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Men’s Health with Dr. Judson Brandeis

Dr. Justin Brandeis discusses Men’s Wellness with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

1:30   Dr. Brandeis feels that men are the hero of their own journey and to live a healthy life requires men to not drink, not smoke, don’t do drugs, don’t eat too much, exercise every day, stretch, visit your chiropractor, meditate and be nice to other people.

 

 



Dr. Justin Brandeis is an MD Urologist, clinical researcher, and a sexual medicine expert. He wrote a new book, The 21st Century Man.  Dr. Brandeis helped pioneer the use of robotic surgery for urological surgery, and his practice now is more focused on regenerative care for men, helping to improve their sexual health.  His website is BrandeisMD.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

 



 

Podcast Transcript

Dr. Weitz:                            Hello, Rational Wellness podcasters. Today our topic is how to help men become healthier with Dr. Judson Brandeis, who wrote the very ambitious book, The 21st Century Man. As you can see, this is a very ambitious book that covers pretty much everything men would want to know about how to improve their health. Dr. Brandeis is a urologist, a clinical researcher, and a sexual medicine expert. He helped pioneer the use of robotic surgery for urological surgery, and his practice now is more focused on regenerative care for men, helping to improve their sexual health. Dr. Brandeis, thank you so much for joining us today.

Dr. Brandeis:                      Hey, it’s my pleasure to be here. Thank you so much for inviting me.

Dr. Weitz:                            That’s great. So in your book, chapter one, you start with this discussion about a hero’s journey, which I guess, comes from Joseph Campbell and you write, “Each of us was born with individual gifts and walks a unique life path of hardship and opportunity with mindfulness and determination. We all have the chance to become the hero of our own story. Some men start in their quest for fame and fortune, others are late bloomers.” Is this an aspiration? Do you think all men have a hero’s journey or? It seems to me a lot of men are simply trying to survive.

Dr. Brandeis:                      Yeah, I mean, that is true, but I honestly believe that we all have the potential to be the hero of our own journey. And to me, we all really know what to do. So I can tell you how to live a healthy life in 15 seconds. Don’t drink, don’t smoke, don’t do drugs, don’t eat too much, exercise every day, get some good sleep, stretch every day, visit your chiropractor, meditate and be nice to other people. There you go.

Dr. Weitz:                           It’s simple,

Dr. Brandeis:                      Right. And you’re ahead of 98% of people, but life is-

Dr. Weitz:                           And don’t take classified documents home with you. No, I’m just kidding.

Dr. Brandeis:                      Don’t do that either. But yeah, we’re both in the People’s Republic of California, so.

Dr. Weitz:                           So

Dr. Brandeis:                      Safe joke in California.

Dr. Weitz:                           So what are the biggest health challenges that men face today in the-

Dr. Brandeis:                      Yeah, well, so we have a lot of stress in our life, and life isn’t so easy. So there are a lot of coping mechanisms. And I see men in their midlife, I don’t see women in my practice, I don’t see kids, I don’t see super, super old people, I see midlife men, guys like you and I who are good guys, we’re working hard, we support our wife and our kids and our families and our job and our community and we forget to take care of ourselves. Right?

Dr. Weitz:                           Yeah.

Dr. Brandeis:                      And so we get fat, we get out of shape, our testosterone goes down, our erectile function declines, and we need help. But we’ve taught everyone around us that we don’t need help. We’re superstars, we’re independent, we can do everything on our own. “Don’t help me.” And so when you teach people that you’re indestructible, then people don’t come and help you. And so I get guys when they’re ready to throw in the towel and I know how to resuscitate them. I know how to help guys lose weight and I know how to help guys build muscle, improve circulation, improve erectile function and it’s really fun for me.

                                           And the 21st century man was a byproduct of that journey that I go through with all of my male patients. And the heroes journey, very few people make it to the end of the hero’s journey. People get sidetracked, but we all have the ability and the determination if we focus on our own journey. The problem is, everyone’s off wanting to be Tiger Woods or Johnny Depp or…? And I feel bad for Johnny Depp, but that trial just was riveting because listen, this guy, everyone looks at him like, “Oh my God, he’s this movie star, good looking guy, gets all the chicks, he got more money than God.” But look how messed up his life is.

                                           Focus on your own problems, don’t focus on other people and think that everyone else has it so easy. Because they don’t. And if you don’t focus on your own problems, if you’re focused on Tiger Woods’ problems and his wife chased him down the street with a golf club, I have some bad days with my wife, but she hasn’t done that yet. If you focus on your own life and your own problems, then you have the potential to live out your own hero’s journey and be a hero to your wife, to your kids, to your partner, to your workplace, to your community. And to me, that’s what it’s all about.

Dr. Weitz:                           Yeah, I can definitely say as a chiropractor, 60% of our patients are women. And a lot of the men who come in are only there because their wife or girlfriend made them come. Men tend to avoid doctors at all costs and do tend to come in only when there’s no other choice.  And they can’t ignore it.

Dr. Brandeis:                      Oh yeah, there’s a sign on the wall of my chiropractor’s office.  It says, “Just because you ignore the problem doesn’t mean it’s going to go away.”

Dr. Weitz:                           Right.  Absolutely.  So yeah, as we know, prevention is worth a lot.  The problem is, I think the average person goes to their primary care doctor and despite the claims, there’s not a lot of prevention that’s really done.

Dr. Brandeis:                      Yeah. So the book that I wrote is all about prevention and early intervention of the most common problems that men encounter. And some of it’s just common sense, but it’s like common sense unfortunately isn’t all that common. So for example, the most common cause of death in men is cardiovascular disease, heart attacks, stroke, et cetera. The second most common cause of death is cancer, and there’s a bunch of chapters on that. Third most common cause of death is accidental death, right?

Dr. Weitz:                            Right.

Dr. Brandeis:                      So it’s the stupid stuff that we do. So in that chapter you’ll find, right, 90% of eye injuries are preventable by wearing glasses or safety goggles. So if you’re that guy in the backyard like me on the weekend with a saw all chopping up wood or making fences and stuff like that, and the blade goes through a little old nail and spits a little piece of metal that embeds itself in your eye and you’re in the emergency room and you need your vision’s jacked after that, you’re that statistic.

Dr. Weitz:                            Right.

Dr. Brandeis:                      And 90% of the time that’s preventable. Or 50% of the time hand injuries are preventable by wearing a glove. I mean, do you really want to be that guy that loses a function of a hand or loses a finger because you are too proud or too stubborn to put a pair of gloves on? Every year I see a patient fall off a ladder putting up Christmas lights or taking stuff out of a gutter. And that can really destroy your quality of life. You can break a hip, you can break a back. I’ve seen all of those things. You lose your job, you spend a year or two in rehab, a lot of people get addicted to pain medication because of that, just because you’re too proud to call up the next door neighbor’s kid who’s 20 and have them put up your Christmas lights or clean your gutters.

Dr. Weitz:                            Right.

Dr. Brandeis:                      But the thing is, you got to understand the aging process. So as you age, there’s a reason you fall off ladders. Okay? It’s because your balance changes as you get older, your reflexes change as you get older, your nerve conduction changes as you get older, your muscle changes as you get older, your weaker than you used to be. Right? And your vision changes as you get older. So there’s a damn good reason that you fall off that ladder putting up Christmas lights or cleaning out gutters. It’s not a sign of weakness to call up your next door neighbor or to spend money on a service to do these things that you’re no longer physically optimized to do.

Dr. Weitz:                            Right.

Dr. Brandeis:                      Sorry, I probably just cost you 50% of your business. All these old guys over 50 or 60 that think that they can wakeboard or heli ski or something like that, and then come into your office on Monday morning, barely able to walk.

Dr. Weitz:                            Yeah. No, as I said, we have quite a bit more women than men, so won’t be affecting us too much.

Dr. Brandeis:                      Okay.

Dr. Weitz:                            But you’re assuming and any of the men listening to this are actually going to listen to your advice.

Dr. Brandeis:                      Okay, well let me throw some statistics at you that I learned writing the book.

Dr. Weitz:                            Right.

Dr. Brandeis:                      A hundred years ago, women lived one year longer than men. Now women live five years longer than men. Okay. So what happened in a hundred years that we lost four years of longevity that women gained. Okay, second of all, even before COVID, the longevity of men in the United States declined. And it declined because of alcohol, opioids, and suicide. Okay? That’s really depressing. Here we have all these amazing technological and advancements in medicine and people are living less long. So men go to the primary care doc half of what women do.

Dr. Weitz:                            Yeah. I would say on top of those three causes you mentioned, we probably have to throw in obesity and lack of physical activity and yeah.

Dr. Brandeis:                      Absolutely. So 40% of men are obese. By the end of the decade it’ll be 50%. 15% of men still smoke, 12% of men don’t even have health insurance, half of men have hypertension. I mean, I could go on. 10 or 15% of men are alcoholics. The state of men’s health in this country is really dismal. But it takes an individual who wants to go on their own individual hero’s journey to make up their mind, to take better care of themselves, because going back to what I said at the beginning of the show, it’s simple. Don’t drink, don’t smoke, don’t do drugs, don’t eat too much, exercise, stretch, meditate, be nice to other people and get some sleep.

Dr. Weitz:                            It’d also be nice to have a healthcare system that had some focus on prevention.

Dr. Brandeis:                      Absolutely. And there’s a chapter in the book, it’s one of the best chapters in the book, I think, on the American healthcare system because it’s really, really messed up. And it’s really confusing. And-

Dr. Weitz:                            It’s a secular care system, it’s not a healthcare system.

Dr. Brandeis:                      Yeah. And I didn’t want to write as many chapters as I wrote in the book. So I would go out and try to find someone who had written a chapter that I was interested in and then just call them up and say, “Can we use your chapter?” Or “Can you write a chapter for the book?” And I couldn’t find a really good description of the American healthcare system, which is really pathetic. And so I had to get a healthcare executive to masters of public health students at UC Berkeley, and myself and we wrote an absolutely amazing chapter. One of my patients used to be the number two guy at Aetna, and he said he was blown away. He said even he who had been at the highest level of healthcare administration for 40 years learned something from that chapter.

Dr. Weitz:                            Yeah. Unfortunately, insurance companies run the healthcare system and they don’t really treat patients right and they don’t treat doctors right. And I see that you don’t accept insurance, so I’m sure you know about that.

Dr. Brandeis:                      Yeah. Well, I mean, the thing is, I used to take insurance and the stuff that I did was insurance covered. But most of the stuff, I’m way out on the sort of cutting edge of stuff that I’m doing now. An insurance companies typically don’t cover those kind of things. But also it gives me the ability to spend the time that I feel like I need to spend with patients-

Dr. Weitz:                            Absolutely.

Dr. Brandeis:                      …to really connect with patients and understand what their goals are and where they’re coming from, and really do the kind of job that I want to do with my patients.

 

Dr. Weitz:                            I’d like to interrupt this fascinating discussion we’re having for another few minutes to tell you about another really exciting product that has changed my life and the life of my family, especially as it pertains to getting good quality sleep. It’s something called the Chilipad, C-H-I-L-I P-A-D. It can be found at the website chilisleep.com, which is C-H-I-L-I-S-L-E-E-P.com. And so this product involves a water cooled mattress pad that goes underneath your sheets and helps you maintain a content temperature at night. If you’ve ever gotten woken up because the temperature has changed, typically gets warmer, this product will maintain your body at a very even temperature and it tends to promote uninterrupted quality, deep and REM sleep, which is super important for healing and for overall health. And if you go to chilisleep.com and you use the affiliate code WEITZ 20, that’s my last name, W-E-I-T-Z 20, you’ll get 20% off a chilipad. So check it out and let’s get back to this discussion.

 

Dr. Weitz:                            So what’s your take on nutrition and what style of eating do you tend to recommend to men? Or does it depend on a person?

Dr. Brandeis:                      Yeah. So I’ve been incredibly successful in helping my patients. I don’t look at weight. I have a body composition scale in my office. And so I look at fat and I look at muscle. So my goal with my patients is to build muscle and to lose fat. It’s easy to lose fat. Stop eating, you’ll lose fat, right?

Dr. Weitz:                            Well, you’d lose muscle too if eat right.

Dr. Brandeis:                      You’d lose muscle too. Right. So the hard thing is to lose fat while you’re building muscle. That’s my goal with my patients. And so my body composition analysis machine gives me what’s called a basal metabolic rate.

Dr. Weitz:                            Yeah.

Dr. Brandeis:                      I try to make things super simple for patients. There are four things that you need to know to lose weight. And a lot of people make this super, super complicated, I’m going to make it really simple. If you want to save money, you have to know how much money you’re making and how much money you’re spending. If you want to lose weight, you have to know how many calories you’re taking in. So you need a tracking device. So I recommend MyFitnessPal to my patients. It’s a free app, and you track how many calories you take in. And then your basal metabolic rate is the number of calories that you burn per day. And that whether you have a caloric deficit or too many calories, you have to know that. Okay?

Dr. Weitz:                            Right.

Dr. Brandeis:                      There are two other numbers that you need to know. One is, if you’re working out and you’re sweating, you burn about 500 calories an hour. So when you work out, you have to get your heart rate up to 220 minus your age times 0.75. So for me, it’s like 125. I’m 55 years old, so it’s 125 or something. And when I hit that range, I’m sweating. I’m burning about 500 calories an hour, give or take. Okay? The other number that you need to know is one pound of fat in humans is 3,500 calories. And that’s it, right?

                                                If you’re running a caloric deficit, your keto, if you buy six loaves of keto bread and you eat them all, you’re not in keto, you’re putting on weight. And if you only have a half a piece of keto bread, then you’re in ketosis. Ketosis just means that you’re burning fat, it doesn’t mean anything more than that. As far as I know, I’m not a nutritionist.

Dr. Weitz:                            Right. Okay.

Dr. Brandeis:                      So everyone puts keto on this, keto on that, I recommend high protein, low carbs, fiber, and healthy fats. So behind my desk I have Costco unsalted nuts, right? That’s healthy fat.

Dr. Weitz:                            Non-organic, sorry,

Dr. Brandeis:                      Non-organic.

Dr. Weitz:                            Can’t eat.

Dr. Brandeis:                      But I have a patient who’s an industrial farmer and he told me, he said, “Well, if you wanted to make the world organic, you’d have to figure out which 30% of the world you want to feed.” So I think it’s a luxury for some of us to be able to eat organic and I support it. But the reality is that you can’t grow food like you can on an industrial farm and feed the world.

Dr. Weitz:                            Right. Okay. So what are some of the genetic risk factors that men need to be careful of?

Dr. Brandeis:                      I’m not a expert in genetics. There is an excellent genetics chapter in the book.

Dr. Weitz:                            I saw that. Yeah.

Dr. Brandeis:                      And so I’ll really defer to-

Dr. Weitz:                            Okay,

Dr. Brandeis:                      Heather Hannan in the book.

Dr. Weitz:                            You got it. So how important is it for men’s health to maintain good testosterone levels? And should men’s testosterone levels really drop with age? It’s often said that men are going to have their testosterone levels drop, but women are programmed for their hormones to really drop drastically after menopause, whereas men are not really programmed necessarily to do that.

Dr. Brandeis:                      Yeah. So women bottom out during menopause, men kind of slowly decline gradually. So at the age of 12, your testosterone might be 200, right? By the age of 16 or 17, your testosterone’s a thousand. And so what happens during those four years? You grow physically, you grow a muscle, you get libido, you grow body hair, your face gets oily, you may get some acne. Those are all a result of a dramatic increase in testosterone. And then your testosterone peaks when you’re 20 and it goes down about one or 2% every year after that. And in this day and age, because we’re sedentary, because we’re obese, and because we eat all sorts of crap that’s processed, and with plastics and stuff like that, our testosterone’s going down even faster than it should.

                                                And so the same things that happened that were good, when you got to 20, begin to slowly wind down as you age. So you get what’s called sarcopenia of aging, which is you lose muscle. So between the ages of 40 and 70, we lose about 1% of our muscle mass per year. After the age of 70, we lose about 1.5% of our muscle mass per year. We put on fat, our metabolism declines, our bones get thin, we become less flexible, we become grumpier, our libido declines. So all of these things that quickly increase from the age of 12 to 16 or 17, now slowly decrease as we get older.

Dr. Weitz:                            Yeah. I think the more you can do to maintain a healthy lifestyle, eat healthy, weight train, exercise, make sure you get your sleep, manage your stress levels. I think men can maintain healthy testosterone levels into their older years.

Dr. Brandeis:                      Absolutely. The thing is, people just want a pill. They want an easy solution. And in life, there really is no easy solution. But the other thing is, if you think about it, hunters out on the plane that take down wild buffalo. You need a high testosterone in order to kill a buffalo. Right? Now, if you’re a farmer, farmers still work hard, but they’re not killing buffalo. So you need a lower testosterone, but still they work pretty hard on the farms. But if you’re sitting behind a computer during the desk answering phones and trading stocks or whatever, you don’t need that high level of testosterone. Your body is smart, your body will only make what it needs. And if you’re not killing buffalos for dinner, why should your body waste energy making testosterone?

Dr. Weitz:                            Right. So when men do have lower testosterone levels, to begin with? What are the most effective ways to raise testosterone levels naturally?

Dr. Brandeis:                      So to raise testosterone levels naturally, like we talked about, exercise, eating properly, getting sleep. The interesting thing is sleep, I have tremendous amount of respect for sleep. So a couple of things happen during sleep. One, your testosterone peaks in the morning and during the day you lose testosterone, your testosterone gets used up. And then when you go to sleep, your testosterone builds back up so that at eight o’clock in the morning, your testosterone’s back high again. So that’s part of what we call the circadian rhythm, the 24 hour daily rhythm. So if you aren’t getting good sleep, guess what? Your testosterone doesn’t build back up to the level that it should get to. Okay, what else happens during sleep? You build muscle during sleep. When you go to the gym, you’re not building muscle, you’re tearing down muscle, you’re putting micro tears into muscle. And so what builds muscle is protein, circulation, sleep.

                                                So that creates the conditions that your body then goes in and repairs that muscle that’s got these micro tears. So if you don’t sleep, guess what? You’re not building muscle. Also during sleep, there’s psychological repairs. So the middle part of sleep is physical repair, the end part of sleep is psychological repair. So your brain goes through all the events of the day and process them so that when you wake up in the morning you’re fresh. And the other really super important thing that happens when you sleep is you get erections. So every time you get into dream sleep, into REM sleep, you should be getting five or 10 minutes of erections. And if you’re not getting that, I have young guys with sleep apnea that come into my office and they have erectile dysfunction because they’re not getting the erections that they should be getting during sleep.

Dr. Weitz:                            So what do you do with young men like that?

Dr. Brandeis:                      I send them to a sleep specialist. And they usually use a need to mouthpiece or CPAP.

Dr. Weitz:                            CPAP. Yeah.

Dr. Brandeis:                      Or their tonsils taken out. There’s a great chapter on sleep written by Mike Murphy is a good friend of mine and is a professor at Stanford ENT.

Dr. Weitz:                            And then for the older men with lower testosterone levels, you recommend testosterone injections or otherwise supple-

Dr. Brandeis:                      Yeah. So for your folks that are listening to this, if you go to my website, which is brandeismd.com and go to media and then eBooks, I have a bunch of free eBooks that I wrote for my patients. One is on testosterone replacement, the second is on all the different testosterone preparations and what levels you can expect to achieve from them and then the third is I see a lot of professional athletes and public safety officers, police, swat, those kind of folks. And I wrote an ebook on performance enhancing drugs.

                                                So drugs that folks take to improve their physical performance. I have some guys that are SWAT team guys that their testosterone’s like 400. And so if you and I had 400, we could get through our day, but we’re not chasing 20 year olds who are amped up on met methamphetamines shooting at us, right? So if you’re a SWAT guy in a big city or a police officer in a big city, I’m sorry, but it’s an occupational hazard for you to have low testosterone because you’re dealing with a different population who will have a big physical advantage over you because their testosterone’s much higher.

Dr. Weitz:                            So when you measure your testosterone levels, the lab ranges are huge, depending upon the lab, it’ll say something like 150 to 1200 or something like that.

Dr. Brandeis:                      Absolutely.

Dr. Weitz:                            What do you consider low testosterone?

Dr. Brandeis:                      What I consider low testosterone is what patients tell me. So if a guy has a testosterone of 200, but he’s telling me, “Listen, I’m doing great, I got full of energy and I’m working out every day and my partner and I we’re intimate and I’m just happy as a clam.” I don’t care what his testosterone is. And if I have a guy that’s got a testosterone of 400 or four 50 or even 500 and then they’re like, I”‘m just dragging. I’m putting on weight, I’m losing muscle, I’m having trouble sleeping, I’m depressed.” And this is the reason why it’s really important to go to healthcare professional. And you rule out sleep issues. If someone has sleep apnea, they’re going to have the same symptoms of someone with testosterone deficiency. If they have a low thyroid, if you don’t check their thyroid, they have low thyroid and you put them on testosterone, you did this person a disservice.

                                                If they’re eating like crap. And if they’re eating Doritos and Ding Dongs every day, and they’re putting on fat and losing muscle and feeling depressed and low energy and you put them on testosterone, you haven’t done them a service. So you have to rule out all the things that can make you hypogonadal or seem like you’re hypogonadal, and then you assess what someone’s clinically doing. And if you’ve ruled everything out and their testosterone number is low and they have symptoms and signs of low testosterone, that is a perfect candidate for testosterone replacement.

                                                And I used to think the important thing would to be to get someone in what they call U-gonadal range in that range between 300 and 900. But you know what, that’s wrong. I get my guys between 1,000 and 1,200 and they do great. I mean they really, it’s like somebody just turned the lights on in the room of their life and they get energy and they get vitality and their mood improves and they’re able to build muscle, they’re able to get rid of fat, they’re able to do all the things that they want to do, but they couldn’t do because their testosterone was low. So-

Dr. Weitz:                            You often see hematocrit levels go up?

Dr. Brandeis:                      A little bit. So, that is something that does happen. So your hematocrit levels will go up. Every once in a while I’ll send someone to American Red Cross to give blood or we’ll even phlebotomize someone in the office. But I think that’s a very overstated side effect. So I did a literature search because I did have someone whose hematocrit went up to 55 or 56. And so his concierge doc and I were talking about it and we’re like, “Well, let’s go see how big a problem this really is.” And we looked and looked and looked in literature, we couldn’t really find any big issues. Now, there were some Belgian cyclists that were taking EPO, so we’re doing blood ding doing EPO.

                                                Their hematocrits were a 55, 60 and then they were climbing big mountains got dehydrated, their blood counts now are up in 70s and their blood turned to sludge in their brain and they got some strokes. So most of my patients aren’t riding professionally in the Tour de France. And so I tell my guys, “Stay hydrated.” We do check blood counts and I will send patients to American Red Cross to give blood from time to time, but I haven’t really found that to be a big problem.

Dr. Weitz:                            And what about free testosterone versus total testosterone? Because I’ve seen some men with maybe decent total testosterone level, but their free testosterone level may be low.

Dr. Brandeis:                      Yeah, that’s a great question and I want to explain what all that is. Okay? So there are things in the body that make stuff and store it. So your gallbladder makes bile to help your body emulsify fat, and it stores it, right? Your testicle makes testosterone, but your testicle does not store testosterone. It just secretes it, it secretes four to six, four to seven milligrams of testosterone every day. So how does your body store testosterone? Your body stores testosterone in proteins. So there’s two proteins that hold testosterone. One is called sex hormone binding globulin, and the other is called albumin. And SHBG really binds pretty tightly to testosterone and albumin binds less tightly. So you’ll get a free testosterone, a bioavailable testosterone, which is free, plus the amount that’s bound to albumin, and then you’ll get total testosterone, which is all the testosterone. And the free testosterone component is a computed component based on the total and the SHBG, sex hormone binding globulin.

                                                And you can’t really do much about your SHBG. You have kind of what you have. And you can think about it this way, when testosterone is released into the bloodstream, about 98% of it, give or take one or 2% is bound to SHBG. So you can think of testosterone like a key, and the key fits into receptor, when it fits into the receptor, it opens the receptor and you get the testosterone going to the nucleus and it produces proteins that create the effect of testosterone. But if you take that key and you stick it into a big glob of clay, now you can’t use that key to open up the door. And that’s what bound testosterone is, is that key in a big glob of clay. But as you use the testosterone in your body, some of the testosterone from SHBG is released, and so it serves as a reservoir of testosterone in the body.

Dr. Weitz:                            Yeah, I found that managing stress focusing on sleep and stinging nettle root are all helpful in reducing SHBG levels.

Dr. Brandeis:                      Yeah, I don’t the literature on stinging nettle, but I’m going to write it down actually.

Dr. Weitz:                            Yeah, make sure you put stinging nettle root. I got that from my friend Geo Espinosa.

Dr. Brandeis:                      Well, Geo’s a smart guy, so I’ll definitely look into that.

Dr. Weitz:                            Go-to guy in the integrated world.

Dr. Brandeis:                      So I have a lot of patients who have borderline low testosterone. And so I created a supplement called Support. And what Support is, is DHEA, which is a testosterone precursor DIM which blocks the aromatization of testosterone into estrogen. So men are from Mars and women are from Venus, right? But the testosterone and estrogen molecules, if you look at them, are almost exactly the same. The only difference is a single hydrogen atom, which is the smallest unit of matter. So it’s easy for your body to flip testosterone into estrogen. And that happens a lot in men that are obese, right? Because for whatever reason, fat or adipose tissue will make that conversion more easily, which is why a lot of guys that are heavy get those man boobs. So just another reason not to be obese. And so it’s got DHEA, it’s got DIM to block that conversion. It’s got tongkat ali, which is a really effective botanical and boosting testosterone, and it’s got ashwaganda and then some magnesium and zinc, which are necessary to produce testosterone.

Dr. Weitz:                            What do you think about DHEA? Do you test that regularly? And do you supplement with DHEA?

Dr. Brandeis:                      I typically don’t test for it, but I do, in patients who have borderline low testosterone, I do supplement with it in that support supplement from a firm science.

Dr. Weitz:                            Yeah. The other thing that I found that sometimes it’s helpful with a lower testosterone is to look at estrogen toxic substances in the environment like mercury and pesticides and thiolates and et cetera. And so we’ll sometimes test for toxins and try to detox some of those things out.

Dr. Brandeis:                      Yeah, well, teach me something about that. Because the thing is mean, they’re obviously environmental toxins, but what do you actually do about those different positives?

Dr. Weitz:                            Well, you got to try to reduce your exposure. So maybe a guy’s holding on to cash register receipts, and that’s a easy way to reduce your level of BPA. And maybe he’s getting Starbucks in a cup with a shiny coating inside and he’s eating microwave popcorn that’s got BPA lining it, or he is eating food out of cans. So first thing, you got to try to reduce the exposure. We know pesticides are estrogenic, so eat organic. So the first part is trying to reduce your exposure to these chemicals.

Dr. Brandeis:                      Yeah. Cool. Interesting.

Dr. Weitz:                            I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. And this is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. And this device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, to get into a deeper meditative state, even to help you sleep. And there’s even a mode to help you wake up. And this all occurs through the scientific use of subtle vibrations. For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code WEITZ 10, that’s my last name, W-E-I-T-Z 10. And now back to the discussion.

Dr. Brandeis:                      A lot of guys were having really bad complications from the treatment of prostate cancer, and ultimately they weren’t going to die from prostate cancer. And so the powers that be in the government looked at the data and said, “We’re hurting people more than we’re helping people by diagnosing and treating their prostate cancer.” And so the US preventative task force gave PSA a D ranking in terms of utility of the test. Okay? And I fully and totally agree that early in my career I was sort of overtreating prostate cancer. Now we have much, much more sophisticated diagnostics and much, much more accurate treatment. And so in the book, and I was one of on the forefront of this, everyone that gets a prostate biopsy needs to have an MRI first. Okay? That is essential, Okay? Because if you have a really big prostate, doesn’t have to be cancerous, but if you have a really big prostate, you’ll have a high PSA.

                                                And it’s just because you have more prostate to go around. And a lot of those patients were getting biopsy after biopsy after biopsy, and then they would get little infections in the biopsy and then it would spike the PSA, and then the urologist would be like, “Oh, we got to do another biopsy. Your PSA went up.” So don’t let anyone stick an ultrasound probe up your butt without getting an MRI first. Okay? Early in my career, I was getting about a 33% positivity for prostate biopsies, which was about the industry standard. After I started doing MRI guided prostate biopsy, it went up to 85%. Because I wasn’t biopsying the guys that didn’t have prostate cancer, and there are a lot of prostate cancers in what we call the anterior zone, which you typically don’t biopsy on a standard 12 core biopsy. And you want to do what’s called a fusion prostate biopsy.

                                                So let me give you a little secret, Okay? Urologists don’t get any more money for doing a fusion prostate biopsy than they do for doing a regular prostate biopsy. And a fusion biopsy takes a lot of… There’s a big learning curve for a fusion biopsy, and they take three times longer than a regular prostate biopsy. So if you’re looking from a purely economic standpoint, you’d be stupid to do a fusion prostate biopsy, and the machine costs about a quarter million bucks. But 10 years ago, I said, I want to do what’s best for my patients. I worked out how to get a fusion prostate biopsy machine, and we went from 33% positivity to 85% positivity. I wasn’t doing biopsies on guys that didn’t need biopsies. So now we have a much better idea of who’s got cancer, and you can see inside the prostate and see how much prostate cancer there is.

Dr. Weitz:                            So how does a fusion prostate biopsy work? How does the machine work? I’m assuming it takes like MRI images-

Dr. Brandeis:                      Exactly.

Dr. Weitz:                            …and then correlates that with ultrasound in some way?

Dr. Brandeis:                      Exactly. So MRI is the only modality that you can use at this point that will identify prostate cancer. Prostate cancer is very, very difficult. It’s the last solid organ tumor that we were able to diagnose on imaging. So kidney cancer, easy bladder, liver cancer, easy, spleen, easy, all these other organs are easy, prostate’s really, really hard. But now because of 3 Tesla Multi-Parametric MRIs, we’re able to pick out prostate cancers. But MRI’s a big magnet. So you can’t take a metal needle and stick it in a prostate tumor in a big magnet. And so what we have to do is we get the images and the radiologists circle where the prostate cancer is, and then we’ll do an ultrasound in the office and we’ll fuse the two images. So they overlay each other, and then you’ll have, it’s almost like shooting at a ghost. So then you’ll put the needle into the ghost of the prostate tumor using ultrasound.

Dr. Weitz:                            Right. So when you measure PSA levels, do you use four as a cutoff or do you base it on the patient’s age?

Dr. Brandeis:                      I base it on the patient’s age.

Dr. Weitz:                            Okay.

Dr. Brandeis:                      Right. So if you’re younger than 50, and you got a PSA of 2.6, 2.7, I’m a little concerned, I’m going to examine you, I’m going to do an ultrasound, maybe I’ll even do an MRI at that point. If you have a family history, if you’re an African American. And if you’re 70 or 72 and you’ve got a PSA of 4.5, I’ll do an ultrasound and I’ll make sure that everything looks okay. Maybe I’ll do a finger exam with a prostate just to make sure there are no bumps, But I’m not that concerned.

Dr. Weitz:                            And is that because it’s less likely to be cancer? Or if it is cancer, it’s much more likely to be slow growing.

Dr. Brandeis:                      It’s much more likely to be slow growing.

Dr. Weitz:                            Right. So a man in his 70s or 80s who gets diagnosed with prostate cancer is much more likely to die something else first.

Dr. Brandeis:                      Yeah, absolutely. So I would not shy away from getting PSA at this point, maybe every other year after the age of 50 is pretty reasonable. But if it goes up, then visit a urologist, but make sure that no one does any biopsies on you unless you get an MRI and make sure if you do get a biopsy that it’s a fusion biopsy, a true fusion. Some people say, “Well, I’m going to do a cognitive fusion.” So all that means is, “Well, I think the prostate cancer is in the upper left part of the prostate, so I’m going to stick my needle up there.” That’s not a true fusion biopsy. The data on that is not nearly as good as a true fusion biopsy. Even if you have to go to an academic medical center, or travel to get that kind of procedure, it’s worth it.

Dr. Weitz:                            I recently had a chiropractic patient who got diagnosed kind of late with prostate cancer, because the patient was taking finasteride, which reduces PSA levels, and it wasn’t really picked up.

Dr. Brandeis:                      Exactly. So you know what finasteride does is it blocks the conversion of testosterone to dihydrotestosterone. So it’s a five alpha reductase inhibitor. So five alpha reductase is the name of the enzyme that converts testosterone to dihydrotestosterone. So testosterone has an affinity for the testosterone receptor, meaning it sticks into the testosterone receptor. Dihydrotestosterone has an even higher affinity, so it has an even tighter fit to the testosterone receptor. And so that’s what makes prostate cancer grow, that’s why some of us, like me, lose hair on the top of your head, that’s why you get nose hair and ear hair and all those wonderful things that happen to guys as they get older. And so if you block the conversion of testosterone to dihydrotestosterone, your prostate will shrink, you may grow some hair in your head, that’s why they call it propecia or finasteride.

                                                But the interesting thing is, your muscles have testosterone receptors, but they’re not used to dihydrotestosterone. So there’s no place and your muscles that makes dihydrotestosterone, so your muscles do just fine with testosterone, they don’t really care if it’s testosterone or dihydrotestosterone. Now, if you look at my Performance Enhancing Drug ebook, you’ll see that a lot of bodybuilders will use DHT derivatives. So they’ll use a testosterone base, and then they’ll use a DHT derivative because they have a even stronger androgenic or pro testosterone effect because they have a tighter binding affinity to the testosterone receptor.

Dr. Weitz:                            What are examples of DHT derivatives?

Dr. Brandeis:                      I think like Windstrol, Anavar-

Dr. Weitz:                            Oh, okay. These are anabolic steroids. Okay.

Dr. Brandeis:                      Yeah. Well, I mean, testosterone’s an anabolic steroid. I mean, it’s anabolic just means you’re building muscle. And steroid means it’s a steroid hormone.

Dr. Weitz:                            Right. These synthetic anabolic steroids?

Dr. Brandeis:                      Yeah. So they basically created these to get around testing. And also they have-

Dr. Weitz:                            They have a greater anabolic effect.

Dr. Brandeis:                      Yeah, they have a greater anabolic effect, and they have slightly, they use them for cutting, they use them for bulking. They have other effects within the steroid hormone families, so their mineral corticoids, which affect fluid levels, and there’s glucocorticoids that affect sugar metabolism. And so they have some overlap with those.

Dr. Weitz:                            What about free PSA? Is that something that should be measured too?

Dr. Brandeis:                      Yeah, I mean, if you have an elevated PSA, it’s worth to get a free PSA. So free PSA is useful if it’s either high or low. So if it’s really low, it’s indicative of prostate cancer, and if it’s really high, it’s indicative of BPH. And if it’s in the middle, then it wasn’t really useful. But about 30, 40% of the time, it’s at a level that’s somewhat useful.

Dr. Weitz:                            Great. So I think those are the main questions that I had prepared. You’ve got a huge book and we could talk about a million things, but I know that we both have time constraints. Any final thoughts to wrap up this discussion?

Dr. Brandeis:                      I mean, the book, I wrote the book for men between the ages of 35 and 85. And it’s a really, really long book, but not every chapter applies to every man. So what I recommend is for people to read the introduction, read the first chapter, which is the Hero’s Journey, go through the table of contents, which is eight pages, and pick and choose the chapters that you feel like are really relevant to you and will help you live a better, healthier life. And there’s some real gems of chapters that really aren’t in any other book. For example, there’s Russ Bartels, who’s a gynecologist, wrote a chapter on What Men Need to Know About Menopause. Incredibly useful for men whose spouses are going through menopause. You have to know what’s going on. Or Susan Bratton wrote an amazing chapter on How To Please A Woman. She’s a incredible internet intimacy coach.

                                                The chapters on health insurance are super, super valuable. I wrote a chapter on How To Make The Most Of Your Doctor’s Visit. There’s just so much in there, and it’s not meant to be read from page one to page 900. You really want to pick and choose the chapters that you read. And the other thing is, Oh God, I can’t stand if I read a 300 page book and at the end of the 300 page book, I’m like, “You could have summarized that in four pages and save me eight hours of reading.” I’ve either wrote or edited every single word in this book, and every single word in this book counts, right? There’s no fluff in the book, but each topic is kind of distilled down to five or 10 pages.

                                                So if you have a prostate issue, go read the prostate chapter. You’ll learn a lot, and you’ll learn this sort of insider secrets of the prostate cancer, of PSA, of BPH. You’ll learn the things that I’ve learned over the past 25 years and distilled down into the advice that I would give you if you were my neighbor and you came over and said, “Oh, Dr. Brandeis, can you tell me a little bit about the prostate and prostate cancer?”

Dr. Weitz:                            Cool.

Dr. Brandeis:                      So it’s a really, a super useful book, and it’s written for men. It’s got a sense of humor, it’s got stories in it. Most of the authors are guys like us that we can relate to.

Dr. Weitz:                            Great. How can listeners, viewers get a hold of you if they want to seek you out or find out more information?

Dr. Brandeis:                      So if you go to my website, which is brandeismd.com, B-R-A-N-D-E-I-Smd.com, that’s for my medical practice in Northern California. That’s where I have my eBooks and a bunch of other stuff. I also have a YouTube channel, which is Brandeis MD, which I do a lot of physician teaching and talking to big groups. And so I put some of those videos up there. My supplement company is called Afirm Science. We have a number of men’s health supplements. So just go to A-F-I-R-Mscience.com and then the book is at the twentyfirstcenturyman.com. So all spelled out in letters the twentyfirstcenturyman.com. And you can read about the book, you can read about the bios of all the authors. I read a couple of the chapters. You can watch the videos. It’s available on ebook, audiobook and my favorite is the hardcover book. I like a big solid hardcover book.

Dr. Weitz:                            Yeah, I love actual paper books myself too.

Dr. Brandeis:                      Yeah, but it’s not a wimpy soft cover.

Dr. Weitz:                            I know. It was hard. I was reading part of it on the treadmill and it was hard holding it on the treadmill.

Dr. Brandeis:                      Yeah, I mean, you’re going to need a hard, thick, big, hard cover book. I promised myself I would never make it a limp soft cover book.

Dr. Weitz:                            Thank you, Dr. Brandeis.

Dr. Brandeis:                      Oh, my pleasure.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica White Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.

 

 

 

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