Double Edge Fitness
This podcast is dedicated to showcasing to our members and any of our listeners who are interested in how this northern Nevada gym operates. Our mission is to inspire others to bring health and wellness home to truly make a difference in the household with the ultimate goal of making Reno the healthiest city in the country.In this podcast, we will be talking about things that are on our mind and answering questions from our members and our listeners to provide a unique listening experience.
Double Edge Fitness
Unlocking Optimal Health: Blood Work, Hormones, and Prevention with Cassie Wellock, PA-C
What if your body was sending warning signals years before disease struck—and you could actually see them? That's exactly what comprehensive blood testing offers, yet most people avoid or minimize the importance of regular lab work until symptoms appear. In this eye-opening conversation, fitness coach Derrick Wellock and his wife Cassie, a physician assistant who recently opened Vertical Primary Care within Double Edge Fitness, share their expertise on using blood work as your body's early warning system.
Cassie explains how standard lab ranges reflect the average population rather than optimal health, and why "normal" results might still warrant attention, especially for those seeking longevity and peak performance. The couple dives deep into cholesterol testing, revealing why an advanced NMR panel that measures particle size offers far more valuable information than standard lipid profiles. Derrick transparently shares his personal journey with high cholesterol and how coconut oil—touted as healthy in fitness circles—sent his numbers "bonkers" virtually overnight.
The discussion challenges common misconceptions about carbohydrates and insulin sensitivity, with both hosts explaining how strategically incorporating quality carbs actually improved Derrick's blood glucose levels. They also tackle hormone optimization for both men and women, providing a nuanced view of testosterone replacement therapy beyond the oversimplified approaches offered by many hormone clinics.
Whether you're a fitness enthusiast who assumes external health equals internal health, someone avoiding medical care, or simply curious about preventative medicine, this episode offers practical guidance for using blood work as a powerful tool in your health journey. As Derrick aptly puts it: "Blood work is like your car's dashboard—it tells you when to act before the engine fails."
Ready to take control of your health journey? Schedule those labs, establish your baseline, and discover what's really happening beneath the surface. The insights could add years of quality life to your future.
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Ready.
Speaker 2:Ready, all right. Hi everybody, this is your favorite content creator of Double Edge Fitness, but we have a guest today and it is my wife. What's your name?
Speaker 3:Cassie Wellock.
Speaker 2:Okay, good.
Speaker 3:So it's not a content creator. So very awkward behind the camera. I apologize in advance.
Speaker 2:But you look good. But premise of today is one to introduce my wife. Many of you guys know her. We just opened her own medical practice here inside of Double Edge vertical primary care, and a big part of us working together is bringing both of our knowledges into one place. We both have lots of conversations at home together about all things health and fitness related and it just like made sense for us to come together as a team and be able to now start bringing this stuff to you guys. So, yeah, bear with us as we start working through our flow of doing these things. Start working through our flow of doing these things. But today, over the last few years for sure, I've been very I don't want to say annoying. But maybe some of you guys think annoying, but I heart people on getting blood work done.
Speaker 2:Yeah, I find it to be very powerful information, something I did not take seriously in my younger years and I probably should have. Uh, would have been able to maybe mitigate some things earlier in life. Uh, perhaps related to hormones. Everything's pretty dialed in now but it took some work and if I didn't find out things about my cholesterol, potentially with blood sugar and stuff, even now, if I would have waited till 45, 50, 55 years old, probably could have been bad it's sometimes hard at those ages to reverse some things versus if you get them earlier.
Speaker 3:The younger you are, the more proactive you can be, and either fixing things or preventing things from developing.
Speaker 2:Yeah, so real quick. It's Cassie Wallach. What's your background, what's your experience? I have notes so I can stay on track some.
Speaker 3:Well, I am a physician assistant and this is my 13th year practicing in the Reno area. I started out in internal medicine and worked in internal medicine for seven years and then transitioned into family medicine, which are pretty parallel. I usually see ages 12 and up and that's just because those are the ages I have seen since I got out of school and very comfortable with that age range. So 12 to Death. Yes.
Speaker 2:It's a weird way to put it, huh, but age is 12 and up With that with family care. What is your big focus when you are seeing a patient?
Speaker 3:Yeah. So I'd say my biggest thing that I like to focus on for patients that's my passion and I think our passion together is preventative medicine. So again, instead of having a retroactive approach to medicine, meaning like treating something after it's already developed, I would love to work with people on getting an establishment of their baseline labs and working towards optimizing those so that we don't have any possibly irreversible or things that we can't fix completely, such as like atherosclerosis, plaques in your arteries, diabetes, those kinds of things.
Speaker 2:Yeah, atherosclerosis it's really hard to reverse. Yeah, once it starts collecting.
Speaker 3:And once you have like calcifications, that's kind of an indication of like scarring of those plaques. Usually the goal is to prevent the progression of that once it's established.
Speaker 2:And ultimately prevent it from happening altogether.
Speaker 3:Yeah, which the younger you are, the more time you have to prevent that and hopefully not develop any flax murders. That's just one example. There's lots of things.
Speaker 2:So when it comes to labs, blood work I've had an onslaught of it. You actually went and did labs on yourself this morning. What are the main labs that people should be one I mean that you're going to order for them if they come and see you, but they should be looking to do whether they're not coming here or not.
Speaker 3:So you always ask me that question and the tricky part is is that I think it depends. Like I have, like baseline labs I'd order on most individuals but it depends on the person and what their past medical history is like, what their current chronic conditions are. So it might be very different for different people. But like if you were telling me, like what are the most basic labs of somebody that has no chronic conditions and no family history of anything, the very minimum I would say annually you should be getting a CBC, which is a complete blood cell count, which is like your white blood cells, red blood cells, hemoglobin, hematocrit, platelets, and then like your differential type of white blood cells, and then a CMP, which is your fasting blood sugar, electrolytes, kidney function and liver enzymes, lipid panel of course, but I would argue for most individuals getting an NMR is superior and we can kind of go into that too in just a minute.
Speaker 3:A TSH, so screening to make sure there's no endocrine issues and thyroid's normal. I love to get a vitamin D on most individuals because I kind of feel like everyone's vitamin D deficient until proven otherwise, so that if we can get that one too, it's easy to fix. We should fix it and it's an important vitamin for a lot of reasons in the body. So those would be like just straightforward, again not having any acute issues, and then of course that would be expanded depending on again not having any acute issues, and then of course that would be expanded depending on what's going on okay, so somebody meets with you during your family history, go talk about all this stuff and then you decide the labs.
Speaker 2:But in general those are like very minimum very minimum once a year. What age do you think people should start doing labs? I mean, I wish I would have started doing in in my 20s.
Speaker 3:Yeah, I definitely usually start when patients are in their 20s and if they're like spot on beautiful and they have perfect health and they want to do them every couple of years versus annually again kind of depending on past medical history If they have family history of cardiovascular disease or diabetes or thyroid issues, then I would probably recommend doing at least annually, but it just depends on their history.
Speaker 2:So you're saying it's a personal approach? Yeah, yeah, as medicine should be.
Speaker 3:And I would argue that it's very rare to find a person that has like, completely perfect labs and is perfect health, I guess across the board.
Speaker 2:I mean, there's people out there but um no, you can probably find the occasional 20 year old. That's in that. But yeah. I mean, in my experience, just working with healthy, fit people. Healthy fit people and I'm kind of an example of that, the assumption of you know I work out every day, I eat pretty healthy, I do all these right things, and then you know it turned. When did I first, you think was that 34, maybe when I, like, had to start really paying attention to my cholesterol?
Speaker 3:yeah, I would say, and I've had high cholesterol since age 19, so I have um a family predisposition to it. So I mean yeah not that I was as healthy as we are now in my early 20s, living on campus at unr, being a college student, but, um, just genetically like that's something that was picked up when I was 19 years old.
Speaker 2:So so, real quick, get into that one. But it's called a familial hypercholesterolemia. Yeah, is that the word? So basically, my understanding is your liver doesn't efficiently remove cholesterol from your body or could it be a couple of different mechanisms?
Speaker 3:Or yeah, so you're not efficiently removing it, overproducing it.
Speaker 2:Overproducing it and or not efficiently removing it?
Speaker 3:Probably no specific way to figure that out well, you can get the lp little a, which kind of gives you a little bit more genetic information on whether you have again like a predisposition of having elevated cholesterol did I get that one uh, I think you did did you.
Speaker 2:I have so much blood work, stacks of things because I thought you did, I think I did yeah now we did the apple b. That was another one, um, that probably you would order on those people now an apple b, yes, um.
Speaker 3:So a tricky part about it is is having a clinical indication for it as well. Um. So if they have a history hyperlipidemia or family history of cardiovascular disease then yes, I would say an apple B is very helpful.
Speaker 2:So would you order like somebody one of our members comes in? Is that something you would include with an NMR?
Speaker 3:Yes, with a high sensitivity CRP.
Speaker 2:High sensitivity CRP.
Speaker 3:Which looks for inflammation with a high sensitivity CRP. High sensitivity CRP which looks for inflammation. Inflammation in the vasculature in conjunction with high cholesterol is what creates an environment for atherosclerosis to develop. So checking for the inflammation in conjunction with the bad cholesterol.
Speaker 2:And that's when cholesterol so when you have high inflammation, so you're metabolically unhealthy cholesterol then oxidizes.
Speaker 3:Mm-hmm. It makes an environment where the endothelium in the vasculature becomes more sticky, I guess for again like the ApoB. So we should probably explain that. So let's break down a lipid profile. So, lipid profile, you have your total cholesterol, you have your HDL, which is your good cholesterol, your triglycerides and then your LDL. The quote unquote bad cholesterol, ldl is the most. Well, I would argue, triglycerides are very important as well, but LDL is the one that we theoretically associate with cardiovascular disease and the one that can create the plaques and the arteries.
Speaker 3:But an NMR is a further lipid profile that we keep mentioning that breaks down that LDL further and tells you whether you have a large particle pattern or a small particle pattern. Large particles, that's the fluffy cholesterol, that's the good cholesterol, bouncing around the vessels and it doesn't stick. The small LDL, that's the bad cholesterol. Those are the ones that can again start to get stuck in the endothelium. They're carried through the vasculature by a protein called apolipoprotein B. It's that protein, that specifically, that starts to get stuck in the endothelium. So if you have a high apolipoprotein B, if you have a lot of the small LDL, then that just increases your cardiovascular risk and we should be more aggressive on getting that cholesterol down for you.
Speaker 3:I've been really surprised over my years of clinical experience to see like if somebody just gets a normal lipid profile again, that just breaks down the total cholesterol, triglycerides, hdl and the LDL and it doesn't break that LDL down further. I've had patients that have like an LDL that's only mildly elevated, maybe in like the one teens, one twenties Um, and we do an NMR and virtually all of it's small LDL, like their small LDL, is grossly elevated and they have a very elevated epilipoprotein B. And I've had some patients that just genetically have a more protective profile where they have a very high LDL and you know you, you automatically would create, should they go, they're real high risk for for heart attack and stroke. Those are usually people telling me they're like no, nobody in my family has any cardiovascular disease and they have virtually no small LDL and their apple B is normal.
Speaker 2:It's very interesting because it is so personal yeah like and that's one of the things I learned in the journey of my own cholesterol is um. There's quite a few variables at play here and um me personally.
Speaker 2:I do have history of heart issues, cardiovascular issues in my family and it's just not something I'm willing to risk and I've been pretty aggressive, last year particularly, but yeah, two years in tackling that and now it's pristine and we can get into.
Speaker 2:I don't care if we dump my medical history Obviously, she's not allowed to talk about patients and give examples per se but I don't care if we dump my stuff on you guys. So you got cholesterol, which is a big one, and then the more that I've been personally just studying, listening to people, it seems that insulin sensitivity is like a massive issue that starts 10, 15, 20 years prior to before you even recognize it. So it pops into my brain on this topic is the folks that are like I don't like going to the doctor, I like doing blood work and it's like catching this early and being very proactive in your metabolic health. When it comes to this seems to be one of the most powerful tools that we could have, especially at a younger age, when we're thinking of prevention, but no question as we're getting older.
Speaker 3:Yeah, and I think the hard part is is a lot of times, um, even patients can act upon symptoms, but most of the chronic conditions that we're talking about you don't have symptoms, Like you don't have symptoms of high cholesterol until you have a heart attack.
Speaker 3:You don't have symptoms of diabetes until it's like pretty far advanced, where you start to maybe have like vision changes or neuropathy or dry mouth or like excessive urination. Like that means it's probably at a very bad point. So, like you were saying, insulin resistance, that's something that can be caught a decade before the diagnosis of diabetes which it would be obviously wonderful to prevent type two diabetes.
Speaker 3:So we're talking about type two, not type one very different and there is genetic components to diabetes as well, so people can have a higher predisposition of developing diabetes and they could be doing the right things and still have that genetic component, unfortunately. But there's a lot that you can do to try to at least prevent it or extend the diagnosis so you're not getting diagnosed decades before, yeah.
Speaker 2:So yeah, the not knowing like these, not showing what'd you say Symptoms. I mean I sent my cholesterol up to 270, 270, my small that the gross little guys that she was talking about went through the absolute roof in like a three-month period of time coconut in your coffee I, when claire got diagnosed, I started doing deep dive and you start looking at all these things and there's this chunk of information out there about coconut being coconut oil being super anti-inflammatory which is not bad.
Speaker 3:Coconut coconut oil is not bad, it's just it has a lot of saturated fat has a tremendous amount of saturated fat.
Speaker 2:So I'm doing now taking on bulletproof coffee not the brand I'm talking, it's it's when you take coffee coffee not the brand I'm talking. That's it's when you take coffee, butter and coconut oil and you blend it up and it makes it's actually a very delicious drink. But I was doing that every day, thinking I'm doing this very proactive thing for inflammation, because inflammation is a hot topic. Got my labs, then I had to do repeat labs and it went bonkers and I was in denial. I was like this has to be a bad lab, has to be this. And my wife's over here. She's like it's the coconut oil.
Speaker 3:She's like I've seen it many, many times people come in coconut oil and they're yeah, it could be like, and that I mean, the blessing for you was that it was one thing that we could kind of pinpoint well, I cut a couple things yeah, you did um but it was saturated fat, but it was very reversible
Speaker 2:oh yeah, it's fast, but that's kind of the nice thing about getting labs is you can work on it and reverse it yep, and if you do them as weirdly as I do them, you can trial and error some stuff and not set yourself too sideways. But that's when I became a believer, because also you hear out there in the keto world, the carnivore world, that fat is the best thing for you and this and that. And I will argue that good unsaturated fat is a big part of our diet. It's very necessary. It's one of three main macronutrients we need. But the overconsumption of saturated fat I became a believer looking at my own labs on how much it could disrupt. Mm-hmm.
Speaker 2:And what was even more mind-blowing, it didn't disrupt me in a protective way. It sent my bad, little, tiny sticky cholesterols up a tremendous amount, not even a little bit like a massive amount and um, I ended up cutting coconut oil immediately I got. I don't use half and half anymore. I get non-fat Greek yogurt, um low fat yogurt. I stick to low fat dairy products and I'm still roughly 10, probably a little more, but I try to maintain 10 percent total my total caloric need, um from fat rated fat. So roughly 250 to 300 calories per day. And I'm not saying I'm perfect. But I'm also medicated now for cholesterol. I proactively what's the word? Prophylactically. Yeah.
Speaker 2:Prophylactically take zetamide, which is not a statin but it blocks reabsorption of cholesterol, so I do that for myself. It's not something that uh. I requested it, um to be very proactive and to keep my lipid profile in check, because I no judgment to the vegetarians and vegans out there I refuse to do that and live that lifestyle because I don't feel good. I need my complete branch chain.
Speaker 3:I do sleep in vegetables occasionally.
Speaker 2:She forces it right Still a child in that department. But I feel better. My body feels better. I'm happier when I'm eating animal-based protein and since I'm trying to get 200, 220 grams of protein per day doing that on a vegetarian. It's not for me. Yeah, might be for some of y'all I've seen successful people in the fitness space be successful on a vegetarian diet, but it's not for me. So this this is that's my own journey right, take it for what it is I know so protein insulin resistance.
Speaker 2:I know I've been picking your brain about this, but there's, like, so many pathways in the body that affect insulin resistance and one of the most fascinating things to me is when you start becoming insulin resistant, your body doesn't down regulate yeah production of glucose. Yeah.
Speaker 3:So to you guys, might? That's because it's not getting in the cell, right?
Speaker 2:Yeah.
Speaker 3:Because it's not getting utilized for energy, which is the whole concept of why we have glucose in our system.
Speaker 2:Yeah. So, no matter what you do, you're always going to have glucose in your body. Like your body is going to create it through lipolysis no, not lipolysis Gluconeogenesis. Your body, your liver, is going to create glucose from fat, no matter what. Like your body, your brain needs it.
Speaker 2:Body functions need it well from yes, from carbohydrates as well yeah, I'm just saying, if you're so I was referring to is, if you're on a super low carb no, no carb diet, your body's still going to create glucose. Right, I have done the keto thing. I went kind of carnivore for a while and my fasting glucose kept creeping up, because I was waking up fasting glucose over 100, 110. And you remember me having meltdowns. Yeah.
Speaker 2:I was getting ready to snap, I was like I'm not even eating carbs. But, like she just said, what'd you say? It's not getting into the cell. Yeah, so your body starts functioning off ketones and then that glucose isn't being used. Yeah, and then that glucose going up, it started causing insulin resistance problems. Your body's not being trained to utilize it Right, and this is one of my big down arguments of not using, uh, keto or carnivore as a long-term solution.
Speaker 3:I think, I mean, I think it, it depends, yeah, it's, it's. I think the most challenging thing with those in particular, those diets in particular, is um maintaining them long-term too. Yeah, they can be a good reset and anti-inflammatory for a lot of a lot of people, um, but they're hard to maintain.
Speaker 2:Yes, so, interesting enough, over the last six months cause you guys know I'm a nerd, I wear glucose monitor. I poke my finger all the time trying to figure this out I've increased my carbohydrate and fiber and I've seen a consistent downtrend in my glucose, because my understanding is I'm retraining my body to effectively and efficiently use it.
Speaker 3:Right, like that's the concept. I think we've been brainwashed, unfortunately that carbohydrates are bad, and it's definitely not the case. There's definitely good carbohydrates and we talk about fiber, the lovely fiber, all the time, on how it can help with insulin resistance and your glucose absorption, and also cholesterol.
Speaker 2:Your microbiome, your gut health, your microbiome.
Speaker 3:So it's eating the right carbs. And then, of course, it's the conditioning component, where you're actually mobilizing and utilizing carbohydrates to be used as energy, which is again like the whole purpose of eating and eating with purpose. Right, we eat to have energy. We shouldn't just be eating to eat yeah, right.
Speaker 2:So if you think of eating as energy, you have three macronutrients, protein, building blocks of the body. You need amino acids for soft tissue, bones, anything. It's the building blocks. I look at fat as being lazy energy. That's the energy you're going to use when you're not doing much, you're just living. You're walking, your know, your day-to-day function you can. Your body will convert fat to energy very efficiently in a low intensity environment. Then carbohydrate is the active, the active energy. It's the energy that we're going to use. Our muscles actively store glycogen readily to use. Our liver stores glycogen readily to use for activity. You know, from training in the gym to any sort of strain at work, something that's going to elevate you from slightly above a resting state, your body is going to function on glucose First. It's the most efficient, easiest way. I mean this all starts at ATP, but glucose is going to be the fastest way, um anabolic, um anaerobic pathway for your body to use. Yeah.
Speaker 2:And if it doesn't have it and your muscles are trained not to use it and they start using ketones for energy, one you're going to find out, your high intensity Crossfit stuff is going to bonk, and that's what I found out yeah like I'd absolutely fall apart out here in the gym now low intensity stuff, like I was fine. I didn't notice that.
Speaker 2:I noticed it in um met cones yeah so that glycogen release circling back around me being on and by some standards I'm still on a low carb diet. I'm just very intentional with my carbohydrates. I can't imagine I get more than two 250 grams per day, which for somebody my size, some people push towards two times body weight. So me getting 400 grams of carbohydrates a day. I do function really well where I'm eating them. Now I'm just very intentional about consuming them related to physical activity and the replenishment of blood, glycogen, protein synthesis for next activity, healing and recovering. So my thought process around carbohydrates is strictly related to how I abuse myself in the gym For the most part. But back to blood work.
Speaker 2:I was obviously getting annoyed with my blood glucose keep going up and I'm trying to do all these things to get it down. Um, I wouldn't have known that if I didn't do blood work.
Speaker 3:Yeah, that's fair. Yeah, and I would say so for to look for the classic like metabolic syndrome or insulin resistance. If there is evidence of it, the labs that would be advantageous to get would be a fasting insulin triglycerides. So triglycerides that's where I was saying they were important are very important in um relationship to your glucose levels. So, generally speaking, when somebody has an elevated triglyceride level I think of high sugar Is it covering it? So if your triglycerides are, if your sugar is elevated, so carbohydrates broken down into the glucose and then that is transported to the liver and then in excess it's, it creates fatty acids and then three fatty acids together makes a triglyceride and then that's stored in the body Again. Then in excess it creates fatty acids and then three fatty acids together makes the triglyceride and then that's stored in the body again when there's excess components and utilization of energy as well. But again, generally speaking, if you have triglycerides that are elevated, it's an indication that your sugar's high, so that with the fasting insulin and fasting blood sugar, those are all high and then you can also get a hemoglobin A1c Again.
Speaker 3:Sometimes that can be normal for a very long time and there's still evidence of metabolic syndrome or insulin resistance. That's why fasting insulin can be a little bit of an earlier indicator than A1c. But a hemoglobin, a1c is glycated hemoglobin, so it's basically like sugar molecules attached to your red blood cells and your red blood cells turn over like every 120 days, so it's more of a percent of your red blood cells that's glycated or again has those sugar molecules attached. We all have a certain level, a certain percent of glycated hemoglobin. Normal is 5.6 or less. 5.6 to 6.5 kind of puts you in that pre-diabetes range, and then anything above 6.5 is a diagnosis of diabetes.
Speaker 2:Type 2.
Speaker 3:Type 2. Well, yes, I mean type 1. It also. We use it for type 1 diabetes, but again, that's a different beast of its own altogether. That's autoimmune disease.
Speaker 2:Yeah, so what do you say? Normal is? For a1c 5.6 or less so I'm sitting here at 5.3 and it's driving me nuts trying to get it down. I want the fours. I'm greedy, I'm trying to get it down, but one thing to realize is 5.3 to 5.2 or 5.4, those are actually big moves.
Speaker 3:Yeah, because it's a very small percentage. So if you move it one or two tenths of a point, that's still profound, especially in a situation like you. You're not diabetic, you're not pre-diabetic, so you're fine.
Speaker 2:But I am going to be curious, since I've made these carbohydrate changes in my next set of labs is June, uh what my A1C does, because prior the year before, I was pretty low carb and trying to figure out my fasting glucose and now that I think I've remedied that through increasing carbohydrates quality unprocessed carbohydrates and I think that's it. Fiber, fiber. I've been pretty diligent about the fiber.
Speaker 3:Yeah, trying to get, I think fiber as a medicinal food is very valuable for a lot of reasons, yeah, and unfortunately the standard American diet. Most of us get like 10 grams or less a day, like we do really really poor on that, and you should be getting 35 to 45 depending on if you're a woman or a man yeah, so more than 35 if you're a woman, at least more than 40 if you're a man so I mean I'm pretty sure I probably get 30 plus grams per day.
Speaker 2:Yeah, not perfect with it because I'm not a high vegetable consumer. So I do supplement fiber and, just real quick on that, I use chia seeds, flax seeds, fruit oatmeal the bread that I eat has fiber in it and then the supplement I take. And the last time I did the math on it I want to say I was around 35, 40 grams when I hit all those things perfectly. Yeah, so well. Lentils We've been consuming recently lentils. Those are pretty high in fiber. Yeah, but that's not every day, so I don't eat those every day. What I just said is like every day and then we do have meals throughout the week. That's like massive boost of fiber for that day. Yeah.
Speaker 2:Then when I'm on an avocado cake, good fiber, right. So look at my notes. Look at my notes. Have you had any mind-blowing experiences where somebody comes into your office and everything looks okay as far as like family history, nothing too crazy but then you get labs on them and it's like now they look like they're healthy you know for the most part and then it's like you get these labs. It's like, oh shit everything's we need to take some action here I would say like this person's, walking around no symptoms.
Speaker 2:Yeah much then get labs's, like you're a 15 year ticking time mom.
Speaker 3:Yeah, yes, that happens a lot, I would say, more often than you would think.
Speaker 2:So let's reiterate that this person that we're describing and I know a few of them personally fit, healthy, for the most part, does everything pretty good. You know, probably not a perfect diet 24-7, but does everything pretty good. And, like she just said, they come in, get labs and, from a preventative standpoint and also current standpoint, the blood work shows a different story, and there is this metaphor that we got here Blood work is like the car's dashboard. And there is this metaphor that we got here Blood work is like the car's dashboard it tells you when to act before the engine fails.
Speaker 3:Oh, I like that. That's a good metaphor. We can make that a poster in my clinic room, because you said, I need another.
Speaker 2:Yeah, we need to add a little more artwork. I need another piece of art and I will attest to that. You know just what I've witnessed with people in my life myself getting blood work and looking at it through what. She looks at it like a very preventative deal. And I want to get into that a little bit because what I found out in my journey over the last six years when you get blood work, as long as you fall into the range, there's not a big lens looking at the 10, 15, 20 year outcomes of what some of these ranges might be. It's like a default knee jerk You're in the green, you're good to go. Is that the case? Not necessarily. Can you explain the ranges?
Speaker 3:Yeah, I mean. So let's take triglycerides. So generally speaking the range is going to be less than 150. But I'm going to argue, if your triglycerides are like 130 to 149, that's pretty high and again, probably an early indication that there's some kind of metabolic issue going on, especially in conjunction Again, you got to look at everything together so in conjunction with the fasting blood sugar, if it's in the higher nineties, like 98, 99, um fasting insulin's elevated.
Speaker 3:Then then again, like taking all those components together, really, even though they're in the green, probably an indication where I need to do some work on that. Um A1C, again, like I do kind of follow the standard range. If it's less than 5.6, people are probably doing pretty well. Ldl, again, like that was probably the biggest eye opener I have as far as it being elevated and where I really try to utilize the NMR more often for individuals if I can, because I just think it paints a more specific picture for people and really gives you like what's, what's their risk in particular. So it's a superior lab in my opinion yeah, on these ranges.
Speaker 2:What I've found out is these ranges are made based on aggregated nationwide data uh-huh it's not yeah so it's like 10 to 90 of the population.
Speaker 3:There's always like take a cbc, for example, like there is. It's very, yeah, so it's like 10 to 90 of the population. There's always like take a cbc, for example, like there is. It's very, very common for people to also fall outside of those ranges and it's not necessarily a bad thing. It could be just that individual's normal for example, like white blood cell count, like some people run at the lower end of normal, some people run at the higher end of normal but they don't it's not necessarily an indication that they have like a cellular dysfunction.
Speaker 2:So again, like you gotta look at the whole picture yeah, but I mean one thing for me personally is I don't want to be lumped into the averages of what I see outside the gym yeah, well. Society in general is not looking too healthy.
Speaker 3:Yeah, I think there's more optimal ranges that would be approached for somebody who's really looking for longevity. Yes, Yep.
Speaker 2:So when I come back to this A1C question 5.6 and lower would you think that a 20 year old, that's 5.5, is different than a 50 year old at 5.5?
Speaker 3:yes, very much so, um, because at least that I'll have to put that down you're trying to cover my mic oh, I don't want people to hear me um, yes, because a 20 year old at 5.5 percent again is it's pretty high. So it's an indication that probably need to make some changes. And, and part of that is too, going through their past medical history of like what is their diet, like, what is their sleep, like what is their physical activity, what is their stress, you know, are there certain components that could be affecting that, and seeing if, again, there's a correlation and creating a plan to fix it.
Speaker 2:Yeah. So I bring that up because every day we live we get older. Lots of these issues are 10, 15, 20 years in the making. So finding out, so you get some labs. You're 20 years old, your A1C is at 5.5 and you're not looking at the big long-term picture. At 20 years old, you haven't lived long enough. You shouldn't have lived long enough to get it elevated to the top end of normal Eating, a healthy lifestyle. So your stuff's going on in your life at a young age. That is already pushing this up to the top end of this limit, up to the top end of this limit.
Speaker 3:And your A1C can be affected. In like three to six months, can your A1C change pretty drastically? Again, if we're taking a proactive approach, yes, so maybe that 20 year old individual again was like me living in the dorms at UNR and eating the all you can eat buffet. I mean, again, they're at a point where it's very reversible. So it might not necessarily be long-term habits, it could be more acute habits, but reversible is like the key component, but it's eye-opening.
Speaker 3:Yeah Right, yeah it definitely is an indication that again, we probably need to make some changes. So it doesn't.
Speaker 2:And the younger you are that you catch this stuff, the better your odds of long-term prevention and optimization for your long-term health, because I wish I did in my 20s what I do now. Now you're dumb in your 20s. Sorry for those of you that are 20 out there.
Speaker 2:You can get away with things when you're in your 20s that you can't get away with and these symptoms aren't going to manifest the same way they are for a 40 year old, 50 year old, 60 year old. So finding out at a younger age, getting some baseline, at least annual labs done, I think it's very important. I truly believe it's very important. Yeah, I would agree.
Speaker 3:It's helpful. My most nerve wracking patients are generally new patients that are coming in, male or female that are coming in symptomatic of something such as like chest pain or shortness of breath, like that's usually more of an emergent issue, but again they're already having symptoms that there's something going on. That's more difficult Because when we get their labs again usually an indication there's quite a few things to fix at that point. Then again we're already working retroactively to try to fix those things.
Speaker 2:Yeah. So they said, blood work is like your car's dashboard it tells you when to act before the engine fails. So in my mind, I think it's heavily irresponsible of you for your own long term health to ignore taking a look under the hood once in a while.
Speaker 3:It's helpful.
Speaker 2:I think it's very helpful. And if you're when I was talking to somebody the other day about aging and it's like from age you can't wait to get to age 21. Once you get to 21, it's like, okay, you've hit all the benchmarks of the barriers to society. And then from about age 21 to probably I mean for me, for instance age 35, you're kind of oblivious to aging, like you're an adult, you're getting into your career, having kids, doing these things, and you're just kind of oblivious to aging. Where it got a little weird for me was around age 38. It's like I'm actually approaching 40 and you can see my life in weeks up here and it's just like this is actually kind of getting real. I'm getting older, body wasn't recovering the same way, wasn wasn't feeling good all the time and it's like you know, it's easy to sit here and blame aging on how we feel, but the reality is the more that I've learned and, diving into my own health, it's an excuse to not do the things we know we're supposed to be doing.
Speaker 3:I think, yeah, I think the biggest thing for me is for my patients is I want to give people the best quality of life for the rest of their life and I think the best established way to make sure we're on track of what we're doing is to get blood work. That's the way that we can really see systemically what's going on and again give us internal cues before symptoms develop.
Speaker 2:Yep, and once I started looking under the hood, coming to terms with you know health actually matters, being consistent, training, smart. And then, obviously you guys know the story, when everything went clear, we really leveled up our diet to a whole nother level. I can confidently 100 say, sitting here at 40 years old, I feel better than I did at age 35, 30, arguably handful of chunks of time in my 20s. Um, we've been together since that's 21, so she's seen me through this whole thing since 20 you're 20 19.
Speaker 2:I was 19 I turned 21, we were together oh, in october yeah, okay, there's something around that. That's when I brainwashed her young, brainwashed her young to me, um, but she's seen me through. She's seen fat derrick, fit derrick, she's seen the hot dog picture. I can find the hot dog picture oh really yeah, oh, you have a good picture. Yeah, thick.
Speaker 3:I've changed to like I spend times when I've been heavier and like, I got pregnant okay, so she's gonna know times before that still spoken up, but she's.
Speaker 2:She's seen me through all this and all this change binge drinking, um, things I'm not proud of, and uh, you know, obviously when you have kids you get smacked upside the head. For a while, I mean, I kind of struggled training wise. Our kids still don't sleep in their same beds.
Speaker 3:Deprivation isvation is very real.
Speaker 2:Sleep deprivation and sleep deprivation is actually massive. Yeah, you can turn your normal labs into looking pre-diabetic from just being sleep deprived for two days.
Speaker 3:And that's why it's yeah, like you really got to put all the pieces together. When you're, when you're seeing somebody that's huge right Like the. The trifecta right is food, so diet, and then exercise and sleep. Stress level two, because if you sleep well but you still have a lot of high stress, if you have excess cortisol, it's going to affect you.
Speaker 2:I want to know who you are, that you're sleeping really well, but you're technically high stress.
Speaker 3:They're probably out there.
Speaker 2:They're probably out there. Yeah, drug-induced sleep high stress.
Speaker 3:They're probably out there. They're probably out there. Drug induced sleep Maybe.
Speaker 2:Or maybe they're just so exhausted that, yeah, so yeah. Next topic oh, talked about the health labs, the main health labs. Yeah, yeah, let's do a little bit of hormone conversation. Okay, get asked this all the time. I'm very transparent about me being on testosterone replacement therapy. We've had a long discussions about this over the last two years leading up to me making that decision of going on testosterone replacement therapy.
Speaker 2:Uh, I spent a significant amount of time trying to get my testosterone up not just from an yeah, endogenously, my body created on its own up and not necessarily based on a numerical number, but symptoms, and there are a few things in my life like improving sleep and during that time of my life that you know could have contributed better. A lot of this came to head in those COVID years mm-hmm for me personally.
Speaker 2:Yeah, and what are things with a male? We'll get into women too. It's just way more complex, you guys, way more complex um with men that you're looking at when it comes to hormones, because right now in society, in current market, in reno, you just everybody's got low t. When you go to a hormone clinic, yeah, they don't look at anything. Lifestyle. I know I went to one, I checked one out because back in the day my primary care provider, they didn't care that my testosterone was in the low 200s, that you get one question you're in the range and can you get a hard on yeah, and that's sorry, but that is.
Speaker 2:that was the extent. So I wasn't getting any answers to my overall how I was feeling Like crap all the time every day, being mentally forcing myself to work out, not having any desire to work out. I was a slug in the afternoon. Sleep was shitty and that could be a catch-22. Shitty sleep can drive your testosterone down, but low testosterone you can have shitty sleep so. So it's like where are we at here? Uh? Yeah I didn't drink for over a year. Yeah, changed different diet. Yeah, I mean we.
Speaker 3:We went through the gamut with your testosterone before we. You decided to start it like we did you. We checked your brain to make sure there was on a pituitary issue.
Speaker 2:It wasn't empty either.
Speaker 3:Well, because it just didn't. You were kind of an anomaly as far as somebody that puts in the work, does all the things like doing the lifestyle modifications. You just had low testosterone.
Speaker 2:The one provider told me they literally told me to lift more weights to lift more weights.
Speaker 3:So I think that the hard thing, like you were saying, being put in this bubble of what's quote, unquote, normal of the average society testosterone, in particular for men the range is 200 to a thousand and I would strongly argue if a gentleman has their testosterone in the two hundreds are probably symptomatic, maybe not, and that is kind of important is it doesn't always just matter what your labs are. Your clinical symptoms are very vital in this situation as well. As far as discussing testosterone replacement, because if you feel fantastic and your testosterone is at the lower end, it's not necessarily an indication for TRT. There are some other benefits, but again, the clinical symptoms is very important in this situation. But again, yes, this would be an example where the normal range does not always tell the whole story for most gentlemen. So if I'm going to work a gentleman up, if they're having like decreased libido, exhaustion, fatigue, difficulty sleeping, yes, ed issues, lack of motivation, energy and drive, then usually would get baseline testosterone levels, getting a total testosterone and a free testosterone, sex hormone, binding globulin, which that's the protein that specifically carries the free testosterone, in conjunction with their albumin, and then an FSH and LH2. You can also throw an estradiol in there too, but I mean the other ones would be definitely like a baseline approach just to kind of see if there is an endocrine issue, but also screening their thyroid again getting maybe like a full thyroid panel to make sure that their thyroid's not off. And cortisol probably would be something to think about if they have a lot of stress in their life Because, again, cortisol can be connected to low testosterone.
Speaker 3:So the cortisol released in the pituitary well, acth released in the pituitary that goes to your adrenal glands tells it to produce cortisol. It actually will down-regulate FSH and LH from the pituitary gland. And then, in conjunction with that, the progenolone, which is like the precursor hormone to a lot of the sex hormones, such as testosterone, estrogen, progesterone, but also cortisol. If you're using your progenolone to make a bunch of cortisol, then you're not going to have as much available to regulate testosterone production. So getting cortisol levels helpful If they are also having those symptoms, though I also always like, yes, going back to sleep and ruling out sleep apnea. So sleep apnea.
Speaker 2:I did get ruled out for that too.
Speaker 3:Yeah, yeah, sleep apnea is actually something that I catch in a lot of individuals, and it's not always body habitus. A lot of people have more of an anatomical obstruction could be a large tongue, or like a small oropharynx, or their uvula is bigger than normal, or again like their sinus passageway, like there can be a lot of variation. I've had very small, petite people be diagnosed with pretty significant sleep apnea. But if you have that, if you think about it, you're not getting restorative sleep, you're not getting enough oxygen to the vital parts of your organs and your brain, and then again cortisol is driven up when you're sleeping and then that's going to dysregulate your hormones too. So those are all things, just primary things to think of.
Speaker 2:Again, if somebody's coming in with some low testosterone symptoms, so this is why I'm very sensitive when people just want to get on testosterone, because there's so much more to it, and this is why I'm so I word this the right way. I get frustrated with how a lot of places approach testosterone and men's health, because I went through it trying to find places that would listen to me. I mean we'd have these conversations, but she can't actively treat me and just seeing what's being thrown out there when it comes to men's health and looking at the full picture of the process.
Speaker 3:I think there's a lot of frustrations on both parts, where, like for you in particular, where you're having significant symptoms but your low testosterone wasn't taken seriously, like I. Have a lot of gentlemen who come in and tell me that you know their provider won't even check their testosterone because they're not in the age range and that can be frustrating because it is very it's obviously very important for vitality for men.
Speaker 2:Well, on the age thing with testosterone, I wish I would have had numbers, because I don't what. The question I've always asked myself is like did it fall off a cliff at age 30? Yeah, Like was. I in the high 800s. I had lived a pretty healthy lifestyle back then. It's when we opened the gym I was working out doing, you know, pretty healthy. Was it age 35? I'm always wondering. Symptoms really started to hit me hard around that age 36, 37. Yeah.
Speaker 2:Yeah, but when was it, I don't know, like it wasn't something we tested till I was like 34. And at that point I had a lab that was like 300.
Speaker 3:I thought you had one in the 200s.
Speaker 2:I have a couple in the 200s. Um, so yeah, but a lot of these places you can get this stuff online. It's the easiest thing to get it used to be back alley bodybuilding stuff. You can, literally it's. I shouldn't give you the resources, but it's, it's, so it's. It's become this cash cow amongst um, in my mind, a subpar element of medicine. But you have places telling young men who have jobs and I'm not going to name the jobs who have jobs that are very stressful and very demanding, that are high stress, like it would make sense for them to have low testosterone numbers, but they're, and they have a referral program that you get financial credit for referring your friends to it. They don't even have a discussion with these young men on the potential for it to make them sterile oh yeah.
Speaker 3:Or testicular atrophy, yeah, yeah. Which can happen testicular?
Speaker 2:atrophy yeah becoming sterile if these men haven't had kids yet. That was another catalyst for me. I mean, jackson wasn't born yet and I started like going down this road, but it's like that's where it came a checkbox for me to go down this road of replacement therapy. I'm done having kids, I've had a vasectomy, I'm in a different chapter of life and I want to feel good into my 40s, 50s and beyond, and this is something I haven't been able to rectify on my own and it's a big deal for me on my own and it's a big deal for me. It's a big deal. But I, just when I tell people like no, she is not a hormone clinic, but she is going to look at the full picture of your health and wellness.
Speaker 3:Yes, well, and I'm always going to argue to patients that endogenous hormones are always superior to exogenous hormones, so the hormones that you produce within your body are always going to be superior. So, and I also don't like going down the rabbit hole of giving a medication for a side effect of something else, whether it be a side effect of another medication, because I've seen that or again like there's something more central going on, such as I've corrected sleep apnea and a handful of people and their testosterone levels go up. So I think it'd be superior to fix the root cause try to figure out what that root cause is.
Speaker 3:Sometimes it doesn't, and then again TRT makes sense and it's the most. Again, weighing risks and benefits of everything because everything has risks and benefits, you know can be very, very helpful for some people.
Speaker 2:So none of these questions were asked at the two men's clinics I went to in this town. Yeah, of these questions were asked at the two men's clinics I went to in this town and I'd never participated in their product, but it was just blood work oh, you're low, 99 bucks a week or whatever it is these days and I had questions on it, wanting to remedy this. Naturally, that was my goal. Going in, it wasn't going in to get tea and they're like, oh, we just need to put you on tea. It's like I had all these questions and then, through another provider and us brainstorming is where I got tested for all this other stuff. I actually ended up working with endocrinologists for a little bit. Then they moved. Yeah you've tried everything.
Speaker 3:I think, think for you the frustrating thing was I don't think we were. We didn't really find a great reason why we didn't find a way to fix it without, without trt. So you are like a prime example of like we exhausted everything and I your quality of life was improved with the replacement, and so I created enough testosterone to create two children yes, you did um, and as you age, you have a rate of decline on testosterone.
Speaker 2:That's why I'm curious if I'm 30, if I'm at like 400 or whatever, I have enough to make kids, enough to function as a man I also think that every, every individual and like same with thyroid, like everybody, has a sweet spot of where they function best.
Speaker 3:Not every man has to have a testosterone of 1,000 to feel great. There's definitely a physiologic range. I think for every individual that could be different.
Speaker 2:And that's been my goal. Getting on it is to find the minimum effective dose of where I feel great, and my total testosterone in the last two labs has been around 600. I know some people will run it up to a thousand. They're like if you're going to be on it, you might as well take it to the top end of the physiologic range. My thought is I want the minimum effective dose to feel how I think I should feel for the lifestyle I live and I feel like I'm there. Yeah, so that's the flyover, the man and the reason I want to bring that up as far as the lab, as far as the labs conversation is because I do get that question a lot as a fitness coach and because I'm very transparent about the fact that I'm on it and I am pro young men getting their testosterone checked. But I will never support you getting on TRT without doing lifestyle um modifications and exhausting these things because, again, risk reward. You want your own body to work naturally. Yeah.
Speaker 2:So it's like when some younger folks come and talk to me about this mid-30s, late-20s, and I know what you do on Friday and Saturdays, I know how much you over-train, I know how much you under-eat or over-eat Like not pulling fast ones on me, boys. But I think it's something for young men to be aware of at a younger age and I 100% support and I bring that up because what she said some providers won't even order it on you. My brother just recently went through that with a separate person. The provider wouldn't even order the labs on. So I think it's good for you and I think you should be allowed to order the labs and know the labs that you want to know. And I do think for a young man these are important. Now the tricky one female hormones. Yeah.
Speaker 2:I know you've been learning a lot about these, uh and there's like in your own journey, but um, obviously I don't get as many questions when it comes to women's hormones outside of the fact. Do I personally, as a health and fitness coach, support hormone replacement therapy? The answer, obviously, is yes, within the context of vitality, wellness and exhausting all other ways to be the best you can be with your own natural self.
Speaker 3:Well, for women it's hard. I mean in men too, menopause affects us dramatically Menopause, manopause. Perimenopause too, yeah.
Speaker 2:But that's a big question.
Speaker 3:Andropause for men.
Speaker 2:Manopause.
Speaker 3:Yeah.
Speaker 2:Manopause.
Speaker 3:That isn't something called andropause.
Speaker 2:Probably that's just something I made up, okay, but I mean, I have the personal belief. If you're putting in the work in the gym, diet, doing everything you can and you're just going through a life's change, I believe you have the right to feel good and we have tools. I'm going to bring up the end of this conversation, tools in medicine that I think are very cool. Two things that have been completely debunked is that testosterone causes prostate cancer. There are variables to that that she can explain. But another one that's been pretty massively debunked is that estrogen causing breast cancer well, so both of those there those studies were kind of skewed what I have.
Speaker 3:What I would have to say about that. Is there things that need to be watched cautiously, I think. When it comes to hormones for men and women, the problem is is that we haven't had great extensive studies that tell us the safety profile definitively the fda just removed the blanket.
Speaker 3:Yeah, testosterone, yeah what I would argue is that if somebody, just like for women with breast cancer, if they develop prostate cancer and they're on testosterone replacement therapy that's the thought process is like is it feeding the cancer? Yes, same with women that have hormone positive breast cancer. There was possibly some correlation more of the progesterone that was utilized in those studies with the Women's Health Initiative, but again, we don't generally use that progesterone. We don't use either that's the general progesterone that they used in those studies previously. So I think we're changing our perspective of women's hormones. I would argue that if a woman is exploring hormone replacement therapy and not a hormone specialist, not an endocrinologist this is just my own experience of what I've learned but doing the bioidentical hormones for sure would be the solid way to go, just for safety profiles and clinical benefit as well. But yeah, so for women it gets a little tricky. There can be some hormone influences under the age of 35, such as if a woman has PCOS or irregular cycles. But I've definitely kind of started expanding my own education in that perimenopause and menopause stage, because it's probably one of the most common questions that I get from women is being symptomatic of some kind of hormonal imbalance. And so for women.
Speaker 3:You know, the hard part is is there such a slew of symptoms that you could have? And again, like you were saying, it's complex. So is it excess cortisol? Is it excess estrogen? Is it low estrogen? Is it low progesterone? It's a combination of several of those things put together. Like you have estrogen dominance and low progesterone and you have a high stress job, so your cortisol, your diurnal cortisol, doesn't like trend down through the day and then that causes low progesterone.
Speaker 3:There's an indirect relationship of cortisol and progesterone for women, like men with cortisol and testosterone, if they're having clinical symptoms, usually in the luteal phase, which is like that week before your cycle, that's when women get usually the most profound symptoms Then I'd usually get an estradiol, progesterone, fsh and LH and testosterone levels. You can get blood tests and you can also get salivary hormone tests for women. So it can also not only look at like your progesterone and estradiol levels, but your progesterone estrogen ratio. So again, for some women. So to explain, like the cycle, you have your follicular phase where your estrogen is going up, and then you have your ovulation when there's a spike and then when you're in your luteal phase, your progesterone actually elevates above your estrogen level.
Speaker 3:But for some women, if they're not producing enough progesterone, then that range and that ratio between the progesterone and estrogen shrinks and then it become profoundly symptomatic. So all of those components together can be helpful to try to pinpoint, you know, what might be specifically going on that's causing those symptoms. Or is it again multiple issues? Because the bad part about medicine in general is a lot of times we want to have like one answer to things and just fix like that one thing, but usually it's a bit more complex than that.
Speaker 3:It's probably more than one thing going on that you have to at yeah, and lifestyle both men and women do play a factor. What you eat women need carbohydrates yes, definitely um programmed around training, for sure. Um, we are not as blessed as men as far as like our timing post workout to be able to train ourselves to adaptation of using carbohydrates. Like we have a shorter window so there's just like different, different tools for women than for men.
Speaker 2:Um, we're just different than men when men typically have more muscle mass so so they're going to have more stored blood glycogen, more mass in general. So you need carbohydrates to train well. So if you are somebody who trains well and tries to live a low carb diet and your hormones are wackadoodle, there's a variable there that you can play with.
Speaker 3:Yeah.
Speaker 3:And again, like for for women in particular. I think that you know in this day and age, um, a lot of women have a lot of stress. You know there's a lot of women working full time and their wives and their full-time moms. There's just kind of a lot of on our plates. And so again, like I would say, cortisol imbalances probably the most common thing that's seen. But again, does that play a role into downregulating, like the progesterone levels, especially if you're still having a menstrual cycle? The other thing that I think a lot of women don't even know this is like after age 35, especially, you have more anovulatory phases, or menstruation months, meaning that you don't release an egg and when you don't release an egg you're not going to have the same progesterone production as you would. If you're going to release an egg, that's going to change your hormones significantly for that month. So that's why some women will feel fine some months and then some months they feel like gremlins.
Speaker 2:No personal experience with that whatsoever no, and I think one thing that's I mean she's gonna be 40 this year, I'm 40 kind of that midlife deal. A lot of this is exploration on our own and she's just very passionate about wellness, health and using medicine and her well education experience and all this stuff to be transformative in your life. She's been transformative in my life, not just because she's my wife, but we get to have these conversations. Yeah, often we'll both, you know, read some stuff and whatever, and just like these conversations happen, I'm blessed to be able to have somebody that I live with, that I can bounce all these ideas and everything off and one and also hold me accountable. So, um, and then I'm gonna hold her accountable to improving her 2k row yep, which I did not do good apparently so we hold each other accountable here.
Speaker 2:uh, last thing I kind of want to talk about is in the health space there's this heavy like no pharmaceuticals, no pharmacology, no using the advancements that have been made in a positive direction mindset. And then there's the other side. Where is only pharmacology? Here's your drug. Go, take it, do this. I do 100% believe you are a perfect bridge of looking at both and using tools available for what needs to be done within a timeline to, not to, prevent really bad long-term outcomes yeah, no, I definitely.
Speaker 3:I mean, I'm definitely an advocate for lifestyle modifications and doing the hard work to try to improve things. But, like you said there, it depends on the severity of what's going on, such as if somebody walks in with a blood pressure of 200 over 100, I and we find that that is consistent and repeated I'm probably not just going to let that go for days, weeks, trying to get that down with, like, weight loss, low salt, low caffeine. That's probably too high to ignore Um. That is too high to ignore Um. Versus if someone's blood pressure is like 130 or 82 and we find that low salt gets it down. Or reducing caffeine from six cups a day to two cups a day is enough to modulate that. Then there's like wiggle room. So it depends on, like, what's going on.
Speaker 3:Cholesterol same thing If they have mildly elevated cholesterol, and again we get their NMR and it's not a ton of the small LDL and they have a normal ApoB. Another tool that I recommend is the CT calcium score, which is a CT scan of your coronary arteries and it looks for calcifications. Tool that I recommend is the CT calcium score, which is a CT scan of your coronary arteries and it looks for calcifications. Calcifications is kind of an indication again of scarring of plaques in the arteries. Perfect score is zero. The higher the number, the higher the risk. So and again, like their CT calcium score is zero, then we probably have time to work on their cholesterol to get it down, possibly with some lifestyle modifications again, pushing that fiber and exercise, reducing saturated fats, those kinds of things.
Speaker 3:If somebody comes in and they have a significant family history, like their father passed away from an MI at age 40, and they got a ton of small LDL and their CT calcium score is 100, like you know that I think it would be advantageous to consider medications in that situation to protect that person as we continue to work on the lifestyle modifications. So, yeah, there's there's a lot of different scenarios that call for different things, but some of us just genetically have high blood pressure. Again, I can have really fit, really healthy people that it's just family history. They have high blood pressure and the blessing is that they're not going to succumb to heart failure, kidney failure, heart attack or stroke. We have these medications as an option to treat them.
Speaker 2:I know I brought up that. I thought insulin resistance is like the silent thing that's going to kill you unknowingly, as it's building through the 10, 15 years of you not paying attention Blood pressure. That's not necessarily a lab that you're going to get blood drawn, but blood pressure is probably the silent killer.
Speaker 3:Yeah, Cause I mean again like I can't tell you how many people I've had walk through my door and have had a blood pressure 200, over 100 and they don't have any symptoms. They feel totally fine. Um, some people will like they'll get like temporal headaches or like dizzy or just feel off, Um, but a lot of people don't feel high blood pressure at all.
Speaker 2:Yep, and a lot of people don't know their blood pressure at all. Yep, and a lot of people don't know their blood pressure, just like they don't know their labs. They don't do an at-home one. They don't go for an annual physical to even get at least an annual check. I do have some problems. She's kind of one of the only people, her and the guy I go to. They do my blood pressure the correct way, because I get that white coat syndrome and, um, I think there's a right way.
Speaker 2:Well, they probably do it the right way, but any worked up not to talk about other people, but lots of times when I walk into an office, somebody just I usually just walked in they slap the thing on me this and that, and it's like I need 10 minutes to chill here.
Speaker 3:Okay, we need to get this accurate you gotta be sitting for three to five minutes.
Speaker 2:Relax, it's usually like instant yeah, and it's usually a little elevated. Then when I get it done at the end of our appointment and the guy I go to it's you know it's pretty close to normal. I've actually scored some normal readings in the last year, which has been cool. Yeah, typically that guy. That's like 130, over 80, 85. But I've had some 120s and the low 60s. But blood pressure my reason to be mindful of it is kidney, yeah, dysfunction. And heart. Heart, obviously.
Speaker 3:Yeah, yeah, but kidney is irreversible. Well, so is the heart. So those are the two subtle things again that people don't have symptoms of too, until until, yeah, you have kidney failure or left-sided heart failure. So if you have high blood pressure and treat it over time, then you can start to dilate the left side of your heart.
Speaker 2:So that's that sounds bad, doesn't it? Yeah, it's something you want to keep tabs on. Yeah, yeah, so those would be accurate blood pressure.
Speaker 2:Take your blood pressure. The home ones aren't that bad, they're not that expensive and it's a good thing to do. I think from time to time that you can proactively do on your own Um, yeah, but it is good to have somebody who's good at taking it. Especially if you're somebody like me. That kind of fluctuates in that little gray area because I go back and forth of meds and no meds. Um, because I will be proactive on that from a pharmacology standpoint if I have to be um, but I don't want to be so yeah, you're kind of in the gray area where it still needs to be watched too.
Speaker 3:I would state that if you do check your blood pressure at home and use an electronic blood pressure machine, those in general can measure just a little bit higher than manual checks. So it's also always a good idea if you're tracking it at home, which is helpful especially if you do have some people do have genuine white coat syndrome um to bring it in to your provider so they can check it manually and electronically and just see if there's a discrepancy too. That's helpful.
Speaker 2:Yep, yeah. And on the kidney thing, um real quick on labs. Back to athletes. Back to athletes. I've always been told, no, don't take creatine, I have kidney issues. What is it your?
Speaker 3:creatinine is usually elevated.
Speaker 2:But then, but what's the BUN? But the GFR. Yeah. Thrown off with me One. Up until the last two years I would take my labs and chances are I really probably worked out really hard the day before. Now I do take an active rest day before doing labs and my body kind of normalize out. But that top real quick on a lab that she does is cystatin c. We learned this kind of testing on me.
Speaker 3:Yeah, yeah, it was kind of something that obviously, being in this world with a lot of CrossFit people that do moderate to high intensity workouts on a routine basis, it is very, very common to see abnormal kidney function, mostly the elevated creatinine levels, um, and that's just an indication of muscle turnover, which is not necessarily a bad thing, especially if you did a high intensity workout shortly before. Even the day before it was pretty high intensity. So cystatin c is another byproduct that's excreted through the kidneys but it's not affected by exercise. So if you do have some abnormal kidney function tests but you do moderate to high intensity workouts could be advantageous to get a cystatin C just to really see if there's any evidence of insufficiency or not.
Speaker 2:So I have some labs there. My GFR and blood protein levels are way up. Chances are I did some really messed up the day before to my body training wise. And then I have normal labs. But my cystatin c across a couple of these is consistent normal yeah so it's just another.
Speaker 2:It's a. It's a test that's she specifically looks for in population like us. Um, because the gfr is an algorithm driven test. As one part the goes up, the other goes up exponentially. It's not accurate. I can't remember what it is, but it's not accurate for people who are fit and work out a lot.
Speaker 3:Yeah, there can be. It can look abnormal and could be fine. Or I ask people to not work out like 72 hours before their labs and I have done that which is funny that I I love this about double-edged members is they have a really hard time going three days without working out. That's that. That's great, that's wonderful. But for lab purposes sometimes it can help us get like a so baseline.
Speaker 2:Now try to plan my labs with the pre-planned. This is going to be a what do you want to say? An off week of training, more recovery, type. I'm not going to beat myself up, I'm not going to train hard, brain farting on the technical training word for this, but when I do my my big labs that's for me I have to get my labs done every six months. Um, so when I do those big draws, I do now cool it to make sure that my body is just in a homeostasis place to get the labs done.
Speaker 3:Anything else I got in here I mean, there's like obviously unlimited amount of labs, just kind of depending on patient symptoms yeah, yeah, so hope you guys got value out of this and if you got questions, let me know.
Speaker 2:We can bring them up in a future podcast here to share knowledge. Obviously she's a wealth of knowledge. She understands all this stuff very well from a medical standpoint not just saying that because she's my wife. I've watched her with people I know personally be transformative in their lives. So, um yeah, it's not just made up. All this stuff does matter. Yeah.
Speaker 2:And having somebody who truly cares about taking you down that path and is willing to put in the work with you is also a a big deal. So, yeah, any other tips from people? I got nothing.
Speaker 3:Alright, that's a wrap.
Speaker 2:That's a wrap. Bye, oh, love you guys. See you later. Bye, bye, bye, bye, bye, bye, bye, bye, bye, bye, bye.