Men’s Health: The Focus on Healthspan and Lifespan for Men

 

00:00 Webinar Introduction

Welcome everyone to our June, DUTCH webinar, I'm Alan Strozier, a member of the Marketing Team with Precision Analytical Creators of the DUTCH test for Men's Health Month. We have a great webinar in store for you with doctor Ralph Esposito.

0:12

He joins us today to discuss a variety of men's health concerns outside of the field of urology that presents significant risks to immense health span and lifespan.

0:21

As a follow up to today's webinar we will be hosting a live Q&A with doctor Esposito on Instagram in the next couple of weeks.

0:28

Please submit your questions in the goto Webinar Control Panel at the bottom of your screen and we will answer those during that live event.

0:34

All attendees here will receive a separate invitation with those details via e-mail.

0:39

If you new to us today and not already familiar with the DUTCH test, DUTCH stands for Dried Urine Test for Comprehensive Hormones. It's a group of validated tests that provided the most complete evaluation of sex and adrenal hormones, including metabolites.

0:52

The simple and convenient at home collection for patients and support on every comprehensive report from a team of hormone experts puts you in the driver's seat to helping solve your patient's most complex hormone issues.

1:04

Registering as a DUTCH provider is easy. If you sign up today, you'll receive 50% off your first five test kits, plus free clinical consults, video tutorials, patient referrals, and expert hormone education.

1:15

Just sign up, just click the link we've posted in the chat, and complete the Become or provider form on our website.

1:22

To get even more Homer and Education, check out the DUTCH podcast on your favorite streaming app.

1:26

Each week, you'll hear amazing conversations and insights from leaders in the functional medicine industry.

1:31

You won't want to miss last week's episode with Tom Williams. He was sharing the research and facts of adrenal fatigue and the so-called pregnant alone steel.

1:39

It's causing a lot of debate so check it out for yourself.

1:41

Visit DUTCH test dot com slash podcast. Is to subscribe and learn. Learn more about the show.

1:47

We've also posted a link in the Chat, and if you're a fan of the DUTCH podcast, please comment and share it with others so we can continue to spread this great educational content around the functional medicine community.

1:58

Now before we get started with today's presentation, please note that we have posted the slides in the handouts section of the GoToWebinar control panel below, and we will also send the recording and slides to everyone via e-mail tomorrow.

2:10

Remember too, the doctor Esposito is a doctor but he's not your doctor. The contents of this webinar or for educational and informational purposes, only the information is not to be interpreted as or mistaken for clinical advice.

2:24

Please consider a medical professional or healthcare provider for medical advice, diagnoses, or treatment.

2:29

Patients can find a DUTCH provider on our website by clicking the Find a Provider button at the top of the page.

2:34

And now let me introduce you to today's presenter.

2:37

Doctor Esposito is a naturopathic physician and certified Functional Medicine doctor with additional degrees in Acupuncture and Chinese medicine personalized style incorporates the Art and Science of Medicine to Solve complex issues Utilizing the foundations of P for Medicine, prediction, Prevention, Personalization, and Participation.

2:56

Doctor Esposito completed his medical training as a medical intern at NYU integrative and Functional Urology Center.

3:03

He holds a position as adjunct professor at New York University, Steinhardt for the Masters of Nutrition and Dietetics program, where he lectures on Integrative Medicine. He is also an advisor to athletic Greens and Diagnostic Solutions lab, and currently practices medicine, with a focus on longevity with doctor Peter ....

3:22

Now without further ado, doctor Esposito, take it away.

 

03:27 Presentation Begins

Thanks so much I'm so excited to be with you all here and excited to talk about the things about that help Men live long and live well.

3:36

And when we talk about men's health, especially in the month of June, we pay a lot of attention to your logical, how we pay pay a lot of attention to PSA and prostate cancer and sexual health, but there's a lot to do with men's health outside of these actual areas. So we're going to talk a little bit about those areas that are, at a focus for many people with, or focus on mental health.

4:01

We're going to talk about a few of the other things that actually are actually more important because when you go into it, there's a lot of things that man's held outside of the prostate, so things above about not just below the belt.

4:13

So, we'll get started today. And essentially what we're going to be talking about today are the things that help men as well with strong improved quality of life not just only from the aspect of urology or endocrinology.

4:30

So, this is our agenda for today. We're going to talk about the traditional category of mental health or the new paradigm.

4:36

We're going to talk about lifespans of things that impact, how long with cardiovascular disease, narrow neurocognitive disorders, neurological health. And then also health span. Things that help us live long and well hormonal heart metabolic disease, mental emotional health, and there's a lot of carryover and intersex intersection between all of these diseases and disorders, but we're going to talk about how we can focus on them to help men live well.

5:03

This is the traditional, traditional view of men's health.

5:08

It's, we look at mental health and in terms of prostate cancer and large prostate, sexual dysfunction, fertility, other neurologic issues, chronic pelvic pain. Waking up at night to urinate that may not be related to BPH, that's an overactive, bladder, etcetera, those we won't go into a lot of detail on, but I think it's important for us to really pay attention to mental health that from the traditional view, but also acknowledge that there is another part to it.

 

05:34 Prostate Cancer Risk

When we talk about prostate cancer, one of the traditional ways that we are one of the conventional aspects of prostate cancer is looking at PSA. No, just a PSA value, and that's not very effective just by itself.

5:48

I recommend most clinicians to actually use PSA as a tool, but not their only tool, and not the tool that exists only in one period of time, but over a period of time, a function of time, and that's where we look at ... Velocity. So, essentially, the doubling time or how much does your PSA change over a period of time? There's several calculators that you can use to help calculate this.

6:10

You would put the date, and you would put the value of your PSA. And then as we go through it or as you convey some of the data, you will get a PSA velocity. You want to make sure that a PSA velocity does not exceed zero point forty-five nanograms per milliliter per year. So essentially, when we measure PSA velocity, the quicker it increases or the, the, the more it increases, the higher the risk There isn't there being an aggressive prostate cancer there. And then we coupled that with PSA density.

6:44

So, PSA density is telling us how, how much PSA's the prostate making relative to the size of the prostate.

6:52

So, whenever PSA density becomes elevated, there's also, which basically means is it making more PSA or a small prostate making a lot of PSA, or is it a big prostate making a lot of PSA. And this is where we tried to differentiate between BPH and large prostate versus prostate cancer.

7:09

None of these tests are diagnostic and as clinicians know, the really the only way to diagnose prostate cancer is obviously through biopsy and confirming with a urologist. But we're gonna go through today's lesson and kind of talk about why is screening and understanding how you screen for mental health and other things that impact a man's health over the decades are important.

7:34

So, these are two markers that have a lot of utility from day to day for the average clinician.

7:40

If you're not a specialist, let me talk about NP, multi parametric MRI.

7:47

This is getting a lot of attention, and oftentimes is replacing the need for PSA or replacing the need for exploratory biopsies. These are very, very specific and sensitive imaging, it’s basically an MRI that can pick out and identify lesions in the prostate that might be suspicious for prostate cancer.

8:07

So, this is how we are evolving and how mental health is starting to evolve now and detecting and even screening for prostate cancer.

8:15

The four K score, it's a very good, useful tool.

8:22

You, the guidelines suggest to use it anytime a PSAs above three. If it is above three, you can do something called a four K score.

8:31

For K, religious stands for the four different types of markers that are being tested to assess a crisis algorithm, and, based on the algorithm and the equation, if that score is high above 7 and 7.5, then you have to be concerned that there might be a risk of there being an aggressive prostate cancer.

8:50

one of the things we're going to talk about today is prostate cancer, obviously, but what we really want to focus on is not all prostate cancers but the prostate cancers that kill people, right? The prostate cancers that men die from.

9:05

And we'll talk about this a little bit later and you might have heard this before is that most men with prostate cancer and not from prostate cancer. But again, a lot of attention and why is it that so many clinicians, and so many practitioners and even people who specialize in this area and neurology focus only on prostate cancer, I think there's other things that we really need to focus on as well. But the four K score, the MRI, the PSA velocity, and density. Really give us good tools to screen for these things, and I'm not dismissing these things at all, right? I'm not only taught focusing on things outside of prostate cancer, but it's also important to know that these things are connected.

9:45

There are biopsies and genetic testing, which obviously are more invasive to really detect if this region is a prostate cancer.

9:54

And if it has any type of genetic mutations that might make it seem more aggressive, and then there's the old-fashioned the digital rectal exam, which is only good for those who actually do them regularly. So, urologists or specialists, who are doing Digital Act exams on a daily basis, are going to have are going to be more sensitive to noticing a lesion.

10:22

Whereas your typical primary care physician, or a person, or a clinician, who doesn't duties every day, the ability for them to detect a lesion that might be, or nodule, that might be problematic or even detect an agile at all is probably worse than flipping a coin.

10:39

So, this is outdated, can be helpful, so if you do notice allegiant, it's a problem.

10:45

But if you don't notice Allegiant, though, that does not mean that there is not prostate cancer because really, you're only checking one part of the prostate by what can be reached through the ******.

10:57

So, this is one of the first steps, and this is kind of like a that was like a crash course on. What did we do to really protect men from the thing that we think threatens a man's life?

11:09

And these are really important markers to understand, but there's a lot more that we should pay attention to and we're going to go into more detail.

11:19

What's important to look at here is the, this is essentially the prostate cancer mortality rate over time.

11:26

So, what we see is that you can see that prostate cancer mortality is, has decreased. There was a slight increase in the mid-nineties, but then over time, it has slowly decreased. Obviously.

11:40

You can see the discrepancy between white and black men, which is another thing that we'll talk about shortly.

11:48

But we were doing a good job.

11:51

We're noticing and we noticed that prostate cancer mortality did increase in the mid-nineties, and then there's many reasons as to why this improved some good, not some not so good.

12:03

one would be that one of the good things that we've gotten better at the things that we just mentioned in the previous slide, PSA density, PSA velocity, multi, multi parametric MRIs for K score, right? These are tools that science, and data, and literature and research has provided us, so that we can now look at the data and say, OK, now we can screen men a little bit better. You're gonna hear this many, many times there's going to be a recurrent theme or discussion or point.

12:37

We have to screen. We have to detect things before they become a problem. So, one of the benefits could be that we've gotten really good at detecting these type of cancers, and that's exceptional. There's a lot more attention to it, because it does kill many men.

12:52

But what is also important to know is that a lot of prostate cancers are not being detected. So, there are more men who are dying. Or we know that more men are dying with prostate cancer than ... during this time.

13:06

There was excessive screening, excessive testing.

13:12

So, they were attributing more prostate cancer deaths, two or more deaths to prostate cancer, and that very well may be true.

13:19

We're not entirely sure I like to believe that we're getting a lot better at detecting and presenting this deadly disease just a good thing for everybody.

13:30

Now, we look at other aspects of traditional men's health, BPH or an enlarged prostate. Now, a lot of this lecture is going beyond the prevention aspect. So, how do we know if somebody has BPH, there's not really a great tests for it. You can do a PSA And now, I will show you that a big prostate will make a lot of PSA.

13:53

And that's actually a good thing, right? Because if you had a small prostate making a lot of PSA, that means there might be some cells in there that are triggering the prostate to release this protein.

14:04

But the good way to identify that is, if you do an MRI, you can see are there any reasons here? There's no lesions, but it's a very large prostate. Then, you could be, it could be, you can rest assured that this is, in fact, a large prostate. You could do a Euro dynamic testing. So, essentially, you can see, how does the bladder void, so you have a gentleman, they will, you measure their bladder before and after they urinate, and you'll see how much is released. Because of the anatomy, the prostate can actually obstruct the urethra, which kinda sets right below the bladder. And yes, it is obstructing because it is large.

14:43

Then you will see more urine or more fluid in the bladder, after they void. Or you can measure how much they're eliminating. Or even the rate at which the urine is being eliminated.

14:55

And that allows you to detect or identify if there is actually an enlarged prostate and then, the physical exam.

15:03

It's not very good for prostate cancer, but when you feel a large prostate, you know that it is a large prostate. So doing a physical exam will provide you some of that insight, but even intake exam would be quite helpful to wake up Wake up at night to urinate or urinating frequently. Are you drinking water at night, if not? Are you still waking up to urinate, or do you wake up? Do urinate frequently throughout the day.

15:30

one thing that you can asked the gentleman, it's like when you go into the urinal or you go into the bathroom, does it, do you have hesitancy? Will it take you time to kind of sit there and wait for the urine to come out.

15:43

That's usually an indication of some type of obstruction. You have to rule out other possible etiologies.

15:48

But an enlarged prostate is usually one of the more common causes of that. And then maybe the MRI and the prostate, the MRI and the ultrasound will provide you with any type of information that will give you the size of the prostate. And then you can know about this is a big prostate.

 

16:04 Sexual Dysfunction

But it's always important to know to rule out the actual to rule out prostate cancer. Sexual dysfunction.

16:12

Yes, this is very important, and I think this is part of health span, and it's often overlooked, because many physicians might not see it as a necessity or may not see it as being very important.

16:26

So, we look at things that, as, for myself, I think it is important, because not only is sexual health a physical symptom, or a physical issue, but it's also a mental and emotional impact. And it can really have an influence on a man's relationship on their confidence. It can have an impact on just kind of how they feel as, man. Right. They may not feel like them. They're all sales, they might feel like they're aging or aging prematurely, right? These are things that you need to keep in mind when you talk about men's health. And I put these into the traditional category.

17:01

Mostly because this is what we think of when we think of men's health.

17:05

So, there are certain questionnaires, like the shim Questionnaire, which cause a sexual health inventory, and you can use this with all of your patients.

17:12

And this will give you some objective data, so you can look and say, hey, when we started, year Shims Gore said that you had no high or moderate levels of erectile dysfunction, and now we're working together, and your score dropped by half.

17:27

And not only does that give them add some confidence in what they're doing is working, but also allows you to be objective and know what what you're doing is working.

17:36

Um, when we look at sexual health, one of the great markers, or one of the great tools that we have are biomarker testing.

17:44

So, when we when we look at certain hormones like testosterone and estrogen uneven cortisol, which we'll talk about with the DUTCH test, we can have an idea of are these things having an impact on a man's sexual health.

18:00

The one that comes to mind and most commonly, is testosterone.

18:04

And it's not only testosterone. In fact, testosterone is not.

18:08

one of the best markers that we have are one of the best biomarkers that we have to assess if a man will not have sexual dysfunction symptoms.

18:16

So, for example, if a man is experiencing erectile dysfunction or can't maintain an erection, sure testosterone Deficiency can be a possible cause of that.

18:30

But there are many men who are abnormal or high levels of testosterone or maybe on testosterone replacement.

18:36

It's still experiencing some of these symptoms.

18:39

So, when you look at sexual dysfunction in men, specifically erectile dysfunction, it's important to look at is this organic or psychogenic or mixed psychogenic.

18:50

Then that means it's probably not due to some type of hormone or vascular issue.

18:55

But when you look at organic, perhaps to just hormonal, perhaps it is vascular.

19:00

Majority of erectile dysfunction usually starts out as some type of organic issue.

19:06

Like perhaps they had too many drinks and were unable to perform, which is very normal and expected, because alcohol can certainly do that.

19:15

Then, the next time there, with a partner, they notice no, last time I was drinking, and I wasn't able to.

19:22

Perform isn't going to happen again, so, something was organic, it became Psychogenic, and now it's mixed, so, it's very important to speak to your patients, get an understanding of, when did this start?

19:32

How did this come about? What has helped before? What did not help? How do you feel?

19:38

You know, do you feel anxious to? do you feel nervous? right? Stage fright. There's another you, or that you can use, is it, does it feel like you're afraid to perform?

19:50

These are things that you can use to help identify, is this actually psychogenic, or is this organic.

19:56

There is imaging, I have to admit, I've had many patients ask to go through.

20:03

Know, the Million Dollar workup and try to find out what is actually causing this.

20:06

I've had one patient where we found some type of vascular issue, with a Doppler patino Doppler but essentially there was really not much, you can do it, there's very little intervention and there certainly are clinicians in situations where it's absolutely necessary.

20:24

But in many cases, these can be resolved with PD five inhibitors, testosterone replacement therapy.

20:31

There are other devices that can be used like extra corporeal shockwave therapy, acupuncture, or even just talk therapy. So, there's multiple different tools that help can, that, can help improve the symptoms. And very infrequently do, I think, imaging provides any additional insights, but it isn't necessary because you need to rule out, you know, it's just neurological Institute, landowner being impinged, maybe in the ... or perhaps being in pinch in the lumbar spine. So, these are things that you really should pay attention to. And it does impact the man's ****, right. So, this is part of the house band, but very frequently doesn't impact their life.

21:10

So, those are the, those are the diseases of men's health that we most think about.

 

21:15 Other Risks to Men's Health

But when we talk about mental health, we don't talk about the things that actually kill men outside of things below the belt, you know, we don't talk about heart disease or we don't talk about cancer outside of prostate cancer, but, you know, cancer kills many men, and it's one of the second one on top leading causes of death for men. And the US. Cardiovascular disease and stroke together are combined the major causes of death and men, Alzheimer's and neurocognitive this kind of group them together. Because diagnosis of Alzheimer's is largely clinical, and I defer to the experts in that area.

21:54

But we kind of group them together because they often have very similar etiologies.

22:00

There's vascular dementia, there's Lewy body, there's Alzheimer's, but Alzheimer's is one of the big killers, men, diabetes, and I and more aggressive in addressing diabetes than many other clinicians. And I don't wait for the diabetes diagnosis, and I think that's way too late. If you're waiting for someone's hemoglobin A one C to be elevated or their blood sugar, to be elevated, I think you have lost an immense opportunity to reverse that and cause, and can cause them to reach this point of no return, where it's very difficult to actually get their blood sugar under control.

22:37

But one of the great things is that diabetes, especially type two diabetes, can be very easily managed, and many times can be reversed.

22:47

If you have the proper lifestyle nutrition exercise interventions and in some cases from silicone inventions, it's necessary and can be quite helpful.

22:58

So, these are the things that, I pulled data from, 2019, which outline the causes of Death.

23:06

I did not include anything after 2020, because I, I do think that COVID has, certainly Tilted the word the data.

23:17

But if we look at 2019, which is not too far back, and we can look and see, what are the things that killed?

23:24

Then in 2019, these are the 10 leading causes of death.

23:28

Other includes accidents, and, you know, other diseases that are not labeled here. So, it could be anything else that causes illness that causes death. You can see unintentional injuries, that also includes accidents, and falls, and et cetera.

23:48

But, when you combine stroke and heart disease, it's, it's almost about 29 to almost 30% cause of death. And men in 20 19 cancers, comes in at number two. Then you have diabetes, and Alzheimer's disease, you do have other causes of death, like kidney disease and liver disease, and I would, I would argue that a lot of these are related. So, if you really can get cancer, heart, disease, diabetes, stroke, also involved, and Alzheimer's, you, you take a big chunk. Almost 50% of them would die from these diseases in a given year. If you can really focus on these issues, you can. You can certainly help a man but well I'm wrong.

24:35

And no, prostate cancer does fall within that cancer aspect.

24:40

But, if we look, that, some of the data that talks about, you know, are we actually doing a good job?

24:48

And the, this is data from 1968 to 2019, which essentially shows the age adjusted death rates.

24:58

And we can see that they're decreasing, right. So, the death rates are decreasing, which means that less people are dying.

25:05

They're living longer, but I would argue that we're not living better or not living well, So, we're allowing people in medicine and pharmaceutical interventions and surgeries, and everything that modern medicine is incredibly good at and very grateful that we have this resource.

25:27

But we're not, we're ignoring the fact that a lot of these people are living longer with these chronic diseases and a lot of men are living longer with these chronic diseases. And I want to make sure that we're really putting a dent in those things that are allowing men or preventing men from living well.

25:44

Because nobody wants to live in the last 5 to 10 years of their life suffering from any type of cognitive dysfunction, you don't want the family to experience that. I know that very well.

25:56

And all, too well, I would wish that upon nobody.

25:59

So, I, I really want us to understand that. Yes.

26:02

We're allowing people to live longer, and we allow people to live with these chronic diseases longer, but it's actually doing us a disservice and we'll talk a little bit about that. So, this is a breakdown from the NIH, which kind of shows.

26:18

the causes of death are the percentages of men that are dying from diseases from age 30 to 75.

26:26

And you can see prostate cancer is not even the number one cancer cause of death from cancer. In fact, it's lung cancer.

26:35

Obviously, this does not include individuals who are just does include individuals who are smoking, so this can be largely outweighed by. So, if you took this out, if you took out smokers, I assume that would be closer to the prostate cancer rate. We can also see colon cancer is a major cause of death and again, another preventable cancer.

26:57

And vascular disease, which has a majority of coronary heart disease, kinda takes on the takes the cake home, I mean, you can see here vascular disease, from age 30 to age 75, is just that, the biggest cause of death for men.

27:16

Then, we look at all these other things, right, and Alzheimer's disease, and, again, neurological diseases, which includes many other things, but it certainly increases as men age.

27:26

And we'll talk more specifically about Alzheimer's disease as we get closer, but it's very good to look at these conditions and say, well, what are things that are causing death?

27:37

And men, and you can even see diabetes as well. It does decrease as we age, but it is a significant risk factor.

27:48

As I mentioned earlier, this is the new paradigm of how they all overlap. They all work together and in the center.

27:55

It's where I want to put a dent. I want to help everybody understand why all these things are connected.

28:02

And I want to kind of treat it from the inside out.

28:06

So, if we just try to attack, you know, one of these circles that would be incredible. And if we can abolish one, you know, cardiovascular disease or Alzheimer's disease or cause of death from cancer, that would be huge.

28:19

But I do realize that we have to be realistic.

28:21

And if we can hit the middle and create this ripple effect, that maybe takes a chunk out, two percentages off of each individual circle, we can have a huge impact on how we help people in the modern medical system. And I hope everybody here can also learn from that as well.

28:39

So, this is the new paradigm of men's health.

28:43 Men's Health Paradigm Shift

So, this is essentially a a theoretical graphed by Matt ...

28:48

which shows you know, how healthy is the health span concept? And you can see here that this is the graph for health span, and you can see this is the graph or lifespan. They all end at the same point.

29:05

Right?

29:06

We can, we can, I'll say that at some point, it doesn't really matter because we all end up in the same place. Sure.

29:14

If that's really how you want to think about it, that’s reasonable, but I wouldn't suggest that you do not think about it that way.

29:21

What we want to focus on is, how can we live? Well, for as long as possible. I mean, this is just a general health metric.

29:28

We don't have a specific way. We're measuring it. We're just saying a scale of 1 to 10, or 0 to 10.

29:33

As we age, we are all generally very healthy. We feel kind of immortal until the age of 40 and then, at the age of 40, we start feeling it, right? You see all my knees hurt a little bit more.

29:43

Or I take this medication from my blood pressure, and that's when life span, And the health metric starts to decline much quicker than health span.

29:52

So, this red, as we can see here, is kind of prolongs. So, we're staying healthier longer.

29:58

Then we kinda decline, you know, it may sound kind of morbid to think about it that way.

30:04

But you don't want to live the last 20 years of your life, as you can see here, really on this very sleek, steep slope of health.

30:15

So, my goal is to have patients get closer to that red line and farther away, so let's shift this graph upward towards a better health plan.

 

30:28 Cardiovascular Disease

So, we're going to break that down into cardiovascular disease, this is our first aspect of improving health span in this new paradigm.

30:37

This is ways that we can kind of assess or test for cardiovascular disease. A lot of fancy tests, a lot of fancy names, right?

30:48

What I think is very important to understand is that there is advanced lipid testing that can be done.

30:54

This is not something that the DUTCH test can give us a direct insight into, but there is a correlation with ... Health. And our cardiovascular health, as you've probably heard from other lecture and webinars that, you know, the benefits of estrogen and maintaining an affiliate function.

31:11

Also, the benefits of ... and dementia and cognitive decline testosterone, obviously, for its impact on nitric oxide synth base and supporting the vasculature.

31:22

But aside from the hormones, we really need to pay attention to what are the things that are causing men to die from heart disease, coronary heart disease, because it is one of the major killers, right? That in stroke, and I kind of loop those two together, because they have very similar ideologies are very similar causes.

31:40

And we look at things like, you know, many doctors, and we'll look at LDL C, and you don't see LDL C on this list here.

31:49

And I think LDL C is a great marker. I think it can be quite useful. It's very cheap. It's very easy to use, but even cheaper would be Apo Lipoprotein B or ApoB, which is a lipoprotein or a protein that's found on LDL particles that gives us a better indication.

32:05

How many ApoB, continuing particles are, how many LDL particles are actually existing in the blood. And that's one of the best markers that we have to assess for cardiovascular disease risk.

32:18

Please do not misinterpret this as this as as I'm not suggesting that this is the only way that we can assess for cardiovascular risk. There are many, many different ways.

32:30

As you can see that this is something that we really need to pay attention to.

32:34

So, if we have the tools, and we have the ability to understand, or get an insight as to what's actually going on inside, that might have an impact on our cardiovascular risk.

32:43

Why not use the tools that we have?

32:45

I'm not saying that we have to use all of these, but I think it's fair to say that you should use some. It's not a majority of these. I would say that the most important will certainly be your ApoB. Your lipoprotein right away.

32:59

I would also look at your LDL Particle, because that can give you an idea of perhaps insulin resistance, and one that's fairly new, and not very common, is your synthesis and reabsorption. Sterols does master all the ..., first to tell us how much cholesterol you make, in the last to tell us how much cholesterol you re absorbed.

33:21

So, by looking at these markers, we've really become very precise. Now we can assess somebody's cardiovascular risk.

33:28

So, looking at these markers together, we can look and understand, what is it that we're doing, that might, or what is it that's going on in our body that we might be able to mitigate and get ahead of?

33:39

And there's multiple different tools that we can use to get ahead of it. What's very, very important to know? And I think if you take nothing else from this lecture, what's important to understand is that ApoB containing particles.

33:50

ApoB 100 containing particles are necessary but not sufficient in the pathogenesis of atherosclerosis.

33:56

So, in order for there to be atherosclerosis in the lining of the artery and the interlock, there must be a liquid that was brought in from the plasma through the through with April. Like a protein B.

34:12

If that brings that N, then there is a potential there for there to be an immune response, and inflammatory response and atherosclerosis to initiate. But, without ApoB that cannot happen.

34:24

one may argue well without inflammation. That also may not be able to happen. But you can have inflammation there without ApoB and there's really no liquid particle to oxidize. So, it's very important to understand that this should be one of the more important markers that you look at and try to assess when you're trying to assess somebody's cardiovascular risk.

34:44

Another test that we can look at it as a calcium score.

34:47

So, we can see here that this first chart shows us individuals who have an elevated calcium score. And we can see that their car you, that their non cardiovascular, cardiovascular disease mortality.

35:02

It certainly, you can see here with the risk factors that go up.

35:07

There's a lot there. Their risk of cardiovascular disease is certainly significant.

35:11

And when you look at there, if they had a negative calcium score, their risk of dying from cardiovascular disease, whether they had increased risk factors decreases.

35:22

So, the moral of the story is, if you look at a calcium score, this tells you, is there any type of atherosclerosis in the coronary arteries if there is?

35:31

And there's evidence of calcification, right? And we would assume that that has to be atherosclerosis.

35:38

And that's certainly does increase one's risk or longer-term cardiovascular disease.

35:43

I would not wait until you have a positive calcium score. You want to get ahead of these things.

35:48

So, it's what's important is that certainly doing a calcium score, getting a calcium square, which is very low radiation, quite inexpensive, given the benefits, knowing that can be very informative for a lot of people.

36:02

So, I wouldn't advise that if heart disease and stroke are, let's say, 28% cause of death in men, knowing this score can potentially reduce your risk and allow you to be more preventive in your approach.

36:20

I think there's an immense amount of benefit there.

36:24

So, what could you do?

36:27

As an ..., I don't prescribe. So, the way that we try to address things is to nutrition and exercise and supplementation. And here are a few things that I use.

36:37

Red yeast rice is essentially a STATIN.

36:40

So, it's low cost and naturally derived doesn't necessarily mean that it's better or worse than other steins.

36:46

Certainly, less potent, then a receiver staton or a tour of a sudden, but it may provide some benefits and tends to have a lower side effect profile. So, less biologists when it comes to these things.

36:58

So, if somebody's averse to a pharmaceutical or you're not allowed to red yeast rice might be a great tool for you.

37:04

I have to admit, I don't get a lot of benefit from bergamasco, but herbrand, I do see some benefit it does have.

37:12

It does get a lot of attention as a anti-aging or a longevity supplement, but actually can inhibit PCSK nine, which allows you to prolong the life of your LDL receptors. And by doing so, you can help clear cholesterol. That whole cholesterol electrode is a whole different conversation.

37:31

So, we could talk about that a different time, but what's important to understand is that you want to help clear cholesterol and you want to help produce synthesis. And there's other things that we can do to help inhibit absorption, it’d be like soluble and insoluble fiber.

37:44

There are other nutraceuticals like Berga Mont Blanc.

37:47

I don't find much benefit from it, but there is some minor data, some some data suggesting that it might have a minor effect. Omega three fatty acids, ....

37:57

We're not sure how these things work, in terms of why did they reduce cardiovascular. They don't reduce ApoB and they don't reduce triglycerides significantly. You can see that and reduce a trial, but they do create these anti-inflammatory molecules called resolve ends and protect ends. Which, if I had a guest was had, it has a significant impact on reducing risk.

38:20

So, not to get too far in the weeds of it, but that might be one way that these nutrients are helping.

38:27

And the nice thing is, it's kind of hit or miss. More miss then hit.

38:31

So, it may be helpful in some individuals have high LTV, but the side effect of that flushing might be uncomfortable for some people and may not work for everybody.

38:41

So, I think it's worth and experiments, very low risk, but I wouldn't put a lot of money on it if you are trying to count that as your morning time.

38:52

These are the dietary and nutrition interventions.

38:56

That's what the testing really can tell you if you need to produce your saturated fat.

39:00

So, if you know, if you're making a lot of cholesterol, reducing your saturated fat might actually be helpful, because saturated fat might cause increased synthesis and cholesterol, and impair how much, quite sure you're clear.

39:13

Then, again, we can talk about fasting clerk restriction, which provide benefit in multiple different ways, depending on which technique that you're using.

 

39:25 Other Cancers

Now, we have to talk about cancer.

39:29

So, we spoke about prostate cancer, but when we talk about ...

39:34

prostate cancer or cancer prevention, there's primary prevention, there's secondary prevention, and then there's tertiary prevention.

39:41

I want to get away from focusing on the tertiary prevention because that's at a point where cancer is becoming too metastasize, as has already invaded and it's it's really in the hands of modern, conventional medical approaches.

39:58

From these large cancer institutes. which have done an incredible job at helping people survive and beat these types of cancers. But I find that the most benefit might be before it invades and at initiation, before initiation, and even just preventing exposure. So, physical activity diets.

40:15

Alcohol and smoking obviously, are factors that we have to avoid, sunscreen, right? So, if you live in the Pacific north-west, really don't have to worry too much about that. In New York, for most of the year, it's pretty gloomy in the winter hours in the winter months.

40:31

But if you live in an area where you're exposed to sunlight frequently, no, skin cancer is real. And we have to make sure that that is something that we pay attention to. And especially physical activity and diet, I think, are the best ways that we can.

40:46

Are one of the best tools that we have at preventing cancer in general, and we know that physical activity and diet have a huge impact on prostate cancer.

40:56

If we're going to circle this back to men's health, secondary prevention, mammography, endoscopy, pap smear, obviously for women, but for men, you know, you do PSA testing digital rectal exams for K testing MRI, Ultrasounds, right, these are tools that allow you to assess things early so that you get them before they become an actual problem.

41:21

Screening is the unsung, hero, about 90% of the nation's four point one trillion dollars in annual health care.

41:29

For people with chronic and mental health conditions, Mean, just look at the staggering numbers of how much we spend per year on heart disease and stroke cancer diabetes is when people have these diseases.

41:42

Obesity, Alzheimer's, even arthritis, $303 billion, or 2013.

41:48

That's an incredible amount of money to be spending for.

41:51

All of these diseases, which, one can argue, are preventable.

41:55

Um, to especially younger populations, right, in your thirties and forties and fifties, I would even consider 60 to be young.

42:04

So, these are things that are really taxing our society, and we have ways to address them, but we're ignoring the fact that screening is one of the tools that we can use.

42:15

So, as we discussed, we spoke about primary secondary prevention, and again, we're spending about $347 billion on these, these preventable chronic conditions.

42:28

So, if I told you that if you had $347 billion to attribute to health care, and, and the medical system, preventing the things that kill people, most people would say, well, we need to find a cure for cancer, or we need to find a cure for heart disease. And yes, we do, and I think that would have been incredible.

42:49

Eureka, like a moment.

42:51

However, we have to also acknowledge that we have some of these tools already, but as we just need to spend some time on focusing on how to improve them.

42:59

And I think one of the ways that we can do that is by helping these things become more effective, and that hopefully people with compliancy, because nutrition and exercise are incredibly powerful.

43:10

And you could put them in a pill.

43:12

It would be very, very effective, one of the most effective tools that we can make, but we can't. You actually have to do with these things. You have to participate. And if we can spend all that money on helping people become more compliant with these things, speed can really save a lot of lives.

43:29

This is some data that I was discussing earlier on, you know, how much is diet, how much is obesity? How much are these environmental carcinogens contributing to disease? So, this is not to say that 35% of your of your diets are sure.

43:45

Of distances are attributed to cancer. What it is saying is that individuals who get these type of cancers diet is responsible or plays a role in about 35% of them some more than others prostate cancer, as we discussed.

44:00

Colorectal cancer to the major killers is largely influenced by diet, and these are attributed to many different large epidemiological studies, which must be taken with a grain of salt.

44:13

But when there's some type of signal there, I think we need to pay attention to it. And I don't think anybody can argue that your diet has an impact on your health in general.

44:24

Even if we just try to manipulate your insulin sensitivity, obesity outside of smoking is probably one of the major causes of cancer and it's largely due to the inflammatory aspect that coincides with obesity insulin resistance so we'll talk a little bit about how we can try to address those things and environmental carcinogens.

44:46

We can't ignore those things, and these are very common cancers, scarcer cancer. Childhood leukemias, which, unfortunately may be due to some type of exposure, not always. And, and I can't say how much they are, I think it's important to understand that the environment does play a role.

 

45:08 Alzheimer's Disease

Alzheimer's disease, you know, when we think about Alzheimer's disease, we often talk about, you know, we think that it's a issue and women.

45:20

And that is true. It is more common in women than it is in men.

45:26

However, women usually live longer with Alzheimer's disease, and men usually decline much quicker.

45:32

You can see here, from 0 to 60 months, that rate of decline is, it's true, and clinically, we do see this. Now we don't know exactly why.

45:42

Is it possible that the long term exposure, pedestrian exposure prior was protective large? Declines to stop sharing my play a role.

45:51

I think whenever we look at diseases that try to differentiate between men and women, we try to blame the *** hormones.

46:00

And that is, I think, part of that picture, but we also have to consider that there's, there's other factors that play a role here, It's not just those hormones and those direct impact of the hormones.

46:10

But what have those hormones done over time to protect or not protect our body from any type of issues that might be contributing to these diseases. And I think Alzheimer's is one of those things that I wish upon nobody, and it's a struggle for the individual, and for the family who have to deal with this. So, just knowing that are just just being acknowledging that, although Alzheimer's disease is more prevalent in women, men also experience Alzheimer's, and they usually decline much quicker.

46:45

So, you can see here there's a twofold increased risk.

46:48

Women versus men, um, but men have a shorter lifespan after diagnosis. So, they usually, as I said, this decline quicker.

46:55

And when we first discuss, I kind of grouped Alzheimer's disease into category of neurocognitive decline. So, there are other causes of cognitive decline that might be mixed up with Alzheimer's like Lewy body dementia, vascular dementia, vascular dementia, overlaps with cardiovascular disease.

47:14

So that's when those two circles really do overlap, and I think insulin resistance, mental, emotional, and psychological health. It's also quite important there. But you can see the rate of decline is increased, and men, and Billy body dementia and Parkinson's, and vascular dementia, is more common in men to women.

47:31

So, Men's Health is not just prostate health. It's not just sexual health and testosterone. It's a lot more than that.

47:42

When we look at men who have prostate cancer, one of the therapies is engineering depravation therapy and those men often decline that quicker cognitive decline as well, because you essentially chemically castrated them.

47:58

So, I think testosterone does play an important role here. I can't tell you exactly how much but seeing men who have been on enter into probation therapy or who have had prostate cancer, it's quite important to understand that these are things that we need to pay attention to, especially when it comes to our minds off over time.

48:18

And I think I need to emphasize that the solution, although it includes the things, it's not limited to, but our biggest tools, our prevention.

48:27

I'm trying to come Alzheimer's disease. cardiovascular neurological and metabolically focus is really the, quote, the approach that we need to take.

48:35

And screaming and screening.

48:36

So, knowing somebody's family history, their biomarkers ...

48:39

genotype, Tom 40 genotype class. Oh, right.

48:43

All of these genes and SNPs can have a significant impact on who we need to be more aggressive with and who we don't.

48:52

I wish that more people knew these things, so that they didn't have to actually go after them when it's often too late, because Alzheimer's disease is not a disease that starts in your seventies or eighties. Starts decades before, it's a chronic disease. And knowing these things beforehand can make a significant impact.

49:14

We have many interventions, very few pharmaceutical interventions.

49:18

I just kinda mad as one medication that has been gaining a lot of attention, and in the right scenario and the right individual, it's probably the right choice, and with the right clinician, that is the right way to go about it.

49:32

We have other tools in our toolbox that really can help us with Alzheimer's disease prevention and cognitive decline, keeping homocysteine levels under control, very important. These inflammatory markers like homocysteine and uric acid, and HST, or P and S are all of these things play a significant role in preventing the vascular aspect of Alzheimer's disease.

49:54

We look at and lipids, as I mentioned, ApoB, other LDL particle oxidized LDL.

50:00

Knowing your sterile absorption markers and synthesis markers allow you to be more precise and actually reducing the contributors that might might cause or play a role in Alzheimer's disease.

50:13

Stress is a big deal.

50:15

We're going to talk a little bit about cortisol.

50:17

I think it's very, very important.

50:19

And what we have to understand is that?

50:23

Stress is a lifetime issue, and we're all going to be under stress about. it's really important, is how do we become more resilient, and can we use testing like the DUTCH test to help us identify when we need to be really more stringent?

50:38

Socialism, socialization, exercise, nutrition is a huge role. We'll talk a little bit later. And understanding that sleep is a huge deal.

50:46

And I, when I, when I lecture to other clinicians and I speak to other patients, we talk about, you know, how important are these things?

50:56

And helping our what things can we do to help our our bodies heal from or prevent these things from happening and sleep, sleep over everything?

51:06

Because if you're not sleeping, you're not recovering. You're not able to perform and able to exercise Your overeating is such a snowball to an avalanche effect.

51:15

So, I think we cannot underestimate, and these are a few tools that you can use this to screen for somebody's sleep quality. So, a PHQ nine F for stopping can assess for state quality and even sleep apnea.

51:30

Hypercholesterolemia is real hypercholesterolemia causes and is a cause of hippocampal atrophy. So, when you talk about Alzheimer's disease, it's really a atrophy.

51:40

What happens is, what you notice on MRIs is that there's an atrophy of the hippocampus due to multiple different mechanisms. And obviously, we have tau and amyloid, which certainly accumulate in various parts of the brain.

51:53

But most of the time in the hippocampus and cortisol has the hippocampus.

52:00

It has many cortisol glucocorticoid receptors and over time, but hydrocortisone anemia begins to accumulate chronic stress, and that stress can be anything from, you know, running from the daily stressor of that, You know, that angry individual who you're hate to see at work, or your spouse, or you are injured, or chronic pain, or sleep deprivation over time, this chronic hypercholesterolemia, not cushing's, Although, crushing certainly can do that.

52:33

And that's one of the cases that we use to kind of make the case that cortisol is an issue, but over time it causes this hippocampal atrophy.

52:43

Then these glucocorticoid receptors are found largely in the hippocampus and at very low levels. They might be protected because they simulate production, other neurotransmitters and adrenaline in which might provide this acute benefit, but over time, there's this inverted U-shaped curve where benefit, you get slight benefit, and then chronic hypercholesterolemia just causes as hippocampal atrophy.

53:11

And that then desensitizes the remainder of the of the HPA axis. So, the brain is noticing that there's cortisol, your hippocampus is atrophying, and then it causes this trickle down, or this large effect of making your body less sensitive to these sensors.

53:29

And then we have the negative impact of these glucocorticoids on ....

53:34

So, brain derived neurotrophic factor, which, as a, as a trophic type of hormone, which helps these nerves to grow. So, chronic cortisol hypercholesterolemia causes these things to decrease, and then, obviously, you have the other aspects of inflammatory cytokines which is caused by elevated cortisol.

53:53

So not only elevated cortisol, but, certainly, as a player, I think, one of the main things that we really need to understand.

53:59

and what I try to drive home is, is that it's not one of these things. It's not just one of those circles, this new paradigm for health is not just one part of that.

54:09

Then diagram, and that's why it looks so silly, with eight different circles, but they all matter, and Alzheimer's disease and Men's Health is a multi-faceted disease and requires a multi-faceted approach.

54:22

This is a very good image image of kind of what happens over time is that this hippocampus be combat atrophied, and a normal hippocampus will have inappropriate response.

54:30

But over time, this negative feedback, it does not work. And now we have this, this vicious cycle.

54:38

And these are some tools that we have to really assess. And I love this image, which really does do an exceptional job of outlining. You know, how does this start and look at all these things up? Here? We have supplement stress.

54:53

Exercise diets, the H R T, which can be quite helpful. Social engagement, right? All of these things have an impact, and whether, you can see here, whether they have a positive or negative impact. Like self-stress, what causes, obviously, a negative impact.

55:08

And can obviously lead to neural transmission issues, which, which then lead to.

55:16

central nervous system. Dysfunction and obviously, all of the other and inflammatory cascades that can occur from that. But we have ways to protect ourselves from that.

55:28

And we have the tools to do it.

 

55:32 Metabolic Syndrome

Metabolic syndrome and I call it metabolic syndrome, because we don't really have a kind of broad reaching category. I think insulin resistance is probably more appropriate, but this is what's usually more discussed in the literature and what other clinicians would kind of understand.

55:46

The underlying cause of ..., many chronic diseases, is metabolic syndrome and insulin resistance, um, cardiovascular disease, we can link it back to metabolic resistance, resistance and metabolic disease, and affiliate dysfunction. one of the necessary causes one of the necessary conditions to lead to cardiovascular disease, cognitive decline.

56:09

No record of selenium causes, elevated blood sugar, they're eating a bunch of, uh, processed foods that's certainly going to have a negative impact, not only on your brain, but on your pancreas and your, your muscles.

56:22

As we discussed, obesity, one of the major causes outside at smoking, or for cancer, I think it's really important for us to focus on Sarcopenia

56:32

We we don't diagnose Sarcopenia until later, in life, but certain opinion is certainly an issue because lower muscle mass makes us less able to metabolize fuel as energy.

56:42

So, if we can improve muscle mass and improve our ability to metabolize fuel, we're going to allow ourselves better tools and, essentially, create this buffer for us to be able to tolerate no.

56:57

That that ice cream, or, you know, that the popcorn or whatever it is, but you can't do that if you don't have the muscle mass, too.

57:05

Kind of the engine to burn the fuel.

57:08

This is a simple schematic of what a normal response should be when you have insulin. events. Finally comes in by the answer receptor glute.

57:16

4% just come out and pull sugar, and but over a long period of time, what happens is that you have insulin resistance and chronic exposure to glucose, chronic exposure to insulin, which is a result of elevated glucose.

57:31

You start having aberrations in this internal cascade and although this is related to cardiomyopathy it does apply to many other conditions.

57:41

And essentially what's happening is that your endoplasmic reticulum and the mitochondria become dysfunctional and when they are not functioning then essentially most of the cell cannot function and they're kind of like the cornerstone of health.

57:55

Understanding how insulin resistance and metabolic disease contributes to all other diseases is very, very important.

58:02

So, this is cardiomyopathy, but this can apply to any type of cells especially muscle cells. So, when we look at cells that are mostly impacted by insulin resistance, it's, it's muscle liver and fat.

58:13

So, getting less, removing the amount of fat cells that we have is very challenging. But we can improve the amount of muscle cells that we have, and we can help our livers be healthier.

58:23

And that's actually one of the techniques and tactics that we use to improve insulin resistance, and obviously prevent the things that we try to focus on in this new paradigm of men's health.

58:34

Again, this is for late onset Alzheimer's disease. But all of this stuff starts decades, decades before, but this central insulin resistance in the brain but also can happen peripherally.

58:46

At first, right, so it starts periphery that it enters the brain, but leads to oxidative damage leads to neuroinflammation, causes these beta amyloid plaques to form, and now these tangles become an issue and now you start experiencing Alzheimer's is right, or cognitive decline.

59:03

But, again, this can happen in any type of cell and anything else in the body, any other cell in the body, but mostly the liver. That's why we see fatty liver disease not then starts to create an increase in CRP and inflammatory cytokines, right?

59:16

So, we're potentially aiding the issue by not actually addressing the underlying cause.

59:24

So, how do you assess insulin resistance, fasting glucose, decent, fasting insulin, better A one C, unless you're diabetic, not really useful, CGM, Oral glucose Tolerance Test and fasting insulin?

59:39

Those are the really the gold standard's OGTT oral glucose Tolerance Test.

59:44

It's one of the best tools that we can use CGM much more popular. Now, I think it's a great tool, not for everybody, but I think it's quite helpful and fasting insulin, these things are elevated way before fasting glucose and way before a elevated A one C. So, I would focus on these things.

1:00:00

First, the insulin CGM, if possible, and even a glucose tolerance test.

1:00:05

You can even do an at home, a finger stick to see what does your blood sugar look like? 30 minutes or an hour or two hours after a meal?

1:00:13

If after 90, to 120 minutes, your blood sugar doesn't get back to normal, there's something going on with your ability to metabolize carbohydrates and your insulin sensitivity, and I would start paying attention to what you're eating and how you're moving.

1:00:28

So, nutrition is our number one tool.

1:00:31

Exercise is a close runner-up. That's arguable some might say exercise. Some might say nutrition.

1:00:36

It's neck and neck.

1:00:38

I think you can’t out...

1:00:39

You can’t out-exercise a bad diet, so that's why I applied nutrition as number one, but together they outcompete, and they outdo any drug or supplement bar none.

1:00:49

I'll go to argue with anybody on that.

1:00:52

These things are incredibly, incredibly powerful and one of the most powerful tools that we have, if you know how to use them and if you know what to look for.

 

1:01:02 Conclusion

So, I'd like to wrap up and just kinda summarize that mental health really does expand extend beyond urology and endocrinology. Leading causes of death, and many are chronic diseases.

1:01:12

So prostate cancer is only one of those and what we really need to focus on risk assessment and prevention, rather than a reactive type of medicine. And if you can do all of these things, and identify, and help the men in your life, realize that, if they want to live well, live long, to see their kids, and our grandkids and their partner, and be able to do the things that 70 that they've done at 20 and 30. Everything in this lecture is going to help them do that.

1:01:37

If you just focus on neurological suffer Men's Health, you missed a man's heart, more than 50%, of that pie, of helping a man with long, including the health. And I'm like, snap, so I'd like to thank all of you for listening to this today.

1:01:52

If you have any other questions, I'm happy to address them.

1:01:57

Thank you.

1:01:59

That's great. Well, thank you for a great presentation, doctor Esposito, and thank you everyone for joining us today. Check your inbox is tomorrow for a link to the recording and we will also send the slides along with that.

1:02:11

You'll also receive an invite in the coming days for the upcoming Q and A session on Instagram, where we'll answer the questions from today's lecture.

1:02:19

So, stay tuned for those details. And if you have any additional questions about today's content, or for any general questions about the DUTCH test, please e-mail our customer support team at info at DUTCH test dot com.

1:02:31

So, thank you all for joining us. Have a great week.