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Episode 25: Aging Is A Disease with Dr. Mark Holthouse, MD

Updated: Jan 15

Podcast Drop Date: 12/6/23

In this episode, Amber Warren and Dr. Mark Holthouse discuss the approach at the FMI Center for Optimal Health, emphasizing anti-aging medicine. Aging is now seen as a disease in itself and the #1 risk factor for the chronic diseases we can get in time: heart disease, strokes, cancers, arthritis, bone loss, dementia, hormone losses, diabetes, obesity to name a few. Dr. Holthouse advocates for a holistic program addressing root causes, lifestyle changes, and the shift to a self pay model for personalized care. The discussion explores challenges in the healthcare system, highlights the significance of hormonal health in anti-aging, and introduces pellet therapy for hormone replacement. The episode concludes with insights into longevity, addressing audience questions on creatine, strength training, and offering valuable perspectives on Functional Medicine and personalized health care.


Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Welcome back everybody. We're here doing something we've never done before. We have a live audience and we're doing two of our shows live to our podcast episodes slides live this evening. So Amber Warren here, I'm a physician assistant, and I'm thrilled to have our most infamous chief Medical officer, Dr. Mark Holthouse, with us. Dr. Mark Holthouse is the chief medical officer for FMI center for Optimal Health and Functional Medicine of Idaho. He graduated from Loma Linda University School of Medicine and went on to obtain his family practice training at UC Davis Medical Center. While in the Air Force Scholarship Program at David Grant Medical Center. Dr. H has over 32 years of family practice experience, and bring brings years of practice in the areas of functional and integrative medicine. As part of the Institute for Functional Medicine Teaching Facility faculty. Excuse me. He has educated thousands of practitioners in hormonal health across the nation over the past decade as an assistant Professor, professor of medicine on the teaching faculty at Loma Linda University School of Medicine. He is an expert on cardio metabolic diseases and prevention, reversing type two diabetes, heart disease, high cholesterol, obesity, and metabolic syndrome. In addition to his clinical and teaching experience, he has over 30 years of owning his own private practice and acting as Medical Director, implementing strategic models in clinical practice in the business of functional medicine. Dr. Holthouse and his wife Tammy, who is lovely, enjoy photography, snowshoeing, skiing, sailing, hiking, kayaking and of course, good food. His newest, newest area of expertise is in precision anti-aging medicine, and that's what we're here to discuss tonight. Such an honor to have you back.

Dr. Mark Holthouse, MD: Glad to be here. This is so exciting. I've been like a kid on New Year's Eve or Christmas Eve all week.

Amber Warren, PA-C: I know you have. It's been palpable getting to work alongside you, your excitement. I think we wanted to kind of start this first episode talking a little bit more about what we're doing here at our new Eagle facility, center for Optimal Health. So how are we different? I love how you how you speak to this.

Dr. Mark Holthouse, MD: Oh my goodness.

Amber Warren, PA-C: What's our.

Dr. Mark Holthouse, MD: Why Amber. The why? This is why we're all here. You know, we've kind of observed these trends coming and going with, you know, the newest sexy, flashy molecule, whether it's nad, whether it's the C 15 new fatty acid craze, whether it's this or that, resveratrol yesterday, nad today. And then we've got all these molecules that come up as we discover these amazing things that they can do. We've got IVs that we can get, we can get hormone pellets, we can do all these modalities. And what I've been struck with is that no one of those things is really going to move the needle for people, either with preventing chronic disease or slowing aging. It's really more of an overall program where you're implementing kind of on the foundation of therapeutic lifestyle change, diet, mind, body and movement, managing stress, using some of this new tech and understanding at Cell Molecular Biology, to put it all together. I hear all day people watching podcasts and they're on Dr. Google and they're really overwhelmed with the information overload. And I've been struck with the fact that they're getting pieces of a bigger, a bigger picture and that there's no one really locally or anywhere that I know of that's putting trying to put it all together in a program that's sustainable, that's not based on the latest molecule. Yeah, really. Moving away from reductionistic kind of an ideology to more of a broad based approach where you're looking at implementing all of these things, not just one aspect of it.

Dr. Mark Holthouse, MD: And we have lots of folks that are getting IVs and getting hormones and things like this that aren't doing some of the other basic things to get long standing results, whether it's improving blood sugar, cholesterol or losing weight or what have you. And now really looking at slowing aging, which we talk about anti-aging medicine. And really, for the first time ever, I think there's a lot of really smart people that are looking at age as a disease unto itself. Yeah. In fact, as the driver of all the other chronic diseases that we're dealing with. So as opposed to playing whack a mole medicine with just looking at, you know, this specialty radiology, nephrology, cardiology, what if we look at aging as a disease itself, meaning that all of these organ systems that are failing in these ologist categories, what if we sat back and said, hey, what's the science showing about commonality at the cell level, which makes tissues, tissues make organs that we can impact to stop these organs from aging and prematurely going into failure. So that's what's exciting. To me is that we're looking at it at this upstream right path that leads to all of these things Alzheimer's, cardiovascular disease, arthritis, bone loss. So many of the things that are on the top ten causes of death in most countries now. So it's more of a way to it's a common thread, right. And it's at the cell level. Yeah. And then branching out tissues organs diseases. Yeah.

Amber Warren, PA-C: So we want to catch you in pre pre pre diabetes or the pre insulin resistant state right before you become that type two diabetic. And then we have to implement. Yeah. That's kind of where we're stuck in our conventional medicine world a little bit.

Dr. Mark Holthouse, MD: Right. Going after these avoidable chronic diseases. You know I love the statistic that's out there because it really drives the point home. It's not really a luxury. It's a necessity now to wake up. Our country does acute care medicine amazing. And we have amazing doctors that do these things. Fixing bones and that are broken and people that are having heart attacks and will always need that. But to acknowledge that 86% of the $4.3 trillion we're spending in this country every year on health care is going towards chronic diseases like we're talking about tonight. This is the bulk of the money. It's, you know, the bulk of that 18% of our GDP that's that's going towards these things. And we've been handling them as if they were an acute illness as opposed to trying to look at it another way. So we're ranked now, what is it by the World Health Organization 37th in quality of care. So we can't really say we do it better than anyone else anymore. We do a lot of great things in acute, but we're really suffering with poor access. A third of the population has difficult access to care, but I would argue that what occurs beyond the door, once you get into the access that we need to be doing a different type of medicine for the bulk of what walks through that door, right, 86% of which is chronic disease.

Amber Warren, PA-C: So why let's talk a little bit. Insurance versus cash pay. Why are we getting into trouble and why are we sorry? Why are we getting into trouble in our insurance model in a certain capacity? And why are we doing it differently here? Why are we why are we focusing on the cash pay model and the center for Optimal Health?

Dr. Mark Holthouse, MD: Great. Great question. As as necessary as insurance is for catastrophic care, for expensive specialty care, X-rays, imaging, E.R. visits, which can potentially bankrupt you if you're uninsured. It's also limited, right? You know, we don't have insurance for putting brakes and tires on our cars. We have automobile insurance. But for the wear and tear, the primary care kinds of things, it was never really meant to be used in primary care. And some of these foundational topics. And yet that's what we're trying to do. I think specifically speaking to the limitations of insurance, it's really difficult because a lot of these proactive types of approaches where we're looking at things that are not yet acknowledged or valued by traditional insurance as being medically relevant. We're really talking about a paradigm shift as opposed to waiting for something to be wrong. Reactionary medicine. We're really having to move towards a paradigm of being proactive, building health, just like we build a 401 K for our financial portfolio. If you don't do something today, you're not going to realize anything different down the line when you retire. Well, the same thing is true with health.

Dr. Mark Holthouse, MD: And yet we don't treat it that way. We don't have people come in and tell there's something wrong if it ain't broke, don't fix it. And that might work well for broken bones in acute care. But when it comes to the 86% of what walks through our door again, that has not served us well and we're not getting the quality that we deserve as as citizens, we're spending $12,500 per year per person in this country, and we're ranked 37th on quality. So I think it's time for yeah, we need to break the status quo. So really the insurance is a reactionary model. What we've done is we've come apart in a cash model so that we can truly work for the client and not for the insurance company. And we can look at a proactive approach like this. Anti-aging is just one way to look at the larger scope of how chronic disease can be attacked or looked at and handled managed. We want to be more than just a management of disease and managing of prescription drugs. We want to be a health care.

Amber Warren, PA-C: System. And side note worth mentioning. When's the last time you've had one of your insurance companies? Of your patients pay for a vitamin D level?

Dr. Mark Holthouse, MD: Right. It's cash.

Amber Warren, PA-C: Anyways.

Dr. Mark Holthouse, MD: Right? Yeah, yeah. Know virtually everybody we check has low vitamin D, especially here in Idaho. And we know it does. It's a hormone. It's probably not a vitamin at all. But it's got so many incredibly important roles. And yet you know this is the reality that we're dealing with. And it's abnormal in most everyone we check. So it's yeah.

Amber Warren, PA-C: Yeah, yeah I'm curious. I mean, I think I know the answer to this, but for our audience and our listeners, we know your your specialties and what you focus on in your several decades of of experience in medicine, what brought you to where you were so invested and interested in digging into this anti-aging precision medicine? How did you come full circle and kind of land on?

Dr. Mark Holthouse, MD: Yeah. Good question. So so I was asked to talk on originally Men's Health by the Institute for Functional Medicine ten years ago, and I really wanted to be part of their cardio metabolic module because that was where my heart was. That's where I taught at the med school the last ten years, and there was no room in the in that team had plenty of teachers. So they said, Mark, if you want to be part of the game, you got to teach hormones. So I said, okay, how can I make the hormone module talk that I give more like a cardiovascular talk? And what I kind of facetiously and what I discovered as I got into hormone medicine, especially with testosterone, was that it was intimately connected with cardiovascular health. Yes, and inflammation, and that it became obvious to me that it was really kind of all the same thing. One of the things that I was struck with in teaching cardio metabolic medicine, with cholesterol and blood pressure and type two diabetes, obesity, metabolic syndrome, and with hormone dysfunction in was that they were just pieces of a bigger puzzle. What the anti-aging issue has, has helped me realize is that it's all anti-aging. It's hormone optimization. We age, I think, largely because we lose our hormones. Whether it's growth hormone, we know we lose that pretty rapidly every every decade.

Amber Warren, PA-C: Wise growth hormone important for us.

Dr. Mark Holthouse, MD: Well, growth hormone is a big deal because it's so important for regenerating tissue. The damage that occurred the day before we secreted at night with our slow wave sleep. And we secrete testosterone in our REM sleep at night as well. So at night, you're taking out the garbage through what we call the Glymphatic detox system, detoxing our brain at the same time, our brain is making these chemicals, growth hormone and testosterone to regenerate our tissues from all the damage and things that occurred during the day. But when I realized, wow, testosterone has got these anti-inflammatory benefits. It has these associations when it's low, with more autoimmune disease, more prostate cancers, more problems with cardiovascular disease, heart attacks, you start to see that losing your hormones is not just about sexual prowess or bone loss in women, but and collagen issues and hair loss. But it's also about having strokes and heart attacks and dying of cancer. Is prematurely.

Amber Warren, PA-C: Alzheimer's.

Dr. Mark Holthouse, MD: Dementia? Alzheimer's dementia, the brain's covered with receptors for testosterone and estrogen. You know, the myth that testosterone is a female hormone is so far off track with science. Testosterone is the most abundant sex steroid hormone in the body and women. The androgen receptor gene is on the X chromosome. You know, this is not a male hormone only, nor is estrogen exclusive to females. So it's in.

Amber Warren, PA-C: Different amounts in males.

Dr. Mark Holthouse, MD: Female the devil's in the dose, the details there. So getting back to, you know, these silos of optimizing hormones, dealing with inflammation and the cardiovascular system, these are two of the biggest components that cause us to age prematurely. We it's now within the grasp of science where the cell has the potential for going a lot longer than we're currently going, and not just longer, but better. We don't want to just create a bunch of folks that are 110 years old, that have diseases that are fragility and and poor quality of life. That's going to be a huge drain on an already suffering Medicare project. The idea is that if you can prolong quality health span. Quality years, not just lifespan well beyond where we are now. Being more productive, working later, contributing to Medicare longer and being less ill until at the very end. So you're going to have a lot more coming in and a lot less being drawn out from a population based concern. So a lot of the folks that say, wow, you know, I don't want to live, why would I want to live to be 110? They're thinking about it as our current paradigm of suffering and illness and fragility. We have now in our grasp in the next generation. I feel it's we're going to see people routinely living into the 110, 115 range, even in the one 20s and again, living.

Amber Warren, PA-C: Well, feeling.

Dr. Mark Holthouse, MD: Good. You know, 120 is the new 50. Haven't come out with that one yet. But this is this is where, you know, some of these podcasts are David Sinclair's new, newer book, Lifespan. He's a Harvard professor, a PhD. He's got all the science behind this stuff. The science is so far ahead of our ethics and our questions with how this is going to occur, what this is going to impact on us economically. Right. You know, there's so many things to consider. But the anti aging paradigm and at the cell level explains the testosterone and the hormone function failure. It explains a lot about what's going on with the aging brain and the neuron, the aging of our eyes with cataracts and macular degeneration, with osteoarthritis, with dementias, with premature problems with cardiovascular disease, high blood pressure. So many of these things that are related to inflammation, oxidative stress, you can track these problems down to the cellular biology. And that's, I think, the stuff of what the next episode will be on. But yeah, so I see it as an overarching theme that takes all of these areas of aging and concern to be optimized and puts it into a program as opposed to just trying to make it a piecemeal what's the fat of the week? Whether it's IV nad keto, keto diet, intermittent fasting, you know, every, every year, it's another fad. And it's not that these things aren't legitimate, but when you try to isolate and think reductionistic early that any one thing is the magic bullet, I think that's where we get into trouble. Yeah.

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Amber Warren, PA-C: I want to go back a little bit to just the term optimizing hormones, because I think it's probably worth defining that. You know, I think I forget we're in our own little world here in Eagle nerding out together, and I forget that there's a whole world out there that sticks to reference ranges, you know, and I will. I think it's safe to say that a lot of times these insurance companies force us to stick to these reference ranges and where we can't kind of practice outside this. How did we get these reference ranges that most people will see on their lab work when it comes to looking at free and total testosterone or estradiol levels?

Dr. Mark Holthouse, MD: Great. Great question. So reference ranges come from populations walking down the road here at Walmart, walking in there and looking. That's your reference ranges. So reference ranges aren't necessarily healthy ranges any longer. And as the population gets sicker and sicker normal becomes something far removed from where we want to be with a healthy lifestyle. Promotion. Reference ranges are basically divided. The couple standard deviations from a median to the negative and to the positive. And if you fall within that, whether you're all the way over to the shoulder or whether you're in the middle, you're still in the normal range. But yet if you go just one little iota off to either side, you're suddenly at an aberrant anomaly and an outlier. So the whole idea of having a reference range like that is really preposterous. What we're finding in particular with optimization in reference ranges of hormones, is that particularly in women, the reference ranges for testosterone really have no basis in science. There really isn't an established reference range, although they're published, they're really not very meaningful. Same is true with a lot of men. Now men, in order to get their testosterone products covered and paid for by insurance, have to meet FDA and Endocrine Society clinical guidelines, which means that you have to have two abnormally low testosterone below 300 on two different occasions to meet the diagnosis of of abnormal T. And we know there's a lot of guys who have values of 4 or 500 who when they were 25 and at 900 and they fallen that far, really aren't feeling very well anymore.

Dr. Mark Holthouse, MD: So treating by symptoms and and choosing your candidate safely and responsibly is, in my mind, more important than sticking to the reference ranges. And so optimization is really getting guys back to where they feel good, getting women back to where they're optimal as opposed to replacement, which you're trying to use these arbitrary reference ranges to stick within as a definition as to when to treat. And I think a lot of us that are not following the typical guidelines on, on these reference ranges have really the proof's been in the the responses of the patients. I would have never treated that person based on a reference range. And man, I'm glad I did because they've got their life back. So there are these folks like that. That being said, there are other parameters with other labs that make it more responsible to give a certain dose or not. There's so many other things to look at besides just the actual reference range of the hormone itself. We look at all these other factors like prostate cancer, breast cancer risk, CBC what's their bone marrow doing in the case of thyroid and optimizing thyroid? You know, there's a lot of practitioners that don't in integrative circles measure any labs. And they're totally basing it off symptoms. I'm not quite that cavalier as a licensed medical doctor. But, you know, there's certainly something to be said about treating the patient in front of you if they're not a piece of paper.

Amber Warren, PA-C: Right?

Dr. Mark Holthouse, MD: Right. If all you're looking at is a TSH, which was never intended to be something to monitor dosing at the very best, it was initially come across to diagnose a weak diagnostic criteria for hypothyroidism. You can often be led down the garden path. So a lot of these folks will have active thyroid hormone levels that are at the 50th percentile right in the center of that normal reference range. And they're still constipated losing hair. They have cold intolerance. You get them on a little bit more T3 closer to the 80th percentile in that reference range, 90th percentile, and voila, all of those symptoms are gone. Their energy is better. They're thinking again, their brain works. They're having bowel movements every day. The brittle, dry skin and hair is resolved. So it's this individual approach personalizing medicine as opposed to treating us like cattle where we're based on these. Normative reference ranges that often are based on non healthy clients that we're trying to get away from and be more personalized.

Amber Warren, PA-C: Back to testosterone replacement for men and women. I know pelleting is something that you and Dr. Pennock are getting wildly busy and efficient with. Why has that become your favorite? I assume it's your favorite way to replace and optimize your male and female patients.

Dr. Mark Holthouse, MD: Full transparency. I'm totally biased on pellets. Well, I know this. We I mean, we manage people with creams if they want to do that. And we'll manage them with injectable as well. But having done all three modalities now for years, certainly there is. Well, the studies speak for themselves that contentment of the client's preference tends to center around pelleting. Not all pellets are the same. Not all pelleting doctors have the same technique, right? So there there are platforms of newer patented pellets that are wildly superior to some of the things I was using even as recently as two years ago.

Amber Warren, PA-C: Can you explain a little bit what pellet therapy is?

Dr. Mark Holthouse, MD: Yeah. So pellets have been around for about 80 years for use in humans, for hormones. And it's the idea of placing a small grain of rice sized pellet of hormone, which is bioidentical, meaning it's gotten from yams, and they convert it to a powder form and they compress it into a small pellet. And what we do is in women at the top of the glute. And guys, we like to go in the back of the flank. We numb the area up. After cleaning it. You make a small puncture. It's not an incision even. And basically you slip it in under the skin, put a little scary strip on it and you see them again. In six months, women were doing more like four months, but it's a nice way to get a consistent dosing curve over the dosing cycle. So many of my guys that are on injectable testosterone, the most common form of that being in seed oil, it's not a true hormone. It's a synthetic. It's got to go to the liver after they shoot it into themselves twice a week and become testosterone. They get wild roller coaster dosing where it's very super physiologic, very high, and can often come crashing down. Some of the earlier pellets did the same thing. The pellet platforms that we like have proprietary patented delivery methods now where instead of packing the powder vertically, where you get hotspots and air pockets, kind of an inconsistency in the dosing. And the women will often feel that through the four months, if they hit a hit, a concentrated area of tea, and then they have a spot where it's low, they've kind of done away with this now where they pack it horizontally this way instead of vertically. They have cellulose sustained release system. So you're getting a consistent delivery and they have micro doses of of steroid in them, like 0.004mg of triamcinolone to minimize scarring. So they've really solved for a lot of the traditional issues that have come up in the past with historically, with Pelleting.

Amber Warren, PA-C: It's a really great technology. It's really cool. It is.

Dr. Mark Holthouse, MD: The technique has gotten so much less traumatic. There's no more cutting. It's what we call a waggle. As you get in through there and you know, it's less traumatic because you don't see the adipose lysis, the fluid coming back at you with the trocar as you're putting it in. So it takes me a lot longer to tell the patients what I'm going to do than to do it. And it's nice. There's no contamination of your pets and your family with creams and things like that. Putting your kids.

Amber Warren, PA-C: To bed after you apply your creams. Yeah, that can be a big deal.

Dr. Mark Holthouse, MD: Yeah, lots of advantages there. I have some diehards that just prefer creams or just prefer the the injectable, which we still do it, you know. Of course. But you know, some people just the thought of having to come in and have something put in a couple times a year is too much for them. They'd convenience. They'd rather do the shots a couple of times a week.

Amber Warren, PA-C: The convenience. Sorry, I was speaking. The convenience in the pellets is what?

Dr. Mark Holthouse, MD: Yeah, the convenience is really the biggest issue. And the consistency, I think, of dosing with the newer pellets, some of the older pellets gave you a huge overshoot. And you know, and the beautiful thing is when you recheck the labs a month after pelleting where it's peaking and you ask them about their symptoms, you can get a pretty good idea as to where the next dose needs to be. You fine tune it and they're happy campers.

Amber Warren, PA-C: No. It's great. We have a few questions coming in from our audience. What are your thoughts on creatine for strength training, for longevity? Sorry, creatine and strength training for longevity.

Dr. Mark Holthouse, MD: Yeah. So so exercise is a. Stimulator of basically something called AMP kinase, which which tells the cell that it needs to upregulate its ancient survival longevity gene pathways. And there's other things like metformin and exercise and fasting that can do that. So I like the fact that there are so many ways to get at that. It's not just one thing that is one of those areas that you can upregulate the sirtuin pathway. Sirtuin is kind of like the holy grail of anti-aging. It's the longevity gene family. There's seven of them that we really focus on in humans. We initially started studying these things in yeast cells back in the 90s and then in roundworms, nematodes and fruit flies and later mice and rats, and then now in human cultured cells and in human trials. So we've got all these human trials looking at all of these things that work that way. So whether it's exercise, whether it's metformin, whether it's rapamycin, whether it's giving NAD, whether it's intermittent fasting, whether it's doing a cold water plunge, you know, looking at red light, infrared wavelength, all of these things we know are working to uncouple the mitochondria, which the end game is to eventually raise this, this longevity set of genes. And it's a preserved ancient survival pathway that's been discovered across species. I mean, from a single celled yeast all the way to complex mammalian cells. So, yeah, that's just one of those things that that is involved in those pathways.

Amber Warren, PA-C: And creating the same as far as.

Dr. Mark Holthouse, MD: So creatine sorry I got off track. So creatine you got me on my sirtuin pedestal. Creatine is great. You know creatine is not something you need to do. I think it's kind of an additional thing to stimulate lean muscle mass. Most of us don't get enough of the right kind of protein. That's not to say that, and this is wildly controversial, and I'm sure I'll stimulate a lot of questions by saying this, but I'm going to say this there is no one perfect diet for everybody. You know, you can do too much of of anything. I think plant based proteins are incredible. There's pluses and minuses for animal based proteins, for sure. There's all kinds of arguments about complete proteins, quality of proteins, the amount of grams per protein that are quality branched chain essentials versus carbohydrates versus calories. When you're looking at plant versus animal based. And that's that could be a podcast to its own self. Yes. Creatine monohydrate. If it's if it's a quality product done pre or post exercise along with adequate branched chain amino acids and strength training is incredibly helpful at improving body composition. Again, I don't think it's necessary if you've got marginal kidney function or you tend to run a dehydrated body, I don't think it's probably a good idea. I would rather people work out five days a week doing strength training along with adequate protein in their diet, pre or post or pre and post exertion than worrying about creatine. It's more of an afterthought and an add on than it is, I think a staple. Okay.

Amber Warren, PA-C: Fair. I love Peter Attia's approach, especially his his chapter. I'll honestly just tell my patients to go read his chapter on exercise. I love how he relates strength training and lifting heavy to not necessarily what you want to do at this point in your life 30, 40, 50 but what do you want to be doing in your 70s or 80s? Do you want to be able to carry your own luggage and lift your luggage up above in the overhead bin? Do you want to be able to pick up your grandchild from the ground when you're 80 years old? I just love that thought process of what are you doing right now to build muscle to help you two, three decades down the road?

Dr. Mark Holthouse, MD: Yeah, yeah.

Amber Warren, PA-C: To keep your quality of life later in life. It's pretty cool.

Dr. Mark Holthouse, MD: What is this saying? Yeah. Sarcopenia. I mean, muscle is the currency of youth. Yes. And sarcopenia is losing that muscle as we age, which is is part of the aging process. The atrophy that occurs in muscle is driven by a lot of these cell senescent pathways that we talk about. And so now that we understand that there are all kinds of things we can upregulate besides just macronutrients to, to augment the strength training. But it's it's so important, especially over age 50, to emphasize strength training. And I like group strength training where somebody's watching you so you don't hurt yourself.

Amber Warren, PA-C: And it's motivating to be in groups that competition, community accountability, accountability.

Dr. Mark Holthouse, MD: It's fun. You get to know people. All. It's hard. It takes an exceptionally motivated person to go out in an Idaho winter in your garage and and find those, those straps and, and kettlebells and do all that for me. So, you know, and if you can do some heavy weights a day, a week, two days a week, out of those five days, that's going to be amazing. Yes. Go out and walk. Walk is underrated. It's the best way to burn fat. Of all the exercises in zone two, you know, Orange Theory, we talk a lot about zone 4 or 5. That's primarily burning carbs. Walking is is amazing. So if you can walk most days and you can do some strength training, those are things that probably for the investment return on investment is right up there in my top two. I agree it's you know, diets probably takes the top seat nutrition. But man it's got to be right there. You know. And a close third would be stress management keeping your cortisol under control. Because I always talk about cortisol from your adrenal stress being Kryptonite to your hormones. Yeah. And your brain yeah. Atrophies your brain.

Amber Warren, PA-C: That's a whole nother podcast. Whole nother. Keep moving on. Yeah. One more question coming in on that topic of supplements and protein. Amino acids. I'm seeing perfect aminos mentioned a lot lately in health ads and in the social media world. What are your thoughts on this supplement and do you recommend.

Dr. Mark Holthouse, MD: It as a proprietary supplement? Yeah. You know, so I got to give credit where credit's due. This is Dr. Charles Penick's baby. He won me over a few months back. Me too, on this product. Perfect aminos. Ah, it's a it's a brand of really the right type of protein. It's a whole protein. It's the right ratio of essential amino acids and branched chain amino acids. And in the cap tablet form, they don't tend to bump your insulin. So for those of us that are doing time restricted eating, trying to bump out that first meal of the day not just to promote longevity, but to lose weight controls blood sugar as well, and detox. These things are a way to get your protein in the morning without spiking an insulin deal and resetting your clock on a time restricted fast. We like to do at least a 12 hour fast overnight, pushing out to 14 and 16 hours where you get that first meal in it late morning midday, assuming you're quitting your nighttime eating at seven ish. And so the capsule form of that, I think it's actually a tablet. Yeah, tablets. I had five of them this morning. They're they're kind of dry and hard to swallow. You got to be good at swallowing pills with those. I will say they're not going to slide down like the fish oil caps do soft gels, but they're nice for people that are doing time restricted, that are wanting a nice pre-workout where they're working out earlier in the day. They also make a powder, a protein powder which has a sweetener in it. I believe that I forget if it's a monkfruit or stevia, but it's got it has a protein in it, and with that you're going to wreck your fast. Basically, it's like, that'd.

Amber Warren, PA-C: Be my post.

Dr. Mark Holthouse, MD: Workout. Yeah, post workout or later in the day. So tastes a lot better. But it's nice because you're you're getting a good quality branched chain ratio of isoleucine. Valine and leucine are branched chains to your essentials. The other nine. And so for people that's a rough estimate. I always use the 5050, 50 rule. You know 50% of your protein supplement should be essentials, 50% of those should be branched chains, and of those 50% should be leucine. That being said, people are a little bit over enamored with leucine, and that's why so many people are doing whey isolates because it's naturally high in leucine. Leucine stimulates muscle like nobody's business. The problem is along with insulin, it's also very pro emptor, which is the subject of probably the next episode here tonight, which we want to balance between AMP kinase. Detox, living a long time healthy autophagy and being lean. Being ripped. Being anabolic. And so many of my patients come in where the teeter totter is really shifted to that anabolic pro growth Pro loosing pro muscle. A lot of my carnivore patients are in that camp and I'm saying, hey, you look great, but enjoy it while it lasts. You're not going to live very long. So they tend to be a lot of my most inflamed patients. So I think there's a balance to be struck when you're looking at this topic. And the proteins are at the heart of that discussion.

Amber Warren, PA-C: I agree. Yeah. Great. Wonderful. Well, I think it's probably a good time to wrap up. We don't want to give away too many secrets for our next our next topic and our next podcast. So thank you so much, Dr. Holehouse. You're welcome. Good tidbits and girls.

Dr. Mark Holthouse, MD: Pleasure. Thank you.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations Podcast. For more information on topics covered today, programs offered at FMI Center for Optimal Health and the highest quality of supplements and more go to

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