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Coming up on the Getline e Klean podcast,
For a middle-aged male, total testosterone you would expect optimal to be between about 500 and 1100. Free testosterone between about 12 and 29 nanograms per deciliter. Picograms per mil is sometimes also used, which is a factor of 10 different. And then for estradiol as high as possible without symptoms, but in general, a ratio of about three to one estradiol to free tea. For example, if your free tea is 20, your estradiol could be 40 to 60, which is about two to three times higher.
Hello and welcome to the Get Lean ean podcast. I'm Brian Grn and I'm here to give you actionable tips to get your body back to what it once was, five, 10, even 15 years ago. Each week I'll give you an in-depth interview with a health expert from around the world to cut through the fluff and get you long-term sustainable results. This week I interviewed Dr. Kyle Gillette, a dual board certified physician in family medicine and obesity medicine, and an expert in optimizing hormone levels to improve overall health. We discussed Dr. Kyle's six pillars of health, along with our calories Important to track will zone two cardio, improved mitochondrial health, important blood panels to test Dr.
Brian (1m 26s):
Kyle's favorite supplements, and is one tip to get your body back to what it once was. Really enjoyed my interview with Dr. Kyle. I know you will too. Thanks so much for listening and enjoy the show. All right. Welcome to the Get Lean E Clean podcast. My name is Brian Grin and I, I'm Dr. Kyle Gillette, welcome to the show.
Kyle (1m 45s):
Thank you for having me, Brian. A pleasure.
Brian (1m 47s):
Thanks for coming on all the way from Kansas. And you have a, a practice there as well, correct?
Kyle (1m 55s):
Yeah, I have what I call a health optimization clinic. It offers direct primary care for locals individualized medicine, which is basically just the whole conglomeration of evidence-based medicine, whether your needs are functional or hormonal or fertility or aesthetics or whatnot. And then a concierge practice as well. And we also do telemedicine.
Brian (2m 15s):
Wow, that is great. Do you see this as like a growing trend in the medical community, what you're doing out there?
Kyle (2m 24s):
I don't think individualized medicine is necessarily a growing trend. There's a few healthcare clinics and a few physicians that do individualized re regimens, but often that requires attention to mechanism of action. So not just knowing what to do according to the algorithm, but also knowing what to do given different situations and understand each person's physiology, get good objective data like labs and diagnostics, and then explain the benefits and detriments in layman's terms to each patient depending on their genetics and their situation.
Kyle (3m 5s):
However, there is a huge trend of like med spas that dabble in hormones or hormone clinics that dabble in functional medicine or functional medicine clinics that dabble in hormones. But I consider those kind of different entities.
Brian (3m 21s):
Yeah. I recently had on this gentleman, Dr. Michael D. Young, he was urologist for 30 years and a surgeon and he, a lot of his talk was how, you know, the medical community, there's not a lot of training as far as nutrition and like preventative medicine is concerned. What type of, I know you're a board certified physician, but what type of other education did you sort of go down routes? Did you go down in order to, you know, provide such a service?
Kyle (3m 49s):
Yeah, I'm board certified in obesity medicine, which does have a lot of training in nutrition, especially if you go to a reputable place like N I h and Columbia has a combined institute of nutrition, I believe. Okay. And they have some great C M E programs. In addition, I'm also board certified in family medicine and I chose a residency that really emphasizes food as medicine and exercises, medicine, which is in Heartly two of the fastest growing student interest groups in medical schools across the country in general. I think the Midwest does a great job of emphasizing primary care in medi in like medical school.
Kyle (4m 29s):
However, during residency education, and there's many reasons for this, I'm just kind of stating the problem, if you will. We have the least qualified and the lowest scoring medical students going into the most complicated broad spectrum specialties like family medicine and internal medicine. So that's, you know, that's the problem. Laid it out there. There's many things that can be done to help, but I am glad that many residencies are emphasizing food is medicine and exercise is medicine, for example.
Brian (5m 2s):
Yeah. Yeah. That is definitely a growing need. And what would you say, I noticed you talk about like six pillars of health. You know, I, I, I, excuse me. Interesting that you have that cause I do, I work with individuals and I've sort of like my six pillars. I'm curious what yours are as far as when you start working with an individual.
Kyle (5m 23s):
Diet and exercise are the first two and I just added a seventh one too. Oh, okay. Convince me to social health is the seventh one, but the last five are all S'S due to alliteration and they're easy to remember. Sleep, stress, social spirit. And I believe there's one other one that I haven't said yet. Sunlight. So sunlight's like sunlight. Yes. Exposure, hot exposure. Being outdoors, humans are not meant to be indoors, so we have not been primarily indoors for quite some time and we have not had the, like the same temperature control and electricity for a long time.
Kyle (6m 5s):
So, but anyway, I, I like to say that these interventions are more powerful than any medication or supplement and they're like the first thing to look for when either treating a, a pathology or optimizing a specific marker of health, like athletic performance or cognitive performance.
Brian (6m 22s):
Yeah, no. So we're right on the same wavelength here and you added in social. Yeah, I, I like that. Especially cuz just like with the whole pandemic, like people, everyone's just not used to being around other people and having like that social interaction. Is that, is that the reason you sort of added that in?
Kyle (6m 41s):
That's one of the reasons, another reason is as I walked into Rich Rolls podcast, I was traveling with my kids and they are both toddlers and both of my boys were just screaming and having fits. So a lot of times the health of the family unit can have profound implication on each individual's health. For example, it's well known in nicotine cessation that like in general all nicotine outta the house, that helps. But everybody in the family attempting to quit at the same time is far more successful. And it's the same thing for any other thing that you're trying to achieve.
Brian (7m 21s):
Yeah. If if it's done in a group atmosphere, it there's a lot more, you're not a lot more apt to change.
Kyle (7m 28s):
Yes. What, what are your six by the way?
Brian (7m 32s):
Yeah, now you put me on the spot.
Kyle (7m 34s):
Sorry I put you
Brian (7m 35s):
On the spot. No, no. Yeah, no food, meals obviously what you eat when you eat. So I do, I've, that's all one. And then sleep, stress, creating clarity and what else am I missing? Sound like you, I you you like have it in your head. Sleep, stress, mindful. Oh like meditation as well. So do, do, is that something you talk about as well with individuals is some type of mindfulness practice?
Kyle (8m 7s):
Yeah, I would consider that to mostly be under the spirit pillar of health. Yeah. Okay. Also the stress pillar of health kind of go hand in hand, but whether it's mindfulness or whether it is meditation or prayer or different types of like subsets of yoga, I think all can be helpful tools and it kind of gets at that interplay or the interconnectedness between your, cuz it's body, mind and soul between your mind and your soul. And your soul is kind of meta, it is metaphysical, it's where you are on Maslow's hierarchy of needs, what you're looking at in that very top of the pyramid, which is self-actualization and then that has very close interplay with how you are fight or flight, arrest and digest or balanced or just your mental health wellbeing in general.
Brian (9m 0s):
And do you believe that there are actually positive stressors that individuals can incorporate into their lives? I know you talk about like sunlight and cold exposure and you know, warm therapy and things like that.
Kyle (9m 13s):
Absolutely. Stress is kind of like effort. If you learn how to enjoy the effort or enjoy the stress, then that is going to cause a positive feedback mechanism where it helps not only your like resilience, science and mindset like Dr. Kram often talks about, but also your hormonal health. So we know that there's definitely a bit of a positive feedback loop when it comes to, for example, testosterone production where you achieve something that is very difficult and then you have that not just dopamine but also testosterone improvement soon after. Now one instance is probably not gonna make a huge dis difference, but cumulatively and consistently over time at camp.
Brian (9m 58s):
Do you think that, I mean I always talk about these stressors, right? Like fasting calorie restriction, even carb restriction, these stressors I've had like some individuals on my podcast recently Jay Feldman talking about more like this bioenergetic viewpoint. I don't know if you've heard of any of that with Dr. Ray Pete who actually recently just passed away, but, and they talk about that, you know, for example like car restriction, these are stressors, they cause these counterregulatory hormones to increase and could cause issues with thyroid and things like that. What, what are your thoughts around that as far as hormonal health with all these stressors?
Kyle (10m 40s):
So I suppose the dose makes the poison with a lot of stressors, especially when it comes to diet. Some things like trans fat and margarine potentially can be a lower dose. Some things require a much higher dose. For example, for one of the 10% or so of metabolically healthy individuals in the United States. Even something like a drink with a whole bunch of sugar in it like refined sugar is not necessarily a stressor. So, and I think your approach is very similar to that as well. It's unique. Some people just literally have a genetic polymorphism to where they tolerate carbohydrates better without developing insulin resistance.
Kyle (11m 22s):
So that, so I don't wanna just answer that, it depends because everything depends. But yes, stressors definitely make a big difference in hormone health. One of the most well known, I guess, widely applicable strategies is when you look at individuals in a significant caloric deficit. So you know, not just 50 calories a day, the group that goes on a very low fat diet does have significant decreases in sex hormones. For example, testosterone. So finding healthy fats, especially when you are in a like a significant diet is of importance for maintaining good hormone health and good lean body mass and then good metabolism and less chance of rebound.
Brian (12m 8s):
Got it. And regarding calories, it's a always a hot topic talked about. And what, what is your, what are your thoughts around calories in calories out as far as that, that, as far as that's role with, you know, diet and, and you know, maintaining weight and, and also, well I got something to piggyback off that, but go ahead and you can answer that.
Kyle (12m 31s):
Yeah, for sure. I love talking about calories and calories out. Obviously you're not gonna break the laws of thermodynamics calories and calorie tracking is one of my favorite tools. One of them. But it is not the only tool. So the problem with that is when you respond to any actionable item or any tool to help with body composition maintenance or changes with no calories in, calories out matters more, then it downplays the importance of other factors. For example, on my nutrition prescriptions, there's like six or seven different things that I like to circle and then ones I add in sometimes, for example, number of meals per day or eating speed or number of plates per each meal.
Kyle (13m 19s):
For example, take what you normally would put on one plate, put it on three different plates, eat one plate, wait five minutes, eat a second plate, wait 10 minutes and then eat a third plate. If you're still not satiated, macronutrients is another one that can be added in from time to time. Slow bites can be added in from time to time using different tools to eat by chopsticks, they eat a lot of different things
Brian (13m 43s):
That would take me a long time to eat. Yeah,
Kyle (13m 46s):
I'm not so good sometimes. Yeah. And sometimes that can be therapeutic as well. But anyway, there's a different tool for each situation for people that are stuck in quicksand, there are different types of quicksand, they need different tools and we also need different unique tools depending on our situation.
Brian (14m 6s):
That's interesting, the different techniques you talked about with putting it on different plates using chopsticks. I'm a big golfer. I'm, I'm just making me think about how there's many ways to learn one thing, right? And that's, that's, that's interesting. You could tell somebody eats slow but they, what does that mean? Like what they might not do, you know, they're, they're looking, they're they need something or almost in their way to make that mean. So same thing with golf, but we won't get into that. Right. Interesting. So how do you get a good measure? Cause my only, you know, ob obviously calories do matter. I, I'm not like totally a against that. I, I don't a lot of times like with calorie counting, how do you constitute that as far as the accuracy of it and then even if they're absorbing everything that they're taking in as well as like calories out, like it just seems like it's a bit am ambiguity, there's a lot of ambiguity around that.
Brian (15m 6s):
And so how do you go about creating accuracy for that?
Kyle (15m 11s):
You could be as scientific or you, or I guess you can be as quantitative or qualitative as you like most people who track calories, it is a very qualitative thing. They are not in as much of a deficit. For example, physicians and dieticians, when they are asked to track calories burned and consumed, they overestimate the amount of calories burned by at least 10% and underestimate the amount of calories consumed by at least 10%. And then for your layman it is going to be significantly higher numbers than that. So that being said, you can qualitatively still use that tool.
Brian (15m 55s):
Kyle (15m 57s):
And I, or you can quantitatively use that tool. You can track your R M R and you can measure it usually at places where you get DEXA scans and then you can like by food services, there's a whole bunch of ways. Most of the time patients have already tried calorie counting and one of the biggest pearls that I have found is that if that's the first thing you go to and there is someone who usually by the time they've found a board certified obesity medicine physician, they've seen a few other professionals and tried it on their own. And if they're like heart is set, that calorie counting does not work for me, then you don't destroy your rapport and then lecture them about how calories in equals calories out.
Kyle (16m 45s):
You might find a tool like tracking macronutrients, which you can estimate their calories from the macronutrients. So maybe they would have better success utilizing that in other tools.
Brian (16m 55s):
Yeah, I mean I've tracked my, my own calories here and there and I find that like, at least for myself, I don't know about you Kyle, it's like you eat the same stuff week and week for the most part. So once you do it for a week or two, you have an idea of of you know, how much you're consuming on average per per day. What are your thoughts around like macronutrients are, are, do you, you know, you you, someone comes to you and you know they obviously wanna lose weight and most people want to lose it really fast even though it's taken them decades to maybe put on this weight. Do you, do you take a certain approach as far as macronutrients is concerned?
Kyle (17m 35s):
Usually my approach of macros is ensuring that they have enough high quality protein sources just like carbs, fats and proteins are not created equal. I have done deep dives in the Gillette Health Clinic podcast into like each of these because there's a lot of medications, for example Omega-3 Ethel, that's a type of fat. But regarding protein you wanna make sure that you have in general about 0.8 and depending on the individual it can be of course be slightly higher and lower 0.8 grams of protein per pound of body weight per day. Which
Brian (18m 14s):
Is what do you, I'm sorry to interrupt you. Do you say per pound of body weight or desired body weight?
Kyle (18m 20s):
I, I usually say per pound of body weight. Okay. For desired body weight it could probably be less than that. In general, usually I just put the caveat in there that depending on the person it can be slightly more or slightly less. So for someone that is, that weighs 400 pounds, that is over 50% body fat and that can obviously be, does not have to be over 300 grams of protein per day.
Brian (18m 45s):
Okay, gotcha. Sorry to interrupt, I just wanted to get
Kyle (18m 49s):
That. Yeah, no it's, it's a good clarification. It's actually a pretty good idea as well.
Brian (18m 54s):
And then so you got protein obviously I always talk, you know we talk about prioritizing protein and then from there as far as obviously fats, where do you go? Is that a lot of times just maybe cooking in the right type of fats, things like that?
Kyle (19m 8s):
Yeah, using the right types of fats to cook. Perhaps chatting with the dietician about smoke points, especially if like knowledge regarding fats and how they can change is not great. And then also thinking about fats that you may not be aware that you're adding. And in addition I'd love to talk about alcohol, seven cows per gram. So pretty high caloric density macronutrient there. And liquid calories in general, whether it's fat or alcohol or carbs, I love to talk about liquid calories and then fiber because a lot of fibers actually have calories as well for example like allulose versus ISOs.
Kyle (19m 50s):
Some they don't have, they're they're carbs so they don't like have 0.5 calories per gram but you might absorb one eight of them so they're like you know per gram how many calories are, are you needing to burn is often lower. So thinking about a lot of those other additions is something that can be clinically significant.
Brian (20m 16s):
And this is going back on your point regarding, because I do DEXA scans with my clients along with myself. We have a lot quite in the, in the area but I just got one done recently. Did you mention that it gives you your B M R or your,
Kyle (20m 30s):
A lot of places like DEXA fitt you'll be able to, they have like a couple different offerings. Okay. And usually try to upsell you a package where you get your B M R and your VO two max and Okay. Et cetera, et cetera.
Brian (20m 46s):
Got it. Got it. Yep. Is that something you use with clients? Do you have them do Dexus? Cause that's something I, I've been trying to do for most of my clients.
Kyle (20m 55s):
Dxa is my favorite thing to test of the three VO two max isn't terrible but usually I do not have them do metabolic rates based on metabolic rates. Dexo is a couple other things, couple other clinical pearls if you will. Yes. If you change the amount of carbs you're consuming, you'll have to think about glycogen depletion and repletion and how that shifts water and water weight which is detected as lean body mass. Same things for creatine. But in general if you're like diet hasn't drastically changed, dexis are pretty good longitudinally over time.
Brian (21m 34s):
Okay. So there could be a, a few downfalls with dexa meaning it might detect, might detect, what'd you say? Lean mass when it's really just water. Is that, is that what you were saying?
Kyle (21m 47s):
Brian (21m 48s):
Okay. Yeah cause it's inter, I I, I just did one, I'm doing this little self experimentation where I've added in an extra meal cuz I used to just do a couple meals a day and do a little bit more fasting and I was like, you know, thyroid was maybe a little bit lower than I, I thought so I been implementing carbs more into my diet and, and yeah I'm gonna be doing a podcast on it soon. But definitely went up in body fat percentage. But I mainly whole food carbs like fruit and things like that. Do you have ways to target and use fruit as, as something, cuz this is, you see this coming with some of the, the carnivore craze, some of the, with everyone that's been so low carve for so long and perhaps maybe it's taken a hit on their hormonal health.
Brian (22m 29s):
Do you see adding backs, things like fruit as as beneficial
Kyle (22m 33s):
And healthy carbs can certainly help increase free testosterone and decrease S H B G, which is the protein that binds up androgens and estrogens. So it can be helpful as most people are aware not all fruits are created equal and chopped up fruit is not equal to whole fruit
Brian (22m 54s):
But don't chop it up.
Kyle (22m 55s):
Brian (22m 57s):
What about food combining? Do you have any thoughts on that?
Kyle (23m 1s):
I'm not, I don't think I'm familiar with what food combining is. What, what's that
Brian (23m 5s):
Concept? You know, sometimes people will say oh you should eat a certain food by itself. You know, sometimes mixing like fruit with other things or it, yes.
Kyle (23m 15s):
So yep, no, definitely significant. Especially when it comes to artificially or low or no calorie sweeteners. Okay. So there's been decent studies done and there will be a lot more, cause that's another super hot topic,
Brian (23m 31s):
The sweeteners. But
Kyle (23m 32s):
Yeah, consuming like liquid or just artificial sweeteners in general or natural sweeteners can like potentiate the glycemic response of a meal. And not all high glycosylated in product foods, which is basically foods that are known to increase things like glycosylated, albumin a1c, markers of diabetes essentially. Not all of those are elevated just due to carbs so. Right. Yeah, I, I guess I do think that that's a fairly important concept but not as much, I'm not sure what the premise of it is if, if it's like eating fruit and meat separate, I wouldn't think so.
Brian (24m 18s):
And then as far as sweeteners, you know, obviously you see like St Stevia is in like everything, which I guess has been, I don't know, you know, what are the studies around that and which sweeteners or maybe people should avoid?
Kyle (24m 32s):
Yeah, a good concept to think about when it comes to artificial sweeteners is there is an opportunity cost for not utilizing an artificial sweetener. And that's, you are much more likely to seek out, especially if you intuitively don't track your calories, you're much more likely to seek out other sources of sugar which have many more calories. So the there, there's actually a lot of, a ton of things are potential carcinogens but are not clinically significant carcinogens. And the artificial sweeteners that are allowed for use, for example, sugar, alcohol, erythritol, aspartame, stevia, xylitol in reasonable quantities.
Kyle (25m 18s):
In my opinion, none of them are consi concerning carcinogens. Especially when compared to, you know, like an equitable dose of just consuming glucose. Developing that insulin resistance in metabolic syndrome is definitely a higher cancer or neoplasm risk. Yeah, sorry if that question rabbit trailed a bit. But in general I am not anti artificial sweetener. I consume some artificial sweeteners myself. It is interesting that stevia has become so prevalent. I try to consume everything in moderation and try to consume as few as possible for people that have a lot of a sweet tooth or they're driven to seek out sweets, they might need to watch it more closely just to keep in moderation.
Brian (26m 7s):
And, and on that note, what is like your typical routine? I'm, I'm a big routine guy. Morning, night, sleep routine. What type of routines do you implement into your day?
Kyle (26m 19s):
I like to eat in the morning and a lot of times I eat eggs. We have chicken like pasture raised chickens out back. Oh nice. They lay a lot of eggs and I like that in general I like to have a protein shake combination of like whey albumin and casein in the morning and after that I exercise not because it's best to exercise first thing in the day day just because that's when I can do it. And then is
Brian (26m 49s):
There a reason you, is it, I'm sorry, you have, so you have eggs and then you bake a shake. Is there a reason you do a shake as opposed to eating foods?
Kyle (26m 56s):
Convenience. Okay. Only convenience. Got it. Of note, I suppose eating whole foods is nearly always better. I try not to consume any liquid calories at all. At one point after I had my first son, I lost probably 40 ish pounds, mostly, mostly body fat but not all. But at that time I did very few interventions. I cut out all my liquid calories with the exception of two, two adult beverages every two weeks. And then I had a Casey and protein shake, which can increase prolactin a bit, but it, it is good for satiety along with a bit of oats.
Kyle (27m 38s):
This was in when I was in residency, so although I don't think time was any more shortened residency compared to now. Right. But anyway, that's basically what worked for me. And I also consumed foods that I really loved a ton that are of high nutrient density but low caloric density. So for me that was spinach, Greek yogurt and egg whites.
Brian (28m 1s):
That's what you consuming now or what you used to
Kyle (28m 4s):
Consume? I used to consume a lot of those from time to time. I still do now, but when I was attempting to be in a caloric deficit and have weight loss, I enjoyed consuming those and they made me feel like I was not hungry, which I liked.
Brian (28m 20s):
Got it. So high nutrient dense foods. So what I, so you'll work out af mid-morning, let's just say, then you probably go to your practice.
Kyle (28m 29s):
Brian (28m 31s):
And then what about evening routine? Anything around there? I know you have two, how old are your kids?
Kyle (28m 37s):
One just turned three and one is 17 months. And we try to eat dinner at the dinner as a family. We use the, we decide what you're eating and when you're eating and they decide how much and when they're done and that seems to work pretty well. Then after that we usually just play around, play little tykes basketball, maybe wrestle and then it's bedtime and then, so yeah, absolute, absolute pandemonium during bedtime. After that I can relax a little bit, catch up on work that I haven't done from earlier that day, perhaps talk to the wife and I tried not to eat after bedtime but sometimes it can be hard
Brian (29m 21s):
And outstanding. Okay. I like to know people's routine. It's
Kyle (29m 26s):
Fun. Yeah, it's, it's not a perfect routine but it's what I have gotten used to and it, it works well enough when I'm in a main space like this.
Brian (29m 37s):
Yeah, I hear ya. And let's t you know, I, going back to your pillars of health, obviously sleep and stress and then you got social. We talked about, you know, sunlight. I'm a big fan of walking. I, well I have two dogs so we walk probably we average like three walks a day, no matter the weather. What do you, what do you emphasize for clients around sunlight? And you even mentioned some cold. I actually have a cold plunge. I put one in, I've had it for like a year. It's like unbelievable. It's great. But anyways, thoughts around sunlight, walking, you know, some stressors that you, you you like to recommend?
Kyle (30m 19s):
Extremely helpful. I, I do try to get my morning sunlight ala Andrew Huberman and I just try to get my evening sunlight as well. We have two wolf founds so we're taking them on walks very often, usually after dinner and then on the weekends after breakfast, lunch and dinner and then noon hour at the office. Myself and as many staff as possible do like to go out when the sun is very strong and take like a 15 to 20 minute walk. So I think that helps us power through the afternoon. Well
Brian (30m 50s):
Yeah, I always say walking is one of those just like biohacks that is simple should be fairly easy for most people. Is this something that you try to get your clients to do maybe right off the bat?
Kyle (31m 1s):
Yep, absolutely. When I was in residency we had something called Walk with a Dock where patients could just literally show up at this nice central park location. Oh And we'd all just walk cuz it's one of the best things that you can get in a good habit of doing. But yeah, walking is not the only exercise people should do. There should be a combination of resistance training and basically cardio and you do have to walk pretty fast, really fast in order to get into zone two. Not everybody's able to do it.
Brian (31m 32s):
And I was actually just gonna touch on that zone two, you know this is coming up obviously Peter, Dr. Peter Teo has talked a lot about it. Maybe explain to people a little bit about that, if that's something that they want implement.
Kyle (31m 44s):
Yeah, zone two is relatively easy cardio, you're not killing yourself, you're usually able to do it for a very long period of time. You can look at your heart rate and calculate based on like your maximum heart rate and where you are for the other zones, what your zone two would be. For most people it's you know, around one 10 to 1 35 40. But it depends on the person. A good rule of thumb and you don't necessarily have to track your heart rate the entire time you do zone two looking at your fitness tracker to see if you're still in, you can but a, a brisk, somewhat difficult pace but you can still talk through it is a good rule of thumb.
Brian (32m 22s):
And what is all, I guess maybe couple reasons why zone two is, is beneficial?
Kyle (32m 29s):
It's particularly good for mitochondrial health zone two and then also REM sleep. That's gonna prevent, it's like the number one and number two things to prevent mitochondrial damage. You can take a full stack of mitochondrial health supplements and they're still not gonna benefit as much as just the zone two and the REM sleep.
Brian (32m 48s):
And regarding REM sleep, cuz obviously sleep is a big one, what do, do you use any supplementation for individuals that maybe need help with sleep or do more or less So look at maybe like their sleep routine and ways to, you know, maximize their, their sleep quality with that?
Kyle (33m 4s):
Yeah, just like any other health optimization parameter, often both the medications and supplements are just tools, whereas the lifestyle interventions are the actual work or digging or or whatnot. I do like the ten three two one zero rule within 10 hours or so, no caffeine or if you know your genetic polymorphism of how fast you metabolize it, you can go sooner or later than that. But in general, nobody should be consuming caffeine within 10 hours just because of adenosine signaling. And then three hours would be, no, I believe it's no, no exercise, no vigorous exercise within three hours or no food within three hours, two hours, ideally no food at all.
Kyle (33m 52s):
And then one hour no bright white or blue lights and ideally no screens and then zero snooze in the morning.
Brian (34m 2s):
Oh, how come? No, no, no snoozing you should just get right up. Right.
Kyle (34m 6s):
Yep. It, it's kind of like, I forget if it's called Pavlov's dog, but it gets you in the habit of alarm goes off. If you need to wake up to an alarm, you are up also your circadian clock will a lot of people do this and when I get up at the same time I do this as well. You wake up like five minutes before your alarm, 10 minutes before your alarm. Yeah. That's not a coincidence. That's usually because you don't snooze as much.
Brian (34m 35s):
Okay. Yeah, you know what I'm, I usually tell myself I, I sometimes I sit an alarm but usually I'd be like, you know what, I wanna get up at this time and I get up. Is that like a, is that, is that a good sign? I don't know, I, I tell myself when I wanna get up and I get up usually at that time
Kyle (34m 50s):
Definitely a good sign.
Brian (34m 51s):
Okay, good. Unless like now you're in Kansas, I'm in Chicago. It is dark. I mean we haven't had sun in like I think this is the ninth straight day without sun. So yeah,
Kyle (35m 3s):
It's been pretty dark here.
Brian (35m 5s):
Okay. Anyways, so zone two cardio. Okay. And then what thoughts around like I just did a big blood panel actually I just got blood work done, I'm waiting back on the results but I usually do that every, I do that in in combination with the dexa, certain blood work parameters that people should look at. I know that obviously you talk a lot about hormonal health. What, what things should people maybe be at the forefront of their mind for, for blood work,
Kyle (35m 34s):
Fasting insulin a1c. There's no reason why everybody shouldn't be getting an a1c. And then S H B G, which is that protein sex hormone binding globulin that binds up all your other hormones, definitely A C B C C M P lipids, which are pretty routine. If your lipids are high, especially an L over about 130, then get a APO B, which is APO lipoprotein B, it's a better marker to track for risk of heart attack and stroke we call A S C V D. In addition, as far as hormones, you definitely wanna get a T S H and if you were at risk or have hypothyroidism, you wanna get free thyroid hormones and possibly even more.
Kyle (36m 21s):
And you also wanna get a C R P, which is a marker of inflammation. Also conveys cardiovascular risk. A lot of people should also get a homocystine, which is another inflammatory marker. But it also has to do with like how well you are utilizing your B12 and folate, how well your methyl donation is and how much inflammation you have in your body. I think of it as oxidative stress. And then testosterone estradiol, which is your main estrogen and progesterone for most people. And then IGF one, which is a decent marker of growth hormone, just those labs, that's basically what I call my essential panel.
Kyle (37m 5s):
But a lot of other people, a lot of other, I guess businesses that sell labs direct to consumer, they call it like a comprehensive panel. But for me that's just the essential panel.
Brian (37m 18s):
Right. And gosh, I was gonna ask you regarding hormonal health, you know, are there certain levels, I mean you talk about testosterone and you know even D H E A and thyroid, are there certain levels that you look for with let's just say middle-aged men?
Kyle (37m 39s):
Yeah, for a middle aged male total testosterone you would expect optimal to be between about 500 and 1100. Free testosterone between about 12 and 29 nanograms per deciliter. Picograms per mil is sometimes also used, which is a factor of 10 different. And then for estradiol as high as possible without symptoms. But in general a ratio of about three to one estradiol to free tea. For example, if your free tea is 20, your estradiol could be 40 to 60, which is about two to three times higher.
Brian (38m 19s):
And explain estradiol just for the listeners,
Kyle (38m 23s):
Estradiol is the strongest estrogen, you also have estriol and estr, but estrodiol is by far the strongest. It binds to many receptors, but estrogen has a whole bunch of receptors, seven or more. But some of the most important ones are estradiol alpha and estradiol beta. Depending on the ratio of those two receptors that you were born with or inherited in your prostate, that has a huge implication for prostate cancer risk. In fact, a lot of things that block specific estradiol receptors can be used for both breast cancer and theoretically prostate cancer as well. Then it also has to do with how fast your growth plates and your bones will close.
Kyle (39m 4s):
So estradiol closes growth plates, but it also accelerates growth. It helps with something called type three collagen synthesis, which is the collagen that's in keloids that helps with like elasticity of the skin or very fast scar formation. So if your wounds are healing slow, then you might have too low of estradiol. And then last, and most importantly, estradiol helps with normal lipid metabolism and platelet formation. So if you have deficient estradiol, we know that those individuals are certainly at risk of heart attacks and strokes because of it.
Brian (39m 35s):
And you said estradiol Pretty much as high as you can get it without,
Kyle (39m 40s):
Without symptoms. Okay. And probably not higher than about three to one estradiol to free T ratio. And that's for people with a normal S H P G.
Brian (39m 53s):
Got it, got it. And I know you talked a little bit before about gene, like do you look at gene SNPs and certain ones for, you know, for example, like I've, I've done the 23andme and, and taken a look and put it, I believe Dr. Rhonda Patrick has some, you know, just software you put Promethease, what's that?
Kyle (40m 13s):
Brian (40m 14s):
Okay. Where sort of takes your, your gene SNPs and sort of parses them out and one of 'em, and I forgot the name of it and maybe you can re re remember for me, but the one where you don't absorb, you don't, I guess absorb or digest saturated fats as well. Is this something, do you have most of your clients do some, well some people might not be for it, so they might not wanna do it, but like do do have them do some type of gene testing?
Kyle (40m 41s):
Yeah, occasionally look at things like that. If you look at lipid metabolism, it can tell you some clinically significant things for pharmacotherapy. Like if you're a good candidate for ezetimibe, also an zetia or not, which affects lipid metabolism. There's also useful SNPs for example, factor five laden which conveys V T E or venous thromboembolism risk blood clot. However, a lot of those services, one, they might not be a hundred percent accurate. Usually they're like 99.9 or 99.8. So confirming with your doctor's always important. Also, whenever you order a genetic test, there's something called the sick role, which is basically you get a test and you find out you have something that's not optimal and then you feel less healthy because of it.
Kyle (41m 28s):
Right, right. So that's also a very important consideration. And then also most tests like 23andme are 0.01 or 0.02% of the genome. So a SNP is like one letter of one word, of one sentence, of one paragraph, of one chapter, of one book of the Encyclopedia Britannica. Except much larger scale than that where you can have different mutations like a frame shift. So instead of just one word, they scramble the words or you can have a deletion, you just delete a word or you can have a repeat where you have C A G, C A G C A G, like in Huntington's disease, fragile X or the androgen receptor. So all of these are very common and you would need full genome or at least full exome sequencing to evaluate those.
Kyle (42m 14s):
And occasionally we do test for those as they're clinically significant.
Brian (42m 19s):
Okay. Okay. So So sometimes you'll bring it in but not, not with everyone.
Kyle (42m 24s):
Not necessarily with everyone, yeah. For concierge patients, if they just want to look at stuff, I think that is also reasonable after a shared decision making process. But I also think that the, for example, nutrigenomics, I think we are a long way from being able to use that in a clinically significant way, especially with every individual. Dr. Michael Snyder of Stanford I think is a good source of evidence-based information regarding like Nutrigenomics and whatnot. But, but yeah, I kind of see precision genomics just like any other test. My colleague Dr. Taylor Martin who's a board certified preventive medicine physician trained at Johns Hopkins and he would say very similar.
Brian (43m 12s):
Got it. And let's touch a little bit about some of your, I've I've seen some of your post rug hour supplements. Have you've done some breakdowns maybe what are some of your favorite supplements? I know there's, there might be a decent amount of 'em that you, you currently recommend.
Kyle (43m 29s):
Yeah, I love talking about supplements. My favorite supplements personally might be slightly different but relatively the same. Personally, my favorite supplements are creatine, hard to beat, creatine, even if it's just for mitochondrial health in the brain, energy in general, decreasing homocystine
Brian (43m 50s):
Do do you normally with, with your creatine, you normally just put it in your shake.
Kyle (43m 54s):
Yep. Okay. I don't mind the taste, my wife does not like the taste of creatine. I can't even taste
Brian (43m 58s):
It, I can't even tell it's in there. So I don't know. Yeah,
Kyle (44m 1s):
Maybe it's something like stevia or licorice or T ps paper where it's just like a genetically predispositioned taste or no taste if people, if if our science majors remember licking that paper in college. So
Brian (44m 14s):
Kyle (44m 14s):
Maybe it's like that, I don't know. But yeah, anyway, I take seven grams a day.
Brian (44m 20s):
Kyle (44m 21s):
I just throw it in with a shake. I guess we could mention protein powder. Personally I like taking more animal-based proteins or high leucine content, high methionine content protein powders in the morning. That way I kind of have a slightly better balanced toward metabolism. I'm not a fan of Casey and shakes in the evening, they're gonna activate mTOR a lot. I try to digest plant or if I take a protein shake in the evening or afternoon I do plant protein and I try not to have too much plant protein or sorry, not too much animal protein
Brian (44m 60s):
Regarding unnecessary, sorry to interrupt you there, but regarding Casey and cuz you've seen that where they're like, oh you should take it towards the evening because it's slower digesting but you don't, you don't like that?
Kyle (45m 10s):
Nope. For, for like a, a growing child or a pediatric patient, if that's something that benefits them, that that's a consideration. But for adults I would think that is the opposite of what you want. So some people are familiar with rapamycin and like Dr. David Sinclair and Dr. Peter Atilla used to talk about that. Think of case protein as the opposite of that. So protein quality matters, you're usually looking at like methionine content, leucine content and those tend to be very high in most animal and dairy proteins like Casen.
Brian (45m 47s):
So you're, are you against caseine or you're just against it in the evening?
Kyle (45m 51s):
Just against it in the
Brian (45m 52s):
Kyle (45m 53s):
You can also, like this is for sure applicable to fasting windows as well. So if you want to get into the like beneficial window faster, then you can skew your proteins to more plant-based as you are approaching the fasting window.
Brian (46m 14s):
Is that because it doesn't, what's the reason behind that?
Kyle (46m 19s):
There's several mechanisms. One, it's gonna boost up growth factors less, but a lot of it and mTOR is not the only marker that matters as an mTOR P I three K A K T pathway. And that is definitely one of the like beneficial cell checkpoints. For example, if you have a mutation in mTOR, it's an oncogene which is related to cancer risk, but between that and other growth factor activation, then you are going to have a faster onset or slower onset depending on what protein source you consume the meal right before you're fast.
Kyle (46m 60s):
Got it. So I guess if you're like ooma or something, it doesn't really matter.
Brian (47m 3s):
Okay. So if you, you're saying if you lean towards plant-based proteins towards a fast, th that's beneficial in the sense that it doesn't stimulate some of the, like the mTOR and things like that that you know, so you'll, you'll help you get you into the fast quicker.
Kyle (47m 25s):
That's what you're saying it would kind of mimic the effect of, for example, taking a rapamycin in the evening every one to two weeks or mimic the effect of taking a metformin two or three times a week in the evening.
Brian (47m 37s):
Kyle (47m 38s):
Yep. There's a lot of strategies. Another interesting one is taking cortan. So it has to do with both the rate of growth and the atia of the cell growth and division. So you want both to be relatively low for 90, probably 98% of people. How you can help this the best is just the lifestyle pillars, diet, exercise and not developing metabolic syndrome and not developing insulin resistance. That being said, I like to, especially for someone who's like has all those dialed in and is concurrently at very high risk of cancer, it is interesting to think about ways that they can decrease their cancer risk somewhat naturally.
Brian (48m 20s):
Okay. So so far we got creatine, we got, we got protein and depending on the type when you're taking it, you typically like to use in the, in the morning it sounds like, or you combined it maybe perhaps with casing and then kirstine. Right. What else we got going?
Kyle (48m 40s):
I also like vitamin D and omegas. So each person's gonna benefit by an EPA to D H A ratio. That's different. I like doing omega checks than just objectively seen like how much omega fatty acid is intracellular and kind of titrating according to that omegas are not without risk. For example, very high doses even conveys an AFib risk. And then vitamin D, most people especially this time of year are gonna be suboptimal. I like that to be between about between about 40 and a hundred.
Brian (49m 15s):
If someone is not, cuz like for example, I, you know, I'm not suboptimal as far as vitamin D is, but like I just said, we've just gone nine days without the sun. Do you think that it's worth even supplementing during the winter? Especially if you're in the Midwest?
Kyle (49m 30s):
Yeah, it definitely is. I supplement all through the winter. I also have a touch of what I'd call seasonal effective disorder where I just literally feel slightly better when there's brighter sunlight and longer days
Brian (49m 43s):
You and everyone else.
Kyle (49m 45s):
My regimen for that is vitamin D and the full spectrum lights that is on like our hydroponic system so
Brian (49m 53s):
Oh like an infrared sauna where, or Go ahead.
Kyle (49m 56s):
I'm not sure if it's infrared but it's just considered like a full spectrum hydroponic light. I believe it's like the same full broad spectrum of wavelength that's on a like a, I think they call it a daytime light.
Brian (50m 10s):
Kyle (50m 12s):
Yep. I don't have an infrared sauna or a regular sauna yet, but at some point
Brian (50m 19s):
You gotta, you gotta join me. I gotta, I'm lucky I put a plunge in a sauna.
Kyle (50m 25s):
Yeah. Yeah. Very jealous of that.
Brian (50m 27s):
That's awesome. Yeah, yeah. I tell my wife, I'm like, she doesn't use them really. I'm like, do you know how many people would love to have a infrared and a plunger? She a plunge in their house. But anyways,
Kyle (50m 37s):
Brian (50m 38s):
Lucky to have that. Okay, so creatine protein and protein powders. There are like a million on the market and we don't have to get all in the protein. I I'm but what's, what type of protein? Like I know not, not whey or casing or is there like specific maybe even if there's a brand that you like that people can look into. I've tried different types as well.
Kyle (51m 1s):
Yeah, I switched between brands really often. I used to get my protein cuz you could get an 11 pound bag and I saw an analytical chemist post somewhere, they evaluate it and the myprotein like protein quality was decent. You get 11 pounds for 50 bucks. But I don't think that's possible anymore. The most recent one I tried is on the Black Friday sale at Gorilla Mind. I bought one of their peanut butter proteins. I think it's good if you can consume peanut butter products way back in the day I thought the best protein ever was Muscle Farm Combat protein. It tasted like cookies and cream and I, I, I did not read ingredients back then so I'm not sure if it's good or not Right.
Kyle (51m 44s):
But I can confirm to me it tasted great and it had albumin my cellar casein and then isolate unh hydroxylate whe. So kind of like your full spectrum of digestion times for animal protein.
Brian (51m 60s):
Got it. Okay. Anything else that comes to mind regarding supplementation?
Kyle (52m 5s):
I love el carnitine as well. L carnitine does many things. One, it can help with androgen receptor density, but it's basically like an extra fuel pump or shuttle for nutrients into your mitochondria. And if you take it orally then you have to take a relatively high dose and potentially even watch t m ao which it can convert to if you have a dysbiosis in your gut. And then pro and prebiotics will round up my list. Mm. I like to make the analogy of you know, your gut is kind of like a fish tank or an aquarium and you have good fish, bad fish, you can feed the bad fish and good fish fish food. But if you just keep dumping in good fish and don't change the like fish food intake and then you have postbiotics kind of like tank cleaner and then you drain your tank hopefully once or twice a day or maybe once every other day for some people is okay.
Kyle (52m 55s):
But yeah, those are my top sum
Brian (52m 57s):
I like, I like that analogy. I've never heard so wait so pro and prebiotics now that's another market where there's a lot out there and it's like, okay, what? What's junk, what's not? You know cuz you know it's not cheap and supplementation is can be expensive on a month-to-month basis. Is there certain pro and prebiotics that you're looking for?
Kyle (53m 21s):
Yeah, there's a lot of strains that I like. Good rule of thumb is lactobacillus and Beto are pretty good at acidification or crowding out other bacteria. Some people really like lactobacillus rooty. It can be helpful for that. Akkermansia is also great at crowding out others. It's also associated with not having metabolic syndrome. Akkermansia happens to like having cilium fiber, but there's a lot of other strains. For example, Sacra isis Belardi is a yeast that helps crowd out c diff. The clinically signi, like the clinical significance doesn't always match the studies. There's a lot that we don't know. There is pharmaceutical companies developing prescription only probiotics mostly for patients that have been hospitalized with c diff before.
Kyle (54m 7s):
What we do know is that strains that are high in lactobacillus and bifido bacterium genus strains are particularly good at preventing antibiotic associated diarrhea, for example from Augmentin. And you can even take those in between like antibiotic doses and then definitely afterward and you'll have less symptoms. So that's kind of the number one use. But I am extremely excited about that. There are many, there's many, many studies on pro and pre and postbiotics being done, but I do not have, there's, there's like not one specific probiotic that's perfect for everyone. Everybody's aquarium or fish tank is very, very different.
Kyle (54m 51s):
One other note regarding microbiome testing, it's kind of like testing for a cholesterol. If you test it seven days in a row, you're gonna have wildly different results even with the same diet and stool habits. So take into account the number of stools. If you're not draining your stools, your microbiome report, whether it's a GI map or a Genova stool diagnostics is, it could look higher if you have not drained it in a while. And that could be normal. Maybe you just need to drain more often. But another thing to take note is just expect a lot of variation from day-to-day. So it's important not to consume the antibiotics or probiotics or change your diet or travel if possible for at least two to four weeks before a test like that.
Brian (55m 32s):
Before like a, a gut microbiome test.
Kyle (55m 36s):
Yep. Yeah. And now we have oral microbiome tests, now we have skin microbiome tests in five years. A lot of this will be standard of care hopefully if things keep progressing in medicine and science.
Brian (55m 47s):
Yeah. So as far as ways to, to improve gut health, you know, one thing I will say I noticed for myself is when I was fasting a little bit more, I wasn't going as often. And now that I've implemented actually some fruit into the diet, I I find that I am going more regular. Is that, is that something that could be beneficial?
Kyle (56m 10s):
Yeah, that can absolutely be beneficial with fiber. You think about your non dietary and also your dietary fiber, both soluble and insoluble and your prebiotic fiber. And you can't just consume one prebiotic fiber. Like you can't just consume inulin, which can cross-react with ragweed from time to time cuz they're both chicory, family derived, but there's multiple types of prebiotic fiber that can help like glycans. And then you also have resistant starch. So the, the world of like fruits and vegetables to help with bowel habits is pretty individualized. The best way to do this is just to try different ones and see how they help.
Brian (56m 53s):
Okay. And is there a certain, I was just looking, I always see ads for them. The company called Seed, are you familiar with them? What do you think about their, I'm looking at their daily symbiotic, which is like a pre and a probiotic.
Kyle (57m 6s):
Yep. Seed does have, I believe it's like a pomegranate capsule. They do have like both prebiotic fiber and probiotics in the capsule. Right. The thing that I don't like most about seed is they make you sign up for a subscription to my knowledge. Right. You can't just like buy 120 capsules. Not everybody needs the same dose and some people don't need to titrate up at all. So, and I don't think people, most individuals need to stay on seed every day indefinitely during certain times. I do personally take one seed probiotic capsule per day.
Brian (57m 42s):
Oh, okay. So you sort of
Kyle (57m 44s):
Titrate higher than that even though I probably could just because there is not a reason to titrate higher. C is one of the best ones. There's also spore based probiotics like MegaSpore and there's also specialty probiotics like Sacra, Mises Belardi or even ACR mania. But I, my threshold for like starting a probiotic like that, especially without like a significant diet or lifestyle or prebiotic fiber change is pretty low.
Brian (58m 15s):
Kyle (58m 16s):
I do like seed though. That was a long answer to say I like seed.
Brian (58m 19s):
Yeah. I, I I I see them all over the place and they seem like they make a good product, but you were right. It is a subscription based model, which makes sense for them.
Kyle (58m 30s):
But, but not many things should be subscription based. But your healthcare with your doctor probably should be, the Cleveland Clinic charges up to $50 per message now and most traditional doctors do not get paid anything for answering messages, even if it's helpful and like improves the time efficiency of both the patient and the provider. So that's another thing to think about.
Brian (58m 55s):
Hmm. Okay. Wow. And, and this before the probio for something like seed, if you're taking that, you don't need to necessarily even take it every day, like you said,
Kyle (59m 4s):
Or you don't necessarily need to titrate up to multiple capsules per day.
Brian (59m 7s):
Okay. Yep. I see. Wow. Lots of good stuff here coming up on the end. Let's, let's maybe give the audience, this is a question I like to ask my most, my guest is, you know, what's one tip maybe to give in, let's just say middle-aged individual, individual that is looking to get their body back to what, what it once was back when they were in their twenties and thirties. What, what type of, what one tip would you give that individual?
Kyle (59m 38s):
Whether the effort is in optimizing your diet or finding a movement past time to last a lifetime. You know, your exercise regimen. Find a way to make that effort feel good. Think about something that you do that you really enjoy that takes a lot of effort, whether it's a hobby or maybe it is exercise or whatnot. And find out how to apply that to optimizing that lifestyle pillar.
Brian (1h 0m 4s):
Love that. So like, almost find something that takes, like something that you maybe did back in your past and bring that back out sort of thing. Like nice love that, like rollerblading,
Kyle (1h 0m 20s):
That could certainly be one rollerblading, rock climbing. There's all sorts of things. It doesn't necessarily have to be a movement pastime either. Okay. But it, it could even be playing video games. So a lot of people can sit down and play video games for 10 hours in a row. Oh my, my gods. It's interesting and there's a lot of nuance to understand and there's definitely a, a reward with being good at something over time. But even for a video game, there's like the first time someone played and they're probably not very good.
Brian (1h 0m 52s):
Right? Or how about learning an instrument
Kyle (1h 0m 55s):
That That's an excellent one.
Brian (1h 0m 56s):
Yeah. Well, this was great, Dr. Kyle. I appreciate you coming on. Where's the best place for people to learn about you and what you're doing?
Kyle (1h 1m 7s):
My main base, I guess, is on Instagram, Kyle Gillette, md Gillette is like the razor with the E shaved off, but you can find me all of the all other platforms, Gillette Health. I also have a Gillette Health Clinic podcast. And then my website is gillette health.com. Spell it anyway.
Brian (1h 1m 25s):
Got it. And we'll put, we'll put those in the show notes so people can find you. And you're in Kansas, so not too far from Chicago, like eight hours, I think. Well, I appreciate you coming on, and thanks again for all the knowledge you dropped on us today.
Kyle (1h 1m 42s):
Thank you. My pleasure.
Brian (1h 1m 45s):
Thanks for listening to the Get Lean ean podcast. I understand there are millions of other podcasts out there, and you've chosen to listen to mine, and I appreciate that. Check out the show firstname.lastname@example.org for everything that was mentioned in this episode. Feel free to subscribe to the podcast and share it with a friend or family member that's looking to get their body back to what it once was. Thanks again and have a great day.
Dr. Gillett enjoys providing holistic individualized care to his patients. His practice includes preventative medicine, aesthetics, sports medicine, hormone optimization, obstetrics and infertility, integrative medicine, and precision medicine including genomics. He believes that each human is a unique creation that requires attention to their body, mind, and soul to achieve optimal health.
He enjoys caring for others using shared decision-making and an evidence-based, patient-centered approach. He is active in Obesity Medicine organizations and firmly believes “food is medicine” and “exercise is medicine”. Dr. Gillett describes the “6 pillars of health”: exercise, diet, sleep, stress, sunlight, and spirit. These are more powerful than any medication or supplement. He enjoys spending time outdoors on the farm with his wife, two sons, and two wolfhounds.