Do Multivitamins Actually Work? Minerals, MTHFR, and Why Guessing Fails

All right, and we are live. It was already recording. All right, a little blooper for those who are live with us. All right, now we're recording again. Um, so if you're joining us live, welcome. Uh, this is the MedMatrix Method podcast. We're going to be talking about two really exciting subjects today. Uh, hormones and vitamins. Specifically, how to optimize them. What does it mean to be deficient in some of these things? What are the strategies you can do in your day-to-day life? What are things that you can do with cutting edge medicine, working with a practice like MedMatrix? Um, none of what we say is medical advice. This is for educational purposes only. And if you're interested in working with MedMatrix as a patient, you can go on over to medmatrixusa.com and click get started. All right. So, um, first we're going to kick things off by talking about um, vitamin deficiencies. So, Dr. Rose, um, welcome. Thank you for making time after a busy day. Appreciate it. Welcome. Happy to be here. Yeah, if you can't tell, if you're just listening on audio, Dr. O and I are matching. Yeah, we got some new merch. We love merch. [laughter] Um, so yeah. All right, guys. So, uh, Dr. O, why don't you talk a little bit about vitamin deficiencies? What are vitamin deficiencies like actually? Well, um it vitamin deficiencies are when for a variety of reasons an individual is not getting sufficient or optimal levels to help with the body's normal um metabolic pathways, hormonal pathways. Um, so kind of like I think of it as like working with a handicap and usually people don't know that they have vitamin deficiencies. So it's kind of like going through your daily life with um, you know, with a handicap with a with kind of extra, you know, weight around your ankles. Um, not feeling great but not knowing why. not knowing that um at least part of that might be because of certain vitamin deficiencies. Um so again there can be a number of reasons. Um it can be anything from um the the food that one is eating the you know where that food was grown if it's plant-based um to issues with gut health and absorption of said vitamins and minerals. Gotcha. Okay. So, a lot of questions here because a lot of people take vitamins trying to solve for deficiencies, right? They just kind of, oh, I should take vitamin D. I should take some magnesium. Um, what just curious like because a lot of patients before they come to the practice, this is their first kind of experience with more in-depth blood testing. um how often are patients deficient in a vitamin they're still taking? So, one thing I do want to clarify is that we have vitamins and we have minerals. And so, I think what we're talking about here is kind of both. Um, and we as a general statement kind of standard American diet, we tend to be more deficient in minerals than we are in vitamins. with some exceptions like I think we're going to dive a little bit deeper into things like vitamin D and some of the B vitamins, but in general um Americans as a whole tend to lack minerals more than vitamins and largely that's because we don't eat enough plants and plants are really rich in in minerals. Um, so some minerals people are familiar with things like magnesium and calcium and then there's some of the lesser known ones maybe like selenium um chro chromium things like that which we also really need. Um, so I just wanted to make that clarification. Um, but I think your question was how often is somebody kind of already supplementing with vitamins and or minerals but they're still deficient? Is that the is that pretty much um I mean just clinically I would say fairly often. Um I see a lot of people taking multivitamins and I think there's pros and cons maybe or it's better to say um sometimes people are using a multivitamin maybe not in the best way is a maybe a clearer way to say it. Um, so I am not in general like a huge fan of a multivitamin as a way to kind of like just take care of everything, right? I think that if what I usually tell people is if you are in a place in your life when you don't know how or you are unable to eat a wellbalanced whole foodsbased um diet, right? And so you're either knowingly or not knowingly kind of malnourished, just not eating enough plants, just not eating a variety, etc. Then a multivitamin might be the right thing for you. Or like, you know, maybe you're a parent and your your child goes off to college and they're just not eating great. Like the food in the dining hall isn't good or they're just like not treating not really eating the way they did when they were at home. maybe that's a good time to take a multivitamin. Um, but what I really like about our testing and our ability to test is that we can get really specific in what where is where are the deficiencies? Um, is it a magnesium deficiency? Is it a vitamin D deficiency? Is it an iron deficiency? And then target based on that. So, it really is really individualized. Obviously, the best thing is food as medicine and to get as much as we can through our food. Um, but unless we're testing, we don't really know what somebody's deficiencies are. Okay. Let's talk a little bit about getting vitamins and minerals through our food because can you tell like talk more about kind of what's happened to nutrients and the soil and food over time because that's a problem, right? I mean, we're not able to get the things we need through our food anymore. How much of that is true? How much of that is not? Yeah. I mean, I think I'm not a farmer. Like, you know, um agriculture is is not my area of expertise, but I think we all have some level of understanding that the way that um our food is grown is different than it was a hundred years ago. And um you know even the fact that food is shipped across the country or across the world um and we just we just eat very we we no longer eat locally. Um and we don't really eat seasonally either. And so we're all accustomed to getting an avocado any time of the year. Now avocados are not native to Maine or anywhere around here and certainly not in winter. So, um, where there's just a level of that kind of like you want what you want, you can get it anytime and you can walk into any supermarket and you can get it. But I think that there are some things that have been lost with that. Um uh so I'm kind of digressing a little bit, but um I think that there's chemicals that are used now um with food production that are impacting everything um including our health. And um in some ways like depleting uh these food sources from the nutrients that you know if again if we were if if food was grown the way it was 100 200 years ago it would be that would be it would not be an issue but things have just shifted to such an extent that we're not really getting that richness like we did. Gotcha. All right. So let me let me ask that a different way. So, would it be possible to be 100% optimal with your health um by just eating good food? I see what you're saying. Or do or or do you have to take supplements if you want to be as healthy as possible? No, I think that if um well, everybody's makeup is different, so it's hard to make a general statement. Um but no, I think it is possible to get everything you need through um your food. Now again, vitamin D, unless we So if somebody were to eat the way the Norwegians eat or used to eat where you're eating like fatty fish twice a day, you probably are going to get, you know, vitamin D um and great omega-3 fatty acids through your food. But most, again, most Americans aren't eating that way. Um, and you're not going to find vitamin D in other food sources. I don't count like fortified milk as a really an option. Um, so, um, but for the most part, if somebody were really conscientious and, um, had a super balanced, well-rounded, lots of variety, u lots of plants, lots of fiber, yes, they could get what they need through food. Cool. Okay. Um, so how can is it possible that two of like the exact same physical person, so same gender, same weight um, same age, can eat the exact same diet and have different vitamin levels and mineral levels. Yeah, absolutely. Because your gut microbiome is different. You can be the same same sex, same height, same weight, but your gut microbiome is different. So, the way that you actually absorb, break down, utilize your food and therefore your nutrients is going to be different. Um, and your everything, your level of um like where your nervous system is. You know, your nervous system is going to need B vitamins. Like if you're really stressed out, then you're going to be kind of soaking up all that B12 and you're going to potentially be at more risk of being deficient. Somebody who's not living with kind of a certain level of chronic stress, then they're not going to be as at risk for a vitamin B12 deficiency. Okay. So, that kind of leads me right into my next question, which is um when someone has vitamin deficiencies, how much of treating it is giving them a supplement where they're deficient, and how much of it is treating the absorption and their gut health and their gut's ability to absorb and use, you know, nutrients. Yeah. Yep. I mean, both. I'm I'm just a real big fan of doing things concurrently. So, treating the gut, treating the nervous system at the same time. um giving them the minerals, the vitamins that they need so they can start feeling better now like while we do kind of the longer what takes longer longer range work of like restoring the gut gut microbiome and gut health. Gotcha. Okay. So, what about all the people who've like gotten the online testing? Like I think function health is probably one of the big one. I know there's a lot of them now once they came out and they, you know, see where they're deficient. Now they're just taking a bunch of like supplements based on where they're deficient. Are those people going to run into problems because they actually have a gut issue where they're not absorbing it properly? Potentially. I mean, it's like it's there's so many layers to this medicine, right? I mean, we talk about root cause medicine and um kind of digging deeper and that it's not you can kind of keep going, right? So one one layer deeper than um conventional medicine would be doing that level of micronutrient testing which is fabulous. That's great. But then the next level is well why why are you deficient? And and then you know getting in again getting into gut health getting into whatever is going on like with an autoimmune condition or hormonally or nervous system or whatever it is and you can kind of keep going and that's where it's individualized. I think that's where it's like, you know, what is this patients this individual's bandwidth? Um where what's their what are their priorities? Like at what pace do you go? Some people like want to dive in. They want to do all of it right now. And most people are kind of like let's just kind of bite off a little bit at a time. Um so somebody who does that online that testing and then takes a bunch of supplements. Um there's also the question of well how much do you take right of of said mineral or vitamin? Um they will probably feel better which is great but as I think you're pointing out uh we're not really answering that underlying question which is why are they not absorbing it or why do they continually why are they still um deficient in iron, right? like they can supplement with iron and they can their energy can be better but why why that deficiency in the first place? Mhm. Okay. So deficiencies as we know now can be a result of poor absorption in the gut. What about genes? Like you've heard a lot of talk about like methylation. Um can you talk a little bit about that? Like what is methylation and um how yeah how does that play a role in you know one's ability to absorb the nutrients they need? So, the one test that a lot of people have heard of is the MTHFR genetic mutation. That's kind of one of the most well-known um SNIPS or genetic mutations. And what that there's a lot of other ones that can be tested for, but that's kind of one of the primary methylation um variants. So, what it is is it's like if you have so it's genetic. So if you have a a genetic um mutation or a genetic variant, that means that the way that you basically process um B vitamins, for example, is going to be different. That your um when you take in B vitamins through your diet, through a supplement, your body has a harder time methylating. And so what methylating is or the methylation process is basically a process where those B vitamins can kind of be converted and actually utilized. So if that's if there's a handicap there and the body is not able to methylate easy easily then you could take all the B12 like you can get the highest quality B complex in the world but your body kind of doesn't know how to use it or doesn't use it as well as somebody who doesn't have that genetic variant. Um and so you see things like elevated levels of homocyine which is an inflammatory marker. you see a deficiency of glutathione um which is like a really potent um antioxidant and kind of helps with detox pathways and inflammation in general. So those things are going to be kind of compromised when um somebody has that that variant. So one kind of I guess you could call it a biohack is like you when you take a B vitamin you take a methylated version or if you take any vitamins you take the methylated version. So they're already in a form that your body can utilize more easily. Okay. Gotcha. Because there's a lot of hype around methylation and y a lot a lot of it was Gary Brea. A lot of it was Gary Brea and and it even impacts estrogen metabolism as well. So it it's Yeah. But a lot of it was Gary Brea. I agree. [clears throat] Gotcha. Okay. Um, so can we talk a little bit just about like conventional like your primaries cares approach to treating vitamin deficiencies versus a functional approach functional medical approach to treating vitamin nutrient mineral deficiencies? Yeah. So I mean I don't want to put all primary care providers in one basket because I know that they there's a just like all of us all providers is a huge range and you know over the years I I have known primary care providers who do say somewhat routinely test for vitamin D which is great. Um that and maybe B12. Um, but that said, nutrition in general is not taught in medical school, in conventional medical school. Um, and it's just not part of the training. It's not usually part of kind of their toolbox. So, um, just to have that as a background, it's kind of, I guess, can at least traditionally not even on their radar to kind of test for deficiencies. um unless it's something yeah just for standard kind of routine care that's just not something that they're going to really think about. Now there's some exceptions like if you know some they suspect somebody's anemic they're going to test your iron level um and maybe your feritin hopefully which is your body's like reserves or storage of iron. Um but so first of all it's just not really on their radar. It's not really tested that much. And maybe because in functional medicine we do have more training, more awareness of nutrition in general that includes encompasses minerals and vitamins and kind of checking for those micronutrient levels. Does that make sense? Yeah. Gotcha. And what about the ranges though? Because you go to your Oh, yeah. Okay. And then there's that. So, um there's this is kind of a classic normal versus um optimal difference. Um so, vitamin D is a good example. Um there's a lot of kind of fear I would say in conventional thought, conventional medical thought about vitamin D toxicity. And part of that is that vitamin D is a fats soluble vitamin. So we don't um it can technically kind of be stored in the fat. We don't unlike the B vitamins which are water soluble. We kind of pee out, you know, um water soluble vitamins. You don't really have to worry about like toxic levels. U but vitamins A, K, E, D, those are fat soluble. So um there's this kind of fear around someone taking too much vitamin D3 and um they will say that a normal level is like 23 and this is I think nanogs per milliliter is the are the units that I'm referring to. So um for me and most of us in functional medicine if somebody comes with a in with a vitamin D level this is serum or blood that we're talking about at 22 23 that's deficient. Um maybe not technically but it's certainly like suboptimal. Um, so that person is just that's impacting everything from thyroid to neurotransmitters to bone mineral density um to immune function, right? Um, our goal usually with a serum level of vitamin D is like at least 60, anywhere from like 60 to 80. Some other practitioners will say even higher. you don't really have to start worrying about toxic levels until you get close to 150 nanograms per milliliter. And in my clinical experience, that's really hard. That's really hard for someone to get to that level. Um, so there's a that's one kind of good example, I think, of a difference between normal versus optimal. Um, in terms of levels, it's it's Yeah. Gotcha. Makes sense. Okay. So, um, [clears throat] diving into some of the show note questions here. Um, can stress, trauma, chronic illness essentially, um, maybe burn like burn through nutrients faster or like make you more prone to deficiencies? And if so, which ones would be most affected? Yes. Um, primarily the first ones that come to mind would be uh, like vitamin B12. Um and then mineral-wise, magnesium. So both um B12 and magnesium are like fuel for the nervous system and the adrenal system. And so when you are when you've experienced trauma, when you've experienced stress of any sort, the nervous system, the adrenal system, they need that's what they that's how they're kind of surviving, right? Like that's what they're running on. But there, yes, I guess you could say burning through those that vitamin that mineral more than a person who's in a more relaxed um state would. So, you're much more prone to become deficient. And you're getting those through food, maybe through supplementing. Um, but it's a pretty common picture, unfortunately. Gotcha. Okay. Um, so how do nutrients uh and minerals, vitamin deficiencies play a role in your mood and your energy and your motivation? And if so, like what are the most common offenders when it comes to the vitamins that are really important in just the way you feel? Um, I mean, probably all of them. you know, the ones that we kind of look at first would be ones that I've already talked about, but um vitamin D definitely in terms of mood regulation, you know, it's kind of classic like part of the reason, you know, in the fall and this time of year why I'm really aiming for all of my patients for their serum levels of vitamin D to be as close to 60 or higher is because of things like seasonal affected disorder and the fact that the days are shorter and a lot of people are really affected by the lack of light. And so having it's having optimal levels of vitamin D is one way to help um alleviate that to some extent. Um and um the and the yeah I mean if you're if you're stressed, if you're tired, uh you know kind of a a B12 a B complex is going to be is going to be big. If you have muscular tension, if you're stressed, then magnesium is going to be really important. Um, and if you're tired, we're we're largely looking at like iron and that and sometimes that can be it can kind of bleed into more of like a depression, you know, kind of that fatigue, depression, malaise. Sometimes it can be a little hard to tease those apart. So, those are all again, it's like how I what I said in the beginning. It's it's like walking around with these handicaps that are essentially kind of lowhanging fruit in terms of fixing them. Again, we want to dig deeper like you know, we want to deal with the trauma, we want to deal with whatever the underlying issue is, but it's pretty easy to replenish those micronutrient deficiencies. So even though it's probably a complex situation that like that's one thing that you can do quickly and people every day people say you know they come in for their vitamin D injections and they're like I felt a difference immediately. Um I had a woman yesterday who she when she came to us her vitamin D level was under 10. I think it was like 9.71 and again our goal is 60. And so that is technically deficient. That's not just suboptimal. Um and so I had her come in once a week for an injection and she would leave every time just feeling so much better. Um and you know we were only in three two and a half months we were only able to get her serum levels up to 23. But again it's better. Um but we we have a little bit more work to do there. Just curious, what did that patient know anecdotally as far as like the way she felt after just like more energy energy. She just felt better. She just felt like she wasn't dragging and um just like her like you like mood her just her mood just lifted. Gotcha. It's a good example. So, uh hey guys, we we really appreciate if you're joining us live right now. We got about six more minutes left in this u subject. So, if you have any questions and you're joining us live, feel free to uh drop them in the comments and we'll see if uh we can get to them with Dr. Rose. Uh or just give us a thumbs up. We'd love to know you're there. If you are interested in becoming a patient, you can go to medmatrixusa.com and apply there. Um okay, so back into the show. How do uh vitamins, nutrients affect sex hormones? That's a good question. I mean, I referred to it briefly earlier in terms of estrogen metabolism. Um, so say somebody has a methylation mutation. They're taking B vitamins, but they're not methylating them properly. That's um kind of inadvertently or indirectly going to kind of affect estrogen metabolism. Um, if this is an interesting one, we actually need cholesterol to make sex hormones. And so, um, like for example, if somebody's taking really high doses of a statin medication and they don't really have that much cholesterol, like that's going to affect their sex hormones. But from a nutrient perspective, like we need healthy fats and that's gonna that's going to kind of provide building the building block for sex hormones. Okay. So, can you explain more how like the vitamins actually affect like how like how like let's use vitamin D as that's one where everyone's like vitamin D vitamin D like but how does vitamin D actually affect the way you feel? Can you kind of break down the in terms of sex like the sex hormone? Yeah, sex hormone. Just like why is vitamin D so important in the way you feel? Um well because it affects your um it's like neurotransmitter balance. It has a role in terms of neurotransmitter metabolism essentially and um it affects your um like inflammation and so so a lot of this I guess I would say is a little bit like in my mind at least a little indirect right like you need these building blocks you need sufficient vitamin D in order to have lower levels of inflammation and in order to have optimal neurotransmitter metabolism and regulation. So, it's like part of the broader picture of um a healthy neurotransmitter response which is going to affect your mood. I know that might not be the most satisfying answer, but um it's like part of the big part of a bigger puzzle. Gotcha. Okay, makes sense. Um let's see here. Just wrapping up the questions on the notes here. Um, so why are like nutrient I guess to give context for this next question is like how many patients when they come in after doing you know a whole bunch of testing and they sit down with you for a full hour what percent of those new patients are deficient in some vitamin or nutrient or mineral? Um 90%. Wow. Okay. Pretty high. Um why do you think it's so high? So it could be anything from um well vitamin D. It could partly be because of where we live um and that we're not really eating again like we really don't eat fatty fish. Uh which would be helpful. Uh but largely it's kind of where we live and then so part of it's how we eat. Uh again circling back to kind of like the foods that we eat, how the how those foods are grown and um gut health. And then there's things like iron, right? Does somebody have a gastric bleed that's undiagnosed? Is it a woman, a menrating woman who has really heavy periods and she's losing iron every month? um is it a person who has a vegan diet and they haven't been kind of addressing making sure to get enough um iron supplementation. So everybody's a little bit different, but uh it's it's super common and again it's it's that also a difference between def like optimal, right? So somebody comes in with a vitamin D of 26, I'm going to treat that. In a conventional medical practice, they'd say that you're fine. So in my mind, they're deficient. Not every provider, you know, outside of functional medicine, not every provider would agree. Gotcha. Okay. And then to bring us on with this um this segment, can you kind of explain a treatment plan or a patient case study other than the one you brought up earlier uh regarding like nutrient deficiencies? Um yeah, I mean let's see. Um well this is a pretty common scenario. Um I have I do have a fair amount of people who you know we go through all the blood work and we go through like the whole health history and there's like a lot of things that we can do as we've and as we've kind of said before a lot of for a lot of people it works to just kind of do one step at a time. So sometimes I'll just kind of do an outline with somebody of these are in general a lot of the things that that that we can do including you know your feritin is low, your B12 is low and your vitamin D is low. And sometimes what people say is well I think I just want to start with that. Like that's kind of I want to do take off like a small bite at first. Um so I will give you a specific example. Um, I have a a patient, he's he's um, gosh, I don't know if he's 30, he's kind of late. I think he's late 20s, and he kind of fit that picture where there were like a lot of different things that we could have done. And he um, his like stress level was pretty high. Um he uh I think even like his cholesterol was a little bit higher than optimal but he was very deficient in um iron, ferotin. All of them the all the standard ones that we test. I think his magnesium level was fine but um B12 was low and D was low. And so he chose just to focus on that to kind of eat um to kind of bump up uh me, you know, animal protein, which would help with the B vitamins, take a B12, a sublingual B12. Um I had him come in for some of those weekly D injections for 6 weeks, and then switched him to oral vitamin D3. I always add in vitamin K with D3. The reasoning for that is that D3 is going to increase your absorption of calcium. You want that calcium to go to the bones, not to the arteries. And that's where vitamin K can help. Um, so I switched him after the injections, we went to 10,000 IUs per day of D3 with K. And then an iron like a chelated iron that's non-constipating and um would boost iron and feritin levels. So he did that for three months and then I retested those levels and saw him and the levels had all improved. It was the same thing. His vitamin D went from um he wasn't as low as the other patient. He was probably like I think he was around 20 and his vitamin D went to 40. Great. Still not at 60 but better. And um but most importantly he just felt so much better. And so it was like again lowhanging fruit. like a few adjustments. Didn't really do didn't really take a lot, but um it was a great first step. Great example. Um okay, two more questions popped in my head. So, one one's about milk because milk is like infamously, uh good for your bones, right? And uh high in all sorts of good vitamins you need, right? I honestly don't even know. I think vitamin um which which vitamin is milk famous for? Calcium calcium and D. D. And yeah, calcium and D. So, like, is that true? Like, should you drink milk for Strong Bones? I mean, that was one of the best marketing ads in the history of advertising, right? I mean, the fact that like people still say that is amazing. Like the whatever lobbyists they had or marketing people did a good job. Um, they I mean there's calcium in milk and they fortify it with vitamin D. There's just a lot of reasons why. So, I still it's and it's partly generational. Like I have patients in their 70s who still drink a glass of milk with every meal. Um, and my I don't think milk is bad, but I think that I don't like that quantity of milk. It's like dairy is often really inflammatory for people. It can contribute to things like post-nasal drip and um kind of like kind of a excess mucus and flem um just inflammation like overall. It's just not my favorite way to get calcium or D. You can get calcium through leafy green vegetables. You can get calcium through um almonds. Like you, you know, through legumes or beans. Like you really don't need to have milk to get calcium. You certainly don't need it to get vitamin D. Okay. So, what's the difference between getting a vitamin or nutrient through a supplement or getting it through a food? Like is it really better to like try to fix your diet, get all the nutrients or should you just take supplements cuz like it's the same thing? I think it's some of both, right? I mean, we kind of talked about this like I think yeah, in an ideal world if you could really it's almost like your full-time job was was like optimizing how you eat, but that also means optimizing your gut health um and kind of knowing what your baseline is and then optimizing it from there. Uh, and knowing exactly where your food comes from, how it's grown, like, yeah, I mean, you do like, yeah, we should all kind of work towards that. Just in all honesty, it's just not super realistic, I think, for most of us to be able to get everything we need through our food given just our the way that our culture and our lifestyles are right now. So, I don't I think it's good to have like a blend supplement when you need to and have that be like targeted supplements. Um, in addition to, you know, eating a balanced diet rich in vitamins and minerals. Gotcha. Okay, sounds good. Um, all right. And I'm going to I'm going to play devil for this last question. I'm going to play devil's advocate. I'm going to come at you a little bit. So, like why like why should someone actually spend, you know, a good chunk of money, get all this blood testing done, sit down with a functional doctor like you for an hour when they could just go take magnesium, vitamin D, calcium, B12, methylated B12 supplements? Like, why go through all this testing and effort and money? Um, obviously there's other things they can do, but as far as vitamin deficiencies, like why bother? Not everybody's deficient and not everybody you don't know unless you do the testing and unless you talk to somebody who's really seasoned in this, you don't know um you don't know if you're deficient and you don't really and you don't necessarily know that difference between like deficient versus optimal. And it's if the conversation is held within the context of your health, your health history, what your what your energy levels are, what your sleep is like, what your stress level is like, what your digestion is like. So it's it's not like in isolation. Um so we don't all need magnesium necessarily. Probably most of us do, but until you really kind of test it, um you don't really know what your baseline is. And even like B12, like if somebody's like, I have all I rarely hear this, but I have as much energy as I want. I wake up in the morning and I feel amazing and their vitamin B12 on the blood test is low. they might not need B12. Like they feel great. They're they're not stressed. Their energy is fabulous. So it's you have to match the whole health picture and the symptom picture with the deficiencies. So that's that's where we come into play and and we talk about well what are you eating and you know so it's part of that broader conversation. Gotcha. Cool. All right guys well thank you for all who joined us live. We're about to transition into the next segment. Um if you are watching recording of this and you want to become a patient, you can apply by going to medmatrixusa.com and clicking get started. Um and yeah, let's move on into the next segment which is hormone deficiencies. So why are hormone and first with the new segment just got to say it. Um nothing you hear today is medical advice. It's really just education that's all. Um so let's get into it. All right. So, um, Dr. Rose, for the people who are just joining us, for the people who are watching the recording, um, can you tell us a little bit about kind of your experience in hormone imbalances and, uh, hormones in general? Yeah, I mean, I it's it's just a huge part for all of us. um kind of really no matter what what sex, what stage of life, um I think we usually start to have that conversation with both women and men kind of, you know, once they're in their 30s, uh 40s, and definitely 50s. And so, um hormones in general is just part of it's just part of it should be part of the conversation really with almost any visit. um you know we we you hear about pmenopause in menopause and then in men there's kind of andropause when testosterone starts to drop. So um there's a lot I think in the media and social u media right now about hormonal health um it can be tricky because these hormones are in the blood and again they affect everything. They can affect they can affect your mood. They can affect your sleep. They can affect um your libido. They can affect even your physical strength. And so it can be hard to say, well, is it is it my hormones? I don't know. You know, it's not it's not always so clear-cut. So that's kind of where we we dive deep and try to kind of sus that out for each individual. Gotcha. All right. So, let's just kind of like for people who aren't aware, how do hormones play a role in the way we feel in our aging, in our strength, just everything because hormones pretty much regulate and control the way we feel, right? Yeah. So, you know, we do talk about that triangle um where there's when we sometimes when we say hormones, we I think by default we are talking about the sex hormones. So the hormones like um estrogen, progesterone and testosterone which are secreted by the ovaries and the testes. But other I mean insulin is a hormone, right? There's a lot of other hormones. Um the ones that we usually talk about being kind of intimately connected would be the adrenal hormones. So people have heard of cortisol. Um another adrenal hormone is DHEA. And then there's thyroid. And so these are all really intimately related and impact each other. So yes, it um hormones, hormonal fluctuations, hormonal imbalance, those are going to affect everything. Mood, just how you feel for sure. Okay, gotcha. So um when do people normally start experiencing hormone deficiencies? Like average person, right? Yeah. So [sighs and gasps] um what we find with I'll just use pmenopause as an example is that um par so pmenopause is going to be kind of when your sex hormones start to fluctuate right so normally before pmenopause in a woman who's cycling every month there's like a certain rhythm I won't go into the like really nerdy details but basically there's like you know there's certain hormones that have like FSH has a spike at a certain time and progesterone, we don't really have any the first two weeks, but we do have progesterone the second two weeks of the cycle. And it's ideally it's very regular. And then starting even as early as age 35, um those can start to fluctuate and it's not necessarily a deficiency at that point. It's just more of a kind of un erratic, I guess. And it's diff it can be different for every woman. Um but it can just be it can be a drop. It can be like a deficiency. There's not quite as much progesterone being um produced. Not quite as much estrogen. But again for even for 10 15 years there's just kind of this up and down. Every month might be a little bit different. Um, what's tricky is we obviously do really like to test for hormones, but clinically we're not necessarily going to see a deficiency in that pmenopausal window. We're not going to necessarily see that a woman's ovaries are not putting out enough progesterone or estrogen because it's just a snapshot. And it's the it's the fluctuations that are the issue, not necessarily like the overall amount of hormone that's the problem. It's really not until a woman is menopausal, post-menopausal, which is technically you do not have a cycle for 12 months is when you're technically in menopause. Um that she's kind of really not making any anymore. And that is obvious on blood work like that. I can I can look at the blood work without meeting the woman and I can just know I don't even need to know her age. I can just look at the the numbers and I can tell she's menopausal because there's just not much there. Um so that's a huge range that some women are going to start experiencing that at age 35 and other women I mean I have some patients who don't you know really start to feel anything. Their cycles don't change until they're like 54. It's like a 20 year span, right? Um, so and then yeah, and then men, I mean, testosterone, there's different reasons for kind of a drop in testosterone. There's, you know, age related testosterone usually drop is really usually we see that starting mid4s, I would say, is when at least on the blood work when you start to see it. There's plenty of men that have kind of suboptimal levels of testosterone earlier, but when it's like age related, I would say mid-4s. Okay. Gotcha. Do you feel like balancing Let's talk about sex hormones specifically. Do you feel like balancing sex hormones is the greatest lever you can pull against anti-aging? Well, there's a question. Um, yeah, it might be. If I had to pick one lever, yeah, I mean, it's it's it can be such a shock to the system to have those fluctuations, to have those drops um that um and it can be such a safe therapeutic tool when done right and when kind of tailored to that individual's needs that it um I mean, you've heard me say this, like you know, people's lives are changed Not everybody, but a number people are just they're not sleeping. They have brain fog. They're irritable. So, right there, that's going to affect every aspect of life, right? That's going to affect family life, work life, energy, your intimate relationship with your partner, your relationship with yourself. Um, and then there's like weight gain that goes along with it. And so pretty soon it's like you just you know as people say like I just don't feel like myself and um and it's confusing because it just feels like it came out of nowhere. So um yes I think when you can kind of like and all of those things are going to age you essentially right chronic sleep deprivation right there that's going to age you. Um, so I think when done right, yeah, I think it is probably one of the strongest tools in longevity medicine. Okay, gotcha. So when some I mean we hear all the time people go to their normal doctors and they're told they patients go to the doctor and they say, "Hey, I want to test my sex hormones." And then they're told, "Oh, we don't do that." or oh it it doesn't matter or blood testing for sex hormones is relevant. What is your kind of take on that? So I think it's this is still current like the American Association of Gynecologists their general recommendation is like they don't it's not part of standard of care to test hormone levels. Um and we do it for a couple of reasons. One is to get a baseline. Um and the other and to yeah to get a baseline and to you know because we get really specific on estradiol which is the strongest form of estrogen. There's like a whole pan there's a whole number of biioarkers um around testosterone not just total testosterone and progesterone and you know it's a very complete list. So we get really like at first glance we get like a really comprehensive baseline picture. So good to have for anybody and then if we do start um some kind of bio identical hormone plan we can it can help us monitor moving forward. Now, most important where I guess I do agree with kind of that more conventional medicine model of we don't of not testing somebody's symptoms and their response to the hormone replacement therapy. That's more important to me than chasing lab values. I like both. I find that putting them together is like the most valuable. But I do agree that um you know if somebody um I guess I'll just use progesterone as an example. If somebody tells me that you know now that they're taking their oral progesterone before bed they're suddenly not suddenly they're now not um waking up between 2 a.m. every morning like they used to. And they feel better when they wake up and they feel better throughout the day. But their progesterone levels, you know, on blood work, their progesterone just went up a little bit. Like it changed, but it wasn't like drastic. That's great. I don't need to pump them. I don't need to give them a much higher dose of progesterone. They've already they're already responding really well. So, that's kind of how I use the blood work. I do think it's really helpful. Um, and I also don't really understand the mentality of like I don't see why not like if if somebody goes to their physician and they ask for it, you know, it's basically dictated by the insurance like unless there's like a reason why the insurance for the insurance to cover that testing, it's not going to be ordered. But being free of that those restrictions, like why not? If somebody's curious and you know how to interpret them, I don't see what the harm is. Okay, gotcha. Um, so what about let's talk about the gut connection and hormones. I mean, all the time in kind of like social media, especially around health, you hear, oh, gut health, right? Gut health is so important, but how like how is gut health connected to your sex hormones? Yeah. So, this I find really fascinating. There's something called um the estrobolome. It's not the estrobiome, it's the estrobolome. And this is like a subsection of the microbiome. So it's it's gut microbes which are responsible for basically um what we say um uh conjugating or kind of metabolizing breaking down estrogen. So ideally estrogen like again ovaries produce estrogen circulates through the whole you know all the estrogen receptors. The body kind of gets what it needs and then the liver and that gut microbiome kind of bind that estrogen up and then you eliminate you poop out the rest. You don't need it. If somebody's estrobolome or that part of the gut microbiome is out of balance, then it that doesn't happen. That process doesn't happen and the estrogen gets recirculated a second time, a third time, it kind of stays in the system longer than it should and therefore estrogen locks into estrogen receptors more often than it should. And so you start to get it's like [clears throat] more exposure than what is optimal, right? More estrogen exposure. So then potentially a woman is going to have what we call estrogen dominant symptoms. And that can be um for a woman who's cycling um PMS and that can either be like emotional signs and symptoms of emot the emotional premenstrual syndrome or it could be physical. It could be really uh tender breasts. It could be really bad cramping. It could be really heavy periods. Um and so it's that again that's like you would not think that that was like a gut issue, right? But it essentially it is. Interesting. You that's so interesting. So how do you fix that? Just curious like what's your when that's happening, what's your approach to fix that? Um, so there's certain supplements that you, well, I again, you know me, I like to test. So I like to test to see what's going on at that gut level. And there's certain um kind of biioarkers like something called betaglucaronidase is one enzyme that we can test for which can kind of tell us how what's happening with that estrogen metabolism. Um, and there's certain supplements that we can take. Um, actually kind of bumping up one's fiber intake. um whether that's dietary um like through your food, even taking an insoluble fiber, that's going to help. Um and uh for some women, while you're doing that, while you're kind of like optimizing that part of the gut microbiome, um bumping up progesterone, which estrogen and progesterone kind of balance each other out. So sometimes taking um oral progesterone especially during that second two weeks the uh um second two weeks of the cycle then the ludial phase that can really alleviate symptoms. So you're yes you have to figure out the estrogen metabolism piece but um you can also kind of just feel better and find more balance when you're optimizing progesterone at the same time. Okay, so let's keep going with this subject. How do um microtoxins or like things like mold and other toxins, you know, things like arsenic um play a role in affecting your sex hormones? Well, those are going to affect the liver and the liver is kind of detoxification pathways. And so if those are compromised and there's it's kind of um you're not processing anything optimally whether it's micotoxins that you've you know mold spores that you've been exposed to heavy metals that you've been exposed to through your occupation or other sources. Um then that's already compromised. it's going to be make it that much harder to kind of metabolize um conjugate estrogen as well. Okay, gotcha. So, can you uh break that down for people who might not know what that means? So, the I mean, we all kind of know in general that the liver is like a really important organ. Um and it's important for a lot of reasons, but one big reason is that it's our primary detoxification um organ. So everything that we put into our bodies um food, medications, supplements, uh and then unintentional things maybe like miccotoxins or heavy metals that all has to go through the liver. And so the liver has to kind of process um process all of those, break that down again, get it into the digestive tract so that it can be eliminated. if the liver is has a level of inflammation, if it's kind of um overt taxed, right? So, there's a lot of medications, there's a lot of alcohol use, there's um uh even even sometimes like a little fatty liver is going to partially impair detoxification. It's like that load if that toxic load is just kind of gets higher and higher things aren't going to process effectively as efficiently. Now I do have to make a point that genetically we have differences too. Some people are like fast processors and some people are slow processors. So it's why some people handle alcohol differently than other people. why people some people have a certain response to caffeine, you know, like they can they feel caffeine much more strongly than somebody else. A lot of that is just genetic. It's just it's not that you're doing anything right or wrong. It's just kind of how you were designed. Um, but you have to you factor all of that in and that's going to affect that's partially going to impact also how you metabolize the sex hormones. Okay. Okay. So, if you're someone who's more affected, it's kind of off topic, but So, if you're someone uh who's more affected by caffeine, like you're more sensitive to coffee, you're probably a slow, you're slow because it stays in your system longer. Okay. So, are you more prone or less prone to um you know, being more affected by alcohol or are they not connected? Uh you're probably probably more you'll be more sensitive, more affected. Okay, gotcha. So, if you're more sensitive to coffee, then you'd be more sensitive to usually. Yeah. Well, I think I think so. Yeah. Yeah. Okay. Because you because it stays in your you're you're not as efficient of a detoxer if you Exactly. Yep. Okay. Cool. All right. Fun little fact for everyone. Um All right. So, let's talk about this saying that everyone knows stress kills. Like how does like scientifically how does stress actually kill you? Um I think in relation to like you know talking about cortisol um yeah tell me more. So people um people think of cortisol as like a stress as the stress hormone. Um so it is produced in the adrenal glands and it is produced um well I'll just back up a little bit. Um the normal what we call dal rhythm of cortisol um like in a healthy individual is that your cortisol has a spike in the morning when you wake up um and then it kind of drops between 8:00 a.m. and noon and then it continues to drop between noon and midnight. So in an ideal world your cortisol is really at its lowest while you're sleeping which should be at night and at its highest in the morning. Um, and what happens is usually early in life, uh, I'll say this, the this has impacts, trauma, stress has impacts for any age, but if somebody is living in a home or living with a level of trauma where they just don't feel safe like for years and years, that cortisol is not going to drop, right? So they're going to be in this like excuse me like hypervigilant state most of the time and that over time the adrenals they can't put that out anymore. Right? So that's kind of like this person's default is to have elevated cortisol all the time. They're in fight orflight mode. They're like, you know, they're not coming down. After decades of this, the adrenals aren't able to really continue to put uh put that have that same output. And so you start to get dysregulation where they're not getting that morning spike anymore. And it's high at night, but it's low in the morning and it's kind of all over. And then the third stage of what we call like adrenal fatigue is no, there's really not much cortisol at all. The adrenals are kind of shot. It's like an empty gas tank. So, and that's um I mean that level of fatigue is pretty significant and there's you know you're really just not able to I mean really really low cortisol you're like barely barely functioning. So I guess that would be kind of your definition of um stress kills, but it's it's a chronic thing and it um it's it's just running on empty is one way to put it. Did that answer the question? It did. Yeah. And I just wanted to thank everyone who's live with us right now. If you have any questions, we're kind of coming to an end on the hormone deficiency segment. So, feel free to drop some comments. And if um you are interested in becoming a patient, you can apply at medmatrixusa.com. So, kind of bringing us into the final stretch here. What is um what is sex hormone binding globulin? Globulin. Yeah. Why is it important? Um because I think this is one that's pretty overlooked. Yeah, it definitely is. Yeah. So, it's one it is it's a part of our standard panel that I really appreciate that we have. Um so, again, usually if you go to a provider and you and they test your testosterone, this is male men or women, although usually it's men who are asking, um they're going to get you're going to get a total testosterone level. Sex hormone binding globbulin is a protein. It's globbulin. Um, it's a type of globulin, which is a type of protein. And the way that I talk about it is that it's floating around in the blood. All of this is in the blood. Remember, all the hormones are in the bloods. Um, so you've got this protein and then you've got your testosterone molecules and they're all floating around together. A glob when a globulin molecule connects to a testosterone molecule, it renders it inactive. That testosterone molecule can no longer lock into a receptor. it and cannot kind of do its job. So a high level of sex hormone binding globbulin is going to basically detract from total testosterone. So we also include um tests like free testosterone and bioavailable testosterone which take that into account. So those are actually more telling than the total um because it it's kind of the calculation after taking the sex hormone binding globulin number into account. So here's an example. somebody a man has a level of um uh 400 450 um on his total testosterone and you're like you know in conventional medicine you're like you're fine but his sex hormone binding globulin is over a 100 now we really for we really want that number to be between for men I think we want it to be between like 20 and 40 um for sex hormone binding so say that for whatever reason uh there's different theories of why that might be elevated, but say his sex hormone bionabulin is really high. Really essentially the the the bioavailable testosterone, what his body can actually tap into is not even close to 400 or 450. It's probably closer to 200 or something. So, this is a guy who's probably pretty tired, um, low libido, low motivation, you know, maybe goes to the gym, but really has a hard time seeing results. like the skeletal muscle mass development is not what he wants. Um, so that's just an example of where how sex hormone binding gabbulin plays a role. And if you're just testing total testosterone, you're really not going to have that full picture. Okay. Gotcha. So pretty important to know, right? And I think on the So what about Yeah. And then what about like bioavailable testosterone too? Well, that's Yeah. So, so what we see is we get a re we get all of that. We get total testosterone, we get sex hormone binding globbulin, we get free testosterone, and then we get bioavailable. And so, um, yes, I'm looking at total, but I'm, you know, more interested probably in the free and the bioavailable because again, that's what that's what his body can actually utilize. Okay, gotcha. Um, let's talk about two more kind of more specific hormones. Let's talk about um DHEA. What is DHEA and why is it also very important in just well-being? Yeah. So, people kind of in the longevity medicine space talk about DHEA. Um it is also made by the adrenal glands. It's kind of like there's a whole there's all these pathways, right, with sex hormone kind of how you you end up with the final metabolites of sex hormones. DHEA is like one step along the way. I think of it sometimes as a precursor hormone. So, it's made by the adrenal glands and then it gets converted um to but testosterone and then estrogen. [gasps] Um so, if you're starting your raw ingredient, your DHEA is low, it's going to be harder for you to have optimal levels of estrogen and testosterone. It can be one reason why potentially you're you're suboptimal with those hormones because that that starting raw ingredient isn't um as optimal or as high as we'd like it. Um DHEA does decrease. It's supposed to decrease with each decade of life. So a younger person inherently is going to have a higher level than an older person. Um what so the goal for most of us as we get older is to maintain you know a certain level of DHEA and um we we specifically measure kind of a a metabolite of DHEA. It's DHEA sulfate or DHEAS. Um that one's just like easier to measure in the blood. So, um, coming back to stress, you know, again, this is made in the adrenal glands. Chronic stress is usually kind of the the culprit, I would say, if somebody has suboptimal levels of DHEA. It's not that they had, you know, a stressful week the week before they did the blood draw. This is like chronic stress, right? like a history of trauma, history of um you know a a really bad relation, long-term bad relationship, other whatever other um types of stress and trauma the person has dealt with have taken a toll on the adrenal glands and this just not making that raw ingredient of DHEA anymore. So in addition to you know the kind of more well-known types of hormone replacement therapy um sometimes we will prescribe DHEA um to kind of support the adrenals help with that raw ingredient and then um test monitor that's helping to boost things like serum levels of testosterone and estrogen. Okay. All right. So, um, why not just take a DHA supplement, um, as you get older? You don't know what your level is. You might not be low. It's not, if it's not low, you don't need to supplement. Um, and um, you can't, you know, it's just good to have that baseline before you then just randomly start supplement. There's also different dosages, right? Like sometimes we just start with 5 milligrams and then we build up to 25. Um but unless we kind of know what the level is, what your what your goals are, it's like hard to tweak that. Um there's also some providers that um you know, you can get DHEA in kind of overthe-counter supplement form or you can get that compounded through a compounding pharmacy. And there are some providers um and I have seen this with some people that the person actually feels better like you actually just get better results when you when it's compounded through a pharmacy. Um that's more of kind of like a clinical anecdote that I've seen a couple times and in conferences I have heard other providers say that. So again that's going to need kind of uh professional expertise in figuring out the right dose and getting that prescription done correctly. Gotcha. Okay. And then last specific hormone we're going to talk about is prolactin. What is prolactin? And um I think that's ref referred to as your like motivation hormone, right? Can't Yeah. Um talk more about that. [snorts] I don't think of it like that. Um, I'm I'm it's I mean I'm usually looking at it kind of um as part of the overall like reproductive sex hormone picture. Um we it's definitely plays a role kind of when a woman's lactating. um it's made by the interior pituitary. And one reason why we test for it is that if it's really high, we need to rule out a pituitary tumor. Um benign or malignant, but um pituitary tumors are not not exceptionally rare, like they do happen. Um, and so prol like testing prolactin is kind of one easy way to just make sure that there's not any kind of tumor. Um, but it can also if the prolactin levels are off or if the pituitary is kind of not functioning as well, you may see like a woman might have um irregular menes. She might have um she actually I have had I have had a couple patients over the years. I had a woman who you know did not had not just had a child was not breastfeeding and she started lactating. Um and that it was and then down you know after kind of all the workup there was a pituitary tumor. Um so irregular higher than desired levels of prolactin can um be detected when somebody is dealing with infertility again menstrual irregularities um and low libido all of that can kind of play a role. So maybe it's the maybe it's kind of when you what did you what did you say that you you heard about it? I for I mean I forgot where I where you got it. I lost your audio. Can you hear me? No, I can hear you now. Yeah. All right. I just switched to my computer. Um Okay. So, um yeah, I I was talking to another provider, but we um Okay, I'll [laughter] have to get back on that. Okay. Okay. So, let's do one more question here. Um let's see. Let's pick a good one. We got a lot of them that we didn't get through. We'll have to do another episode. Uh let let's talk a little let's just do one little bit on um hormone replacement therapy because I know it's something we do a lot here at Med Matrix. Like what's the difference between um bio identical hormone replacement therapy, something that we do a lot of versus kind of like the synthetic hormone replacement therapy that most women would get by, you know, they go to their OB or um just what you would normally experience. So um the quick answer to that is that bioididentical hormone replacement is um they are molecularly identical to our own hormones. Um whereas synthetic are molecularly similar but not identical. Um and so for example like conjugated ecoin estrogen was the hormone which is synthetic was done was the hormone that was used in the kind of famous now famous women's health initiative which is what caused like the medical community to tell you know to tell everybody to go off of HRT in 2002 just like overnight. So bioididentical um hormones are generally considered safer because they kind of mimic more much more closely mimic our own hormones. Um the hormones that are in uh birth control are um synthetic. Um the hormones that we prescribe um are bio identical. So that includes like oral progesterone. We almost exclusively use transermal estrogen which means like a cream or a patch and that is also bioididentical. Um, so it's really an issue of safety and that most people prefer to put more natural substances in or on their bodies than synthetic. Um uh I will say this like if you go and you get an estradiol patch anywhere that is bio identical like it's not excl like you can you know a gynecologist can or a primary care can prescribe an estradiol patch and that is bioididentical. They're just not all they're first of all a lot of them are refusing to do it and it's a skill in knowing how to prescribe it and knowing how and when and what level because there's varying differences in dosage and concentration etc. Um so it's like a whole we call it like menopause medicine and it's a whole it's a whole another level of training. Um, so it's not that like, you know, you can't get it elsewhere. It's just that it's not most people aren't really well trained in it and or aren't really willing to to do it. All right, good answer. [laughter] That was good explanation. Thank you. So, all right, guys. That will do it for today's uh segment on vitamin deficiencies and hormone deficiencies. We talked kind of about both men and women there. Um, so yeah, if you're listening, you're live now with us and you're not yet a patient, you want to become a patient, you go to medmatrixusa.com and you can apply there to become a patient. Um, don't forget to like, share, uh, you know, subscribe to the channel if you want to hear more. We're going to be we go live pretty much every Tuesdays, um, some Wednesdays, some Fridays around 4:30. Uh, if you like joining in. And that is everything. Dr. Is anything else you want to say? No, it's great. Great topics. Awesome. All right, everyone. Thank you so much for joining live. We'll see you in the next one. Bye.