Functional Medicine with Robin Berzin MD

Today I'm speaking with Robin Berzin, MD, on the Longevity Optimization Podcast. In this conversation, we delve into the principles of functional medicine, emphasizing its focus on treating the root causes of health issues rather than just symptoms. We discuss the importance of preventive care, particularly for women, and the need for comprehensive testing to understand metabolic health, blood sugar levels, and hormonal balance. Our conversation highlights the significance of dietary interventions, lifestyle changes, and the crucial role of sleep in overall health.

Dr. Robin Berzin is a leading advocate for functional medicine, dedicated to transforming healthcare by addressing the underlying causes of disease. Throughout our discussion, we explore the complexities of women's health, focusing on cholesterol management, proactive health measures, and the importance of nutrition and lifestyle in preventing chronic diseases. We emphasize the significance of personalized medicine and the need for women to take charge of their health through regular testing and informed dietary choices. The conversation underscores the role of foundational health practices, such as nutrition, movement, and sleep, in optimizing health outcomes and longevity, offering listeners practical advice for enhancing their well-being.

Let’s be friends!

Instagram: https://www.instagram.com/kaylabarnes/?hl=en

TikTok: https://www.tiktok.com/@femalelongevity

X: https://x.com/femalelongevity

Website: https://kaylabarnes.com

Join Female Longevity Community: https://kayla-barnes-lentz.circle.so/checkout/become-a-member

Follow Robin Berzin MD

Follow Robin on IG: https://www.instagram.com/robinberzinmd/

Website: https://www.robinberzinmd.com

Timestamps

00:00 Introduction to Functional Medicine

03:01 The Shift from Conventional to Functional Medicine

05:54 The Importance of Preventive Care

08:58 Understanding Blood Sugar and Insulin Resistance

12:11 Comprehensive Testing for Women's Health

15:03 Dietary Interventions and Lifestyle Changes

18:06 The Role of Sleep in Health

20:56 Cardiovascular Health and Women's Wellness

24:11 Navigating Hormonal Health

26:59 The Importance of Nutrient Levels

30:12 The Future of Functional Medicine

40:39 Understanding Cholesterol and Cardiac Risk Factors

42:38 Proactive Health Measures and Heart Scans

44:48 The Importance of Baseline Testing for Women

46:58 Bridging the Gap: Women's Health and Chronic Diseases

49:46 The Role of Nutrition in Preventing Chronic Illness

52:05 The Impact of Lifestyle on Health Outcomes

55:14 Foundations of Health: Nutrition, Movement, and Sleep

58:33 Personalized Approaches to Cholesterol Management

01:01:50 Key Recommendations for Women's Health

01:16:14 Final Thoughts on Health Optimization

Transcript

[00:00:00.000] - KAYLA BARNES-LENTZ

All right, Robin. It's such a pleasure to have you here with me today.

[00:00:03.420] - ROBIN BERZIN MD

It is so fun to be here. It's also so fun to see your gorgeous home. Thank you. To get some sun in LA, come in this New Yorker here. It's like sun starved this winter. So thank you for having me.

[00:00:14.440] - KAYLA BARNES-LENTZ

Of course, of course. Yeah, we got to get some more sun exposure today, maybe. I'm so excited to talk about all things functional medicine, functional health, specifically as it relates to women. You're obviously the founder of Parsley Health, which was The way I see it, like one of the leaders, really, in all functional medicine, you guys operate in 50 states, and I'm sure you've worked with thousands. How many patients have you guys worked with, would you say?

[00:00:41.010] - ROBIN BERZIN MD

Tens and tens of thousands. You know a lot about functional medicine. Yeah, we've seen it all.

[00:00:46.650] - KAYLA BARNES-LENTZ

I want to start. I get these questions a lot. First, maybe just really, what is functional medicine? I think a lot of listeners already know. But then where do you start? Let's maybe put it through the lens of a woman. Where should a woman maybe consider starting in functional medicine?

[00:01:03.310] - ROBIN BERZIN MD

Functional medicine, for those who aren't familiar, is an approach to medicine where we focus on treating the root cause, finding and treating the root cause. It's really about the why. Instead of saying, You have migraine headaches, and here's a painkiller for a migraine, we'll say, Well, what could be causing those migraine headaches? 75% of migraines happen in women for reasons that are poorly understood. Triggers for migraines could be a dairy sensitivity, a magnesium deficiency, uncontrolled high blood pressure, an imbalance in the hormones in the menstrual cycle, chronic stress, caffeine overuse, the list goes on. Those are all the root causes of a migraine. In functional medicine, we don't just treat the symptom, we treat the cause. In partially health, it's just my practice, we do a really in-depth intake to look at your health history. We go all the way back to childhood. We do in-depth testing, and we spend time getting to know you as a whole person to understand your story. That leads us to be able to treat you more comprehensively than maybe a regular doctor. So yes, we might prescribe a painkiller for your migraine. Maybe that's really helpful for you to not experience pain.

[00:02:12.460] - ROBIN BERZIN MD

But we'll also, say, we discover your allergic to dairy or sensitive to dairy, help you get on a dairy-free diet, and help your migraines go away completely. We see this over and over again. I think for women, specifically, today, women increasingly aren't getting the medical care they They're delaying going to the doctor because they feel dismissed or unheard at the doctor. 55% of women report feeling gaslit or dismissed at the doctor's office, and women don't have time. They're not getting the care they need. And yet women are suffering from GI, autoimmune hormonal conditions, cardiometabolic conditions at rapidly rising rates. Functional medicine is a better approach to getting healthy, staying healthy, reversing chronic disease and optimizing health than, say, your regular PCP.

[00:03:04.610] - KAYLA BARNES-LENTZ

Yeah, I mean, absolutely. That's what I'm going through with all these labs and stuff. It's also how did you, because obviously you're conventionally trained, what happened to make you want to switch into this root cause approach? Because one would think that it's actually how you should be traditionally trained, right?

[00:03:21.710] - ROBIN BERZIN MD

It should be, but it's not. I'm fortunate to be trained in conventional medicine. I trained at Columbia and Mount Sinai Hospital in New York City The light bulb moment for me was in my training, seeing how we had unintentionally created this revolving door between primary care and specialists, that patients were flying through, getting more and more procedures, more and more pills, getting sicker and sicker, not getting better. I could see how totally unsustainable this was for our patients, also how unsustainable it was for our health care system, which is overburdened, overwhelmed, long wait times, high cost. I was fortunate enough to learn and discover functional medicine and understand that there was a way to interrupt that revolving door, to slow it down, to say, Hey, let's take a minute. Instead of reactively treating what's right in front of us, let's dive a little deeper, let's do the right tests, let's leverage nutrition and fitness and sleep and supplements in addition to drugs. I could see that that form of medicine could be the wedge that completely transformed our healthcare system and a lot of lives. And once I trained in it and I understood it, it just for me, there was no going back.

[00:04:34.750] - KAYLA BARNES-LENTZ

Yeah. I mean, that makes so much sense. I mean, I hope I think a lot about the entire system. I don't know if you have any thoughts, but do we think we're ever going to get to a place where nutrition and exercise and sleep and mitochondria optimization are within medical schooling?

[00:04:52.550] - ROBIN BERZIN MD

I think we have to. I don't think we have a choice. I mean, when you look at the fact that 60% None of American adults have at least one chronic disease, and now not 40%, and now 40% have two or more chronic diseases, that these chronic diseases are driving 90% of our health care costs. They're costing $4 trillion a year. Those costs weren't just an ambient thing. They're being passed down to all of us in the cost of the health insurance and the cost of medical services. What drives me crazy is that we could be spending a fraction of that $4 trillion on proactive preventive testing, education around nutrition and fitness and sleep, and understanding body as ecosystem. We would send the entire health of America in a totally new direction. But we're willing to wait until somebody's really sick and perform a $300,000 surgery like a cabbage, where you take a vein out of somebody's leg and tie it around their heart when their arteries are blocked from disease. We're more willing to do that than we are willing to spend a few hundred dollars on a doctor's visit that lasts a little bit longer to understand how nutrition and lifestyle factors are impacting that person's health.

[00:06:13.910] - ROBIN BERZIN MD

Despite very well-established research, no questions asked that the way that we're eating and moving and living today is causing most, not all, but most of those diseases.

[00:06:26.230] - KAYLA BARNES-LENTZ

I know. It's backwards. It is. It really is. I don't know what the catalyst will be or when the curriculum will change, but I just hope for that future relatively soon because it is a little bit more difficult to find great providers. Obviously, Parsley operates in all 50 states, but it's not super easy. Then you have to pay for your medical insurance and you have to do this other thing. So it would be great if we can get there.

[00:06:51.790] - ROBIN BERZIN MD

Yeah. Well, that's really my mission. I mean, that was my mission in starting Parsley was to make functional medicine more accessible, affordable, something anyone could find and use. Use. I think that to your point, I think the tipping point is really going to come from all of us looking for these services and saying, You know what? This is my life, and I don't want to spend it sick. I don't want to end up on 15 medications. We can't control everything about our health. We just can't. But there is so much that we can control and have input on. We're not educating our population around that. We're not educating our medical system around that. But I think people like you and me, and many, many people I know, have really woken up to the fact that in large part, there are big aspects of our health that are in our hands, and we're not going to accept this reactive, episodic medical system that just prescribes another pill.

[00:07:48.070] - KAYLA BARNES-LENTZ

Yeah, absolutely. I have a random question that I've been thinking about a lot, but I've never actually asked any of my friends or doctors, so I'll ask you now. Okay, let's just say someone comes in and their HbA1c and all of their insulin and glucose markers are very clearly trending. They're about to be prediabetic or diabetic. What is it about it? Is it just because you can't assign a code that you don't... It doesn't seem like people are getting a heads up in advance enough in the traditional Western medicine. Is it simply because until you can assign that code, it's not relevant?

[00:08:25.010] - ROBIN BERZIN MD

Essentially, yes. Essentially, in the conventional medicine model, it's on or off. You either have the disease or you don't. There isn't the sense that we have in functional medicine of trend lines, and are we heading towards optimal or are we heading off the wagon? Somebody might have a hemoglobin A1c of 5. 5 or 5. 6, their PCP will be like, Good news, you're doing great. I know. Then the next year, it's 5. 7 and it's bad news, you are now prediabetic, and there was no intervention for that patient. In functional medicine, we'll say, Hey, we're looking at your fasting insulin, and you know what? It's around 10. We're looking at your fasting glucose, and it's 95, and it should be 80. We're looking at your A1c, and yeah, you're not diabetic yet, but it's 5. 6. You are heading in the direction of diabetes. You have early signs of insulin resistance and dysfunctional blood sugar. We're going to intervene around what you're eating, how you're moving, help you build lean muscle mass, help you assess, are you living on an ultra-processed foods diet, which is 75% of the American food supply today, Are you doing squats every 45 minutes as I posted yesterday, which I saw you liked and I was very proud.

[00:09:52.760] - ROBIN BERZIN MD

Of course. Or are you sitting 11 hours a day? We're going to intervene around all of these things, and then we're going to retest, not in a year, but in six months, maybe even three months, and it says, Are you shifting this trajectory? So many people could be completely heading off in a different direction when it comes to their health, but they're not given those tests and they're not given that information.

[00:10:15.740] - KAYLA BARNES-LENTZ

Absolutely. Yeah. Well, that would be a great thing to see change. But until then, we have great places like Parsley. We do a lot of functional medicine, too, finding these private clinics that can be really helpful. I think we just need a shift in mindset around health care and paying for health care in general, because we just have to start thinking that this is our responsibility. Unfortunately, it should all be covered by insurance, but the best things just aren't.

[00:10:44.250] - ROBIN BERZIN MD

Yeah. Well, that's really been our mission and the battle I've been fighting for the past, gosh, it's been like nine years.

[00:10:53.930] - KAYLA BARNES-LENTZ

Yeah, because you guys are doing insurance.

[00:10:55.120] - ROBIN BERZIN MD

Yeah, we take insurance. We're in at work today for over 15 million people in New York and We have more states on the way. Our program is designed to be very accessible and affordable compared to what typically functional medicine costs out there on its own, just cash pay. Then we have programs now that are in network, and so people are using their benefits to cover the visits with our providers, which is amazing. It's been a huge game changer. What's cool to me is I've spent... This has taken years and years, by the and many, many hours and lots of meetings with health insurance executives and having to explain functional medicine. What's really cool, though, is in the past two years, I've noticed this insane shift where I used to go into these meetings and people didn't know what functional medicine was or they were really skeptical of it. Now, more times than not, I would say 90% of the time, the health insurance executives, the benefits leaders and employers, the hospital system leaders that I'm talking to, they know what functional medicine is, and they or someone on their team is looking for it. That, to me, represents the exact sea change I was talking about, where if we all know what it is and we talk about it, that will start to shift the American health care system, and it already is.

[00:12:22.010] - KAYLA BARNES-LENTZ

I love that. That's so exciting. I forgot about the insurance thing, but you told me that. I love that. That's a huge, huge perk. To dive into women's health. A lot of women are confused. Let's say that they're doing functional medicine. What labs might be appropriate? Where would you just want to start? Maybe we start with small budget up to bigger budget, and then maybe in certain menstrual, perimenopause, menopause, what would you be looking at?

[00:12:51.690] - ROBIN BERZIN MD

Number one, I would start with a comprehensive set of functional bloodwork. This bloodwork, by the way, can be ordered by your regular primary care doctor. A lot of times they're not trained or open to ordering it. There's a lot of places to get this blood work. We offer this bloodwork as part of some of our programs included. This is looking at things like blood sugar, which we already talked about. So your metabolic health is paramount as a woman. I just actually had this conversation twice this week with two different friends about what I would call borderline PCOS. There's indications of PCOS, polycystic ovarian syndrome. One of my best friends, I I was actually explaining her labs to her the other morning while I was in the airport lounge coming out here from New York. She had a slightly elevated testosterone, and she has some symptoms around her periods. They're a little bit irregular, a little bit erratic. We ran all of her labs, and I was explaining to her that PCOS, polycystigovarian syndrome, is actually highly driven by metabolism and blood sugar. I wasn't going to actually do anything in my intervention around her testosterone.

[00:13:59.050] - ROBIN BERZIN MD

I was going to start with fact that when your blood sugar goes up, your insulin goes up. Insulin, everyone, is the hormone that takes blood sugar out of your bloodstream, where if it floats around too much, it does a lot of damage to your body, and it puts it inside your cells where it's safe and it can be used. When you have a sugary food or even just anything you eat and your blood sugar naturally goes up, insulin gets pumped out by your body, by your pancreas, to put that sugar away. But when insulin goes up, which is really interesting is then testosterone goes up, too. When testosterone goes up, eventually estrogen goes up because your testosterone is metabolized into estrogen. That is how blood sugar leads to conditions and hormonal imbalances like PCOS, even endometriosis, irregular periods, heavy periods. Back When we're going to testing, metabolic health is really critical place to start. Fasting insulin, fasting glucose, hemoglobin A1c, there's other insulin resistance markers that we order standardly. That gives a really good picture of where you are when it comes to your blood sugar.

[00:15:00.220] - KAYLA BARNES-LENTZ

I love that. Just to stick on that point for a second. Let's say that someone gets labs and sees that they're moving in the wrong direction. What would be some of your first interventions for them?

[00:15:09.970] - ROBIN BERZIN MD

Number one, let's just do a dietary assessment. I can't tell you how many people think they're eating healthy, and they're eating way more sugar and processed foods than they think. There is so much greenwashing in our food system. All these bars and crackers and packaged foods that say organic on them, or there's a green leaf, and people really think that they're eating healthy, meanwhile, they're getting a highly processed ultra-refined carb diet. Anything that's bars, cookies, cakes, crackers, I can't tell you the number of health bars that have 30 grams of sugar in them. Your target total sugar intake for the day, not just added sugar, but total sugar, so that's naturally occurring sugars in fruits, and that's added sugars, which maybe you're going to have some of here and there, should be 25 grams a day or less. A lot of times people are getting that in one bar. They're getting that in... When I go to look at the shelves of green juices, you and I should just go around all the convenience stores and quote, unquote, health food stores and show people how many green juices have more sugar in them than a Coca-Cola.

[00:16:14.500] - ROBIN BERZIN MD

It's wild, right? We start with that dietary assessment because a lot of people are eating more sugar than they think. Then we can look at times of day. A lot of people are eating a high carb breakfast, and that can be really metabolically destabilizing. We try to shift them to high protein fat and fiber breakfast or intermittent fasting, depending on the person. Then we're looking at movement and building lean muscle mass. For women in particular, and we could talk about this lots today, building lean muscle mass is critical. When you build lean muscle mass and understand your body composition and how much fat mass versus muscle mass you have, it can be really instructive. Because if you don't have a lot of good lean muscle mass, it's really hard for you to balance your blood sugar. That muscle mass is what is doing the hard work for us. When you build it up, your resting metabolism is higher and you don't have to work so hard to balance your blood sugar. It's just happening while you're sitting down, which I think a lot of people forget. We look at those couple of things first. Then we look at sleep.

[00:17:13.890] - ROBIN BERZIN MD

One night of poor sleep impacts protein synthesis the next day. It can make your blood sugar super erratic. It leads to cravings. People eat, drink caffeine, then they eat more sugar. That's a really vicious cycle. We'll look at sleep We'll look at all of these different lifestyle patterns in your life. Then we might even add certain supplements from there. With my friend who had the slightly high total testosterone, she is 44. She was worried that she was going into perimenopause. Actually, all of her female hormones were perfect. Even based on her symptoms, I was like, Based on your symptoms and based on your labs, you're not in perimenopause. You've got a ways to go. You're not even close. What I'm seeing is actually this light, PCOS is what I'd call it, and metabolic dysfunction, because she also had a couple high cholesterol markers and some other markers, high fasting glucose, that tell me that, like we talked about, she's heading in the wrong direction.

[00:18:17.540] - KAYLA BARNES-LENTZ

Yeah. No, I love that. Going back to sleep real fast. So this is just really like end of one. I believe the data says that women need 11 to 20 minutes more per night of sleep. But I really found So I've been blessed enough that I can go to bed and wake up as I naturally would. And my husband thrives in seven hours. But I am just consistently seeing that if I allow myself to wake up natural, no alarm clock, I'm getting eight hours, sometimes even during menstruation a little bit more. I feel like that's one lie that maybe women have been told a little bit that it's all the same in terms of sleep needs. What's your opinion on that?

[00:18:56.570] - ROBIN BERZIN MD

Listen to your body, and it can change in time. It can change and fluctuate with your menstrual cycle. It can change based on just the intensity of your life. Most women need at least eight hours of sleep, and often 8: 00 to 9: 00. Most people I mean, I love that your husband is one of these people who, quote, thrives on seven hours. The data shows that most men and women don't. Most men and women need at least eight hours of sleep. To be an optimal mental function, cognitive function, metabolic function, digestive function, we forget that poor sleep, interruptive sleep is one of the drivers of erratic digestive patterns and digestive symptoms, IBS. I'm a big fan of, Actually, I ran into... He's like the sleep expert, Michael Bruce, yesterday. Dr. Bruce.

[00:19:48.880] - KAYLA BARNES-LENTZ

I saw that on your- Yeah.

[00:19:50.330] - ROBIN BERZIN MD

I'm like, I didn't know him, so I didn't recognize him. When we got into this whole conversation on sleep, and he immediately convinced me to have him come talk to all of our doctors at Parsley, which I'm happy to do. But we are addressing sleep consistently in all of our patients because I'll have a patient, a woman who's dealing with brain fog and weight gain and anxiety and high blood pressure. I'll look at her sleep and I'll say, You know what? If you're not sleeping, none of the other interventions I'm going to give you are really going to work. We have to start there.

[00:20:27.890] - KAYLA BARNES-LENTZ

I feel like that's the bedrock. I designed my life around my sleep. It's like, I know I'm going to be in bed, I eat 30 every day. And so everything else works itself around that, not the other way. Like even friends. I mean, from time to time, I think you're probably going to the dinner tonight, right? Yeah. I'll see you there. I'm still advocating, by the way, for health event dinners to be moved to 5: 00 PM. I'm really advocating heavily for that.

[00:20:53.400] - ROBIN BERZIN MD

I'm with you. Unfortunately, that memo has not been received yet, but we will be there today.

[00:20:59.670] - KAYLA BARNES-LENTZ

Health events at my house or at 5: 00. I'm like, It's five o'clock. But yeah, I think everything else is built around sleep. I definitely, I think in my labs and overall sense of well-being, it makes a huge difference.

[00:21:12.690] - ROBIN BERZIN MD

And figuring out what is essential for you is so important. For me, my kids are not in bed right now until 8: 30. If I then go to bed at 8: 30, I literally have no waking hour of my entire day to myself. Zero. Because I'm up with them in the morning. It's immediately lunches and getting people dressed, myself and three other little humans for school. Then I'm straight into my crazy long workday, and then I get home, and then it's dinner, and it's bedtime, and it's baths, and it's all of that stuff. I need that time to finish stuff up, decompress, talk to my husband occasionally. Oh, you. Yeah. Funny, you would like this. My husband's actually more of the sleep geek in our family. We've got the eight sleep and the blackout shades, and he's got his eye mask, and he's got his watch that's tracking all of his sleep and his ring and everything. And literally, he will be in bed, and I'll be like, Hi, poking him. Could we have a conversation for 15 minutes before you go into your zone? But we really need it. Otherwise, we're dysfunctional for our family, let alone ourselves.

[00:22:34.270] - KAYLA BARNES-LENTZ

What about sleep timing in general? It doesn't have to be 8: 30, but I've heard a lot that before 10: 00 PM or you might miss out on the release of these beneficial hormones in deeper stages? What are your thoughts?

[00:22:46.760] - ROBIN BERZIN MD

The data definitely shows, and then I think most people find this in practice, that getting to bed by 10, certainly before 11, before that, we call it sometimes the second wind, but you do have a second cortisol spike, sometimes between 11: 00 PM and 1: 00 AM. It's different for different people. It depends a little bit on your day and where your rhythms are at. But that can then interrupt sleep later at night. So eating earlier so that you're not eating a big meal and then trying to digest that meal right before you go to bed is great. I always advise all of our patients, when it comes to sleep, be in bed by 10: 00 PM, that's your goal, and have a wind-down routine. A A lot of people are going from zero to 60 with the kids and the work and the scrolling of the phone and the TV or whatever it is that they're doing and dropping into bed and then wondering why they can't sleep. And your brain just can't catch up. And so then they toss and turn, they have a hard time falling asleep. They have a restless sleep.

[00:23:48.510] - ROBIN BERZIN MD

They're experiencing anxiety and agitation. So even just a 20-minute wind down period before bed, dim your lights, do some gentle stretching or yoga, meditate, sleep, do an Epsom salt bath, which can be really calming. My husband used to accuse me of interrupting my sleep because I would take a hot shower before bed. And then I showed him the research that said that actually that can really relax the nervous system. I'll often just take a five-minute warm shower. You would be like, What are you doing? You're just waking yourself up. I was like, Uh-uh. I have found the thing that really helps me gear down for sleep. But I find when patients and folks who work with a partially do that, wind down even 20 minutes, it makes a radical difference in their sleep quality, and they see it in their sleep trackers.

[00:24:38.780] - KAYLA BARNES-LENTZ

Yeah, I found if I can get my resting heart rate down as low as possible before bed, my metrics are always really good. It's a big focus of mine, just doing breathwork or for me, prayer and even cuddling with my husband as part of my wind down. Yeah. Nice.

[00:24:56.200] - ROBIN BERZIN MD

Before he shuts you out with his eye mask and taste.

[00:24:59.600] - KAYLA BARNES-LENTZ

Yeah.

[00:25:00.320] - ROBIN BERZIN MD

I'm the one- Like mine.

[00:25:01.140] - KAYLA BARNES-LENTZ

Well, he's getting really good. He used to before we were married. He would go to bed way later, eat wee later. Now he's adopted a lot.

[00:25:08.160] - ROBIN BERZIN MD

Well, he can't be married to you and be on that schedule. I'm sorry. That's just clearly not going to work.

[00:25:12.340] - KAYLA BARNES-LENTZ

I know. He's very aware. Now it's about 8: 30, and he's ready for bed, too, which I love. Okay. Yeah, I love all those tips. We talked a lot about insulin and glucose, blood sugar, metabolic health. When it comes to females, what else would you start to look at?

[00:25:29.210] - ROBIN BERZIN MD

Absolutely looking at cardiovascular health twice a year. So numbers like ApoB, lipoprotein A, more important than total cholesterol, and understanding triglycerides and HDL as well. Heart disease is the number one killer of women. And many women don't get diagnosed with heart disease until after they've had a heart attack. And again, it just drives me crazy because only 10% of people or so get preventive testing in this country. There's so much that people are living with that they don't know. And We do an NMR, an in-depth lipid profile on every patient, and that's one never, ever skip. Also super important to look at your female hormones. A lot of doctors will tell women that that's not necessary. It's not going to tell you anything that's completely wrong. I think we should be looking at our hormones every year from when we're 25, maybe even 15, to understand what our baseline is so that when you start to experience any symptoms around your menstrual cycle, for example, which your menstrual cycle absolutely is a vital sign. It should be treated like your heart rate or your blood pressure for women. You know where you were, and then you can compare that to where you are now and see how things are changing.

[00:26:45.190] - ROBIN BERZIN MD

Now, for some women, we're testing female hormones more frequently because they've got PCOS or endometriosis, or we're in a fertility journey, or we're titrating menopause symptoms against our hormone replacement therapy protocol. For other women, once a year is fine. If your periods are clocking and you're feeling good, we don't need to be testing your hormones over and over again. But I like to look at total estrogen as well as estrogen metabolites. I look at, obviously, progesterone, DHEAS, which is an adrenal hormone. That's like your vitality hormone. It can tell us if you're burning the candle at both ends too much or not. Testosterone free in total, sex hormone binding globulin, which is the school tests that ferries our hormones around the body, and then they get off and do work. That really gives me a good picture of where you are and if we need to intervene around your hormones. I can't tell you for how many women come in to Parsley and say, It's my hormones, my My hormones are off. My hormones are a mess. My hormones, it's their fault. We look under the hood and we look at all these other tests.

[00:27:53.350] - ROBIN BERZIN MD

Their hormones, their sex hormones, which is what they're referring to, is completely fine. But they might have thyroid hormone markers that are off. They might have adrenal hormone markers that are off that no one's tested for. They might have blood sugar markers, like I referenced earlier, that are pushing on their sex hormones and causing the downstream problem. Just as a starting place, these things, nutrient levels, regular doctors will also say, People don't have a nutrient deficiencies here. I'm like, I can tell you the opposite is true. People have often very low levels of B12, low iron levels in women that can be causing brain fog, exhaustion. There's so much we can see in terms of nutrient levels and then inflammatory markers. Eighty % of autoimmune diseases in women for reasons that are poorly understood It's good. Autoimmune disease is on the rise, as many as 50 million Americans have it. It takes a long time to diagnose. It shows up in all these different ways from joint disease like rheumatoid arthritis, skin diseases like psoriatic or plaquesyriasis, and eczema even, shows up as thyroid disease and Hashimotos, so it has all these different presentations, constantly gets missed.

[00:29:09.790] - ROBIN BERZIN MD

Women are living with a baseline level of very high inflammation, an active autoimmune disease. They don't know it, and that is causing their irregular periods, their infertility, their menopause symptoms, and no one's tested them for it. This comprehensive set of functional blood work, it's about 100 analytes, give or take, can be wildly instructive, is not that expensive. If you just start there, you can uncover so many things that people are living with. I think some of the reason people don't get this testing, by the way, is that they feel like they don't really want to know. I think that's why the work that you're doing is so powerful. When we flip our mental model from, Eek, I don't really want to know about this stuff, to, Hey, I want to know because there's so much I can do about it. Just in my day-to-day life that isn't going to land me in the hospital or anything, it just flips the script on this idea that I'm getting testing because I'm sick, to, I'm getting testing because I am determined to be well.

[00:30:16.740] - KAYLA BARNES-LENTZ

Yeah, I love that. I get that question a lot. Isn't it scary to be doing so much blood work and imaging and all this stuff? And are you scared when you go to get a prenuvo and what if they find something? I'm like, Well, if they find something, then I know I didn't have it last year or last six months or last three weeks whenever I did my last whatever that lab is. I'm in the best position to overcome that obstacle, versus just waiting and waiting and then getting a late-stage diagnosis, which is the exact opposite.

[00:30:47.510] - ROBIN BERZIN MD

I know. I will say for tests like Prunevo or Esra, which are the full body MRIs, and there's other brands, I think as well, or let's say, Galerie by Graal, which is a cancer DNA test, blood test. We offer those tests. We will refer for those tests. I will say that as somebody who sees patients, there are some people I see who are not ready or capable of emotionally living with that information. It's actually one of the misses, I think, in the industry because we have people come to us, Should I get these tests? We'll have a real conversation with them. I have patients for whom, like you and I, I got my full body MRI, and I was really pleased to have that information. I actually learned I had thyroid nodules I didn't know I had. Now I'm getting annual ultrasounds, and I was already checking my lab work, but I'm on top of it. If one of those nodules should grow larger or need a biopsy or potentially become cancerous, I'll be way ahead of it. I can handle that information and act on it. I definitely have patients for whom that information would just be crippling.

[00:31:57.060] - ROBIN BERZIN MD

I do think that we're all a little One of my good friends, actually in LA, who's super into health and wellness, that type of information for her, she wouldn't sleep for months. We decided, You know what? We're going to do all of your blood work. We're going to stay on top of everything and all all these other ways, but let's pace ourselves when it comes to some of these types of scans or tests. Gallery by Grail is really interesting. However, there's a pretty big gap between I have a bit of cancer Potentially cancerous DNA from some tumor in my bloodstream to all of the scans and tests, which could then turn out normal. Then what do I do with that information? Again, I could live with that information and be proactive about it, but not everybody can.

[00:32:45.220] - KAYLA BARNES-LENTZ

Yeah. No, I'm excited for us to get even more accurate data as well, because when I first got my full body MRI, the first one, it wasn't at prenuvo, so it's somewhere else before prenuvo was even really a thing. They a couple of white matter changes on my brain, and they just didn't have a big enough data set at that time to know that this was actually normal, to have a few per year of life or one per year of life or whatnot. I got thrown into a whole thing. I was thinking for a while that I had MS, and I was literally... I was living in Ohio. I went to the Cleveland Clinic, MS Center. It was so terrifying at the time because I was around all these people that were so ill. At that point, the data just isn't there to know that this is okay and it's not a big deal. I went through this whole weeks of appointments and doctors and just being so scared. They're like, Oh, this is not anything. You're fine.

[00:33:41.640] - ROBIN BERZIN MD

Well, I mean, and that's the thing. Some of these private companies, they should have known that. You know what I mean? Their data set, but the medical data set at large, would tell you that it's totally normal to have some of these things, and then you just track them. Same thing, I had a patient or really a friend in New York who did one of those scans and He had just a cyst in his spinal cord, and of course, freaked out looking for the world's top neurosurgeon. Actually, people live with little cysts in their bodies all over the place. Sometimes they're just there, and There's not a thing to do about them at all. That's where I'm super, super pro all of the data that we have available, because as more and more people get these kinds of tests done, we're just learning so quickly and empowering so many people when it comes to their health. Having testing data from blood tests or scans or whatever it is, it's just a starting place. I cannot emphasize enough how critical it is to go have a functional medicine doctor, have a provider to work with, have somebody to put that information into context so that you don't spend three weeks at the multiple sclerosis center at Cleveland Clinic when you don't need to And so not just that, but so you actually know what to do with this information.

[00:35:03.320] - ROBIN BERZIN MD

So many people bring us their tests, their blood work from other services, and they're not even sure what to do with the most basic information. Hey, my vitamin D is low. What should I do? Even that can be mystifying. And so I think there's a big leap between having data and taking action.

[00:35:22.150] - KAYLA BARNES-LENTZ

Yeah, I mean, absolutely. And just for clarification, I went to, and I was like, Hey, guys, just letting you know that I have these couple of white matter changes I want to let you know now so you don't make it a big deal. They're like, Oh, no, we know that that's completely normal.

[00:35:35.930] - ROBIN BERZIN MD

Yeah. I think the sophistication is rapidly improving for sure.

[00:35:40.480] - KAYLA BARNES-LENTZ

Totally. Yeah, I agree. Okay, when we talk about what mind to just give people some maybe functional ranges if they're listening to this and maybe they do have current blood work that they can look at? For women, what do you like to see insulin and glucose and HbA1c at?

[00:35:57.800] - ROBIN BERZIN MD

Yeah. So hemoglobin A1c, I love to see it at least at 5. 4 or less. People can have a perfectly healthy blood sugar balance at 5. 4. It doesn't have to be 5. 2 or lower. I look at it in the context of their other numbers. So it's really important to say, Okay, where's your A1c? A1c, everyone, is a measure of, I always call it your frost flakes, your red blood cells, and how coded are they in blood sugar. It's a three-month look back. It essentially tells us how glycosylated, how sugar-coated your red blood cells are over the past three months. If they're super-coated in sugar, those blood cells are dysfunctional. They can't carry oxygen to your cells, and that's what diabetes is. That's why people lose feeling in their feet. That's why they go blind. That's why diabetes is so destructive to the body. But if someone's at a 5. 4, 5. 3, and they also have a fasting glucose of 80 to 85, and they have a fasting insulin that's undetectable or five or less, and everything else is clocking, I'm not stressed about a 5. 4 in a vacuum. That's why I think you have to look at these things together, not just say, this number must be here.

[00:37:15.500] - ROBIN BERZIN MD

I'm also looking at APO-B. I know that there's some longevity docs out there that are pushing APO-B way down and want to see it at 60 or less. There's also a lot of medical literature, not around APO-B specifically, but around cholesterol in general and statins that says over-managing cholesterol and pushing it too low is also negative and doesn't have actually increasing medical returns or health benefits over time. I know this, especially for women, because cholesterol is the building block of all of your hormones. If you don't have cholesterol, you can't make estrogen and testosterone and progesterone and all the things. It's part of why the anti-fat craze for all those years was so bad for people. Healthy fats are a beautiful thing. Our brains are made of fat. Our hormones are made of fat. Our cells are coded are made of fat or cellular walls have big fat globules in them, and that gives them their flexibility. Yes, I'm looking at an APO-B. I certainly want to see it at 80 or less. I think 70 or less is optimal. I'm not going to go scorched earth on somebody and put them on a statin at 25 when they have perfect blood sugar and all the other hormones are great, and they're trying to get pregnant so that they can have an APOB of 60.

[00:38:44.710] - ROBIN BERZIN MD

That would be a complete waste of time. This person is not going to develop cardiovascular disease for many, many years, if at all, and we're going to be trending it and keeping them in a healthy range. Also, there's research showing that statins aren't even that useful if your HDL and your triglycerides are normal, we're not even so sure how much mortality benefit there is to statins in those people who just have a high LDL or a high APOB. Research is moving in real-time, but those would be optimal numbers. But if your APOB is like 100, we got to talk, right? Or more. Lipoprotein A also is an independent cardiac risk factor. Lpa is like a little hook that sits on your LEL, and it can create extra damage to the arterial walls, and that's why we care about it. That's why in and of itself, it's not so good. Lpa is tough because it's genetic. It's rarely lifestyle-driven. People who have very high LpA They can literally live on brambles and exercise all day. It doesn't ever go down that much. It will come down with the overall LDL coming down. For those folks, oftentimes, statin is the only reliable way to get it down.

[00:39:59.920] - ROBIN BERZIN MD

It's always a negotiation of what you're trying to achieve. I also remind my patients that, Hey, we're going to get a calcium score, or now some of the more advanced cardiac scans, clearly, we're going to get them at 50 proactively. Even if you're not diabetic and you don't have any signs of heart disease and your cholesterol is, let's call it pretty good but not perfect, and you're active and you're eating well, I'm going to do a heart scan at 50. If all of those numbers are off, I'm going to do it even earlier. If there's no reason to do it earlier, I'm not necessarily going to do it. But we're going to look at that and we're going to see, do you have any evidence of heart disease? We're going to take that information in the context of your labs as well.

[00:40:44.110] - KAYLA BARNES-LENTZ

Yeah, I've been Clearly as well.

[00:40:45.760] - ROBIN BERZIN MD

Was it interesting or was it just like, your heart's great?

[00:40:48.870] - KAYLA BARNES-LENTZ

Yeah, it was zero plaquing pretty much. But still good information to know just because we do know that CPD is the number one killer in women. It gave me, at least as you I'd say, baseline to understand.

[00:41:02.110] - ROBIN BERZIN MD

For me, I'm 43. I'm not in perimenopause. My hormones are great. I'm focused on my cholesterol, my metabolic health, optimizing my hormones I'm supporting my adrenal health because adrenals are often what drag down our sex hormones early. I have zero indicators that I have any need for a clearly or similar today, but I will get one proactively in seven years at 50, Because for me, based on what I know about my body, that will be the time that I want a baseline. And that's based on everything I know and medically what I see in patients. But if you have the cash and have the time and are interested, there's absolutely no reason not to get it sooner.

[00:41:47.560] - KAYLA BARNES-LENTZ

Yeah. I mean, obviously. 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. 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. Everything everyone listening to the show knows to take my testing cadence with a massive grain of salt because I'm doing it for a lot of other reasons other than just understanding.

[00:42:57.070] - KAYLA BARNES-LENTZ

I basically, at this point, want to see granular changes. Like, what does this one intervention do? And is it helpful or not helpful to me as an individual? So I'm just doing so many more. I actually was on the phone with my mom yesterday, and I called her and she's like, What are you doing? I'm like, I'm on the way for my blood draw. She's like, Kyla, this is all you do is blood draw. It's just like every time we talk, because I always call her when I'm in the car, and typically I'm going to get a blood draw. So there you go.

[00:43:23.160] - ROBIN BERZIN MD

Yeah. I think you should just have a full bottomist on staff. I think that that's awesome, though. And Because you're proactively using that information, amazing. For most people, what I find, the cadence that I typically recommend, which is twice-a-year bloodwork, getting a baseline with some of these scans at the appropriate ages, if your numbers look good, getting them earlier if they don't. My newsletter from my website, Robin Berz and MD, just came out, and I recommended my baseline testing that I think everyone should get. It includes thinking about MRIs, thinking about gallery and grail, thinking about some of this more advanced testing, and here are all the basics that everyone 100% needs as a starting place. One that I think people really forget, especially women are not getting, is a DEXA. Body composition and bone density, everyone. This is a cheap test. As far as I'm concerned, every woman should be getting this every year from when she's 25. We, as women, start losing bone density 1% a year when we're 25.

[00:44:36.700] - KAYLA BARNES-LENTZ

Wow. I did not realize it was 25.

[00:44:40.130] - ROBIN BERZIN MD

Menopause accelerates that dramatically. In menopause accelerates that dramatically. And in menopause, women with estrogen falling off a cliff at that point, we really rapidly lose bone mass as much as 10% to 20%. Many, many women I see don't have any indication of what their bone density was at 40 and are just at 50 or 55 or later getting a bone density body composition and seeing that they're already in osteopenia, maybe they're already in osteoporosis. You can combat that. But once you're already in osteoporosis, the drugs that we have for this condition are terrible. You can only take them for a couple of years, even the newer generations. Newer generations still have some potentially gnarly side effects. The road to rebuilding bone later in life, it's possible, but hard road, right? A lot of weight training, absolutely augmenting with hormonal replacement therapy, if that's appropriate for you. Those two things together, the right minerals and supplements. But I like to see women, it's part of my protocol called Brains, Bones, and Booties for women. It's all about getting ahead of this. I think we forget about the bone piece of brains, bones, and booty a lot.

[00:45:56.780] - ROBIN BERZIN MD

We talk about the brain a lot. We talk about the booty endlessly. No one forgets the booty.

[00:46:01.490] - KAYLA BARNES-LENTZ

No, that's not what I got.

[00:46:02.560] - ROBIN BERZIN MD

No one forgets the booty. Everyone forgets the bones, right? And then getting to your point, getting a baseline of your body composition, where's your lean muscle mass versus fat mass? Again, moving away from any short of shame about weight or what you should weigh. I don't care what that number on the scale is so much as I care about that body composition and getting motivated by that to build some lean muscle that will build your bones, that will build your resting metabolism, that will make that booty look perky, and that will help you with your brain health because actually exercise is one of the number one ways that we combat dementia.

[00:46:39.790] - KAYLA BARNES-LENTZ

Which also is very prevalent in women, right?

[00:46:42.350] - ROBIN BERZIN MD

Women have two times the Alzheimer's as men. I think we forget sometimes, it's obvious, but that women go through two major life changes that dramatically set them up for higher rates of these chronic diseases, cancer, diabetes, dementia, even Alzheimer's, heart disease than men. They go through pregnancy. Eighty-six % of women in the US will have a baby by the end of her childbearing years. So not everyone has a baby, but most do. And 100% will go through menopause. And these two major life experiences and the hormonal changes that happen in them make us more likely to get autoimmune disease, dementia, all of the diseases I expressed. And so getting ahead of this is so powerful because I think we talk about... You talk about living to 150. I see a lot of people... I'd love to do that, too, by the way, so I'm going to be doing all the things that you're telling me to do. A lot of people are living just within years of chronic illness that we can start, we can get to 150 if we reverse these things now.

[00:47:51.530] - KAYLA BARNES-LENTZ

Yeah, absolutely. And you feel so much better now. Yes. I mean, it's so beneficial for your health span to just get this sorted out. It I have met so many great women, and just because I have a bit of a reputation in the health world, I think people tell me a lot more about their health than they normally would just like some of their meeting. But I swear, every single woman that I've met, and I'm not being hyperbolic, has some issues. This is like early '30s, PCOS, multiple autoimmune conditions. It's just wild, and it's so heartbreaking to me. I'm excited to see more data come out on actually exactly why these autoimmune conditions. I have my own theories. They're probably very similar to yours, but I can't say enough, be proactive, because there's things that you can do. I'm sure you guys do it all the time, but even with Hashi, There's things that you can do to really bring down those numbers.

[00:48:48.640] - ROBIN BERZIN MD

Oh, absolutely. I mean, we've had many patients have their Hashimotos thyroiditis completely the reverse. If you're gluten sensitive and you're eating gluten and you take it away, for many people, not everybody, Everybody, many people, Hashimotas goes away. That's one small example. But the thing you just said is so interesting to me because it's very true that there are hundreds of millions of people, tons of millions of people daily living with these chronic diseases at younger and younger ages. The recent data shows that cancer in younger people is massively on the rise.

[00:49:24.050] - KAYLA BARNES-LENTZ

No one knows why.

[00:49:25.700] - ROBIN BERZIN MD

But then they've shown correlation very clearly to high sugar, ultra-processed diets and the resulting diabetes and obesity and inflammation. To the people who say, No one knows why, we've identified correlation and not causation. Correct. We've identified correlation and not causation. But we know that diabetes and metabolic dysfunction increase your rates of cancer. That's well-established established, that when your blood sugar is high, your immune system is dysfunctional, and your immune system's job is to pick off the cancer cells, and when your blood sugar is high, it can't do that. We know that when you have autoimmune disease and inflammation in the body, which high blood sugar also leads to, that your immune system is dysfunctional and you are not as good at healing or fighting off infectious disease or getting rid of cancer. We know that chemicals from cigarette smoke to toxins in our environment are well-established to create tissue damage and DNA damage that leads to cancer. From my perspective, causation is established. I think that when people say Well, we don't know the cause. It's like putting our heads in the sand a little bit. I don't think that actually comes from a bad place.

[00:50:56.020] - ROBIN BERZIN MD

I think it comes from this almost wish or hope that will identify one chemical, just one thing that's in the food supply or in the water. Then if we can just get rid of that one chemical, whatever it is, that all of this will go away. I understand that hope. I understand that feeling. That would be so much easier than the reality that we have to radically change our food system. We have to change how we move. We have to change the toxin level in our environment. We have to increase our fiber intake dramatically. These things aren't escapable, but we run from them sometimes by saying, Well, we need more research.

[00:51:41.440] - KAYLA BARNES-LENTZ

Yeah. No, I mean, that's a great point. I mean, it's just funny because I think I shared a headline the other day about something related to cancer and not knowing why, and then you shared it, and you're like, No, it's very clear to me, as do so many of my other friends or medical doctors. It's really not that surprising. You look at the average American life these days.

[00:52:02.730] - ROBIN BERZIN MD

Actually, somebody commented on that for me, someone I know and respect tremendously, and asked me about, well, is this blaming the victim? I'm like, no, this is calling out that we are all victims of a food system, for example, that is a runaway train with our health. The more we know that, certainly there are types of colon cancer, types of cancer, types of cancers that have nothing to do with what we're eating. But there's a big amount that have a lot to do with that. My grandmother died of colon cancer when I was in college, and she died much earlier than she needed to. She had eaten the standard American diet, which is known as the SAD, an app name. She had smoked cigarettes for a long time, both of them well-established risk factors for colon cancer. She hadn't gotten a colonoscopy in time. She hadn't gotten standard preventive testing at the cadence she was supposed to. That really left an impression on me. It was a big reason why I went into medicine. I think about all the things in her life that she didn't know about the diet, about the cigarettes. People didn't know about cigarettes, and they just had no idea, and they were smoking them and thinking, This isn't such a big deal.

[00:53:22.190] - ROBIN BERZIN MD

Now we know what we know and we regulate these things. I just want as few people as possible to experience what she has experienced and for people to know. I think in that, we have to move away from the conversation of this idea that it's anyone's fault and move towards the conversation of how do we empower everyone to know this information and to make their best decisions that they can around it.

[00:53:48.390] - KAYLA BARNES-LENTZ

Yeah, absolutely. I think that everyone... It would be a great world if there was this one thing or one pill or one supplement that you could take that would result in health. Because so many people ask me all the time, Oh, my gosh, what supplements are you taking or what IVs are you doing? I'm like, You can't. I wouldn't even be thinking about that until you had mastered your sleep, your nutrition, your movement, getting some morning sun, these things that are relatively low cost, sometimes free. Then think about those extra things because the idea that you can just pay for health is exciting, maybe for some people that have the ability. But unfortunately, it's really those lower cost things that you can do that's going to get you like 95% of the way there.

[00:54:33.060] - ROBIN BERZIN MD

100% too. I was talking with one of the doctors you and I both are friends with and know in the longevity space yesterday. He was saying the same thing. He's like, You know what? He's like, Functional medicine is the foundation, and that's like 98% of it. And 2%, he was saying, is what I do, which is the IVs and the hyperbaric oxygen and the cryo and all of the different treatments. He's like, If you haven't done this, then these things are not going to be nearly as effective or beneficial, but they can be powerful tools if we add them to that foundation. We were joking about that, but it's absolutely true. We were joking about how people spend a lot of money on treatments and not be willing to get a blood test to look at their cholesterol. I find that to be really fascinating.

[00:55:26.920] - KAYLA BARNES-LENTZ

It is fascinating. Yeah, I mean, well, if One thing is marketed. When I say that, I say it in the best way because it really will benefit you. But like you said, it's not going to... One IV therapy is not going to reverse your cardiovascular dysfunction or your mitochondrial dysfunction. It's in combination with. It's getting good to that peak optimization, which is what I'm always striving for, just to see what's possible and what does it look like in the future as we start to develop more regenerative therapies, I think. Finding great health with regeneration, that's an exciting future.

[00:56:03.400] - ROBIN BERZIN MD

Great. I think the whole field of regenerative medicine is in its infancy and is so exciting when we think about the potential to use things like peptides and stem cells to essentially do what healthy food is also doing, and our microbiome is also doing if it's healthy, which is to help the body heal.

[00:56:22.050] - KAYLA BARNES-LENTZ

Yeah. Actually, I would love to stick really quick question about cholesterol, just to go back. Let's see if those markers are out of range Do you believe in any of the supplements? Then what percentage of your diet really is impactful? Because I've heard mixed things. If you really change your diet, does it drop significantly? It can.

[00:56:40.590] - ROBIN BERZIN MD

You know what? It depends on the person. This is cholesterol is a really interesting thing. There are people with genetically high cholesterol where legitimately nothing they eat won't bring it down very much. They can be perfect. It will just stay high. Those people really benefit from medication. I mean, straight I will say to those patients, Listen, we're going to start. We're going to do six months, and we're going to really change your diet. We're going to get you into weight-bearing exercise. We're going to help you build lean muscle mass. Probiotics can be deeply helpful. I like Artiracil, which is a seaweed extract. It could be really helpful. We do some testing sometimes to see whether there are folks who are making more cholesterol or they're absorbing more cholesterol, and then we might address those two different things. I do not use red yeast rice almost ever because statins and red yeast rice are the same thing. They're both HOMG, ECOA, redactase inhibitors. They're both blocking the enzyme that makes cholesterol from the liver. Again, I'm not a natural or the highway type of person. I want to use the best tool for the job. If the mechanism of action is the exact same, for a lot of people, the medication is cheaper because it's covered by insurance and so on and so forth.

[00:57:59.720] - ROBIN BERZIN MD

But there are some supplements. A really great blend of soluble and insoluble fiber supplement could be dramatically really boring, really boring old fiber. It can be dramatically impact on people's cholesterol. What we usually do is say, Okay, here's where we're at. Let's begin, and we're going to address the diet. We're going to get your fiber content way up. We're going to make sure you're eating the brambles, as I like to say, all the veg and roughage and get you on high protein, healthy I'm going to look at, is your HDL really low? And that's something we have to work on. Is your HDL already in a good space? Is your triglycerides high, which often implicates people are eating a pretty high sugar, refined diet, a lot of pasta. They could be drinking a lot of alcohol, or maybe even a little bit of those things, but it's really knocking up their numbers. We'll use diet, we'll use certain supplements in a targeted way, and exercise. If they If we can do those things and do them really well and really consistently, you will often see all of those numbers come right back into range. For others, one of two things happens.

[00:59:11.760] - ROBIN BERZIN MD

One, they just can't do it. They do their best. They can't stick to it. I have patients for whom I've started with them, and they're maybe in their mid-forties, and they're like, I'm going to do it all. Every six months or however long we meet, and they're doing their best, but they're just really having a hard time I'm eating that way consistently, exercising consistently, and their numbers really aren't moving. I have a heart-to-heart with them, and I say, Listen, your numbers have moved a bit, but unless you're really consistent with this and it becomes your lifestyle, they're not going to get all the way there. For some people, that's a wake-up call, and they say, Okay, cool. I'm going to really commit. Others say, You know what? You're right. I'm never going to do this. I'm like, Cool. Let's acknowledge that right now. We can add additional supplements to see if that will move the needle, or we can add medication, and either a statin or a newer form to bring down your cholesterol to healthier ranges to avoid heart disease in the future. I have other patients who say, You know what? I don't want to take a medication no matter what.

[01:00:14.110] - ROBIN BERZIN MD

I say, All right, we're going to use the supplements, do the diet, exercise, because all of that is going to be great for your bones, your brain, your metabolism. We're going to make sure your blood sugar is in check. We're going to do heart scans, like Clearly or calcium score, whatever people have access to. We're just going to trend and watch. Some people say, You know what? I'm more comfortable watching, doing heart scans, proving to myself I don't have heart disease, living a I'm a healthy lifestyle, and I don't want to be on a medication. This is where the personalized medicine really comes in, because personalized medicine is not just about your biomarkers. It's also about your personality, where you live, your resources, and what you are legitimately willing do. Then there's a handful of people, like I said, they do absolutely everything right, and the numbers just don't get there. That tends to be just how they're built, genetic, ethnicity, background. Then we address that as we need to.

[01:01:15.540] - KAYLA BARNES-LENTZ

Well, that is super helpful. Thank you. What about... Actually, one more question. How much fiber do you like for women per day?

[01:01:24.960] - ROBIN BERZIN MD

I mean, at least 30 grams, ideally closer to 50. If you're targeting between that at least 30 grams, 30 to 50, the recommendation is 25. The average person is getting 15. If I have somebody that's going to 15 to 30, I'm pretty happy. It's a metric or a macro rather, that a lot of people don't keep a lot of track of. It actually can, by keeping track of it, really help you start to make healthier food choices.

[01:01:57.320] - KAYLA BARNES-LENTZ

Yeah, definitely. You're okay with those supplementation supplementation just to hit where you need to hit?

[01:02:02.240] - ROBIN BERZIN MD

Totally okay with supplementation. I also make it a fun game. I posted my snack haul from Whole Foods the other day for my flight, and I pack some snack foods. I like a snack food every now and then. I like a salty, crunchy snack. That gives me peace on a plane. I don't know what it is. It's just the thing that keeps my sanity. But my pea crisps, definitely not the healthiest thing in the world, people. These things fried. They definitely have... But you know what? They're organic. They have 5 grams of fiber per serving, whereas a potato chip, which is the equivalent, has 0 grams of fiber per serving. They have 5 grams of protein per serving. Now, I know it's not a complete protein. It's not enhanced with branched-chain amino acids, but there's some protein in there. I'm going to max out my omega-3s so that I'm at my 4 to 1 omega-6 to omega-3 ratio and not stress about that little one-time dose of canola oil that I had for my pea crest on the plane. I'm also going to add to that a whole bunch of fruits and vegetables. I had a massive salad.

[01:03:08.700] - ROBIN BERZIN MD

I think I had at least 50 grams of fiber on that flight on my way by my felt from New York to LA. I proved to myself that it was doable. One way of balancing the fact that, Hey, I'm on the go. I don't want to eat the plain food. This This food isn't healthy. I wouldn't eat this on a daily basis in my house, but I'm going to think about it the right way.

[01:03:38.140] - KAYLA BARNES-LENTZ

Yeah, definitely. I love that. I need to do a little bit better of a job tracking my fiber. I'm assuming I'm hitting it because every morning I have a ton of broccoli in my morning breakfast, and then I also have a ton of cruciferous vegetables at night, but I don't know if I'm hitting 50 grams or not.

[01:03:56.660] - ROBIN BERZIN MD

It's a good thing to just eyeball and get a sense of. A lot of folks, there's some great fiber supplements out there that if you're making a protein smoothie for your lunch or as your snack, just throw your fiber supplement right in there and you don't have to think about it as hard.

[01:04:11.400] - KAYLA BARNES-LENTZ

Do you have a favorite one?

[01:04:14.150] - ROBIN BERZIN MD

I'm not deeply attached. Sun fiber is pretty good. There's just the basic metagenics. Metafiber does the job. Under the hood, all those things are the same. What I care about is that they're clean and that they are what they say they are. We tend, partially, to recommend professional-grade brands because the safety profile and the accuracy profile and the efficacy, therefore, is so much higher than anything in consumer land, where people always ask me about consumer elements, and I'm like, I can't really say anything about them. I can't tell you that they are what they say they are. I just know that most likely they're not.

[01:04:52.010] - KAYLA BARNES-LENTZ

Yeah. So like, Metagenic, Thorn.

[01:04:54.830] - ROBIN BERZIN MD

Metagenic, Thorn, Orthomolecular, Xymogen, Designs for Health, Pure Encapsulations, APEX Energetics. These are all brands that are professional-grade. They sell through providers, generally, and they are safe, tested. They are what they say they are. Made in GMP-certified facilities doesn't mean that there's no consumer brand out there that's great. I've been super impressed with Seed, for example, and what that team has done around the research around having an actually quality consumer probiotic. But if you look at the research on this, 90% of probiotics on the consumer shelves are just sawdust or junk. It's really unfortunate because supplements get a bad wrap, and supplements can be really powerful tools. There's specific strains of Lactobacillus, for instance, that can be really beneficial for balancing blood sugar. But because the quality of so many of the supplements on the market is so bad, if you're taking one of those, then, yeah, you are going to get no benefit. I understand both sides of the argument, and it's just another example of how not everything is created equal.

[01:06:07.590] - KAYLA BARNES-LENTZ

Totally. Yeah, I agree. Unless, from time to time, I'll try some stuff for fun. Totally. But for the most part, I usually do like metagenics or Thorne, or my two favorites.

[01:06:18.610] - ROBIN BERZIN MD

When the consumer supplements send stuff and want to chat, I get on the call with them if I think they're reasonably legitimate, and I grill them. I was on one of these calls recently that I agreed to do, and they brought their lead scientist, and they were deep diving and all this stuff. I was like, This is great. What you're telling me is that all of the trials are preclinical, and none of this has any validated clinical benefit. That's fine. Cool. But I'm not going to make it something that I recommend as a medical intervention. I might say, Hey, this is a really high quality, pure version of this supplement, which might have benefit for, say, improving mitochondrial health. But I can't say that it's going to reduce your risk of disease. I think a lot of that distinction gets lost in the market and for most people. There are a lot of things out there that fall into what I call the can't hurt might help bucket.

[01:07:21.860] - KAYLA BARNES-LENTZ

Yeah, and I totally agree with that. I love Fullscript.

[01:07:26.920] - ROBIN BERZIN MD

Yeah, good old Fullscript. Yeah. Thanks, people at Fullscript. For making these things more available.

[01:07:32.150] - KAYLA BARNES-LENTZ

Totally. Yeah. I mean, plus there's been just so many wild studies of taking products off shelves at CVS and testing them. It's either way more than they said or way less than they said or not accurate ones.

[01:07:43.650] - ROBIN BERZIN MD

Yeah, or not bioavailable or the bugs are dead. It's crazy.

[01:07:48.230] - KAYLA BARNES-LENTZ

Yeah. But see, I had a chat with their owner, and she's amazing. And she really like... Because I used to be in this camp of there can't be a one-size-fits-all probiotic just because a lot of times, we'll do the GI test, the Genova, and it requires. You would have now more in the camp of having the one, but then targeting all the other ones that you actually need, really, specifically as well.

[01:08:11.260] - ROBIN BERZIN MD

I also recommend that people understand that a probiotic is like a traveler passing through town. It's shifting and shaping your microbiome and having influence on it. But who truly takes up residence in your gut is a matter of what you eat every day. The foods you eat and drink and the medications that you take and the things you put in your mouth every day are much more important for shaping who lives and who dies in your gut than any probiotic you take. With that said, probiotics can be really great and have been super impressed with seed. There's also lots of other companies that have been really committed to making something that's high quality.

[01:08:56.840] - KAYLA BARNES-LENTZ

Yeah. I'm meeting lots of pomegranate It's these days. Good. Trying to get down natto, which tastes awful.

[01:09:05.470] - ROBIN BERZIN MD

It tastes terrible. I can't eat it.

[01:09:07.160] - KAYLA BARNES-LENTZ

I'm getting through it somehow.

[01:09:09.120] - ROBIN BERZIN MD

Well, we have now come across the distinction between Kayla and Robin, which is that Kayla will eat natto, and Robin will eat canola oil drenched pea crisps once in a while. And therein lies the divide.

[01:09:25.620] - KAYLA BARNES-LENTZ

You are so funny. Yeah, it doesn't taste good, but I'm really trying to get like, there's acromantia in this, right? What do you think are the main... Because not only do we know that women are experiencing more health problems, living with more chronic disease, but I also saw a stat the third day that by 2050, I think the current average lifespan in California is 79. But by 2050, there seems to be a precipitous drop, but most specifically in women's health. What are the few things? We talked a lot about biomarkers and maybe some ranges to look at, obviously working in functional medicine. But is there anything else that you would really significantly recommend for women to start today if they can or in the very near future?

[01:10:12.370] - ROBIN BERZIN MD

Number one, get your macros right. Making sure that you're having 25 grams or less of total sugar per day, getting somewhere between 0. 7 and 1 gram of protein per pound of body weight a day. That range is because everybody's a It's a little different, and not everyone's trying to be a bodybuilder and massively bulk up. Some people have bodies will put on muscle really great with 0. 7 grams. But if you're getting 0. 2 grams, which is like a lot of women are, you're not going to be able to build any muscle mass. Getting healthy fats into your system. I drink a teaspoon of really high-quality olive oil every day. I just drink it. Getting on a high-quality tested fish oil supplement, eating sources of low-mercury, high-quality seafood. These things are building your brain. They're building your hormones. That fat, protein, fiber, low sugar mix, those macros, critical. Then you can start to think about your micros, meaning your micronutrients, and that's just eating the rainbow. All of those phytonutrients, those fancy words like anthocyanins and all these things that we talk about in podcasts like this, they are all of these little chemicals that are information for yourselves.

[01:11:27.790] - ROBIN BERZIN MD

One of the things I deeply agree about with some of the, let's say, leading gentlemen doctors in the longevity space is that a calorie is a calorie. I know. A calorie is not a calorie. And yes, your macros are critical, as I just explained. Shooting for that 30 to 50 grams of fiber a day, making sure you're getting a couple of grams of EPA DHA a day, like 2 grams, 2,000 milligrams. But your micros matter, too. And I'm sorry, 100 calories of soda 100 calories of broccoli are not doing the same thing in your body, from cellular signaling to the impact on insulin spikes and blood sugar and getting diabetes, to the fact that broccoli has Indle 3-carbidol and other phytochemicals that are plant-based chemicals, which are helping you metabolize and digest your estrogen so that you don't develop cancer. Getting those phytonutrients, food is 70-80% of the battle for a lot of people. Then exercise is nature's medicine. That I do agree with the after mentioned male longevity doctor community. Building lean muscle mass and then with it, bone strength. One of the misrepresentations I see in women's health right now is that you can just wait to menopause or even perimenopause and then start hormone replacement therapy, aka HRT, and that will work its magic.

[01:13:02.210] - ROBIN BERZIN MD

Hrt is one piece of the puzzle. It won't build your muscles, it won't build your bones, it won't make you lose weight, it will not reverse dementia. It needs to be paired with building the muscle mass, doing impact and weight training to build your bones, getting your Dexa to understand where you're at when it comes to body composition and bone density. If you really look at your food and your movement, those two things will go a massive amount towards your longevity, but also looking good and feeling good right now. That's really where I recommend people start, even before the bloodwork, even before the fancy supplements that we all talk about. There are some supplements that are critical. Vitamin D3K2, I take every single day. Methylated B vitamins, which help me detoxify. They help me make neurotransmitters. They help me metabolize my hormones every day. They help me tremendously with mood. I have two copies of a genetic variant called MTHFR. I have seen how when I'm taking my methylated bees, I am a much happier version of myself than if I stop them for a week or two. Wow, it really shows up. Those things can be additive, right?

[01:14:18.370] - ROBIN BERZIN MD

Getting testing is imperative. A lot of women are walking around with chronic diseases they don't know they have that are not, say a lot of your friends and family diseases. They are diseases that can be managed, that can be treated, that can even be reversed. It's the food, it's the testing, and it's the exercise. Those three things can dramatically change your life trajectory.

[01:14:44.360] - KAYLA BARNES-LENTZ

Absolutely. I couldn't agree more. It's been such a pleasure to have you here.

[01:14:49.710] - ROBIN BERZIN MD

Gosh, thank you for having me. It's so fun.

[01:14:51.090] - KAYLA BARNES-LENTZ

Of course, yeah. I'll see you later. I'll see you later. We're going to have a fun talk tomorrow. I know. It'll be a good day. It'll be a great day. Thank you for being here. Thank you. This podcast is for informational purposes only, and views expressed on this podcast are not medical advice. This podcast, including Kayla Barnes, does not accept responsibility for any possible adverse effects from the use of the information contained herein. Opinions of their guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. Individuals on this podcast may have a indirect financial interest in products or services referred to herein. If you think you have a medical issue, consult a licensed physician.