—including micro-dosed GLP-1 and other peptide therapies.

https://elliemd.com/michelefolan - Create a free account to view all products.

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Transcripts are created with AI and may not be perfectly accurate.

Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions regarding a medical condition.

Foundations Before Peptides

Michele Folan

The information shared on this podcast is for educational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional regarding your individual health needs. You already know I don't believe in shortcuts. If you're not lifting, walking, eating enough protein, managing stress, and prioritizing sleep, peptides are not the answer. Lifestyle is the foundation, always. But here's the truth: midlife biology can be stubborn. Hormones shift, recovery slows, body composition changes, and energy dips even when you're doing the work. That's where medically supported peptide therapy can be layered in, not as a replacement for discipline, but as strategic support. Physician prescribed, clinically guided, compounded through an FDA-regulated pharmacy. This is about optimization, not escape. If you've built the foundation and feel like you've hit a wall, this might be the next intelligence step. Lifestyle first, strength mandatory, support biology when it needs backup. If this resonates, send me a message and let's have a real discussion. Or check out the link in the show notes. I'm your host, Michelle Folan, and this is Asking for a Friend. Have you ever walked out of a doctor's office with labs labeled normal, but you know you don't feel normal? You're exhausted, your weight has shifted, your digestion is off, maybe your heart races, but the answer you get is everything looks fine. For too long, women in midlife have been told they're okay when they don't feel okay. Symptoms get brushed off as stress, aging, or anxiety, and we start questioning ourselves. Today we're talking about the space between normal and optimal. What do lab reference ranges actually mean? What cardiovascular markers should we be paying attention to beyond a basic lipid panel? When is hormone therapy appropriate? And what about starting estrogen later in life? And how do we advocate for ourselves so our symptoms aren't dismissed? Joining me is Dr. Aaron Hartman, an integrative and functional medicine physician and the author of Uncurable From Hopeless Diagnosis to Defying All Odds. His work focuses on identifying root causes, optimizing physiology, and helping patients move beyond your fine to truly thriving. Dr. Aaron Hartman, welcome to Asking for a Friend.

Aaron Hartman, MD

It's great to be here. I haven't heard about you for a long time, so I'm excited to have a conversation with you today.

Michele Folan

So I won't divulge who it is, but a family member of mine, actually two family members of mine, are patients of Dr. Hartman. And I feel like I know Dr. Hartman. And uh so this is this is fun because um I've heard so many wonderful things about you over the years. And this conversation, I feel like, is way overdue. You are traditionally trained and board certified. I want to start at the beginning because what happened to your daughter Anna's health journey that led you to explore functional and integrative medicine?

Aaron Hartman, MD

So to kind of fill out what you said, yeah, I'm triple board certified. You know, I've had a clinical research company for years, part of 70 clinical trials. I've published in Lancet. I've been an assistant clinical professor of medicine at the Medical College of Virginia since like 2010. So very academic, very typical, very nothing outside the range of normal there, right? But my daughter changed everything. And um, that part of the story has to do, goes back to 2006, 2007. My wife, who is an occupational therapist, who works with kids with special needs, one of her patients' homes was closing down, and she said, Hey, would you consider bringing Anna into our home to foster her? I'm like, sure. And after a while, I fell in love with her, and we considered kind of adopting her. And one of the issues was her weight. She's failure to thrive, which means she's less than fifth percentile. So she's was born itty bitty, still itty bitty, even to this day, and um petite, we say petite now. But um, and the treatment for that, typically for kids, is you put a feeding tube into them and put formula into that to put meat on their bones. And so um, when we spent months and months feeding her, went back to the GI doctor and they said, Yep, failure, wrong. Standard of care for all these kids. This is what we do for everybody, and we're gonna treat you like everybody else, nothing special about you. You get what everybody else gets. You get a surgery, you get a feeding tube, and we get to pour sugar water with seed oils and high fructose corn syrup. And there's actually a big debate now on a government level about changing formula because it's so bad for babies. And um, we said no, like it that affects speech development, that affects brain development. If you know, it's kind of hard to learn how to walk and crawl when you have a tube out of your belly. The system had set the stand the bar so low. She was never supposed to walk, she was never supposed to talk, she was never supposed to crawl. So they didn't really worry about like what she looked like five years from now. They just wanted her to look better on the the growth chart. We said no to that and got reported to child protective services for for child neglect, so medical neglect, yeah, for refusing to basically we just wanted to give her real food, so we got reported to the the authorities. And so that was like my first inflection point where like the system, this whole system that I've been a part of, you know, graduate summa cum lata from with a biology major from you know university, all that kind of stuff. They don't like it.

Michele Folan

Apparently.

Aaron Hartman, MD

When you push back, right? And so um, six months later, my wife, being my wife researching things, found a growth chart with kids with my daughter's diagnosis. Her official diagnosis is cerebral palsy, and she was 50th percentile, she was in the middle. So all of a sudden, it's like the experts don't know. They had no idea that she was fine, that what we were doing was okay. She has this diagnosis, cerebral palsy, she's just gonna be small for whatever. And in her in her world, one surgery begets another surgery. So to put things in perspective, I'm gonna fast forward 20 years right now, she's 20 years old and actually getting ready to move out of our house two months from now, which is starting to worry me a little bit. So I'm getting a little anxious about her.

Michele Folan

Congrats, Dad.

Aaron Hartman, MD

Yeah, but um, but um, she's had zero surgeries in her life. To put things in perspective, a typical kid with her diagnosis has had 13 surgeries by the time they're her age. So literally, we've got these crazy outcomes from her by literally not doing what the experts say. I still went to the specialist, still got their advice, but all us were like, you know, cutting your eyes to help with the eye muscles, cutting your spinal cord to help with tone, cutting your heel cords. These are surgeries that have been recommended to her. None of them sounded good. And we've actually figured out ways around that to the point that she has beaten every odd. And that's what the book is about. And that's kind of what got me down this pathway of looking at things differently because I was not because I wanted to, I had no choice. I had to figure out a different way for my daughter.

Michele Folan

Yeah. And then that inspiration, now you are doing the same for patients. You you have to just be on top of everything because things are changing so quickly right now.

Aaron Hartman, MD

Things have always changed quickly. Um, but yeah, you do. I'm always learning something new. I mean, I literally I was at a conference over Christmas on time, the biggest in the world for in the grain of medicine, 9,000 people, 9,000 practitioners from around the world in Vegas, right? And I learned about a therapy called neurotherapy that blew my mind. We started using it in my clinic a couple months ago after learning about it. The coin was termed in 1925. So, this cutting edge therapy that 5,000 practitioners do in Germany that I've never heard of here in the United States until you know this past Christmas time, um, is 100 years old. And there's so much stuff that's like that. Lipid therapy that I do, that's almost 50 years old. There's so many things that actually really smart people, mass cell activation. You know, Lyme is now all the three age, right? Lyme disease, you know, it's been around for decades. It's not new, right? It's just now coming to public consciousness. And there's so there's more that's like that. You people want the new flashy thing. I don't want the new flashy thing that's going to be like no good in a year. I want the thing that's survived the test of time, that's around for decades, that no one's talking about. And there's so much of that out there that I'm still learning every couple months. I find something new I've never heard of before. And I've been doing this for 25 years, and I'm still hearing of things I've never heard of before.

Michele Folan

So yeah, that's it's exciting. Was this that longevity conference that was out in Vegas?

Aaron Hartman, MD

Yeah, it's A4M longevity, it's the biggest of the of its kind in the world. Um, the top people from around the country come and talk at it, and they have like all these breakout sessions. And usually what I do is I I actually bought all the recordings, and it's about 200 sessions, and so over the next couple of months, I'll just listen to the talks because you can't listen to all of them there. You know, it's just three days.

What Functional Medicine Really Means

Michele Folan

So yeah. Yeah, you're not superhuman. So, in practical terms, how do you describe what functional medicine is to my listeners?

Aaron Hartman, MD

Functional medicine is it's the ultimate personalized precision care. It's learning about you, Michelle, your issues, your history, where you grew up, your family, what you ate when you were a kid, were you breastfed, what makes you you now? And then based on your lab testing, your symptoms, putting an individualized plan together for you that's unique and works only for you. It's not saying you've got diabetes and we'll treat you the exact same way I treat the last hundred people. You're depressed. You know, is your depression from a concussion 20 years ago? Is your depression from a folic acid deficiency? Is it from your gut where 75% of your neurotransmitters are made? Like, why do you have this thing we, the syndrome we call depression? Actually figuring that out and treating the person as if they're a real person, an individual that has unique needs and requirements. Like that's basically all I do.

Michele Folan

All right. And for my audience, which is roughly 50, 55 plus women, why do so many of the women I speak to on a daily basis constantly hear your labs are normal when clearly they don't feel well?

Normal Labs, Unwell Women

Aaron Hartman, MD

When you look at labs, you're looking at data points. You know, it's like looking at it's like those games, everybody play those games, like you put a little thing here or a thing here, and it's the mountains, or you try to guess what you're looking at, you know. So literally you're taking the entirety of you, taking, you know, 10, 20, 30, 40 data points, maybe 50 if you're lucky, the person's, you know, advanced, right? And you're trying to guess without your history, without and taking those data points by themselves and not actually applying them to your fiber, your chronic fatigue, your hot sweats, your brain fog, your hormone issues or whatever it is, to connect them. They're treating just the labs. And, you know, and if you're doing that, of course, you know, most labs are gonna come, no matter what you do, most lab results come back normal. So if I do less of them, the odds are more than what the proportion wise that they'll be normal. And to put things in perspective, when I see an intake, my intake patient um gets about 500 labs done, um, like data point labs done. And over the period of year, it's about 900 to a thousand. I just did a rerund on my daughter because she's gonna move out of the house and have to tune her up before she goes out. And I got um 900, I haven't looked at yet. I got yesterday I got in the mail from the lab company 900 biomarkers that I have to review and put put a plan together for her when she's leaving in two months. Like she's got a lot of stuff going on, and that made me a little anxious because oh my gosh, and everybody we always have stuff going on, right? But if you're not looking at that much stuff, it's not surprising that you don't see anything, right?

Michele Folan

Yeah, and so there's there's normal and then there's optimal.

Aaron Hartman, MD

And I think that well, there's that as well. I'm I'm talking about just in general, then there's normal and optimal, and that's a that's a totally different world.

Michele Folan

Yeah. And so when a woman presents with I'm I'm just gonna throw this out there, like fatigue, brain fog, gut issues, poor sleep, but standard labs look normal. What would be the most common blind spots for that patient?

Gut, Hormones, Toxins, And Nutrition Blind Spots

Aaron Hartman, MD

Well, well, one, you can have um leaky gut or increased gastrointestinal permeability, which is a thing where your gut breaks down a little bit, and you actually react with the food you eat, and you can develop these things called IgG food responses. So you actually start reacting with the food you eat, and you can get that just from eating the same thing over and over again. You can also get this thing called dysbiosis, which is overgrowth of bad bacteria in your gut, 75% of all your neurotransmitters, 90% of serotonin, which is your happy neurotransmitter, 50% of dopamine, which is your go get them neurotransmitter, are made in your gut. So all of a sudden, if you're not making those optimally because of abnormal proportions of bacteria in your GI tract, you're not gonna feel optimal. Also, 90% of your immune system is in your GI tract. If you have a brain issue, brain follic fatigue, here's an interesting data point for you. If you get concussion, everybody who gets a concussion will actually develop leaky gut. That's how closely connected your gut and your brain is. When people, when um, when runners get runners' diarrhea, you know, you run really long, that's actually a stress-induced leaky gut that causes this diarrhea. Now, the healthy person goes away. So all of a sudden, for a female, you gotta look at the gut. And then your hormones is the other thing. You know, how many doctors are checking FSH, LH, estrogen, um estradiol, estrone, progesterone, DHEA, pregnantolone, which is your primary hormone of memory. No one checks that, right? And then your hormones are detoxified to your liver and to your gut. So all of a sudden there's a connection between your hormones and your gut, right? And then as far as like the brain fog stuff, you know, the average female puts 200 chemicals on her body every day. And a lot of these chemicals are neuroendocrine disruptors, which is a fancy way of saying the chemicals act like estrogen, you know, phthalates, for example, or an estrogen modulator. That's the soft, that's the stuff that makes all your skin cream silky smooth. That's the stuff that makes that's that's the stuff that makes plastic like really malleable. Women put that on their bodies every day. And so you do that for decades. And there's just a few of the things I see routinely that aren't being looked at by our healthcare system that can make a middle-aged 50 or 60-year-old female feel like she's not, you can age quicker. And then there's all the nutritional stuff. Oh my gosh, I didn't all the nutritional stuff. Women need more protein, they need more trace minerals, they need more collagen. You know, have you had a fatty acid analysis, um, a um an amino acid analysis, all these things to see are you actually absorbing what you eat? So all of a sudden, nutritionally wise, you might just be malnourished. Everybody see has a deficiency in something nutritionally wise. You know, if you haven't had a full nutritional panel, sometimes just fixing your amino acids, proteins, your vitamin D levels, your B vitamin levels, sometimes that's all I need to do with patients to make them feel better. So all of a sudden, with the five things you said, I've already mentioned, you know, a bunch of things that I look at on everybody because it's it's the foundation everything else is built on, you know?

Michele Folan

Yeah. And so I'm smiling only because this goes way beyond just making sure that you get 25 to 35 grams of uh fiber in your diet every day. I mean, that's great and that helps, right? But but what you're telling me is that there is just this whole theater of things going on in in your gut that you know we're we're only getting to one little piece of it by just adding more fiber.

Aaron Hartman, MD

Yeah, and one of the one of the things I do with all my patients is there's the thing called predictive autoimmunity. And the idea is that it's very common as we get older to get more inflamed. It's called inflammaging. As you get older, you get more inflamed. And part of that is autoimmunity. And that doesn't mean you have like, you know, lupus or whatever, but many women will develop thyroid antibodies, will develop a rheumatoid factor, elevates sed rate, elevated cardiac CRP. And just finding these inflammatory markers elevated lets me know which part of your immune system is off out of kilter. That's a standard evaluation, and it's it's interesting how many women will come in and have thyroid antibodies, and all of a sudden, like this is part of your brain follic fatigue, hormone, you know, osteoporosis, osteopenia. Is this your body's actually attacking itself? And then there are some basic things, interventions you can do, but that's like a screen for me. Like that's like everybody gets that. That's not optional. Autoimmune diseases by themselves are the most common disease. If I'm all together, are the most common disease like in our country. And it's like, you know, something like um something like between 10 and 20% of Americans, depending on which population you're in, will have a positive autoantibody. So why isn't screening for that standard in regular medicine? And it's because until you get a disease like you know, rheumatoid arthritis, the uh traditional world doesn't have a treatment for it. But in my world, it's like great, let's dress those toxins, leaky gut, let's uh um direct your address your immune status. And you can actually get these autoantibodies to actually normalize over time. And I've had that happen to hundreds of patients. Wow.

Autoimmunity Screening And Inflammaging

Michele Folan

Okay, this is so exciting. And I wanna I wanna pick up after the break here about cardiovascular disease, because I think we're gonna we're gonna we could go down a rabbit hole on this one. So um, we'll be right back. Before we jump back into today's conversation, I want to ask you something. If you've been listening for a while, you know this podcast isn't fluff. We talk about muscle, metabolism, hormones, brain health, longevity, the stuff that actually determines how we live in our 70s, 80s, and beyond. And the show keeps growing because you share it. So if an episode has helped you rethink your health, send it to a friend, text it to your sister, share it with your walking buddy. That's how this community expands. Smart, curious women bringing other smart, curious women with them. Also, I'd love to hear from you. What topics do you want me to explore? Who do you want me to challenge? What questions are you afraid to ask but secretly want answered? You can use the link in the show notes to join the community or send me an email with your ideas directly. This podcast exists because you're asking better questions. All right, let's get back to the episode. Okay, we are back. Before the break, we were talking about autoimmune disease. I'm gonna back up real quick here. How do we get our primary care doctors to do some some of these tests if we suspect we've got an issue?

Listener CTA And Community Invite

How To Ask Your Doctor For Better Testing

Aaron Hartman, MD

So I actually one of the resources in my book, actually, on curable, is a how to talk to your doctor section. So kind of like this little video thing I did and some check, like how do you, if you have 15 minutes, like how do you and so part of that is you have to realize you know, there's only so much you can do in a 15-minute time slot. I think the current data point is like the average person spends eight minutes in a their a doctor's office. So it's like, so you have to go in there like prepared, ask two, maybe three things tops. You have to, you know, hold your excitement down and say, hey, you know, I'm feeling kind of crate. Would you mind checking my thyroid antibodies? Because I, you know, my thyroid panel and checking my D level and you know, maybe doing a fatty, you know, what just a few things. And for me, when patients came and asked me those questions, I was always curious. I'm like, huh, what's a thyroid? I mean, man, I know that endocrinologists do that, but who am I to do that? Sure, why not? And then it comes back and you comes like positive, and I have to figure out what to do with it. And that's kind of actually one of the things I started doing early on is just ordering stuff and learning from the stuff I was ordering. If you're not working with someone who's even open to the idea of doing anything outside the box, which is a lot of people, you know, 80-20 rule, 80% of people are going to do like what everybody else does, right? So you have to find someone who's like thinks a little different, who's open to working with you, you know. And then if they order it, you have to be willing to do a little legwork on your own, right? Because, you know, if you're in a busy practice, you know, the way I learned how to do this, I was getting up my with my daughter, part of the story, is I was getting, I used when we got her, I realized I had to figure things out. I was getting up at four o'clock in the morning reading research articles, reading doctors' opinions, reaching out to people for two hours in the morning and then an hour at night. So I was spending three hours a day of my own time figuring this stuff out. So I learned a lot really quick. But you know, most physicians don't have that time. I've invested hundreds of thousands of my own dollars into learning about this. So it just you have to realize that most people don't have the margin for that. And so you have to be willing to do some legwork yourself. Show them some grace, be patient. But ultimately, if the person doesn't have the temperament to like work with you, and they're like, they're like, that's not standard of care. You don't need to do vitamin D levels on people, they're all low. Just take vitamin D. We don't check A1C's on you because you're not diabetic, you know. I'm like, well, A1C can you can predict my risk for diabetes over the next 10 years. Like, that's not a big deal, or you know, and so if you don't have a person who's at least open to it, which is a lot of people aren't open to it, then you might need to find someone else. But I did a whole thing on this about how you actually work through this. It's a big deal because the reality is if every doctor in our country went to functional medicine, we would need 10 times more practitioners than we have now to meet the current need, and we still don't have enough, right? So the reality is there's not enough people out there like me to meet the need for everybody.

Michele Folan

So yeah, and it's I as you're sitting here talking, I'm I'm going, yeah, I I have to ask my doctors for certain labs, and they'll say, Well, why do you want that? And I'll say, Well, because I want, I want to check this, this, and this. So I've I've done my homework, but what you're saying is we it's some of the onus is on us to make sure that we are doing that.

Aaron Hartman, MD

The one thing you can like Lab CornQuest actually have discount labs that you can directly you can get your own labs, you just pay cash price. And they actually have special prices that are about 10 to 20 percent the sticker volume, you know. So you can get an A1C for like $12, right? You can get a vitamin D level for 20 bucks. So you can actually, if your physician isn't gonna order it for you, you can just pay cash and go online and order it to these places at Lab Core Quest and order a lot of these things. That's an option as well. But then again, the onus is on you. So then you get the results back to figure things out. But I was tell people. start with basic you know B vitamin levels you know B12 folic acid homocysteine levels you know uh uh omega omega check which is a fatty acid blood fatty acid analysis antibody tests there's a lot of basic things you can do vitamin D levels you know there's a lot of basic things you can do on your own but then it's then it's on you to figure out what to do with them.

Michele Folan

Are those in your book any of those like suggested tests?

Aaron Hartman, MD

Those um I do oh yeah I do have a whole section that talks about things that do with my daughter and tests and I don't think I actually mentioned if I recall sometimes I say so much stuff I forget what I say where but um I don't know if I mentioned the actual um lab companies like one's like one lab but um but they're not hard to find because they've got all so many ads up so all right great all right I want to talk about cardiovascular disease and in particular because right now I'm working through the American Heart Association for the Go Red event to raise more money and awareness around women and cardiovascular disease.

DIY Labs And Starting Points

Michele Folan

So I have a kind of a soft spot because I've worked in the cardiovascular metabolic world for most of my previous career. And I was wondering you know beyond the fact that cardiovascular disease is the leading cause of death in women, are we missing early warning signs in midlife that this is impending?

Women’s Heart Disease: Missed Signals

Aaron Hartman, MD

100%. You know, one of the things I do talk about in the book and I talk about on social media a lot is this idea of medical gaslighting or medical blind spots. And so unfortunately women hit the brunt of that great example you know it's funny most of the studies on men, middle aged men, Caucasian men until recently and women tend to present with heart attacks more stomach pain. So literally women would come in I got reflux my stomach's off you know um it's just your anxiety and they would be having angina but women present differently and that took us I mean I remember that was cutting edge when I was oh my gosh cutting edge women look different than men with heart disease and you're like well they kind of sort of are different. And so yeah the 100% early things but the thing about that is people start developing heart disease in their teens and early 20s. We know from autopsy reports that teenage kids will already have soft plaques. So the question isn't don't wait till symptoms that the heart disease the heart disease you have when you're 60 is a plaque in your 40s which was vascular inflammation in your 20s so the question the better question is can I actually do lab test and the answer is yes by the way can you do lab testing that picks up dysfunction in the lining of your arteries inflammation immune dysregulation which are the three causes of all heart disease it's can I pick those up you know in my 20s and 30s and actually prevent the whole thing from going forward and the answer to that question is is yes and a data thing for you this was actually published by the NIH they're legit I think they're still legit right November of 20 of 2024. And you can predict the females 30 year risk for heart disease with three numbers it's your HSCRP which is a marker for inflammation in your arteries your LDL particle number okay which tells you big small stuff and then an ellipoprotein A or LP little a knowing those three numbers and if they're high you're like if they're low it's like wow you are now in a low risk and that can help predict your risk for the next 30 years. So my thing is like shouldn't every female get those three labs done? Yeah you know and the other the other data point for you in general in our in our country 30% of all heart disease is directly related to lead exposure.

Michele Folan

What?

Aaron Hartman, MD

Okay is directly related this is this is EPA data this is not Dr. Hartman this is government data. Okay and and most and of course and that's older people you know people in our range I'm 5253 if you were born before 1991 you had you were exposed to lead whether the paint the gas whatever so all of a sudden now if you're a female or a male worry about heart disease you know what's your blood lead level you know it should be undetectable and if there's any in there that's a bad thing. So those are you know three labs and one metal that everybody who's concerned about the heart and you can get into genes and a bunch of other stuff but those are just super basic things that have big big bang for your buck.

The Three Labs That Predict 30-Year Risk

Michele Folan

All right so then I have to go to LDL because everybody uses that as your marker because oh you've got an LDL of 140 we need to throw you on a statin what else do you look at before you suggest a statin?

Beyond LDL: Particles, Oxidation, And Function

Aaron Hartman, MD

Well the question is is what's the LDL made of is it made of really big fluffy healthy particles or is it made of hard dense damaging particles? Is it oxidized? Oxidized LDL is horrible that's actually a marker for burning actually in the the cholesterol molecule so tell me about the kind of LDL and the answer is they don't check those things. And so the LDL it's the devil's in the details LDL by itself is not bad. It's like what's it made of and then HDL is another one you might have a good HDL number but is it functional or dysfunctional you might have a you know female with a 50 or 60 HDL but if it's if your HDL particle number which is an indirect way of looking at the functionality or now Quest labs through Cleveland Heart Labs offers a an HDL function test. Is your function low right so all of a sudden all these details and I can ramble on about this aimlessly so I don't want to ramble on too much but the question I ask people is what's the what's the ultimate ultimate cholesterol number for all cause mortality you know my clinical research company they all we do studies and they you know the question was all cause mortality like you know dying for any reason right and there's an ellipse this thing called a it's like ellipse J curve and if your cholesterol is too low you have an increased risk for dying of all causes and that's like more neurological neurological in cancer. If it's too high you have a risk for dying for things that's more cardiovascular. That number that you have the old the longest the best outcomes is between 220 and 240. So it's not 170. Now if you're a diabetic that's different you've had a heart attack that's different. I'm talking about in the general population right yeah concern with women with statins is that statins increase your risk for developing diabetes maybe up to 48%. Why is that it's there's we don't quite know but it's it's in postmenopausal it's menopausal women not less than but it can significantly increase your risk for developing diabetes. And so I give you statin and lower your risk for heart disease 25% I'm a good doctor I did a good job. If you get diabetes I just increased your risk for heart disease 400% if you're a female statin I want to see your fasting insulin and your A1Cs and if they're tracking up stop it see if it comes down if it does then I know you're statin the statins um well actually I guess I do know why statins I'm sorry I do know why um statins I'm sorry I didn't think about this sorry oh sorry I do know um statins are actually toxic mitochondrial toxicants the actual toxins to your mitochondria which are the powerhouse of your cell they also induce cocutin which is a nutrient required for energy production deficiencies B12 deficiencies folate and magnesium deficiencies so any one of these can actually increase insulin resistance. So if you're a female male or anybody taking a statin are you supplementing with at least 100 to 200 milligrams of cocutin and are you taking a good B supplement that gets all the Bs in there and then add in some magnesium as well because it can also cause magnesium deficiency and by the way 80% of Americans are magnesium deficient anyway right so um how many people are doing recommending that and the answer is very very very few.

Michele Folan

Okay now I hear this in my in my research and stuff that if we lower cholesterol too much it can increase the risk of um dementias that our bodies our brains do need fat so how do we how do we parse that out with too much is not a good thing.

Statins, Diabetes Risk, And Mitochondria

Aaron Hartman, MD

To my point it's not just cholesterol like what's your what are all these other markers what's your LDL particle number what's your size what's your HS therp what's your homocysteine level vitamin D status your vitamin D being low increases your risk for cardiovascular disease. What is your omega 3 level there's a thing called omega 3 check if you're here's a great data point for you if your omega 3 levels are low you have an equivalent risk for heart disease as a smoker with a normal omega 3 level holy cow holy so like that's the way the literature presenting so my question is is is taking omega 3s as good for your health as not smoking? Like because that's what that suggests and how hard is it to check an omega 3 level and replete it the answer it's really easy right and so the question you need to ask is not what is your cholesterol that's 20th century thinking. 21st century thinking is I mean the three causes of cardiovascular disease are immune dysregulation inflammation and endothelial dysfunction which is dysfunction in your the belonging of your arteries the question is what labs correlate with those things being off oxidized LDL, elevated LDL particle, HSCRP. There are some genes like an ApoE4 gene which is related with inflammation, fibrinogen levels there's a lot of other labs so we're like in the data I'm talking about this data is like 20 some years it's old now it's decades old it's not new but medicine takes decades to pick up things. So we're still practicing medicine and that's the standard of care. You know standard of care lags the literature sometimes 40 or 50 years. So the questions you're asking are good questions but they're just acknowledging a phenomenon that the practice of medicine lags the literature anywhere up to 30 to 50 years. And so you're just your problem is you're stuck in that because you're learning this and you're like well I'd learned this but why why is this the standard of care? And it's like well standard of care is always going to be lagging the literature by decades.

Michele Folan

Yeah. All right and one other question about LDL you have apopee and you have LP little a.

Aaron Hartman, MD

Okay.

Michele Folan

Right?

Aaron Hartman, MD

It's one of those hereditary the LP little a so this is the mantra is um the the science is I say science because science you know changes all the time right so the science is that LP little a is genetic. So you don't have to check it a lot you check it it's high low um to your point but I have patients who have come with um LP little A's 240s 250s I got them still elevated but down to 170 160 with some interventions. So I have to ask myself self if it's that genetic how can I can change it with nutrients things like omega 3s things like berberine things like aged garlic how can I can change that the the number you know vitamin C and acetyl cysteine how can I change it if it's only genetic I think the setup like anything you know the genes load the gun the environment pulls the trigger I have one patient his entire like his grandmother's in her 90s his mom's in her 70s and he's 40s and they all have high cholesterol they all have high LP little A's and he's freaking out about it and like and his his his um family's from the islands and like his grandma like your grandma she's never had a heart attack right her cholesterol is like you know 300 huh how much your mom same thing. And so and they all have this LP little a thing. So it does increase your risk but the point is it's not determinative and you can do things to lower it I think that's the big picture.

Michele Folan

Okay. I had to ask that because I you know we hear of familial hypercholesterolemia and I didn't know if that was different.

Aaron Hartman, MD

That's a different thing familiar hypercholesterolemia is actually a genetic thing where you have like three, four, five that's doesn't apply that's a different thing. That's actually a a different gene thing where you have like you know three, four, five hundred number cholesterol and you have a family and like my dad had a heart his first heart attack when he was 35 or 40 people are having events in your family at a young age. So that's a different those people the PSK9s which are some really fancy drugs hydostatins like the reason we have those drugs is for those people. That's brilliant for them um but that's a different creature altogether.

Michele Folan

All right thank you for defining that because that I that does come up from time to time with clients of mine I would cover off on that. Okay I want to talk about the thyroid and I think this is one of those things that gets missed very often because we do some general testing but we don't go deep enough. On the thyroid front is TSH alone adequate and when do you expand testing to free T3 or free T4 or antibodies?

Thyroid: TSH Isn’t The Whole Story

Aaron Hartman, MD

So TSH is adequate for screening in a population so if I'm just going to screen the population screen 330 million people for thyroid disease just check 330 TSHs is it good for figuring finding out thyroid optimization and subclinical people that are on the borderline for having and the answer to that question is no. And so I again I see people individualized stuff I'm not seeing 330 million people you come into me what about my thyroid I'm not going to tell you what I would tell the exact same thing to the next 339 you know million nine hundred ninety nine and so you everybody gets a TSH you know third generation TSH gets a free T4 it's a free T3 which is the actual active you know free towards free T uh T4 is kind of like the storage form it's 10 times less potent than free T than T3 that's the active form of thyroid though T4 has some actions reverse T3 that is literally the breaks to the whole thing when your body has the T4 mitochondria actually will turn T4 into either T3 or reverse T3. So it's a wave your body saying whoa whoa whoa something's going on here I need to take a I need to hibernate or something so reverse T3 and then thyroid antibodies as well I'd put those those are all part of my standard which is TPO and antithyroid globulin antibody part of my standard protocol panel because you ultimately don't know just know what the brain is saying because you had a brain injury or a train brain injury or an infection that might affect your your brain saying I need to hibernate so what's your brain telling your thyroid then what's your thyroid doing and then what's your body doing with what your thyroid tells it to do. So I'll look at the whole cycle not just one piece of the puzzle.

Michele Folan

If a woman comes into your office like what and you may suspect and I know you do these tests routinely but for for my audience how might they self-diagnose that they may have some kind of thyroid issue?

Aaron Hartman, MD

Well thyroid issues can sound like hormone issues can sound like cortisol issues can sound like a lot of things but typically it's hair loss I'm cold my cycles are off you can be having more menopausal hormone cycles related to your thyroid as well brain fog weight gain you you tend to get like a little swelling you can get like this thing called mixedema where you get like you get kind of puffy constipation um poor sleep poor resilience you wake up feeling tired I always said hair loss thinning of your skin there's a whole host of things that can be related to um hypothyroid and hypothyroid which is those side is usually the opposite of everything I said lots of energy can't sleep maybe a little manic you feel hot all the time you get diarrhea you know you're warm um your hair grows fast like your weight you're losing weight you feel like your heart's racing all the time um so not there's not a direct correlation to like those two but um all right well I'm not sure I'm like what which one would I want?

Michele Folan

Probably neither but yeah I see I see where this can kind of mimic when your cortisol levels are high too so that's that that's kind of an interesting call out. Are there common nutrient deficiencies you frequently see in midlife? I know we talked about vitamin D. What about ferritin?

Symptoms, Ferritin, Iodine, And B Vitamins

Aaron Hartman, MD

Iron deficiency and iodine deficiency I see all the time iodine deficiency is very related to where you live in the country like there's a there's a goiter belt in the Midwest where all the soil is low in iodine and people get lots of goiters so you have adequate iodine and the ferritin iron is a super important part of um of thyroid function you need adequate iron and and those are the two most important mineral well selenium iron which with ferritin is the active form and then um iodine the thing about ferritin is not standard test that's done usually they do a blood count which is CBC maybe with hemoglobin is 12 or 13 that's normal but if your ferritin's like eight or six or twenty you have a low level of functional iron and that could affect hair skin you get little ridges in your nails and you affect your thyroid function as well is that an expensive test to run a ferritin test okay no ferritin ferritin um um selenium iodine tests are not expensive to run all right so we talked about doing an omega 3 um it is what about um vitamin B levels B12 are those pretty standard in the regular world no all right in my world yes yeah but I would you typically order B12 level of folic acid I also order a homocysteine and methylmalonic acid those are two um organic acids the breakdown products of the metabolism of those vitamins so you can have a blood level normal of folic acid and B12 but not get enough in your cells so you can be functionally below B12 functionally low folic acid and you won't pick that up unless you do a methylmalonic acid or homocysteine. And the homocysteine level being elevated and both of it both it's counterintuitive both of these are high when your nutrients are low and elevated homocysteine levels associated with automine issues, inflammation, dementia, neurovascular disease, cardiovascular disease so just knowing your homocysteine by itself actually improves cardiac outcomes, right? So those are standard things that everybody should get as well.

Michele Folan

All right but back to the lab testing is there normal versus optimal on homocysteine?

Aaron Hartman, MD

100% there is the normal it depends like a lab core quest normal usually is less than 12 but optimal is six to eight same thing for TSHs you know normal is anywhere from 0.5 to five optimal is like you know depending on which lab it is like one to two I like that I try to get as close to one as possible. B12 is a great one because the the normal range on that's like 250 to like a thousand but the literature the medical literature PubMed literature is that if your vitamin B12 level is less than 500 you have an increased risk for neuropathy. So I want all my patients to have their B12 levels over 500. So all these labs have that those nuances of normal range versus optimal range.

Michele Folan

So is neuropathy an issue beyond having diabetes?

Estrogen, Brain And Heart, And Timing

Aaron Hartman, MD

100% you can have it from heavy metal exposure you can have it from toxins and chemicals in the environment you can have it from um nutrient deficiencies there's lots of reasons for to have neuropathy.

Michele Folan

Okay oh that's really interesting I I that never on my radar but okay I want to talk about estrogen I know this is my audience though we have to talk about it I've talked so much about estrogen the last year I'm I'm I love estrogen it's great and are you estrogened out but there's there's so much opinion that is runs the gamut on when is it appropriate to start estrogen. So what are your thoughts?

Aaron Hartman, MD

So my question is when are you okay losing your heart in your brain then you don't need estrogen anymore. So just that's a little that was meant to be shocking. This is an example of medical either blind spot or gaslighting depending on what your worldview is so as of um November 2025 we can do estrogen again right black box is gone right according to the medical and this is just literature this data anybody can pull this off a PubMed and with AI you can figure it out now if you have the right prompts but hormone replacement therapy lowers our female's risk for heart disease 50% and your risk for dementia about 35%. So according to the doctor um blind spots Marty McCary had wrote a book about this called blind spots he actually quotes these these data points in that book that um potentially 1400 women died prematurely in the United States due to lack of access to hormone replacement therapy from 2002 to last year. So this is a this is a big deal 40 to 60 million women were undertreated. And I don't know why people aren't like really up in arms about it because it was a big a big oops a big a big miss and it's you know when should women start getting you know what most of the bone loss osteoporosis most bone loss occurs during the first two years of menopause. So you really want to be watching your hormones as you're going into the change of life the first 10 years after that are most important for neurological cardiac and bone health but estrogen is important for brain health it's important for your skin it's important for like you know tell a guy he doesn't need testosterone estrogen doesn't men in women what testosterone does in men. So what age do men not need testosterone anymore you know the grumpy old guy who's you know you need it when you're 80. You need it when you're 80. And so it's the same thing with women women need it and they're older and so if you want to be 80 and have your mind and be active have a have your bones stable then you need it. Yeah there's no limit to when you can get it um it's just I think the devil's in the details it's how do you get it do you topical do you be or do you do oral do you do creams do you do pellets that's where I think the details are and um never do oral estrogen because that's where all the that's where you get in problems. And never do oral print pro which is horse urine estrogens equine and never do and it has midroxy progesterone which is known to cause tumors in lab animals. So it's like of course if humans eat that that causes that causes problems. Don't use that.

Michele Folan

Okay. When you are looking at a woman who is perimenopausal do you ever suggest estrogen for someone in perimenopause?

Perimenopause Strategy And Hormone Hierarchy

Aaron Hartman, MD

100% depends. I actually check the hormone levels I don't guess typically what happens is women late 30s early 40s their um testosterone will start kind of going down and then early 30s to late 40s or progesterone will start going down and the estrogen will actually start going up and start doing this kind of wavy thing. So what happens is is a lot of these symptoms that might look like like look like estrogens upper low whatever it's actually a dysregulation an imbalance between these. So what happens a lot in the early perimenopause area is you're doing a little bit of testosterone, you're doing a little bit of progesterone, maybe your and this is where now I'm gonna take a stop here you have to you have to honor the hormonal hierarchy and sex hormones at the bottom of the hormonal hierarchy. The top is cortisol insulin thyroid so if your cortisol is off you're insulin resistant and you have subclinical hypothyroidism it's going to make you have sex hormone issues particularly in this age and it's gonna make them worse in this age group group so you have to you have to address that. And all your sex hormones are detoxified through your gut. So you got your gut squared away so I just I don't want to say too much about that but you got to respect this Hormonal hierarchy before you hop into hormones. So that aside, with the hormones, I tend to do more with progesterone, testosterone early on, and then just track the estrogen. And what I do a lot of actually is detoxification of estrogen because what I see a lot is estrogen dominance, heavy periods, fibroids, fibrocystic breast, right? In the face of low progesterone. So you get abnormal bleeding, spotting bleeding, all that kind of stuff. And that also can lead to some of the things that you don't tolerate stress. Your sleep is poor. That's a progesterone deficiency thing. Your libido is off, you're losing muscle mass. That tends to be a testosterone-related thing. So all of a sudden it's a little more nuanced. It's not all just about estrogen, though. Estrogen is a super, it does give you your superpowers. So you have to look at all those things.

Michele Folan

You know, it's funny, you talked about testosterone. And I get so frustrated when people think of testosterone as a male hormone. I'm like, no, we women have testosterone too, and it needs to be replaced.

Aaron Hartman, MD

Well, how many of your friends, colleagues have issues with recurrent UTIs, painful intercourse, atrophy of your external genitalia? The out the outer one-third of your of your female genitalia are testosterone-sensitive tissues, androgen-sensitive tissues. So if you're female, and I see this a lot in my 60-year-old range, well, they'll come in, you know, I love my husband, it's painful, I have intercourse, it's thinning, I've got lichen sclerosis, you know, lichen planets, these things. A lot of those actually are androgen, testosterone, androgen deficiency issues. And so if you want your body parts to not get UTIs, not be painful, and not to like get these little ulcers and things on them, you actually need adequate testosterone for that stuff.

Michele Folan

And vaginal estrogen, correct?

Aaron Hartman, MD

Well, you can use that as well.

Michele Folan

Yeah.

Aaron Hartman, MD

That the vaginal estrogen, it's it's nuanced. The vaginal estrogen, again, the outer one-third is um more androgen sensitive, though, of course, estrogen as well. The inner part is more estrogen sensitive. And also depends on the reason why you're using the estrogen as well. So got it. Test don't guess. Just we're right now I'm guessing. Just you can get the testing done to figure out what's off and just address it.

Testosterone For Women And Genitourinary Health

Michele Folan

Do you have I have to ask you this. Do you have an optimal testosterone level? So say say you put me on testosterone cream. Do you have an uh an ideal level where you like to have your female patients?

Aaron Hartman, MD

It depends on the this is what gets tricky because every lab has a different reference range. And so I look at your sex, your testosterone being the the the third to fourth quartile. So take that normal range, you know, whether it's a blood test or a sitbit test or um, yeah, those are the two major ones, and you basically cut it up into fours and look at what the top the top quartile is and just kind of put the level right in there. And then with testosterone, you want to make sure that um, you know, um it can turn estrogen. So you kind of follow up on that as well. But I try to focus on the the third third to fourth quartile.

Michele Folan

Okay. I'm I'm laughing only because I was um I do a topical testosterone therapy, and I was noticing that I was getting, you know, some little extra chin hair and and those sorts of things. So those those are nuisance things. I also noticed that my sex drive was probably getting a little kind of out. Like my husband was happy, but I was like, okay, this isn't normal. And it I went back and got tested, and it was it was a little high, it was out of her comfort zone. So we cut my dose. So anyway, that's sometimes too TMI went on the show, but I don't really care. All right. I want to discuss a little bit about detoxes. So you you say you know, like you may detox someone of estrogen. What does that mean physiologically when we do some kind of a detox?

What Detox Really Means

Aaron Hartman, MD

Well, your body naturally takes estrogen, you conjugate it, making it water-soluble, you put it in your bile and you poop it out. So improving women's detoxification is just helping you poop better, help your liver work better to detoxify that. So if you're chronically constipated, you're gonna have estrogen detoxification issues. If you've got the wrong kinds of bacteria, if you've got an elevated baked beta glucuronidase, is a stool test that you can do that shows you're actually uncoupling this whole process and reabsorbing the estrogen, so it can tend towards estrogen dominance. Then you can improve the liver function. You know, that you can do that with things like olive oil, DEM, surfane. Um, I mean, certain amino acids actually part of detoxification requires protein. I mean, one of the things you probably know pretty well in your age range, you need more protein. Right. Having low protein is going to affect this phase two detoxification. It'll affect how your body gets the stuff out of your body. Um, you know, sulfation, gluconidation, just getting more amino acids. So that's what you're talking about when you talk about detoxification is your liver binding it, putting it in the bile, you know, and curcumin helps with that, you know, dandelion helps with that. There's a lot of herbs that help with that. Get it into your gut and then get your gut to move to get it out of your body. That's that's what the process is.

Michele Folan

So it's not just estrogen, it's uh, it's other things too, that we need to have this. We need to have a good detox detoxification system just in general.

Aaron Hartman, MD

Yeah. And one thing, one passion I have, I shouldn't say passion, one one point I make a big deal about is sweating. A lot of solvents, a lot of these neuroindocrine disruptors, which are chemicals that act like hormones, are actually excreted through our sweat. Now, the question may be to you when's the last time you sweat profusely? And the average American doesn't sweat at all any. A hundred years ago, you would sweat all day long, all summer long, depending on where you live in the country, and the falls well, you know. We don't sweat anymore, and people forget that's one of the ways we detoxify. So it's not just pooping, it's not just drinking adequate water, it's not just eating clean food, breathe, breathing clean air. It's also, do you sweat profusely three to four times a week at a minimum? The answer is no, it's gonna impact your detoxification process.

Michele Folan

And so do you suggest a sauna?

Sweat, Saunas, And Cardiovascular Benefits

Aaron Hartman, MD

The best way to sweat is to be physically active outside, moving, moving your lymphatics to sweat. I realize that means working outside. Okay, so most people aren't gonna do that. Saunas are awesome. They um actually help. There's actually lots of great um Finnish sauna in Finland. There's a lot of data on actually, here we go. Back to your point. Um, this is male data because you know, the whole medical gaslighting thing, but you can lower your risk for heart disease 25% by um being on a sauna three times a week and lower your blood pressure 10 points. So literally doing a sauna four times a week acts like a blood pressure medication. So all of a sudden, sauna has cardiovascular prediction, protective benefits to it, as well as detoxification. But saunas are great. Um, I try to use mine three, three or four times a week. It's very calming as well, it's great a part of an afternoon process if you have one at home, just to get in the mood to fall asleep. If not at the gym, just use it after you work out. But yes, saunas are good.

Michele Folan

Okay. I told you we were gonna talk about this because I'm curious, but parasites. I hear about parasites, like, oh, you need to do a parasite cleanse. Give me the skinny on parasites. Are are we really at risk for parasites?

Parasites: Risk, Testing, And Context

Aaron Hartman, MD

I mean, we have lived the majority, the majority of human history, all but actually 99% of human history up to the month has been with parasites. You know, it's interesting. Country countries, sub-Saharan Africa countries where parasite infections are endemic, you don't see autoimmune diseases, you don't see cardiovascular diseases. There's a whole field of medicine looking at parasites as a thing that modulates your immune system. You know, there's a there's actually um I've got some patients that are autistic that have actually given oral parasites to to calm their gut down for their autism. And I got these from Duke, I special ordered these parasites. It's actually a porcene, doesn't infest people. But um, so there's that thing. Like, not all parasites are bad, you know. But put that aside, the problem is you have to be a healthy host. If you're an immunocompromised, sick-inflamed host, parasites go crazy. Just like your gut microbiome, are all bacteria bad? No, we need the 100 trillion bacteria and you know, are all viruses bad? No, 8% of our DNA actually is viruses that introduce themselves into our DNA. Parasites is a very similar story. You know, I um I don't know where to go with this, but but there are a lot a lot of patients I see who have chronic fatigue, fibro, who have multiple nutritional issues, B biome deficiency, they got SIBO, gut, IBS. Those individuals they can't have parasitic infections that are overgrown, that are now activating their immune system, just like you can react with meat and gluten and dairy and soy and all this other stuff. So, can you now have a dysfunctional relationship with parasites? And the answer is 100%. The other thing about the parasites is in the modern culture, most parasitic exposure is actually from your indoor pets. So, are you gonna get rid of your dog or your cat? No, so and you so and you give them a dewormor. It's funny, like we give our animals dewormors like every six months. When I go to um go to Guatemala on a mission trip down there, I go to this hospital in the middle of nowhere. Um, that's schools. We go to schools literally and just give the kids dewormors.

Michele Folan

Really? Okay.

Aaron Hartman, MD

Because they're so common. So parasites are a thing, they're everywhere, they're common. That some of the gut testing I do does look for parasites, and when I have patients who are chronically ill, I will do an advanced parasite test. That's only one place in the country that does it. And some people it makes a big difference. But just like all bacteria are not bad and all viruses are not bad, all parasites are not bad. Devil's in the details, do I test for them? Yes. Um, and if you if I'm seeing someone who has health issues who's sick and is auto-immune, do I treat them? Yes. But if you look for parasites in healthy individuals, you'll see it in a lot, a lot of people. Quick aside, most ancient cultures that have a have a healing tradition, like Ayurveda medicine, traditional Chinese medicine, will have a seasonal detox cleanse of some sort that does a parasite cleanse, right? It's usually cinnamon, clove, artemisia, oregano, which all these things also balance your gut bacteria. They also improve detoxification. So these cleanses people talk about are not solely, not solely parasite cleanses. They're also rebalancing their gut bacteria. They're also a detox. So you have to keep that in mind as well.

Michele Folan

All right. I had to ask. It was just a burning, burning question that I've had. I want to talk a little bit about longevity medicine in in general. I think we can talk about lifestyle all day long. We know that lifestyle is imperative. Good lifestyle is imperative. Looking ahead though, what emerging tools or therapies in longevity medicine are you most excited about?

Longevity Tools Versus Mastering The Basics

Aaron Hartman, MD

I think the funny thing about longevity medicine right now is we're looking at all these cool things, cool gadgets, cool technologies, stem cells, exosomes, peptides, you know, vibrating foot plates, clotho gene, you know, all these really cool this cool stuff. If you dig into the science and look at how they work, they're just doing what high-intensity interval training, physical activity does, what fasting does. And so I think in my mind, all this cool stuff is cool, but it's reinforcing to me you have to perfect the basics. You know, if you have a clean diet rich in nutrient-dense foods, you're getting accurate protein, clean protein. If you're if you have meaningful, you know, meaningful relationships, you know, blue zones, places where people be 100 more than anywhere else in the world, don't have access to cool biohacks, don't have access to hospital and cool labs. They say real food, they have family, they're outside a lot, and they live for you know really long time, right? So I feel like a lot of the cool technology stuff, it's awesome, cool. I love it. I do it all. I'm done with my daughter, you know, we've done all kinds of cool, you know, NMS, neuromuscular stimulation, hyperbaric, you know, all that. But that should always be on top of the foundational stuff. The foundational stuff is by definition foundational. For me, I I get what you're saying, where you're you know, what's my new cool, you know, my my cool hack right now, I guess, is lipid therapy using fats to heal your brain, which is like 40 years old. The new thing. It's a new thing, it's really old, right? But um, but really it just speaks back to you, you need sitting is the new smoking. Literally, sitting around being inactive is bad for your health as smoking, right? So all of a sudden, like, do we really need like a new supplement or a new peptide or a new zappy device, or do we need to need people to be more physically active to get chemicals out of our food? So I tend to focus on the things that the average person can do, and that's actually the most important thing to do. And then once you're doing that, cool, let's talk about. Well, here we go. I love this. Here we go. Cancer stem cells. You can use things to actually remove senescent cells to remove cancer stem cells, quercetin, crewman, uh, turmeric, um, apogeninum. These are really cool things we're learning now that actually, when you have these senescent kind of old, crumpy dead cells, you can remove them and improve telemark length, right? That's a cool biohack. But if your diet's horrible and you don't sleep and no one likes you because you're a miserable person, you know what? Yeah, you know, you probably won't make it to 100 with all your health, you know.

Michele Folan

Right. Yeah. And I I that I think that's a great point. You know, I've done, you know, the resting metabolic rate test, and I've done a, you know, a whole full body DEXA scan. And and those things are great for data points, but that's not necessarily gonna help me live to be 105.

Aaron Hartman, MD

So I mean you wanna you want you wanna be able to be 105 and have your mind, have your health, and be able to interact with your great great, who knows, great grandkids or whatever. You know, you don't want to be slobbery on yourself. And you know, I look at you know, blue zones, places where people do this on a regular basis, and they don't have all the cool fancy stuff we have, but real food, physical activity, meaningful relationships, and the and the environments by nature aren't full full of toxins because they're not in the middle of you know, New York City or Chicago, whatever they're you know, um Okinawa, Nicoria, Costa Rica, Sardinia, Italy, and then um Okino's. The one that's kind of interesting is um Loma Linda, California, which is Seventh day Adventists, or their their community is a blue zone, which you know speaks to faith and family because that's a big part of that blue zone there. But the point is that these are basic things that we all should be doing and we should all should be perfecting. And then let's do all this other cool stuff as well.

Michele Folan

Yeah. Can you share a patient story of a woman who was told everything was normal? She came to see you, and you were able to get some improvement by looking a little deeper.

Case Studies: From Decades Sick To Recovery

Aaron Hartman, MD

Well, I can talk about my I have lots I can talk about. I can talk about my lovely wife, who we talked about her before in our podcast. Um, she had a lot of chronic fatigue, barbro, brain fog. She actually lost five years of got horrible debilitating fatigue after, like, pulled a um a nerve in her neck, got in pain, went to the doctor, nothing wrong with her, gave her steroids, and just she was in bed for like five, basically barely functioning for five years. And um, come to find out, you know, what started this was a stressor was the life event of you know actually getting our adopting our son, bringing her house, and then she pulled a nerve in her neck and they got steroids and it pushed everything over. But underneath that was actually toxicity. She actually, um, in anatomy lab in grad school, you know, you you were around formaldehyde for half a year and she got a massive formaldehyde hit. And during that point in time, her anxiety got really bad. She was she thought about dropping out of school multiple times and didn't. And then as school went on, she got better and better as she got away from anatomy lab. She had some issues with toxic shock syndrome as well. She actually diagnosed her own toxic shock, balancing hormones, GLP ones for inflammation, yada yada. But she's now doing great, thriving. But there's like five years of her life that she kind of lost because she literally was just, yeah, I'd come home and she would go to bed and sleep and I'd take over and make meals and stuff. And that's that's an extreme version, but um, I can give another here's another example. Here's another example um of someone that I started seeing in their 70s who had chronic fatigue and fibro, brain fog for something from her 20s. And she came to see me. And on our first visit, I diagnosed her undiagnosed Lyme disease. Like no one ever thought to do a lime, uh, do to do a Western blot Lyme titter on her. And six months later, 80% of her symptoms were gone. And then we started talking about her hormones, and of course, her hormones are off. So we started replacing that. We're already working on her and go up, and now we've been working together for four years, and she feels great, but it's interesting with her because in her mind, she's still like waiting for the like I was sick for 40 years. Like, when's the when's it gonna all come back? And so every time she has like a little setback, she's always like, uh-huh, you know, I'm like, look, you're doing so well, you're doing awesome. And it's funny how when someone's been sick for a long time, you get like a trauma brain. I see this all the time with patients, and you gotta get you're kind of expecting, okay, what if it comes back? And that's one of the things you have to learn to retrain your brain. I work with a lot of trauma with patients as well. Because if you have if you've been chronically ill for a while, it does affect the brain wiring and does put your body in this fight or flight situation. And so that with a lot of my patients, um, becomes a big part of their healing journey as well, once they've worked through all the basics, the basics, right? Yeah, that how do we rewire your brain and work on that stuff as well? So um, I mean, I have another story that's popped in my head. Um, but yeah.

Michele Folan

Yeah, yeah. You gave her her life back. That is that's incredible. And and so this is this is where I, you know, this is my pep talk to my listeners and even my clients and my friends is don't put up with status quo, get answers, be curious, do the research, but be your own best advocate because we can't we can't solve issues if we're not putting it out there and and asking for the right questions. All right. This is this is a question for you. This is a personal question. Besides the sauna, what is your single most important daily health habit that you consider a non-negotiable?

Non‑Negotiables And Real Food

Aaron Hartman, MD

I just eat real food. I don't want anything processed. 80% of heart disease and 70% of most cancer can be prevented by diet and lifestyle alone. So um, I just eat real food. You know, it's it's amazing how just eating real food, how that much of a difference. The devil's in the details, though, because when you say real food, you're like, well, what do you mean? I'm like, well, it's not milk you buy at the store, it's not bread you buy at the store, it's not the ultra-pasteurized that heat it to like 280 degrees and burn the milk from cows injected with become bravine growth hormone, you know, that are fed glyphosate latent, you know, soy and corn that's genetically modified. It's like that's not the milk we have at our house, you know. Uh so it gets the devil's in the details. Now it's actually resourced in the book as well, it's like a uh food sourcing guide where people can figure out how they can find real food, wherever they're out in the country. So, but that's like the non-negotiable is just eat real food.

Michele Folan

Yeah, yeah, I love that. And then Dr. Aaron Hartman, where can listeners find your work and your book Uncurable?

Where To Find Dr. Hartman’s Work

Aaron Hartman, MD

So I have you know a bunch of things, podcasts, social media, YouTube, but the hub for all that is just Aaron Hartmanmd.com. That's a website you can go to, that'll take you to, you know, on all those things. Just start there and then you can hop from there, wherever you're including the book. The book you can you can go to from aaronhartmanmd.com or uncurablebook.com, and then you can get the book on Amazon or Audible or wherever you, wherever books are sold.

Michele Folan

Fantastic. Dr. Aaron Hartman, this there's there's a lot here. The show notes are gonna be very important to my listeners, but uh thank you, thank you so much for being here and just tying a bow around this because I know there's gonna be more questions, but if if there are questions, I'll I'll send them your way.

Aaron Hartman, MD

Sounds good. Thank you. I really appreciate it. It's fun.

Closing And Newsletter Invitation

Michele Folan

Thank you. Before you go, thank you for being here. If you want to go a little deeper, make sure you check out the show notes for this episode. That's where I link anything we mentioned, resources, partners, or tools I actually use and trust. And if you're not already on the Asking for a Friend community newsletter, that's where I share practical midlife tips, favorite finds, recipes, and the things that don't always make it onto the podcast or Instagram. You'll find the link to join in the show notes. Take care, and I'll see you next week.