Individualized Medicine with Dr. Martin | Longevity Optimization Podcast
In this episode of the Longevity Optimization Podcast, Dr. Martin shares his approach to individualized medicine, emphasizing the importance of a personalized healthcare strategy focused on prevention and addressing the root causes of diseases. He discusses his experiences in preventive medicine, highlighting the value of comprehensive health assessments and lifestyle interventions as essential tools for effective health management.
The conversation covers critical topics such as cardiovascular health, lipid markers, and the use of advanced imaging techniques to assess disease risk. Dr. Martin explains the significance of correctly interpreting test results, warning of potential risks linked to direct-to-consumer health tests. The dialogue also explores the evolving role of patient agency, innovations in preventive health screenings, and the importance of lifestyle factors in managing hormonal health, particularly testosterone.
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Timestamps
00:00 Introduction to Individualized Medicine
02:47 The Journey to Preventive Medicine
05:50 Understanding Preventive Health Tests
09:00 Cardiovascular Health and Lipid Markers
12:08 Lifestyle Interventions for Heart Health
15:00 Imaging Techniques in Cardiovascular Assessment
17:56 The Role of Medications in Plaque Management
21:01 Navigating Health Testing and Interpretation
28:16 Empowering Patient Agency in Healthcare
30:42 Innovations in Preventive Health Screening
32:50 Hormonal Health: Gender Differences and Optimization
34:15 The Role of Lifestyle in Testosterone Management
44:53 AI in Healthcare: Enhancing Patient Care
56:23 Nutritional Supplements: Essentials for Health Optimization
Transcript
KAYLA BARNES-LENTZ (00:00.174)
All right, Dr. Martin, it's a pleasure to have you here today. Absolutely. It's so fun to meet you. Obviously, Dr. Gillette kind of connected us, so you guys have an interesting practice.
Thanks for having me.
DR. MARTIN (00:13.452)
Yeah, Kyle's a college. Alette is a great friend and a mentor of mine. So our practice is we phrase it as individualized medicine. And so it's fully comprehensive primary care, but really personalized to the patient based on their their needs and their priorities and their family history and really taking a precision approach. One of the limitations, I think, with traditional medicine is this kind of cookie cutter approach to diagnosis. And so they come up with these guidelines on
what you should and should not test in different criteria. But at Gillette, we really kind of individualize that to the patient. So we'll discuss pros and cons of different screening exams. And then if the patient wants it, then we'll do it. So it's a little bit different than the traditional approach.
Yeah, I absolutely love that. Will you talk a little bit about your background? And I would also love to talk about, I've talked to so many MDs on their training and they've, many of them have said the same thing. There wasn't a lot of emphasis on nutrition. So yeah, if you could talk about your background and then, you know, kind of your training, did you have to do a lot of like extra like training on your own to learn this more precision approach?
I guess I'll start from the beginning. I chose to be a DO. So there's two types of physicians in the United States. There's DOs and there's MDs. It's kind of like dentists. There's DMDs and DDSs. Two different schools, same residency, same board exams. The DOs kind of market themselves as being about the mind, body and spirit. So that's what really drew me to becoming a DO and why I wanted to go to a DO school. When I got to DO school, I was a little bit disappointed about the actual application of that.
didn't seem like we got much mind and body, or mind and spirit, it was a lot of body, because they're training us to do well on the board exams so we can match into a residency. And so I would say the differences there seem to be awash, which is a little bit disappointing. And so I was really looking for something more in healthcare. And as I was in medical school, I found kind of the limitation with the traditional healthcare model where you're really putting band-aids on disease rather than kind of trying to find the...
DR. MARTIN (02:18.818)
the root cause and treat it more upstream. And that's why I found preventive medicine, which is a specialty that physicians can train in with their primary specialty or as a secondary specialty. So some of my colleagues will become internal medicine doctors or family medicine doctors and then go on and do a fellowship in preventive medicine. But I just went straight into preventive medicine. So preventive medicine just briefly is, it's kind like a primary care practice that is really focused on approaching disease from the three buckets of prevention. So primary prevention.
preventing disease from occurring in the first place, secondary prevention, diagnosing that disease, and then tertiary prevention. Once you develop that disease, preventing it from causing end organ failure and death. It's like if you develop diabetes, not letting it hurt your eyes or your kidneys or your nerves. So that's sort of the approach I've been trained in. In medical school, yeah, I didn't get too much of this type of stuff, but I got a lot of it in residency. Our residency was really comprehensive and I learned a lot about...
Lifestyle medicine and more this kind of functional medicine approach
I love that. think, as I mentioned, we do functional medicine in my clinic. And it's so amazing because you get to just see amazing results, right? Like people feel so much better. And that's so exciting. And I'm sure that you guys see that all the time too.
Yeah, that is really exciting. I mean, as a clinic, as someone taking care of people, you want them to feel better and those wins kind of feel like your wins. And to be honest, seemed like that was the most frustrating part of their traditional health system. It felt like I wasn't helping anybody. You know, if somebody came in with diabetes, we would just give them medication to manage that diabetes and kind of keep it existing as it was. Unless somebody came in with an infection like that you could treat with an antibiotic, it really felt like I wasn't helping anybody's life at all.
KAYLA BARNES-LENTZ (03:59.214)
Yeah, I mean, it'll be interesting like what happens in general with the training like around medicine and I wonder when or if it's ever gonna really go back to like a whole body system, you know
Yeah, I wonder that too. There's a lot of commentary on physicians should get trained more on nutrition or on some of the social determinants of health that affect people's access to healthcare. I think the challenge is there's only so much time that you have to fit into it. And the trend seems to be decreasing the amount of time that people are in medical school. UCLA medical school just went from four years to three years. They shut down that kind of didactic time, that book learning time from two years to one year.
So unfortunately from my perspective it looks like it's kind of going the opposite direction where we're just going to keep people training for board exams and then moving on.
Yeah, yeah. So, okay, let's talk about prevention. So let's just say, you know, someone comes into your office, what are we looking for in terms of preventative tests, maybe imaging and different diagnostics?
So we'll start with a really good past medical history. And this is not your past medical history that you get at your general primary care. That's five minutes. You this is probably an hour at least long conversation. We're really getting to understand you and how you've developed and certain challenges in your life from a medical perspective to a social perspective, learning about your family history, and then talk about your priorities with your health. And then from there, generally we'll develop a kind of comprehensive lab panel to really look into how all organs.
DR. MARTIN (05:29.314)
systems are going and so you know a patient may have a family history of diabetes and so will definitely be building out prevention plans for their diabetes but even if they're not at risk of cancer or dementia or any of other sorts of diseases we'll still kind of think about those three buckets of prevention and how we may start to address those so we'll be getting metabolic labs and lipid panels and kind of a full course of things.
I love that. Well, the scary thing is, that even though people may not have family history, just given our environments, we see the rates of cancer and chronic disease, you know, skyrocketing, unfortunately, same thing with type two diabetes. So, I mean, family history is so important, but do you guys find that, you know, it's still, you got to do like a deep exam anyway, because even regardless of family history, know, chronic disease is just skyrocketing.
Yeah, you're absolutely right there. There's a lot of environmental factors to some of these diseases. So just because you don't have a family history doesn't mean it necessarily rules you out. But it may increase the risks or decrease the risks depending on the family history. And all that comes into play because a lot of these screening exams aren't necessarily perfect. Sometimes they can give us false positives or lead us down a diagnostic pathway that's not helpful to the patient. And so we really kind of take into account the family history.
So let's talk about cardiovascular disease and general lipid markers. What are you guys looking for and what is, as we talked about before the podcast, there's so many interesting schools of thoughts on what LDL, HDL, Trigs, and all these more like, I would say comprehensive markers like TMAO and APOPE. Can you walk us through some of those markers and what you think are, like the most important ones people should be focused on?
Absolutely. So kind of a traditional lipid panel looks at your total cholesterol, which is just a calculated estimated level. And then it looks at lipoproteins. So we're talking about cholesterol. We're really talking about the lipoproteins that hold onto the cholesterol that are traveling through the blood. And a lot of those are bad. They can deposit plaque into your arteries and lead to plaques that cause heart attacks and strokes. And so the lipids that do lipoproteins that do that are LDL and VLDL and LP little A.
DR. MARTIN (07:38.976)
All of those that carry atherosclerotic risk have one protein on the outside of them called APO-B. And so we can quantify your risk of atherosclerosis by checking an APO-B. So I would say of all tests, that's probably the most definitive one of looking at your risk, but you really need to look at all the lipoproteins to have a good understanding. Another one is LP little A, which medications don't have very much effect on.
There's kind of this misnomer that you can't affect LP little a and it's purely genetic, but you certainly can improve it with aspirin a little bit can improve it. A PCSK9 inhibitor can improve it a little bit. And then increasing your estrogen can also improve your LP little a to some degree. So those are some of the lab tests that are part of kind of a basic lipid panel. And then in APOB is maybe the next thing I would add onto that. There's kind of more comprehensive lipid.
panels that look at your particle size and particle number that can be helpful depending on someone's But I end up not worrying that on everyone. So those are kind of the blood markers for atherosclerosis. And then there's all sorts of imaging tests to see if you are developing disease.
Yeah, that's really important. What do you think that the range should be for A but B? Like what is the highest that you want to see that?
Highest I want to see it is 80. And I think if you have a strong family history or you have known plaque on imaging test, that goal goes down to 60. So that's what we use.
KAYLA BARNES-LENTZ (09:11.692)
And what would you, what are the primary lifestyle interventions that you would use or would you just immediately recommend to statin? Like how much impact can you make with lifestyle?
You can make huge impact with lifestyle, not quite to the impact that you can with other sorts of metabolic diseases like insulin resistance, but you can definitely make a big dent with lifestyle. So kind of the main drivers here are saturated fat intake. So limiting your saturated fat. So if you're eating ground beef going for 90, 10 or 95, five instead of an 80, 20, and then increasing your fiber as well.
By getting over 30 grams of fiber, can decrease your lipids significantly. So the two main drivers. There's also another lipoprotein that we didn't talk about called HDL. People call this the good cholesterol. I wouldn't necessarily say it's good, but it sequesters the cholesterol. And so the other lipoproteins that are bad can't hold onto it. And so by increasing your HDL, you subsequently decrease your ApoB. And so you can drive up your HDL by increasing monounsaturated fats. like avocado oil or olive oil.
and then hit exercise as well, that high intensity can increase the HDL.
What's the mechanism with fiber? I'm just curious. So why is fiber helping to lower the
DR. MARTIN (10:26.918)
I think part of it is cholesterol absorption in the gut. It helps it so it doesn't get absorbed. think additionally it decreases inflammation, but I don't think we have a full understanding on how fiber works with cholesterol. Fiber has a huge impact. They've done interesting studies where they'll categorize people and how much fiber they're getting. 10 grams, 20 grams, 30 grams of fiber. Each 10 gram increase, there's a 10 % decrease in all cause mortality. So death by heart attacks and strokes, but even
unrelated things, which really is a kind of the gold standard for an impactful therapy.
So do you feel like the minimum intake of fiber should be around 30 grams per day?
Fiber, think the minimum intake of fiber is to get as much as your GI tract can handle. A lot of people can't handle much fiber and some fibers bother people more than other people. And so I think it's really individual on how much, you can handle before you're running to the bathroom first thing in the morning.
Yeah. What about fiber supplementation? Do you like that if you can't handle, you know, maybe just a ton of leafy or cruciferous vegetables? Do you like patterns?
DR. MARTIN (11:39.35)
Yeah, I think those are a reasonable substitution, like something like psyllium husk, add some bulk to the stool and can act as fiber. I don't think it's as good as fiber from your food. Food is the best medicine kind of all around. To go back to your earlier point, you go straight to a statin. I don't go straight to a medication in any situation. It's always food and lifestyle is the best treatment. It's the most sustainable. It's the most impactful in lot of situations. So I think if you can get your fiber through food, that's the-
the best source. If not, then yeah, considering some of these supplements or selium husk is a good option.
There's some interesting thoughts around having extremely low LDL. Have you read any, we won't even name names, but some people think it should be below 30. mean, cholesterol, it works as a hormone, right? And isn't it kind of important, or an antioxidant as well? Is that correct?
I don't know the part about the antioxidant, although I wouldn't be surprised. It is a really important precursor to the hormones. so having a zero total cholesterol would certainly be negative. I have seen nothing in the literature to substantiate the goals of getting an APOB below 30 or some of these kind of extreme goals that I think you're referring to. The bet, yeah, the lowest I've seen with good evidence behind it is less than 60. So that's what I use.
There can be negative side effects from decreasing it too much. Cholesterol is really important for your brain and cognition, so you wouldn't want to lower it too much for that aspect. And then you see with, if you do lower cholesterol with a pharmaceutical agent, you can get side effects. You can get brain fog. So that may be due to the lipid lowering aspects in the brain.
KAYLA BARNES-LENTZ (13:25.208)
Yeah, that's a great point. Okay, these PSK9 inhibitors. I don't know much about them at all, but I'm excited because I've heard a lot of interest around it. Can you talk about what it is and what it might do?
PCSK9HRZY
DR. MARTIN (13:40.366)
Yeah, so the PCSK9 inhibitors increase the LDL receptors on the liver. And so the liver ends up sucking more of the LDL out of the blood into the liver and breaking it down. So one unique aspect about it is that it's working just in the liver. So it tends to have less systemic side effects, which is one of the main limitations with a statin or the other medications Zetia, Zetimibe, is that they're systemic and so they can have systemic side effects. But when you're localizing the treatment to just the liver,
Um, yeah, it's, it's a little more specific.
Are these relatively new or are they just becoming more popular or maybe I'm just hearing about.
They are relatively new, although they have been around since I had been in medical school, but they are new. There's still emerging evidence about them. They're fairly difficult to get from at least covered by insurance. Insurance has been quite sticky with them so far.
Can you get them just compounded like at a pharmacy? Like a private pharmacy?
DR. MARTIN (14:41.184)
I am not aware of that. I've not been able to compound it.
Interesting, okay, putting that on my to-do list. Okay, so cardiovascular health still, we talked about imaging. What are you looking at? What imaging are you doing to assess risk and what are you looking for?
Yeah, that's good question.
DR. MARTIN (15:00.526)
So there's some different types of imaging. There's the coronary calcium score. That's the least expensive and the least invasive. It's just a CT of your chest and that can pick up hard plaques. So it's also the least sensitive. there's the cholesterol can cause plaques in the heart that are both hard and soft. The soft plaques are actually more dangerous because they can get dislodged and go downstream and cause blockage in the arteries. So the coronary artery calcium score only picks up those
hard plaques. So if you have a zero on the the CAC, then all that means is you have zero hard plaque, we have no idea if you don't have any soft plaque. Kind of the step up exam is a CCTA and this is an angiogram. So it's a little more invasive, it's a little more expensive, but it's much more specific. So it also can identify soft plaques. So actually going in the arteries and visualizing those. And then an interesting
kind of layer on tool to a CCTA is you can feed that report into a clearly analysis, which is an AI tool that is able to pick up on very, very small changes in the arterial wall diameter that the human eye can't pick up on. So it's very sensitive to picking up small plaques. And then lastly, there's IV ultrasound, which is really the gold standard at understanding your plaque buildup. The issue with the CCTA is that it is only looking at the lumen
the diameter of the lumens, so the inside of the artery. But if you think of the artery as kind of a pipe, it's not able to see how thick that pipe is. And that pipe can get really, really thick, which can be the plaque growing on the outside of that. so cardiologists can go in with an ultrasound and actually identify the thickness of that, the arterial wall.
That's great, I've done the CTTA and I've done the CLEARLY. Everything looks good. But when it comes to the just calcium score, so if you have a zero, I mean, great. But does it work? Is it like linear? Because what I've heard is that it can go from zero until it's not, and then it can actually have a high number. So it's not like, is it creeping up? So let's say, you you're a 36 year old male, you go get a calcium score and it's zero.
KAYLA BARNES-LENTZ (17:12.962)
But then the next year, if you're just slightly building a plaque, is it going to be like a one or a two or does it jump to like 60 or does that question make any sense?
That does make sense.
You know, all I could answer is with hypothesis. don't have any kind of hard data to back that up. I don't know if we've done kind of, longitudinal CACs on people kind of year by year to see, you know, how quickly that builds up or if it jumps. it does seem like, people, the few people who I've seen go from a zero to a positive score do jump up to multiple digits. So it's a 10 to 30, on their first positive score from a zero before, as opposed to like a one or a two. Yeah.
Yeah, and the reason why I even bring it up is because I think like my concern would be around that test in particular, like of course if it's the only thing you can do, you should definitely do it. But if you have a zero and then you think you're good, you know, and then all of a sudden the next time you go and you don't have a zero, that's why things like the, you know, obviously like IV, you know, ultrasound is gonna be the best, but even something like clearly it's gonna start to show you that you have the soft plaques, which then can later turn into the calcified plaques, right?
Absolutely, yeah. I think there's a big risk with a false negative giving you a false sense of security when maybe there is an underlying brewing illness. And the good thing about the soft plaques is that you can regress them. You can get them to turn into hard plaques by using a medication. And so if you do have soft plaque, it's good to know sooner rather than later, because that may change kind of our decision on if we should use a medication or not.
KAYLA BARNES-LENTZ (18:53.943)
A medication can essentially like revert the soft plaques back so you don't develop hard plaques.
Yep, the statins and the PCSK9 inhibitors seem to harden the soft plaques.
remove them or harden them? Because do we want them to be hardened?
you do want them to be hard and the soft plaques are the really dangerous kind. I kind of think of them as like a big fluffy like scab that can like flake off and go downstream. So you want them hard, which ended up being a little bit smaller. So they're causing less turbulence inside the artery, but also less like the dislodging.
Is there any way to just get rid of them if you find you have soft plaque?
DR. MARTIN (19:29.166)
So there's these papers about plaque regression and I'm still a little confused if they are hardening or if they are completely removing. But the language that is used in these papers is regression. And so I've seen people have like soft plaque scores go from a positive number to a zero number, but I do not think they're fully removing them.
Do you, what were they using? Do you remember?
medication wise.
is it just like a medication?
Yeah, as far as I know to regress the soft plaques, the only way to do is with medication.
KAYLA BARNES-LENTZ (20:04.258)
We have this interesting IV at my clinic and I will say I have not seen it clinically, but the data that has been provided is pretty impressive. It's called Plaquex, like literally Plaquex, and it takes about 20 different treatments, but it's actually removing the plaque. It's really interesting. So I don't know for sure because like I said, it's a very expensive and huge time commitment. So I haven't seen a lot of patients actually do it, but that could be exciting in the future.
That's fascinating. I have to read about that. So it's an IV session, like they'll take it for an hour and.
Yeah, but you need essentially like 20 to even make a dent and it is, I will tell you the active ingredient, it's Gwyneth Paltrow's favorite IV. It'll come to me. But I would love to get your phosphatidylcholine.
interesting. So do you have internal data at your clinic looking at CCTA?
We don't yeah, I can't wait until we do but because it's like such a massive package and it's a very expensive IV for us Which then of course becomes an expensive IV for the patient you have to do 20 of them No, but if I get any plaque, I mean I'm immediately doing it just to see what happens Yeah, I'll share some information but I mean I love the idea that we can fix a lot of things like if you are willing to put in the work You know, but not everything of course
DR. MARTIN (21:17.678)
Well fascinating, yeah I gotta read more about
DR. MARTIN (21:29.908)
Yeah.
Okay, so anything else on cardiovascular health that you'd be looking for?
DR. MARTIN (21:37.55)
You know, would say if I don't think kind of on initial consult, I think even for the imaging tests, I like to use them. I don't like to kind of start with those. I really like to use those if there's a decision being made and we need an extra test to help us make that decision. So if a patient comes in and their APOB is elevated, but not at the point that's, you know, frankly dangerous and they need to get on a medication ASAP and they, we work through lifestyle changes and they don't quite get there.
And so we're really deciding, you should we keep trying another three months of lifestyle changes or should we, you know, step up and be more aggressive? I think that's where we can use, you know, an imaging test to really help us understand those things. In the same way, I like this cholesterol absorption test, which you can get from Boston Heart Diagnostics. And so that shows you, that looks at different plant sterols in your blood and that can help you understand if you're a hypersynthesizer or a hyper absorber of cholesterol. So just to take a step back, you create cholesterol in your...
in your body by two pathways. One is absorbing the saturated fat in your GI tract. And the other is all cells are creating the cholesterol inside them. And so when you have high cholesterol, then you need to decide which medication to use. Do you use a statin medication or you do use a Zetamide? And how I like to do that is by using this cholesterol absorption test. If you are a hyper synthesizer of cholesterol, you block the synthesis of cholesterol with a statin.
And if you're a hypersynthesizer, a hyper absorber of cholesterol, then you use the azetamide to block the absorption of cholesterol in the gut.
Yeah, that seems like a great test that one I've never done. So I'm not sure which one I am.
DR. MARTIN (23:10.54)
Yeah, well, maybe we should test it.
Yeah, I I love, I've done thousands of biomarkers. So it's like one of my favorite things. I know some people are always like, well, aren't you scared you're gonna find something that is bad? I'm like, no, because then I can fix it before it becomes like a real problem.
That's true, you can't be proactive unless you're looking for any issues. I guess one question I have for you is, do think there's any risk in finding things that are non-conclusive and then lead to more testing? Yeah.
Yeah, so I think it depends. And I actually have an interesting story I'll share with you. So I did my first full body MRI like six years ago, maybe, before it really became super popular, maybe five. But at that time, they didn't have enough data as to what does a normal 30 year old, you know, at that point I was in my late 20s, brain looks like. So I had a couple of white matter changes and they...
scared the heck out of me. So I got the report. It's a very prominent clinic that I went to. got the report and they're like, you need to see a neurologist immediately. So I went down this entire rabbit hole. was living in Ohio at the time, so I had the Cleveland Clinic, which was amazing. But I found myself at the Cleveland Clinic Center for MS and it was terrifying. I saw, I mean, it's a horrible disease, right? And I was in the room with these people that had the disease and I was just, I was so scared.
KAYLA BARNES-LENTZ (24:40.65)
after months of testing and other brain imaging comes to find out that actually a couple of white matter changes at this age of life is totally normal. So I went through this entire experience that was really scary. And what I will say though, in a good way, is that later when I got my first Pranuvvo scan a few years later, so Pranuvvo has obviously like a very large database. So now we're learning things that we didn't know before.
Because before, if you were getting an MRI, the rheologists are looking for something, right? It's a diagnostics tool based on like suspicion of something being wrong. And so when I went to Pernuvo, I told them upfront, said, listen, I have these couple of white matter changes. I've already had it explored. Please don't scare me with like, hey, there's a few of them, unless there's a lot more or, know, and they're like, no, we already know that. They're totally normal. So yes, I think that there can definitely be.
some areas, but I think we're gonna have so much more data and know what we're looking for and what's normal and what's not and over the next decade. But that was probably the only example. I think a lot of the blood work stuff for me is, I mean, just helpful, benign in terms of like risk, but I'm trying to think through anything else. I mean, I guess depending on the practitioner that you go to, let's just say, for example, you do a total tox burden and you have like some levels of heavy metals. And let's say there's like a financial incentive for
that practitioner to just recommend chelation. That's very hard on the body, right? So I think as long as you have a really good provider, that was the only scare I really had. But what about, Evan, what do you think? I think obviously if you're doing a lot of CT scans, that can also pose risk because of the radiation. But the MRIs I think are okay like every year or so.
Yeah, I 100 % agree with what you're saying. I think it's really important to be working with a trained healthcare professional who understands the tests themselves and the limitations of those. To me, coming off the top of my head on just blood work, there's these tests, rheumatoid factor or ESR, these are kind really nonspecific markers that sometimes people will get these direct to consumer lab tests and come to me and ask me to interpret them and...
DR. MARTIN (26:53.366)
they're really hard to interpret. would never order those tests unless I was looking for something specific. And so that may not mean anything. And so think sometimes it can cause a little more stress than benefit. But as long as you're doing it with a kind of a purpose in mind and you're using that to make a decision, I think it can provide value.
Yeah. And I'm really blessed too, because I have an entire medical team. you know, we employ like medical doctors and nurse practitioners and PAs and I get like so many opinions and all my friends are doctors. So it's, I haven't really been like misguided in that way, but I'm sure you could be. And I think some of the direct consumer tests too, I mean, also some of them are, I just, they're a waste of money because you, it's not specific enough. And like, I mean, gut testing, for example, like do you guys do gut testing? So we do a ton of it. Like,
We do some, yeah.
One of our main providers came from the Institute for Functional Medicine and the Cleveland Clinic Center. I'm so lucky because we're right next to the Center for Functional Medicine in Cleveland. So a lot of, you we get some of their providers. So we do tons of gut testing, but the difference between like seeing a comprehensive gut test and understanding all of the different bacterias and what's good and what's bad versus like sending off direct to consumer gut test and getting like a very random kind of score. It's like, okay, well, what does that mean?
Like where's the data? How are you deciding that? So I don't know, gut tests and probiotics, like one size fits all, probiotics are like a thing I don't love.
DR. MARTIN (28:16.718)
Yeah, I 100 % agree with you. I don't want those either. Those are a little bit of a pet peeve of mine. Yeah, I think some of the direct, I think this movement of direct to consumer diagnostics overall is a great thing. I think it's been a huge problem that we have this shining beacon and that's the only place you can get healthcare. have to come to our hospital or else you're not going to get any testing and you're not going to get any medication. You can't even know what's going on.
Even if you do go there, because so many people have reached out to me because they're like, I know that you guys do this testing, right? But it's expensive. So can you send me the list of tests that's on your longevity panel? I'm like, yeah, sure. Send over the list. It's like 120 biomarkers. They take it to their doctor. And the doctor's like, absolutely not. I'm not calling in that for you. But then that's not fair. We should definitely be able to have agency over our body. And if we want to know what our TMAO is, we should be able to find that out.
Absolutely, yeah, I 100 % agree. Yeah, I think it's good that people have access to these things or taking more control of it.
I totally agree. And same thing with wearables. You know what mean? We can get a lot of data now that we couldn't get before from, we were talking about my friend, Dr. Casey, I mean, her company levels, that's amazing. I mean, it's so cool that you can just take a little monitor on the back of your arm and potentially prevent getting type two diabetes because you know what your glucose is doing. And then you can take steps on your own to, you know, lower that.
Absolutely, yeah, the CGMs are a really cool technology in a lot of different ways how easy it is to access The way that you can gamify it and really kind of change your behavior based on it The fact that it's longitudinal data so much of our data is cross-sectional so we only know what your Cortisol I guess for this example your fasting glucose is at the second that we took your blood test And three months later that we know what it is. We have no idea what happened in the three months in between then
DR. MARTIN (30:07.0)
but the CGM is kind of constant data. So we really understand a lot.
Yeah, none of them. Plus there's so many different factors, right? Like you're gonna be stressed and you could have increased glucose or insulin and there's just so many nuances. So it's so nice to have something that's monitoring all of them. I can't wait until they do like cortisol. I just wanna monitor that like does all the things all the time.
It'd be really interesting, yes. I think there's huge use cases for that. Yeah, cortisol would be a great one. The sex hormones would be a great one, especially for women. Like progesterone and estrogen would be fascinating.
I totally agree. think there's a company working on it that I just saw.
I'll have get the name for you after you.
KAYLA BARNES-LENTZ (30:42.146)
Yeah, yeah, that's amazing. So, okay, we talked about cardiovascular health. What other stuff for prevention are you guys gonna look at with a new patient?
We'll do all sorts of, do kind of a full cancer screening of them. So that's mainly starting with risk factors and family history, and then some age-based screening and then some exposure-based screening. So the age-based screening would be like a colonoscopy or breast cancer screening. Yeah, depending on your age and for breast cancer screening, there's, I mean, we could get into that as well. There's a bunch of different ways to screen for it.
traditionally nanograms, but we're kind of shifting away from those now. And then kind of exposure-based screening. So if you've smoked for an X amount of years and quit within X amount of years, then we'll consider a low dose CT to make sure you don't have anything brewing in your lungs.
That's great. think that based on I interviewed on amazing. She was a surgeon that would, you know, operate on breast cancer patients. And then she left and she went to functional medicine. And she's about to open up a bunch of clinics with something called QT imaging. So it's supposed to be like the next wave because there's no radiation. Whereas with the mammogram, there is there's no radiation. And it's really good for like dead breast tissue, which we know I think about half the population has. So it's just supposed to be a lot more accurate.
We also do at my clinic this test called the grail test, or it's like a liquid biopsy. Do you guys do those at all?
DR. MARTIN (32:11.828)
Yeah, we do them. We don't order those on everyone, but if someone is really worried about cancer, they have a strong family history of it, we certainly will. And the grail is great.
Yeah, I love that test. then I even kind of, mean, what I'm doing is so over the top because it's like my profession and I posted all my labs publicly and it's like just becoming this thing that I'm doing. But I do that with the Pranuvvo. So I mean, I'm hopefully gonna catch like anything if it pops.
Yeah, yeah, hopefully.
Yeah, all right, well, what else in terms of prevention? So you have like the cancer risk, we talked about cardiovascular health, what about differences between men and women?
There's a lot of differences between men and women. I guess depends on kind of their age and yeah, if they're ovulating or post-menopausal would probably be the biggest differentiating point on how we would address those things. But we do a lot of hormone optimization in our clinic. It's bread and butter prevention. So it's a really important part of the practice.
KAYLA BARNES-LENTZ (33:12.384)
What, so like HRT for men, for example, what is, well, first of all, do you guys see that testosterone levels are in general much lower than they were, let's say 30 years ago?
I don't know, I wasn't around. But the data does show that, it does look like it has decreased.
Because you are not
KAYLA BARNES-LENTZ (33:28.93)
Yeah, are you guys seeing like people coming in younger wanting testosterone therapy?
I'm seeing a lot of young men, I think there's a selection bias in our clinic. I don't think we're getting a lot of young guys who are wanting testosterone, but I get a lot of young guys who came from a clinic where they were put on testosterone, probably in my opinion, inappropriately, and we take them off or wean them to something else. So there are a lot of young men looking for hormone optimization things. think part of that is do this kind of direct to consumer marketing for some of these products. I think another part of it is just,
It's become prominent in the current zeitgeist, talking about hormones and how to optimize your hormones and how important testosterone is. Yeah, I don't know if I answered your question, but yeah, there are young men who come in.
Hi guys, I'm going to interrupt this episode for a brief announcement. As you may or may not know, I started a community for females by females, and it's a female longevity optimization community. This is a place that you can connect with like-minded women. We are all here to support each other, and there's a variety of different benefits to being a member. You get a monthly ask me anything, so submit your questions and I'll answer them directly. We also have an entire library of courses on
all of the important components of longevity such as labs, nutrition, exercise, sleep optimization, longevity optimization protocols that I'm doing along with real time updates to my personal protocols. There are so many benefits of being a member of the community. We'll also be doing in-person live events here in California and virtual events for anyone that can't attend. But if you're interested in joining the community, I would absolutely love to see you there and I will include a link in the show notes.
KAYLA BARNES-LENTZ (35:13.838)
What would you say, let's say you're in your 20s, verse 30s and 40s, what would be like the lower limit that you would be looking at before potentially putting someone on testosterone therapy? Or would you go like a supplemental route? Like let's say you're 20, five. And would you, is there like a range? I mean, we know the standard range is like insanely huge. So what is it like 200, 1200 or something?
Yeah, and that's really just based on a bell curve of our population. And so it really means that's not the optimal range. Yeah. It doesn't give us any information on what's good or bad. It just it's how relative you are to the rest of the population. I really don't use the numbers too much in determining if somebody is hypo gonadal or has androgen deficiency. If they if they're told testosterone is below 250, then that is a clear sign they are not making enough androgens. But outside of that,
don't rely too much on the numbers. I do it more based on symptoms. because the numbers really matter based on your androgen receptor density. So say you were a man and your testosterone was 500 and my testosterone is 500. If I have double the amount of receptors that you have, you could be totally fine and have no symptoms. And I could be full blown hypogonadal and really need testosterone. So it really matters how saturated you get your receptors. And some men have a lot of receptors and some men have very little receptors.
And so I have men that come in in the four hundreds or five hundreds at their primary care clinic. No one is even going to consider TRT. But if they're full blown hypogonadal, then we'll consider increasing their testosterone. And so there's a bunch of different ways to do this in a young man. would not opt for testosterone. I would opt for life for every man. I would opt for lifestyle first. That's I think my hypothesis on the decreasing testosterone levels in men is all due to lifestyle, due to rates of obesity and
poor sleep and access to dopamine spiking things on the internet. Like pornography? Like pornography specifically, yeah. I think it's very bad for testosterone. So anyway, lifestyle would be kind of the first step with everyone. After that, it'd be looking at the micronutrients that are involved in testosterone production. So vitamin D and selenium and I guess your whole thyroid panel would be important in that kind of evaluation.
DR. MARTIN (37:34.882)
And then from there we could discuss some of the treatment options for that. And there's different medications and they work at different levels of your body. And so for younger men, we tend to use more of the upstream medications because those keep your testes functioning normally. Cause when you use testosterone, you become infertile.
like anklomophene.
I yeah, and clomophin is one of those medications and clomophin is a a CIRM. So it's a selective estrogen receptor modulator. And so it blocks how estrogen binds to your brain. And so when estrogen binds to your brain that tells your brain that you have enough sex hormones and you should not create any more. But by blocking that it's saying that you have low sex hormones. And so it releases more LH or an FSH to tell your testes to make more testosterone. So that is one way of increasing it. I
I don't love enchlamophin because I'm confused about the side effects. Testosterone, I can counsel a man exactly the side effects that he is going to have or is at risk of having. Enchlamophin, the side effects are all over the place. Sometimes it's vision changes, sometimes it's depression, sometimes it's a decrease in libido, even though we're maybe doing this to increase libido. Basically, how I was taught is that it's symptoms above your neck and it can be kind of anything.
That's interesting. So what else would you guys recommend for someone young or like what kind of different therapies do you guys offer?
DR. MARTIN (38:58.574)
So HCG or Pregnol is another injection medication that is kind of like synthetic LH. So it tells your testes to release more testosterone. So that's what I'm using a lot in my younger men, those who need more testosterone production. There's a peptide, KissPeptin, that can work in a similar way. So that can also increase your testicular output.
What about supplementation? Is there any strong data on what supplements might be able to help boost testosterone?
So there's a lot of things market right now as testosterone boosters. I think those are maybe mischaracterized. think those are micronutrients that are maybe replacing micronutrient deficiencies in people who have low testosterone. So I think a lot of people have low testosterone because they're eating a highly processed food diet and they're not getting vitamin D and selenium and cholesterol and all the things that you need to create your sex hormones. And so those replenish those. And so that's how I think a lot of them are working.
There's some adaptogenic herbs that seem to increase testosterone, ashwagandha, fadoja. There's one other I'm kind of blanking on. Tanggali, yeah. Those, in my personal experience, have been quite disappointing. I have not really seen them improve anyone's testosterone. But the evidence, particularly for ashwagandha, I was just looking at this the other day.
get all
DR. MARTIN (40:27.894)
You know, it's a common thing not to get too sidetracked, but it's kind of common thing to prescribe for women with PCOS, which is kind of the opposite of what you would want to do is by increasing their sex hormones. So was kind of going back in the literature and looking at this and it does seem like there is a clear link between sex hormones and ashwagandha use, particularly in men, is who have most been studied with it.
wonder if the mechanism is just stress reduction because that's what ashwagandha is kind of doing, It's supposed to reduce stress.
It yeah, it does decrease your cortisol and your stress. It also can improve sleep. So maybe it's partially acting through that. Yeah, I don't know if they've accounted for. Yeah, I guess I haven't seen any papers where they account for stress or cortisol. So everyone's the same exact cortisol and they give a group ashwagandha and they give a they don't give a group ashwagandha. They give them a placebo and see if that increased their testosterone. That would be a good study.
That would be a great study. I think everybody wants a pill just to make everything better. And the thing is, testosterone, it's a marker of health, right? I mean, in some respects, just like there's other markers for women. My husband, when I met him, he was on a very low dose, like half of the lowest dose. So I don't remember what that would be, but we wanted to have babies, so I asked him to get off of it, and he graciously did very quickly.
And when I met him, his testosterone was like 7, 17 or something. When he went off testosterone, it dipped a little bit down to like 550, but then I changed everything about, not everything, he was already very healthy, but we started going to bed at 8.30 versus one o'clock in the morning and even doubled down on strength training and did some cold therapy and I changed his diet to all organic, helped detox with a lot of sauna therapy, and now his testosterone's 9.16 naturally. Wow, that's awesome.
KAYLA BARNES-LENTZ (42:13.974)
Yeah, it is a huge win, but I only like really talk about that because, know, I would love if men are listening to this or your husband or your significant other, it's very possible to do with lifestyle. I mean, yes, it requires a lot of work, but all of those factors, we think about when I just broke down, reducing the toxic burden, adding in the right nutrients, getting high quality sleep, and, you know, really pushing your body in the gym. It's like, that's great that you can do that because I don't know that people...
are so aware of the potential impacts on fertility and testosterone.
Yeah, I don't think they are. And it's great that your husband bounced back so quickly. And even his dip doesn't sound that bad from my perspective.
He was only on it for a really short time. So he had just started it, I think like three or four months prior to meeting me.
Got it, that makes sense. You some people are on it for five, 10 years and then come off and then they'll get really hypo gonadal. you, depending on how much you dose, maybe if your husband dosed a lot more and for a lot longer, he would shut down his endogenous production. And so he'd be very, feeling quite bad at the start. And that's a really empowering story that you can do those things without any kind of medication. know, a pharmaceutical company or a supplement company is not, you know, giving you the key. Like he has, you guys have the key yourself.
KAYLA BARNES-LENTZ (43:28.014)
Yeah, I mean, we have so much power, you we know over our health status just by what we do every day. And everybody wants to do like all this cool like longevity stuff and, you know, even met a fun medications like what's a rapid myosin or metformin. That's all great. But the stuff that's going to move the needle the most is the stuff you're doing every single day all day, like sleeping, eating, breathing, moving, you know.
Absolutely, yes. It's so fun to nerd out about all this really minutia stuff that it seems like you're interested in as well. But it really is not near as impactful as the lifestyle, the pillars of lifestyle medicine. Sleep, social connection, exercise, nutrition. Like those things, you can get 80 % of your health.
They're like free or close to free. know, it's, well, some of the stuff we're talking about can go into the thousands, multiple thousands of dollars when it comes to like NAD drips and chambers and all this other stuff. But it's like the stuff that moves me the most is like basically free. I mean, food obviously costs money, but going to bed earlier doesn't.
No, it doesn't. And it's sustainable. You can keep it going once you've felt that habit.
Yeah, and plus it feels amazing. I don't know what people are doing. I'm in bed every day by 8.30, nine o'clock at the latest. What are you doing until one or two in the morning, truthfully? This is just crazy. All right, so we talked about prevention, we talked a little bit about testosterone, anything else on men's hormones that you wanna talk about?
DR. MARTIN (44:53.666)
guess the one other thing to take a step back is, you know, we're first looking at why someone's testosterone is low in the first place. You know, for a young man, I would think the most likely scenario is lifestyle. And so we jumped there first, but there's anatomical reasons why someone can have low testosterone. Maybe they, one of their testes was non-descended and so they removed it. And so they only have one testicle. So that person is much more likely to actually need testosterone replacement than, you know, someone with two well-functioning testes. The same way trauma can cause issues there.
And then as you age, then men go through something kind of similar to men and women called andropause. And so their testosterone is going to naturally decrease. And then it becomes more reasonable to kind of consider TRT in those kind of populations.
the edges that normally start.
That's kind of around the 40s to 50s.
But it's not, with menopause from what I understand, it's a very like, it's like a big drop off. With men, it's a much, it's like a slower decrease, right?
DR. MARTIN (45:52.014)
slower decrease, a lot quieter, you're not getting the hot flashes and symptoms like that. It usually starts with brain fog or a little bit of fatigue, these kind of nondescript symptoms that it's hard to really pinpoint what exactly is causing it, but then can manifest into really disease.
Yeah, that's so important. Anything else on preventative testing, imaging, anything you guys do at your clinic?
There's a lot more that we do. I'm probably missing some things, but I think that covers it.
What about GLP-1s? Like, what do you think the current state of GLP-1s are?
I like GLP-1s a lot. They've been a great tool for those who need them. I think there's a lot of interesting emerging science on other use cases for them outside of diabetes and heart disease prevention and weight loss. Yeah, weight loss always the best way to start and metabolic disease and insulin resistance, the best way to start is lifestyle, but it's a great tool to support that.
DR. MARTIN (46:57.198)
You know, if you failed lifestyle or need a little added help or you need to lose 50 or 100 pounds to even, you know, start to exercise, I think it's a great tool. There are some risks, some GI discomfort risks. Here's this talked about risk that people will lose muscle mass more than body fat and have a worse body composition after using the GLPs. I have not seen that in the literature, the most recent systematic reviews that takes all
good high quality papers about JLP ones and puts them together and then kind of weights the outcomes. And so it's kind of an index score for all the studies published that showed that the amount of muscle loss is the exact same as muscle loss from any other sort of weight loss, even by dieting. So I think that's just part of the risk of being in the calorie deficit is that you may lose some muscle mass. And so it's super important to have a resistance training.
Program in place, be prioritizing protein and getting high quality foods. And then make sure your Androgen status is okay.
Yeah, well before the FDA just like mucked everything up with peptides, we were doing CJC with some of the GLP ones just to help, know, and we saw good results with those.
Yeah, CJC is an interesting one, which increases growth hormone, which does seem to decrease adiposity, particularly in the abdomen, the visceral adipose tissue, which is the most dangerous. So I like CJC and a lot of those peptides as well.
KAYLA BARNES-LENTZ (48:31.99)
Is it something that people like is the expectation that people, cause I've never tried any GLP one that they're going to be on forever. What is the timeline you guys kind of look at? Do they go on it for three months, six months, and then you want to get them off or is it something that people are going to be staying on for a very long time?
My goal is that they're coming off and that's how I kind of phrase it from the start and we start very, very low and slowly go up, but we try to treat with the, excuse me, the minimally effective dose because the lower the dose that you're on, the quicker that you're able to get off. So I always have kind of an off or a down titration plan that I discuss with the patients. That being said, there's a lot of patients who are still on the GLPs and some that have rebound weight gain after coming off of them.
So I think that's to be determined. I think we've started a lot of people on GLPs and a lot of people are still on them and liking them. So I guess we're going to have to see kind of what that looks like, but we have taken patients off of the GLPs and have good success with it, but it takes a lot of work.
Yeah, yeah, I could see that. I mean, again, there's just, there's no, I mean, this kind of looks like like save, save your pill, but I mean, or injection, but at the end of the day, you still have to make the lifestyle changes or else you'll probably end up in the same spot, right?
Absolutely, yes. The GLPs alone, if you maintain your lifestyle, are not benefiting you. They're putting the band-aid on a problem that's going to come back the second you lose access to the GLP or you move states or whatever reason that you come off of it, you're gonna go right back to where you were, if not higher. So it definitely needs to come hand in hand with lifestyle.
KAYLA BARNES-LENTZ (50:15.01)
I agree. Okay, let's show AI in healthcare. What does that look like for you? I'm doing, you know, a little, I'm dabbling. I'm trying to create this little bot with my own data and, know, hopefully it can start giving me recommendations. I'm just interested to see what it says.
like an LLM on your data.
I actually don't know what an LLM is, but it's actually, Jonas introduced me to it, the sequel thing. So I'm like just putting in my data and it's linking to my aura ring. I'm trying to see like what it's gonna spit out, but what is the future in AI healthcare medicine look like in your opinion?
the future is well connected between AI and physicians. think the future is AI augmented care. think AI is not taking anybody's jobs, but all physicians, all clinicians are going to be using AI, to, interact with patients and, yeah, hopefully improve outcomes. AI in healthcare has a long, long history. We've been using AI in healthcare since like the sixties or seventies. I guess I kind of think of AI as a continuum.
And on one side, there's like artificial intelligence, a computer that knows everything like her from the movie. And on the other side, there's statistics, there's linear regression and logistic regression, very, very basic things, but they can predict outcomes. And we've been using those since early medicine, not early medicine, but yeah, 60s and 70s, developing risk algorithms from that. Radiologists started using AI for ultrasound in like the 80s.
DR. MARTIN (51:49.102)
And we've had AI tools for the EKGs for the entire time I've been in medicine. But then really in the last 10 years, there's been a huge explosion with machine learning and deep learning. And then since October or November of 2022, since the large language models really busted out, that's changed a lot in medicine.
DR. MARTIN (52:18.572)
I think one thing is identifying patterns and insights that humans can't see. So the clearly is a great example of that. Cardiologists were originally reading the CCTAs and identifying plaques, but you feed it through an AI tool and it's able to pick up plaques that humans can't even see. And I think the same thing in the electronic health record data. We have so much data. have hundreds of thousands, if not millions of data points on each single person that we have stored.
in this cloud that we're not using for any sort of decision making, because we don't really know how to use it. It's way too much data to deal with. And so I think using large models to parse this data and come up with predictions is going to be huge. And I think the other side is kind of alleviating clinicians of a lot of administrative tasks. So we've had this huge digital movement in medicine in the last 20 years. There was this meaningful
there's a Obama era policy called meaningful use, which got all physicians on electronic health records, which has been great for access, but has added a lot of work to doctors that takes away from their ability to interact one-on-one with the patient. And so now when I was a primary care doc at UCLA, we'd have 20 minute appointments. I would probably spend maybe two or three of those minutes face-to-face with a person interacting with them as a human. The rest of the time I was like, I felt like a slave to the computer, just documenting and filling out this form.
And so I think a lot of that can be alleviated from the clinician so they can spend that full time with the patient working at the top of their license doing what they're trained to do and offload a lot of that to the AI. So ambient scribes that are listening to the conversation and documenting everything, we're starting to implement kind of automated patient responses. So when patients are sending in messages, large language models will craft a response based on kind of your historical responses and then
Ultimately though, is up to the clinician to make the final choice. So, AI I don't think is ever gonna be treating patients on their own. I think it's always gonna take the human kind of final click and responsibility is still on the human.
DR. MARTIN (54:27.501)
yeah.
DR. MARTIN (54:53.038)
It saves so much time. Yeah, it's a very impressive tool. Yeah, this is one thing I don't think a lot of people or patients quite appreciate, but as a clinician, I think this is gonna be a huge driver for recruiting high quality doctors. Every doctor's gonna want them to have an AI scribe.
DR. MARTIN (55:37.774)
Totally, yeah, that one-on-one interaction between the patient and physician is really, really important. Even talking about non-health care stuff, learning about their family or what they like to do is really important for crafting a care plan for them.
DR. MARTIN (55:59.086)
Totally.
DR. MARTIN (56:08.748)
Nothing specifically comes to mind.
DR. MARTIN (56:23.598)
What I end up recommending a lot, yeah, it might not be that interesting. Omega-3s, high quality omega-3 fatty acid, creatine monohydrate, yeah, maybe a fiber supplement if you're not getting sufficient amounts of fiber. If you have an elevated homocysteine, a methylated B vitamin, those are usually kind of my main staples. Everything else is fairly individualized. So yeah, that is a bad response, I'm sorry.
DR. MARTIN (57:00.716)
Yeah, yeah, it's it's met. That's why blood work is so important understanding where you are and then developing a plan for that. One thing I like is an omega quant or you know, some way of checking your the omega three levels in your serum. So that's something we never really did at at the larger health systems. But we do a lot at Gillette Health, just making sure that your omega three doses is adequate.
DR. MARTIN (57:32.686)
How often do you do that?
DR. MARTIN (58:02.146)
Yeah, it is crazy. That's the great thing about growing food yourself is you control the entire process from start to finish.
DR. MARTIN (58:11.736)
Yes, thanks for the opportunity.