How to Manage Testosterone and Estrogen in Athletes [transcript]

Written by Christopher Kelly

Jan. 21, 2018


Tommy:    Hello. And welcome to the Nourish Balance Thrive podcast. My name is Tommy Wood. And today, I'm joined by Dr. Ben House. Hi, Ben.

Ben:    Hey, how are you doing?

Tommy:    I'm doing great. Thanks for joining me. How often do you just go by Dr. House?

Ben:    I don't really care. People can call me whatever they want. It doesn’t really matter to me. That name, like everyone— They find out I’m a doctor and they're like “Really? Your last name's House?” I’m like “Yeah.” But as that show gets older and older, it becomes less and less funny.

Tommy:    Yeah. That's true. I guess it's connects for years going out. It was the thing I watched when I was at med school. So, it kind of like stuck in my brain.

Ben:    When I like applied to med school, it was in the heart. So like it was just—

Tommy:    Yeah. I’ll have to admit that I recently heard you on a podcast. I’ve never heard about you or your work before. And I guess the reason why I invited you on is because I was struck by the fact that you were clearly pretty small and pretty sensible. And in the kind of world that we function in, people are either really smart and not very sensible or they pretend to be small and they may be sensible, but that's sort of playing the other side. So, I really enjoyed a lot of the articles on your website. And today, I wanna talk about testosterone. I'm getting jacked and swobbed because I know that that’s something that you’re into as well as the functional medicine side. So, maybe just start by giving us a bit of your background, what you’re interested in, and then we can sort of dive into the other stuff.

Ben:    Yeah. So, I’ve been a meathead since I’ve first walked into a weight room at like 12. I found a barbell. I saw someone bench pressing 135 and I said, “I'm gonna do that. I’m gonna do that quickly.” And I saw someone benching 225 reps and I was like “I’m gonna do that. I’m gonna do that as fast as I can.” And I have an adopted brother who is actually— He’s just a freak. Like he was a D1 defensive and he ran a 45, 40, 64. So, I’ve been chasing him my entire life. And so, I’m 5”9’ 180. I’m 190 now. Genetically, I’m not there. Right? But it’s still fun to push the envelope. And so, everything that I've done is built on that. And I think a lot of us in the research world can get lost in like— Most of the stuff is research. Right? And what brought me to functional medicine was my dad got really sick. And so, I was applying to med school. I got into med school. Yada, yada, who cares. And my dad got sick at that time. And he had celiac disease. And this is like 2005, 2004, maybe a little bit later. And so, that wasn't on anybody's radar. I don't consider it any conventional medicine’s fault or anything like that, but he had 10 inches of his colon removed, his gallbladder removed. All kinds of stuff happened to me. Eventually, I found like he should probably eat Paleo. And he had celiac disease. So, he avoided gluten. He was symptom free in 3 days. So, of course, I thought that was like the holy grail of everything. Then I just applied to UT. I got a PhD in nutrition. That was fun. Ran some metabolic trials and then really just jumped into— My PhD was really— I’m so thankful for it because it gave me time. And I had a graduate adviser who would let me— I'm like I wanna go everywhere like I wanna know the things. Right? And so, she tried to like box me and like this is what you need to do. And so, she just kind of dealt with my research ADD-ness and got me out of there, but that research ADD-ness has kind of really helped me because you talk a lot about systems biology. If we think about testosterone, but we don’t think about thyroid, we don’t think about mitochondrial health, we don’t think about exercise, stress, nutrition, like you’re gonna be a loss and you’re gonna put everything into your box. And so, the more I know, the less I know and I’m okay with that. It’s a good time and I’m never gonna retire. Right? Neither of us are. We’re just gonna keep doing this until we die. And hopefully, someone better than us comes along after we die.

Tommy:    Yeah. As long as I have a job and then somebody else better can come and replace us.

Ben:    You mentioned that Max Planck quote in one of your podcasts and I've never heard anyone else— Like most of us in this field, we kind of have God complexes. So, the fact that we’re not that important really gets people.

Tommy:    Yeah. There’s something nice about knowing that actually in the whole sort of universe, you really don’t matter very much. Personally, I find that quite comforting. So, you now work with athletes. You're based in Costa Rica. What took you down there and what does your practice look like currently?

Ben:    You guys are way down the chute in kinda change psychology or behavior change ‘cause I think when we think information doesn't really— You study the brain. The brain having more information doesn't really lead to a lot of changes. Right? So, if you wanna work with people one on one, that's probably your biggest thing. How do you change people's behaviors? And what I found is we have the most hedonistic society known to man ever created. Right? So, I wanted to create a place where I could basically helicopter someone out of New York City where they constantly see through advertisements. I wanted to try to get that in. And so, they constantly see these food ads, are constantly bombarded with stress and all these things that makes them hedonistic. So, I wanted to create this place where they can have this top of the mountain experience and feel what it's like to, you know, have your circadian rhythms dialed in, eat really good food, and not have to worry about anything else and be around people that are like you, your tribe, who are naturally tribal as humans.


    And so, it's gonna be really powerful and it has been already and I’m excited for that.

Tommy:    So, you’re bringing people over for retreats that includes some of this kind of testing, analysis, and the functional medicine part of that.

Ben:    Yeah. So, I have 2 retreats with Brian Walsh and one of them this year. So, there’s about 2 weeks where i have retreats down here and then I’ve done some I guess you would call ‘em like metabolic work type studies where people come down. I cook all their food. I plug in a CGM, a continuous glucose monitor. We train and we just watch. And as you know, a lot of the training research is in— It doesn't tell me anything if someone squats 240. Cool, you got 58% stronger in 6 weeks. Awesome. Fantastic. You did ball squats and it worked. Of course. And so, I wanna see what happens in the people who are close their genetic potential because anything works for a new person. People who are trying to put 1 pound of skeletal muscle more on their frame and they already have an FFMI of 29 like that’s cool to me.

Tommy:    Maybe we can take a step back and you can tell us about the FFMI and how you analyze that and how you use that ‘cause you mentioned it.

Ben:    I’ll try not to mention acronyms that people might not know. So, fat free mass index, it's kind of like— So, for us average people like average Joes, if you’re a D1 athlete, things— Like Traxler has a great paper in like if you look at D1 and D2 football players, they can go higher than 25 on a fat free mass index. It’s all based on body composition like how tall you are, how lean you are. And so, most of us without performance-enhancing drugs probably aren’t gonna get above 25. Like I’m at like mid-24. It’s been stuck there for like 3 to 4 years. It's a good time. And so, you get to this threshold and that's where you're at. And so, if you have an FFMI of 20, you know you still got a long way to go. And you’re tall, right? How tall are you?

Tommy:    6’2”. Yeah.

Ben:    Yeah. So, you’re 6’2”. So, I’ve worked with— I mean, we both have. Right? So, I’m like, okay, this person can probably have, you know, 170-180 pounds of muscle mass on his frame. Maybe a little bit more. Right? And so, you start to see someone gets a body comp and they have 150. You’re like, okay, we got a lot to do. But if someone’s at 175, you’re like, okay, it's gonna be incrementally exponentially harder for them to put on muscle mass. And that's probably really important for a lot of your endurance, people at Nourish Balance Thrive too. You gotta kind of auto regulate your lean body mass for those endurance sports.

Tommy:    Yeah. So, that’s something that we talk about very frequently, is not necessarily muscle mass, but at least muscle strength. And that’s something that the endurance athlete tends to— they tend to neglect it because they probably just go out for a long ride, long run. But in terms of both performance and injury prevention, getting under a barbell or doing some kind of strength training is super important. So, that's definitely something we try to encourage in terms of like the endurance side. Do you have any tips on how people might incorporate that, you know, even though it’s maybe not something that’s like their main focus?

Ben:    You talk about longevity. You talk about it a lot. Like one of the biggest factors longevity is power. Right? So, that's what diminishes [0:08:14]Inaudible]. And so, we have to maintain power output and that’s where the gym comes in to me. So, for your endurance people, they might not wanna put on a lot of lean body mass because that's not gonna benefit them. Right? Like if you're in an Ultra, you don’t want— Like I’m not gonna run an Ultra. Like I got way too much meat on the pavement for 100 miles. It isn’t gonna happen. Right? And that's probably not that muscular anyway. Like if you look at the best of marathoners, they're not running on muscle. They’re running on tendons. They’re running on connective tissue like it's all recoils. And so then, it becomes all about how long can you do this because most of us, we have— Part of our identity— Like you take away my ability to squat, I’m gonna be pretty grumpy. And it’s probably the same thing. Like I don't care what people do. I'm not trying to change their goals. If you love to ride a bike, like I want you to be able to ride a bike as long as you can. I want you to be able to move in a way that you find enjoyable. I want you to be able to do that throughout your life as long as possible. And so, that's why I think strength training comes into play. And there’s some good studies where— So, say you wanna build strength or hypertrophy. You should probably put that first in your program. Right? If you just wanna maintain it or like just status quo, then you put it second. So, obviously, for your nerves guys, it’s they shouldn't be spending 5 hours strength training, but maybe 2 hours a week and just hypertrophy based or even like just power stuff would be helpful.

Tommy:    Yeah. Absolutely. So then, this brings us to the topic that I really wanna pick your brains on, which is testosterone, right. And we have a number of people who have what we might consider either low testosterone or lower end of the normal range or they have low testosterone symptoms, which, you know, the two aren’t necessarily correlated. And then we have other people who they want their testosterone to be top of the normal range because that's where they think they’re gonna get the most benefit. So, maybe we can start by talking about why men are so obsessed with testosterone, why is it something that we care about so much, and should we care about it so much.


Ben:    I mean, we definitely should care about it. It’s what makes us men. Like it’s very important. Like male and female physiology, like the deeper you get to it, the more parallels you find. Evolution is an adventure. It's a tinkerer. And so, like total testosterone is turned into like this bench press number, so [0:10:20][Inaudible]. To me, it’s way bigger than that, right, because, yeah, you want— Like you want your total testosterone number to 550. It’s longitudinal trials. It’s like observational one. So, if someone has a testosterone over 550, they don’t die as fast as who’s under. Right? But that's testosterone as a canary. If you're testosterone is dropped off and you’re living in the Western world, you don't work out, and all that stuff, like testosterone’s probably gonna go down because it’s related to every metabolic disease and you just pick something bad. It's good have low testosterone with it.

Tommy:    Absolutely. Yeah.

Ben:    And so, if we're thinking about athletes, what I think about like— The biggest thing is the under recovery mechanism. So, is this a person who is blowing it out? They’re not sleeping well. They have 60 hours of stress from their work and like— So, yeah, like that's gonna inhibit testosterone production at the level of the brain and at the level of the testicles. It's very clear. And so, endurance athletes are very, very prone to this, more so than strength athletes because you guys get— It's called the exercise-induced type hypgonadal male. It’s weird ‘cause it's not— Let's talk about that circuit a little bit so we don't leave people at dust. As you know, everything is related by the brain. Like hypothalamic-pituitary-testicular axis. Right? So, the brain is gonna control all of it. And that hypothalamus is the air traffic control tower for everything. That's where your appetite lives. That’s where blood pressure regulation lives. That’s where stress lives. That’s where every thyroid function. Right? And so, this hypothalamus just takes in all these inputs and then it decides what the output is gonna be. And so, if we think about this hypogonadal male, they have a ton of stress from exercise. So, their CRH or the hormone that leads to cortisol secretion from their hypothalamus is elevated. That is gonna feedback on that exact loop and that's gonna lower luteinizing hormone. So, luteinizing hormone and GnRH. So, I don’t know how nerdy we can make this, but—

Tommy:    As nerdy as you like it.

Ben:    So, GnRH is kind of the show in terms of like testosterone or estrogen, progesterone, whatever you wanna say. So, GnRH is pulsatile. You want it to drop every 60 to 90 minutes. If it goes out to 120, you're gonna run into trouble. And so, they've done a ton of studies on this GnRH. And if energy availability is low, GnRH is gonna be smoked. So, at the level of the brain, if you diet too hard, you’re gonna shutdown reproduction. And you’re the head of the ancestral health. Physicians for ancestral health, right? So, this makes complete sense. Right? What's the most expensive thing a human being could do? Make a baby. Make a baby, right? And what's the whole purpose of us being on this planet? Turning calories into babies as much as we want for you to know. That's the point of this whole thing. So, you gotta think the brain is gonna have tons of stop gaps on that system. What’s the reproductive cost for a male? We make, God knows, like billions of sperm everyday like it’s insane. Maybe millions. I’m not sure. I can pull the number. But like our reproductive cost for making a baby is not very high. Like it or not, we can do the job and then dust out. Women, the reproductive cost is insanely high. They're gonna be way more sensitive to energy availability. They’re gonna have way more stop gaps to protect fertility.

Tommy:    I actually wanted to just stop right there ‘cause you obviously started talking about men, but that point you just made is super important to a number of people who will be listening to this and other people we work with, which is that we are on this planet to turn calories into babies. So, you wanna make babies? You need more calories. And that is the balance of what you eat and then what you do the rest of the time. Right? It’s gonna be super important.

Ben:    Honestly, like the biggest problem I find in athletes is under eating. People are scared of everything. They’re scared of fat. They’re scared of carbs. Now, they’re gonna be scared of protein because—

Tommy:    Oh yeah, ‘cause [0:13:57][Inaudible] and cancer. Yeah.

Ben:    But yet if you give someone insane amounts of growth hormone, like they don't get cancer like—

Tommy:    If you have acromegaly, which is usually a tumor releases loads of growth hormone, those guys have a bit more colon cancer, but that’s about it and it’s not even that much more.

Ben:    Yeah. So like do you wanna waste away like— So, energy availability, to me your body is gonna— Like leptin, everything in that— The basomedial hypothalamus, which is where appetite lives, which is so important— It’s amazing to me that everyone who walk here on this planet is 800 pounds in a wheelchair like seriously ‘cause the optimal foraging theory is the most— Your body is not gonna go after kale. Your mind doesn't want kale. Zero part of you wants kale. Every part of you wants to go eat a doughnut and it should because that's gonna give you the most calories for the least amount of calorie expenditure so that you can make more babies theoretically. So, your brain is wired to go find fantastically delicious food. And so, we have to bring that into the scope of our practice.


    My first thing that I do with everyone is I figure out what's the most you can— especially if they're not a weight loss client— Weight loss clients, everything kind of changes. But if they’re an athlete, I’m like “Hey, how much can you eat and stay weight stable? Let's just try to figure that out.” And like most people are so surprised. They’re like “I’ve been eating 2,800 calories.” And then we get ‘em up to like 3,800 or 4,000. They’re like “Oh, I feel amazing.” I’m like “Yeah. That’s how much you need to eat. If you’re gonna eat sweet potatoes, it's like 17 pounds of them. So, you get to work.”

Tommy:    There’s the combination of factors there. Right? So, people, regardless of what sport they’re in, you know, we become scared of calories and various macros. And then there’s the other side, which is a lot of people that we work with, by the time they come to us, their diet is pretty great, right, in terms of quality. But when you're eating high-quality, nutrient-dense food that’s not calorie dense, how do you get people to get in those calories whilst maintaining diet quality? Do you worry about diet quality as much or do you let that slip sometimes? Because depending on the— If it's gonna be a calorie balance issue, then you sort of reintroduce the refined foods. Do you have some rules there or some tips?

Ben:    Yeah. That's an amazing thing. So, to me, I think of it like we think about extreme, right— So, say you have that endurance athlete who spends maybe 3 to 4 hours a day training, that’s time they can’t be eating. That’s time that blood flows not going to the GI tract.

Tommy:    Yeah. Absolutely.

Ben:    So, if they have to eat 5,000 to 6,000 calories a day and they have all the cortisol running out, so their digestive health might not be very good. And I can't tell you how many people I talked to and they’re like I've had diarrhea for 5 years.

Tommy:    We see that. Yeah, very common.

Ben:    You don’t think that was a problem? If they have digestive distress, obviously, we're gonna work on that first. But if someone doesn't have GI complaints, my goal is to make the organism as robust as possible. I want someone to be able to eat 700-800 grams of carbs and not go over 140 mg/dL on blood glucose. Like I'm after resilience, but I also want them to be able to fast really well. I want them to be able to, you know, if they miss a meal, it's not the end of the world. And so, for me, it's all about context. If we bring this back to like kind of our case study for the day, it’s someone who wants to gain mass like most guys come to me. They're like I wanna gain 5 to 10 pounds of muscle. Well, depending on where you are in the spectrum. So, let's just say it's someone like you or I who has been training for a really long time, maybe accumulated a fair amount of lean muscle mass. They don't wanna blow the roof off of caloric intake. So, they don’t wanna go anything more than like 1,200 calorie access. You're gonna probably lower testosterone, which makes sense to me just because of an oxidative stress mechanism. We should probably talk about that because that's probably the underlying cause of a lot of the hypogonadal stuff in endurance athletes. And so, what I'm gonna do with them is I always think about quality first. So, if you think about I've taught hundreds of RDs, right, they focus on quantity first and that gets them in a lot of trouble. Lot, a lot of trouble. But the same thing gets functional medicine people in even more trouble I would guess. Maybe the same amount of trouble. But they focus on quality first and they just completely disregard quantity. So, I can't tell you how many people who live the athlete's lifestyle who have gone to another functional medicine practitioner who come to me and they're eating like 2,000 calories and I'm like “What are you doing? Like what are you doing?” So, there's gotta be some leeway there. And also, if we think about in our sphere, one of the two most damaging things that we could do, the first one is missing something. Right? You're an M.D. So, it's like I think this low white blood cell count is you are overtraining or under recovering at 1.7 and you really have lymphoma like “Oops, I have it.” And then the other thing we do is we create insane amounts of unnecessary worry. That's what I hate even more is like I find all these people like they're worried about everything. I’m like “Dude, that’s not why you got here. That's not why you came to this, is to worry about everything in your life.” And so, my goal with food is to take away that worry. So, yeah, if gluten’s a big deal for you, don’t eat gluten. But if you can have dairy and you know you need to get in 400 more calories that you can't consume through nuts, vegetables, things with high fiber, maybe some ice cream at the end of the day is gonna push you there, but I wanna make sure that you don't blow the doors off glucose control. I'm gonna use hedonism. Right? I’m gonna use diet variety to make— ‘cause you’re not gonna OD on brown rice, broccoli, and chicken breast. Like your body is gonna shut that down. You can make it delicious and I think that's part of the thing. Like talk to most bodybuilders and they eat just super boring food. It tastes like shit. Like if you want to cook, your life would be a lot better. But for the most of the people, we gotta use both. So, we gotta start with this base of diet quality. So, for me, that's gonna be lean proteins. I'm not against non-lean proteins. I don't really care, but people can blow up calories real fast eating like 80-20 ground beef. I don't think people get that. You eat 21 ounces of 80-20 ground beef, like you're not gonna get any more fat for the day depending on what your diet is. And so, then we can get [0:19:51][Inaudible] maybe we don’t, probably not. I think about that first. So, we’re gonna need some amount of lean protein. Then I want everyone to try to get like 2 pounds of vegetables a day.


    And the average person on the Western diet gets 1.3 to 2.1 servings of vegetables a day. So, it's chaos. I would say like eat like an adult, but then you look at the top 6 foods that adults eat. It’s chicken nuggets, alcoholic beverages. Like that’s one of my slides in one of my launches. It’s always good for laugh. You look at the top 6 things adults eat and then you look at the top 6 things children eat and they’re exactly the same.

Tommy:    You just add booze.

Ben:    Exactly. You just add alcohol to the adults. So, to me, that's the first step. You gotta increase your vegetable consumption. I think everybody can agree on that unless you kind of now all of a sudden leptins are the devil.

Tommy:    Oh, and the 100% meat diet is also a big thing now.

Ben:    That’s a thing?

Tommy:    Oh, yeah. It’s a big thing.

Ben:    Wow. So, all those phytonutrients that we don’t know the names of, those aren't important at all.

Tommy:    Apparently, they’re just sort of modulators and we don't need them. And if we just remove them actually, we’d be better off.

Ben:    Yes. Scurvy is not a thing. That wasn't a big—

Tommy:    I know. So, this is the current theory in that group, which actually we can’t just prove by the way. We’d just say it’s interesting. Is the high glucose intake and high blood glucose. Increase of the need for vitamin C because the two compete with the same transporter. So, if you have low blood glucose and low carbohydrate intake, you actually need less vitamin C and also glutathiones plus vitamin C. So, if you’re eating enough protein and you have low oxidative stress, then you actually don’t need that much vitamin C. So, maybe the same if you’ve got scurvy ‘cause all they ate was dry bed and they needed high— I just thought about that actually. They needed high—

Ben:    That’s super interesting.

Tommy:    …vitamin C intake. So, it’s interesting. It’s super interesting. And obviously, people are in that kind of side of things. That’s where they’re going down. I’d be tempted to say that all of those things matter. But yeah, it’s interesting.

Ben:    That’s cool. Yeah. I didn't even know that that was a thing like—

Tommy:    Look up a guy called Shawn Baker. He’s an M.D. He’s also like super strong, super jock. Eats nothing but meat. He’s starting some project called N Equals Many. And he’s got guys doing like a meat only diet for at least month; measuring basic blood metric, lipids, CRP, all that kind of stuff and just seeing how stuff improves. A lot of these guys have some metabolic health issues. So, it’s kind of a low carb, keto type diet.

Ben:    So, they’re not eating any meat. This isn’t like 4 times—

Tommy:    Oh, yeah. No. No. This is rib eyes and, you know, all that good stuff.

Ben:    You’re probably not in ketosis because you’re driving up those gluconeogenesic amino acids. So, you're probably gonna keep yourself out of ketosis.

Tommy:    Wheel cycle an hour. I’m sure some of them are in ketosis for a good amount of time, you know. Now, you can get 50-50 or 60-40 ground beef and fat with the fat contents trying to maintain ketosis. That’s kind of become more popular.

Ben:    I think this is a great— The majority of the people who hear this stuff, they’re like “Okay. That’s cool. Maybe I’ll try it.” Like anything like ketosis, vegan. Like I don't care what people wanna do like those don’t bother them. They wanna do that, I’ll help ‘em. I’ll try to create a meat-based diet for ‘em. But what gets lost is what is the #1 driver of everything in our field? Consistency. What can you do for years? Like you can't put me on that diet. My wife would kill me. She would give me an [0:23:06][Inaudible]. It’s not gonna work. She’s like “Why are you only eating rib eyes? Like I made this kale salad. I made all these things for you.” I’m like “Oh, I’m on the meat diet.” It’s not [0:23:14][Inaudible]. So like if you’re a single dude and you wanna deadlift 800 pounds and take peds, like maybe sure, cool. Maybe it’ll work. Cool. I’ll try it. I’ll run the data for you.

Tommy:    Okay. We got side tracked, but on a great topic. So, coming back to some of the stuff that we're talking about earlier, you mentioned calorie excess as a driver of reduced testosterone.

Ben:    And calorie deficiency.

Tommy:    And calorie deficiency. So, obviously, you know, it’s a U-shaped curve. You kind of go on it like Goldilocks effect. Most people that we work with, they’re definitely on the under eating side. You know, it’s very rare that we see overeating because of all those things like diet quality. But can you maybe go through some of the things that you think are decreasing testosterone? So, testosterone does seem to be dropping in the Western population. Once you adjust for insulin resistance, obesity, that seems to be where it’s coming from. Right? But what sort of things might people need— Again, you’re gonna introduce worry. What things might people need to be worried about or not worried about in terms of their testosterone levels and when do you get to a point where that’s good enough and you’re probably at the right kind of level for you?

Ben:    One of my mentors is Bill Hardman who is amazing. He’s actually a PT. And he’s like we need to always go back to first principles. If we think about like where is testosterone made, okay, it’s made in the testicles. 5% of the cells in your testicles are Leydig cells. The other 90-95% are Sertoli cells, which makes sperm. So like what’s more important to your body? Making testosterone or making sperm? Okay, making sperm. But like Leydig cells, you're born with this discreet amount and you use them. Right? So, what is the rate limiting step in testosterone synthesis? It's moving cholesterol into the mitochondria to make pregnenolone. Like that’s the thing. That’s what causes it. So, okay, right there, we have fat shuttling and we have mitochondrial function.


    Those are gonna be pretty important. So, to me, it’s all about mitochondrial function at the testicular level. So, I want my testicles to be able to produce testosterone. That’s gonna be important. I wanna hold on to as many Leydig cells as I can for as long as I can. And I want that signal from the brain ‘cause that signal governs everything. So, LH, and thyroid hormone tell those Leydig cells to uptake cholesterol and turn it into testosterone. And then there’s cofactors. There’s all the nutrients. Right? You're not gonna be deficient in those nutrients if you take a multivitamin and you eat a real good diet. Like that’s not gonna be the thing for most people especially the people that we’re messing with. Like it’s probably not a nutrient deficiency at that point. So, I think things people need to be conscious about. Overtraining, like that’s gonna inhibit testosterone synthesis at the level of the brain. Like you’re gonna have a lot of things that go with that. Right? Like you’re probably gonna have metabolic derangement. Your body is just gonna feel like shit. Right? Like I don’t feel good-itis. Right? It’s every CrossFitter after like a year. They get the Paleo flu and it’s ‘cause like your brain doesn’t like inflammation. Like your brain doesn't have pain receptors. When inflammation hits your brain and puts you in that sympathetic response, it creates a lot of loops. And so, to me, that’s square 1, is how do I get somebody  out of sympathetics. So, heart mass, flow tank, going  for a walk. Like people live on a stress loop and I gotta break that loop if I want any hope with testosterone. Now, there’s gonna be people that are gonna fly in the phase of that, you know. They drink Jack Daniels on a [0:26:27][Inaudible] 80 and a 5. They’re electrician and they work 90 years and somehow they have a testosterone at 800. I don’t know the answer to that, but there’s always gonna be exceptions and that's cool. But if you're struggling with low testosterone, first thing you need to do is you need to make sure you don't have a problem with the axis, so you don't have a brain-based problem like you haven't had a traumatic brain injury where all of a sudden your pituitary stalk got bashed and you can’t— All of a sudden you can’t secrete insulin, you can’t secrete LH. A good M.D. in the States is gonna be able to differentially diagnose that. The other thing I wanna check is you wanna make sure that you don't have a varicocele, which is essentially you can't get blood flow out of the testicle. And that's actually pretty common. It’s 10% of cases are that.

Tommy:    I have one.

Ben:    Yes. So, you gotta get that fixed because then you can't get testosterone out of the testicles. That's a pretty big deal. Like that's probably the base. That’s what it is. Right? And the stuff is the testicle is not going systemic.

Tommy:    My testosterone is okay. So, I’m not too worried about it.

Ben:    Another thing is like the look test. Right? So, if someone comes to me and they don't have a problem with motivation— ‘cause testosterone is gonna feed our frontal lobes. It’s really what makes us mad. They don’t have a lot of those like brain-based testosterone symptoms. And say their testosterone is like 400 or 500 and they don't have any— Everything else looks fine. I'm gonna have ‘em get checked for what you had, a varicocele. I'm gonna make sure that that's not the thing if everything else looks good, but maybe I use this example. So, my brother who we think about because I mentioned him earlier, he probably has like a size 12 hormone shoot. Like he probably needs like a good amount of hormones like he had a beard at 14. We know those people. Right? And so, whereas you think about me, I probably had like maybe a size 8 hormone shoot. So, you shove me into a 5 or a 4, it's not comfortable, but I don't feel as bad as if I put him in a 3. Like he’s gonna feel pretty shitty. And so, I think, as we know, like research is the law of averages, but we have to take that into account. And so, it's all about tracking this as you age. And so, I have guys who have, you know, gotten testosterone when they’re 18. How beautiful is that? I can see throughout their life cycle, wow, you got a 10% drop. Like what’s going on with your sleep? What's going on with your food intake? What are you doing as far as stress? But then again, where we’re in trouble in the functional realm is, okay, we hit someone with all these adaptogens. We hit him with every nutrient known to man. They’re taking fenugreek and everything. And they had 7 TBIs as a high school running man. And you just made them spend maybe $3,000 a year in supplements.

Tommy:    They make you spend half hour on an MRI and they could have figured out that much faster.

Ben:    And the other thing is like they probably— In that case, if it is a secondary or primary hypogonadism, they probably need TRT. Like as much as we wanna bash it— And like give someone who has a testosterone deficiency testosterone, it’s gonna make a big difference. If that happens, then you have to manage all the things that are potential negatives with that ‘cause we’re gonna get EPO from the kidneys. So, you gotta make sure the blood doesn’t get [0:29:28][Inaudible]. You’ve talked about giving blood. It’s gonna probably get even more important. HDL cholesterol is gonna drop. It's just what happens like I don't know if there's not really a way to rise it up and we don't know if that’s bad, but the first thing you're probably worried about with TRT is heart disease ‘cause you’re gonna get concentric hypertrophy of the left ventricle and you’re gonna get that constant production of red blood cells. And we don't know if TRT is gonna be bad or not in that context. We just don't know.

Tommy:    Yeah. Okay. So, we already talked about testosterone. So, on your website, you talked about things like the free androgen index, SHBG.


    There was a thing about estrogen. Mainly, there was a really nice study. It was published in the New England Journal of Medicine a long time ago. They took some guys. They gave them a GNRH antagonist to completely get rid of testosterone production. Then they gave them testosterone back. Then half of them they gave an aromatase inhibitor drug. So, they weren’t making any estrogen. And those guys had worst metabolic health and I think they had worst body composition too. So, estrogen is super important. So, is there any scope to like measure all this stuff? Should we just be looking in the mirror to figure out like what’s the best thing? Like what metrics can we use? What’s important? What are we sort of overthinking?

Ben:    I’m gonna hone in on that estrogen question ‘cause I think we love to like bash things. Right? We just love to make things bad or good. Right? Like carbs are bad. Fat is bad. Estrogen is bad. But let me tell you like estrogen, it’s so necessary. Your muscle cells have receptors for estrogen. Your brain absolutely needs estrogen. And so, the other thing is people don’t understand the numbers of the hormones especially in the serum. Estrogen is insanely potent, but there’s almost none of it around. It’s measured in pg/dL. Like that’s 10 to the -12. Like we can't even fathom like how infinitesimal that is. And so, testosterone even in males and females— There’s way more testosterone in both of us than there is estrogen. So like if I convert all those values, you're like at 0.025 ng/dL of estrogen. But then as you know, most guys are gonna be somewhere around 500 to 1000 ng/dL. You got way more testosterone than your estrogen, but estrogen is insanely potent. And so, the other thing to think about is how good is your metric? How good is your measurement value? So, I've had guys who come to me and their estradiol is at 50. I’m like, okay, let’s not overreact ‘cause that is outside of where we want. We probably want that estradiol to be under 30. But how accurate is that test? Not accurate. It’s 12-dollar test. It could have like a 20 to 30 percent leeway, but you can’t have your panels be $700. Like what the good TRT doctors are doing now is they’re grabbing ultrasensitive estradiol, which, you know, it doesn't have the same error bars. Testosterone has the same error bars as well. There’s more of it in the blood. So, it’s less. That's important to talk about. So, I think you want your testosterone to be high, but you don't want to necessarily worry about it. Your value as a human being is not based on your testosterone number on a lab work. Like you are not your labs. It's what we can measure right now. I'm not sold on the Dutch stuff. To me, it just doesn’t have enough validation on it. Serum hormones are probably where I'm gonna go the most. I don't even use serum hormones in females because females are the most variable creatures ever. It’s insane. They take all these women and they have normal cycles, 28-day cycles, and then they have them come in for blood draws everyday for 28 days. They all ovulate at different times. They all have different LH spikes. They all have different things going on with estrogen, progesterone. So, you’re telling me if I get day 21 in a female that it’s gonna be normal on every female, absolutely not. So, females, you gotta focus on the fundamentals even more so than the numbers. Whereas guys, just to give people parameters, you wanna be probably in that 20 to 30 range in estradiol. Testosterone, if you look that longitudinal stuff, you probably wanna be over 550. That’s probably a good idea. Sex hormone-binding globulin, that’s tough because the conventional MDs are gonna— They look at free testosterone and be very, very careful if you go to someone who is a 1-trick pony at anything. Just realize that they're gonna try to shove you in their box. Right? And so, if you go to a TRT guy and say your total testosterone is at 600 while your free testosterone is at 8, they’re gonna be like “Oh, well, you know, you meet the diagnostic criteria for this. Let's do another draw and let’s see what they’re again.” But we don't know that sex hormone-binding globulin is bad. Like we know that low levels are bad because sex hormone-binding globulin is made in the liver and low levels are actually related to the bad stuff like obesity. But high levels, we don't really know that much about it. It could be overtraining. It could just be genetics. And then the other thing is our muscle cells have this protein. We use to think like— So, third of testosterone is bound to albumin. Bioavailable. Two-thirds is bound to sex hormone-binding globulin. It’s “not available.” But your muscle cells have a protein called megalin. Megalin takes that sex hormone-binding complex with testosterone and it phagocytes it into the cell. Oh shit, maybe sex hormone-binding globulin— You have sex hormone-binding receptors on your nuclear envelope. It’s like we don’t know, guys. Let’s not pound this down with— The other thing is like there’s nothing really that lowers sex hormone-binding globulin.

Tommy:    Yeah. Well, except for obesity and diabetes.

Ben:    Yeah. Your testosterone is 600 and your sex hormone-binding globulin is high. So, let’s give you obesity. I hope that helps. Like there’s a lot of numbers in there. And I think if people slow down, they’ll have an appreciation for it.


Tommy:    I think that does help. The group we talk with, work with, the SHBG is always on the higher end. It goes up with instant sensitivity. It goes up with overtraining. It goes up probably with under eating. All that kind of complex. There’s all those kinds of things. It also goes up with total testosterone. So, the more testosterone you have, the higher SHBG, which is quite normal.

Ben:    In the textbooks, it doesn’t. Testosterone is supposed to lower sex hormone-binding globulin. Estrogen is supposed to bring it up. I don’t see that.

Tommy:    Yeah. At least the epidemiological study is there. You know, they measured both from a few thousand people. It seems to be a linear correlation between total testosterone and SHBG. It gives people something to look out. Maybe they’ll appreciate the things on good and bad. Right? Everything's important and it's important also to not overthink it.

Ben:    I would say this though. You talk about measuring the thing that you actually wanna change. Dont measure HRV. Measure all the things that are gonna change your HRV. What is testosterone gonna change? Well, it's gonna change your ability to put on muscle mass. Like if your testosterone is low, you're not gonna be able to put on muscle mass. If you've been following like an educated training program, you know you're not close to that high into the FFMI or like you’re not even there and you’re not able to put on muscle mass. I don’t care where your testosterone is. It's probably gonna be low, but why are you not adaptive? That's a bigger question to me. Like let's chase the adaptation.

Tommy:    So then, in that kind of scenario, what would be the things that you look out? I mean, you’ve talked about— So, it’s calories, stress. All that kind of stuff. Is there anything else that you'd sort of wanna dig down into? If you're not getting the adaptation, you think that person is trying to gain muscle mass or game fitness, whatever it is, gain resiliency, but they’re not. Is there anything else that might be a missing piece?

Ben:    I’m gonna first go to all the fundamentals. Right? So, I’m gonna go to sleep. Then I’m gonna ask to actually see their training protocol. If their training protocol is just garbage, if you're driving someplace, everyday you go to drive to someplace and you go for an hour, but you never get there, wouldn't you try to ask at some point in time? I can't tell you how many people I see at the gym and they’re like 35 and they've obviously been going— They love the gym. They've been going there for a long time, but they don't look like they go to the gym. We have a problem here. Like you're not getting to where you wanna go. We have to look at what does your training actually look like. Are you pushing the weights? This is the thing that people will wanna hear. If you wanna get hypertrophy, you're gonna have to be a little uncomfortable. It's gonna have to suck. You don't have to train to failure, but you have to overload the system. You can't do 135 on the bench press for 12, for 7 years. Like that’s not gonna to work. So, you gotta overload the system and then you gotta recover. You gotta figure out what is your adaptable line that you're recovering to and then we have all the things that are gonna help us like nutrients, sleep, stress reduction, just enjoying your fucking life. People don't think about that enough. If your whole existence is the gym, like how many CrossFitters have you gotten? Like they wake up. They go to CrossFit. Then they go to work. And then I ask them what they do at home. They’re like “Oh, well, I think about CrossFit.” No wonder. Like you don't have anything other than that to do. That's your whole existence and that's gonna get you into trouble. So, you gotta have some other thing other than exercise that you love to do.

Tommy:    Absolutely. I mean, we’re both massive fans of Brian Walsh and this is something that he’s talking about more and more frequently, is that you gotta have a purpose, a goal, something else other than sitting at home and worrying about whether the carbs in this banana is gonna give you diabetes and sort of having that bigger picture.

Ben:    Yeah. What are you doing it all for? And you’re not gonna figure that out unless you do stuff. Like for you and I, it’s like I know that my learning intricacies of the science isn't necessarily gonna help me do my job any better. That might throw people for a loop, but like I know information doesn't change— It just allows me to do the right thing. So, I'm always after like I wanna do the right thing I wanna do right by people. And the Hippocratic Oath is do no harm. Right? And so, if we keep chasing that and working with people at broadening our scope, we’re just gonna do the best you can. Right? And I think you guys are definitely doing.

Tommy:    That’s nice to hear and I think that’s, I mean, definitely the same case for you. But I do wanna go back into that training piece. And having been on your website, looked some stuff out, there’s this MASS 2 Training Protocol and that’s obviously something that you’re involved with. And just looking at some of the sample workouts that I think you’ve done and post some information, it sounds like the kind of stuff that I’d like to do. So, maybe you can tell us a bit about it.

Ben:    Yeah. So, Pat Davidson, MASS is his brainchild. And so, you have to understand Pat Davidson to understand MASS. MASS may not be like the most like scientifically best program. And he will tell you that. It's got a lot of science behind it, but what runs the show? What runs the show for most guys is dopamine. So, I gotta create— Everything in that gym needs to revolve around dopamine. I gotta create habits that I know pre-workout doesn’t help me.


    I don't take 400 mg of caffeine a day. I’d never sleep. That's how much you need to get— But even if I just have like a little bit like 25 mg, it’s built into me like that dopamine hit and I wanna go train. And so, MASS is really all about dopamine. You see your numbers increase. It’s a nuclear bomb of volume. So, I will tell people that. If you don’t have a high training age, don't try to do MASS. You're gonna be crushed. My clients used to ask me like can I do MASS? I’m like absolutely not like no way. No. And Pat will tell you that too. Like he runs it with his personal training class. He just takes it all down. The volume aspect is— I use it with some of the guys here in Costa Rica. It’s one of the protocols. There's like a 30-30 and a 20-40. So, you pick like 5 exercises and you do 10 reps in 20 seconds and you rest 40 seconds. Most people are insanely inefficient at the gym. Like you can be inefficient. When you get to your level, you probably want to maximize training volume. You probably wanna take a good 2 to 3 minutes rest between sets. But if you're not, you probably just wanna accumulate training volume. And cycles are fun. Most people come to you. This is a Pat Davidsonism. It’s one of my favorites. And the personal trainers out there can get in a lot of trouble when they get into our sphere because like you go Outback Steakhouse. You sit down. You’re like “Oh man, I’m so excited for this Outback Steakhouse for some reason.” And you order the biggest steak they have, a baked potato, bacon like the whole 9 yards. You’re jacked up for this thing. And so, the waiter comes back out and he brings you a tofu salad. Like how are you gonna feel? You're gonna feel like you got absolutely jiffed. If you're coming to train with someone, they want a steak. You know, they wanna move. They kind of wanna feel like shit. They wanna punish themselves a little bit. And so, you gotta give them that. You have to give people what they want. I build people meal plans. I never want people to follow a meal plan. It’s most rigid, invariable thing ever, but they still want it. So, I give them the most structured and flexible meal plan I can provide. They want that. You gotta give it to ‘em, but you gotta give it to ‘em in a smart way. And I think that's kind of the emphasis if you use those kind of like high volume training protocols. Just know that it's a hammer and you can screw some people up. And you could screw some people up with whatever you do, but I’ll use this example. So, say I gave someone that type of protocol. It absolutely crushes them, but they love it. They’re like this was amazing. I wanna get better at this. And I'm like “Okay. Well, to get better at that, you cannot sleep 5 hours a night. You cannot be in a plane 70 days out of the year.” And so, if they start to restructure their entire life, all the behaviors to be better at that dopaminergic thing, then I'm okay with it, but I'm not just gonna keep slamming with that hammer if they're not gonna do all the things they need to adapt to that hammer.

Tommy:    Yeah. It makes perfect sense. They have a shorter training history or they've been training in a different sport. So, endurance athlete is obviously an example we come back to and they maybe haven't spent that much time lifting weights in the gym. What's the best way for them to assess what kind of program they should be following? Because there is a million programs that people are gonna be able to have access to. You can pay for them. They can be free. You can find them in men's fitness magazine. What’s the best way to kind of start and figure that out?

Ben:    Yeah. It’s a fantastic question. I always go back to like if I know nothing about something, I'm probably gonna find somebody's who is pretty good at that. And I'm gonna hire them because like I think about— Like if someone wants to do what I do, yeah, they could spend how many years I spent floundering around on PubMed. They could do that or they can come talk to me. If their strength coach — I’m sorry. You have to pass the look test. Like you have to look like you lift. Right? And so, find somebody who knows what they're doing and have them first— If you wanna get really good at anything, form is gonna be important. Right? If you don't know how to lift, the exercise choice is gonna be super important. Like I probably shouldn't back squat you the first day in the gym. Maybe you could move really well and that might not be the case. Well, I’m probably gonna gradually talk to ‘em. I'm gonna use exercises they're gonna lower that risk. Also the nuances that people aren’t gonna get from any program. And I'm not saying you need to be strapped to a personal trainer or strength coach your entire life, but using one for 2 to 3 months and learning the basics— because hypertrophy and strength training, it's all about doing that basics insanely well for as long as possible. And so, you know, learn how to front squat really well. Learn how to deadlift very well. If you don’t wanna do bilateral stuff, that’s fine. Do all unilateral stuff and that’s cool too. I don’t care. But make sure you do it well. Make sure you chase that progressive overload in an educated fashion. And if your program does that and you move well, I think you're gonna find results.

Tommy:    Okay. That’s the perfect answer I think and it’s just— As everything, it’s not the answer that necessarily some people want to hear, but it’s the one they need to hear. So, you said so far we need consistency. They need ease up. They need to recover. And they need some kind of progressive overload.


    They need to figure out where they are. And they need to slowly tax the body more and more, but then recover from it.

Ben:    Yeah. If you got all those ducks in a row and you're still not adapting, then we gotta look under the hood. Okay. Maybe you have crypto or you have some kind— You have Giardia. And so, you're constantly getting LPS and IL-6 coming off your gut, which is putting your brain is sympathetic response that you can't do anything about. Then we start digging deeper. But if you get those fundamentals onboard, that could get rid of Giardia right there. Like maybe not Giardia. If you optimize the immune system, maybe this person all of a sudden can get rid of some of the stuff themselves.

Tommy:    Absolutely. It goes the other way too. You know, you find something in the gut. You don't fix the physiology and you just like try and treat what’s in the gut. Something else is gonna pop up afterwards. Right?

Ben:    They’re all opportunistic.

Tommy:    Yeah. Exactly. So then, if people do wanna look under the hood, they wanna find you, I wanna hear more about what you're doing. But before we go into— [Talk Out of Context]. I wanna hear about your thoughts on training to be a practitioner that does the kind of stuff that you do. And we get this question a lot. People are like I wanna change my career, I wanna do this. But if you were retraining, what qualifications would you do? I mean, you have a PhD. You've done functional medicine. You’ve done FDN. Which of those is useful? What would you do differently? What would you give as advice to somebody starting out?

Ben:    I get that question so much. It's a great question. It's an amazing question. And so, you have an M.D. Correct?

Tommy:    Yeah.

Ben:    You come back to licensure. Right? Licensure, why it was created was to protect people. Like you don't want me doing heart surgery on you. Like trust me. You don’t want it. I don't have license for that, but there's a gray area there. The registered dietitian is the ADAs or Dietetics Association. That's their version of the M.D. and then they go to the States and they try to— Obviously, they want that license to have more power. So, they try to get to the States to recognize that license so that other people who don't have an RD can’t talk to people about food. And there’s a lot of states in the United States that you need to have an RD to talk to people about food and then there are stipulations inside of that. So, the first thing I tell people is you have to respect your lane. You have to respect that if you're not an M.D., you can't deal with pathologies. You can't even talk about them. That’s not within your scope of practice. So, you need to help other people to refer out to. Correct? The other thing to think about is what we learned in school. So, if you get any terminal degree, M.D., PhD, I don't care what it is, in 10 years, everything you learned is gonna be obsolete. Everything that I'm teaching right now in my mentorship is gonna be obsolete. So, if I don't stay on top of my shit, it's gonna fall apart. And so, functional medicine is what everyone would wanna call an integrative medicine, anti-aging medicine. It's right with pseudoscience. It is the most pseudoscience field ever. And so, be very, very careful about people telling— Because when you sign up for any kind of certification or any kind of training, what you're doing is you're believing the story that someone tells you. And so, I very rarely believe the story that anyone tells me. I wanna go to the research. That's just the kind of a person that I am. And I know there's negatives in that mindset, but that’s just how I’ve been trained [0:48:17][Inaudible]. I think people that are really, really good, people like yourself, Brian Walsh has some great courses. He’s a great researcher. You know, he does paintings in black and white. The guy constantly goes back to first principles of like this is a physiological need. This is why bile exists. This is why it's important. So, if you go back to that, if you constantly go back to physiology, you’re gonna be okay. You’re gonna be able to see through a lot of bullshit. I think if you wanna do what I do, it comes down to credibility. Right? So, how do we build credibility? You have obviously built credibility because you have an M.D. after your name. That’s instant credibility for a lot of people especially in the later generations. They have a lot of that white coat— If a wear a snapback hat and I'm talking to a 6-year-old like it’s not gonna work.

Tommy:    You need a white coat and the stethoscope as well. Yeah. You're right. They grew up in the period of more paternalistic medicine, which we’re kind of moving away from, but that’s sort of definitely the time that they grew up in. So, that’s more what they’re used to definitely.

Ben:    It’s becoming the opposite. So like in 30, 40, and under, they become skeptical. All of a sudden you have to prove yourself if you're an M.D. It’s inanely wild, but then they’ll go to somebody who like runs neurotransmitter testing out of their garage. This must be legit. No. It's not. You cannot measure neurotransmitters. It's all about cerebrospinal fluid and they change way too fast. I’m sorry. I’ll get off that tangent. So, if you wanna do this, you wanna build credibility. You build credibility by kind of one in two ways. You build it by getting that degree and that's gonna kind of have that instant credibility, whatever it is. I don't think a lot of people see me if I'm not a doctor. I don't think they really pay attention what I have to say if I don't have that PhD after my name. That PhD just really taught me how to learn.


    I’m so grateful for that. So, that's important. The other way you build credibility is you think about guys like Chris Crosser. He has an LAC. I don’t think he’s doing any kind of acupuncture.

Tommy:    No. No.

Ben:&nnbsp;   The guy has just put out insane amounts of content for years. And so, that’s another way to build credibility. And then you look at his practice. Oh, he’s so credible that he has a bunch of MDs that work under him.

Tommy:    Yeah. And he appreciated that there are things that they can do that he can’t. And so, he's built that group of— I mean, they’re doing amazing work. He’s not doing it by himself. That’s the point.

Ben:    I think of it like I hate strip malls. I hate all that shit. But in America, you're probably gonna need this we all work together. The problem here right now is like nobody talks the same language. The doctors don't lift. So, they can't talk to anybody who trains that way. Right? And then people like us, most of the functional medicine people, they can't necessarily talk to conventional people. They can't talk in their world. And so, if I tell like an M.D. that someone has hypothyroidism but they have a TSH of 1.5, they’re gonna look at me like I have 5 heads. Like I have to speak their language. I have no idea what I’m talking about. So, I have to be able to talk their language. I don't care what certification you take. It doesn't matter to me. Just have this growth mindset and follow people and try to realize that you're never gonna have all the answers and that don't believe everybody's story. Be skeptical.

Tommy:    Perfect. I love the answer. So then, if people wanna follow your story and learn from you, where should they go to find all that stuff? You’re doing some retreats in March I think. Brian Walsh is speaking at one of them. Yeah, tell us about those as well.

Ben:    So, one of the reasons I moved because to Costa Rica is because it's all about like needs versus wants for me. And I think for most people it's about needs versus wants. If I can lower my wants to an insanely low value and I can only have needs, financially I can do some cool stuff so like I don't need to make a lot of money. So, I have like variable cost on my consults like people can pay me what they can. Now, if I have an office and I had to pay for overhead, like that doesn't happen. I completely get that. And because of those, I'm able to put out an insane amount of information for free and I enjoy doing that. I write articles on Facebook. My goals are like just put out as much informed content as I can. I’m never get in battles on the internet because you're gonna lose every single time because the research shows like if I spend all my time mongering people that— Say someone believes in the insolent varied and I spent all my energy like trying to like convince them otherwise, I'm actually gonna propagate their myth for them. So like what I do is I just try to put out positive content and that's available primarily on Facebook. The big articles, the long from articles are on my site. And then I have a mentorship that will come out in probably next July or August. And I have retreats every year. The retreats are kind of— They’re where I want continuing education to go. I've been to so many seminars. It's like annoying. And they're all in hotels. You have muffins for breakfast and like it's just— You know, you have this old school like suit and tie. You get this weird feeling like who am I gonna go to lunch with.

Tommy:    And you sat down inside staring at PowerPoint all day.

Ben:    Yeah. And everybody is toast by 11 a.m. I could just like start drawing pictures of teddy bears on the board and people will be like “Ah, that’s important.” And so, what I did is I try to create an environment that’s tribal ‘cause people— You know, being in our tribe is gonna be incredibly healing. You know, just feeling accepted. It’s gonna be so important. And so, there are generally about 30 to 40 people. They’re 2 weeks long. This year is already sold out. And so, they come down. We have lectures for— We’re done at noon and then you can choose. Like do you wanna train or do you wanna go jump in the waterfall? Like do you wanna go to the beach a learn how to surf? And then we do it again and we do it again. And we recorded ‘cause I know that no one's gonna get into that first pass. And they’re gonna need to rewind it and listen to it again and watch it again and then kinda get it— Just digest it. And so, that's my goal for continuing education. And it’s the big reason that I created this retreat center so that someone else can do the shit and I can go as an attendee. Because let me tell you like all these things— I'm a natural introvert. And so, like it takes a lot out of me. What my favorite moment will be will be like I get to go to Prague and someone else is doing this or I get to go to Australia and someone else, you know, copied my idea and they maybe do it a little bit different or a little bit better than I do. So, that’s my goal.

Tommy:    Perfect. We will definitely be down there at some point. We’re banging down your door to take part in one of these retreats. I guarantee it. So, is your website. And is there anything else you wanna mention, things we didn’t cover?

Ben:    Like we didn't get into the carbs a lot like the ketosis and the carbs. I think the trump card there is the hypocaloric setting.


    Like you look at metabolic disease. And so, I don't care what you do as far as your diet. I just wanna make sure it works. And so, like ketosis is incredibly powerful. But if you can’t do that, don’t think that it's anything against you. There's this great 52-week longitudinal trial where they look at every blood marker known to man and they have people in a hypocaloric setting. One group eats 40 grams of carbohydrates. The other group is eating 250. And guess what? Their metabolic markers at the end of that— They all lose about 10 kilos, 20 pounds. Their metabolic markers are the same. Well, if you’re a weight loss client, your #1 rule has to be to try to drive calories down and that’s a very complicated thing. It's not that simple, but it’s a moving equation. Right? So, it’s probably not move more, eat less. It’s probably move more, eat more. And then I think we can get lost in the macros of it all. But if we focus on food quality and food quantity, good things are gonna happen regardless of whatever we name it. Does that make sense?

Tommy:    Yeah. It makes perfect sense. We have talked about calories a lot because some people say “What you need to do is find how many calories you’re eating and cut it by 500.” And the number of times that I've seen that work is very few people particularly with the people that come to us.


Tommy:    Yeah. Exactly. And so, focusing on the basics, yeah, super important. I complete agree. Maybe we'll come back and we'll talk about carbs, and insulin, and all that.

Ben:    It is kind of selfish for me. So, I read all of [0:56:28][Inaudible] work. And I’m gonna keep you on this thing ‘cause I wanna talk to you about this. I read all [0:56:32][Inaudible] stuff. I read all the low carb stuff. I understand it for ultra endurance athletes. I completely get it. I think it’s a viable strategy. I think they can run purely on fat. I think that you guys are probably doing a lot of carb loading around ketosis or metabolic flexibility. I don't really care about it in guys. I'm not really worried about it, dudes. My big fear and maybe you can help me with this is, so, there are zero trials on ketogenic diets in females. Right? And we know females are— Their brains are super carb sensitive.

Tommy:    So, this is something that we see very frequently and there are certain cases where ketogenic diet works really well in females. It doesn't tend to be the high intensity— It is their high intensity athlete males and females that are doing a lot of [0:57:15][Inaudible] then keto generally isn’t a good fit. But if they're a high volume training athlete, and female, and keto, it's guaranteed shut down of HPG axis, massive calorie deficit. Everything starts to fall part. There are some people who if they work really hard to maintain their calorie intake, so these are again the females, then they can make it work, but it is hard work because you just end up being not hungry all the time and then you spend the high training volume again like you said. Time you can’t eat. You can do it. It's never our go to, but some people that's just what they want to do and some people do find a way to make it work. Again, it’s hard work. You gotta make sure you’re eating enough.

Ben:    ‘Cause most females in our culture have carbs phobia. They have carb PTSD.

Tommy:    And fat PTSD from the last how many decades.

Ben:    From the `90s. Right? Just get on hypotheticals. Say we have a 150-pound female, 5’6”, wants to get down to 135, and she's an endurance athlete. What does that look like for you? What do you do with her?

Tommy:    We did actually record— Chris and I— a podcast on this a while back. So, we always go back to those same fundamentals that you talked about. So, it’s gonna be sleep, and stress, and recovery. And is there anything in your environment that's telling your body that weight loss is not something you should be doing? And it could easily be under eating. It could be your eating window. It could be your circadian rhythm. Find all of those things because any of those could be the one thing that was an issue. So, if you get all of those ducks in a row and you are somebody who— especially if you’re a high performing athlete and you have a performance goal, a lot of people will see, people that they’re competing against. And they’ll say, “This person has a lot of body fat percentage than me and they’re going faster than I am. I should be losing that weight.” I can guarantee that that's the case. I don't know that that level of body fat that you have is part of what makes you perform well, right, you know, particularly if you’re talking about athletes where their performances is their livelihood because there are those guys. If you get everything else, get all your ducks in a row, all recovery piece and we still think that losing some body fat obviously is gonna be beneficial, then, you know, you do have to play with calories and you have to do it strategically. And we would start by figuring out exactly how much you’re eating. So, you need to do— and you need to be willing to keep the diet fairly similar because the amount of calories that you're extracting from your food has very little to do with what it says on the box, right, depending on whether it's cooked, ground, however you’ve processed it, whatever. So, if you know what your diet looks like and you can figure out what the calories are in there, then you can reduce that by, you know, 10-20%, but I would still slide up and down, so maybe you spend a few days in a slight deficit and then you bring it back up.


Ben:    You do [1:00:00][Inaudible]

Tommy:    We do [1:00:01][Inaudible] It’s not necessarily gonna be massive, but we would let that happen just to prevent any adaptation. Negative adaptation. And then we spend a lot of time looking at thyroid hormones and things. Most of the people that come to us, they have some thyroid issues. You can just track basal body temperature. You know, it will give you a decent metric to see if that’s slowly coming down over time. You’re probably in too much of a deficit. But equally often, we go the other way. So, somebody needs to eat more calories to allow that weight loss to happen just because then, you know, maybe you’re sleeping better, recovering better. There’s some really nice data on how your body adapts in terms of nonexercise activity. Right? So, if you have a really high training volume, you spend the rest of the time sat still not doing anything because your body is trying to conserve those calories. So, maybe then if you increase, then it allows more of that stuff to happen. It gives you more energy to be moving the rest of the time and actually end up in a better balance. So, you figure out where they are on that spectrum and then sort of work those tricks is kind of what we’ve tried it.

Ben:    Okay. That's super helpful for me ‘cause like that clientele and I always talk about this in any kind of lecture that I have. That 40- to 45-year-old female who is a mother and trying to lose 15 pounds, that is the hardest client. For anybody, it’s gonna be the hardest client. And I think those are the most underserved people. And it’s tough. Like those are the people we find we need to care about the most ‘cause those are the people that are bringing up the children of the next generation and they’re swamped. And so, thank you for doing that. What I see a lot is I see females who are super low carb. They think they need to be low carb and then they think they need to train their faces off. Before they know it, they're eating 1,200 calories, which is on the absolute low end of energy availability anyways and then they're training 2 hours a day and they’re not getting any results and then they come to you and they don't know why. It's such a depressing place to be.

Tommy:    There’s something about that. At some point, somebody decided that 1,200 calories is how many calories women should eat. The number of times people turn up and like “oh, I’m eating 1,200 calories”, it’s nonsense. And then you go back to the super low carb. Why do you need to be low carb? Most people don’t. Yes, there are so many people. Most people that we work with in the larger population, they could definitely do with cutting out the refined carbohydrates. They’ll be instantly ready for it.


Tommy:    But in that kind of population, so, there’s one client. He’s done a podcast. He talks about it a few times just because he actually interviewed me for a podcast once. He’s an old school horse racer. He’s called Ryan Baxter. I remember looking his labs. Everything is in the tank. He doesn't mind me talking about it because we’ve talked about it before. The first thing I said was this boy needs some carbs. Just give him some carbs. He’ll feel so much better. You look at everything that he's doing. And yes, there was a lot of stuff going on. He had some thyroid stuff. That’s important too. But you know, just increase the calorie intake, increasing those carbs can make a big difference.

Ben:    Like in that situation, what I tried to do is I try to just maintain with them. It’s kind of a tough sell because they’re after weight loss. And I’m like “Hey, I just need you to be nice to your body. I just need you to— Let's try to eat as much as we can and stay weight stable and like chill out and like move more and just like try to start to like love your body again.” And it sounds like what you guys are trying to do is you're trying to find a limit.

Tommy:    Yeah. Yeah. Definitely. But I think that's a really nice trick that maybe we could use more, is say “As a thought experiment or a real experiment, how much can you eat and still remain weight stable because everybody is scared by eating more of gaining weight? So, prove it.” And because if you do gain that weight, if it’s a short-term gain, I'm fairly sure I can help you lose that weight that you gained in that little experiment, right, but it's gonna be very rare that that actually happens. I think it's a nice thing. You know, people are under eating. Okay. So, if you’re all worried about eating is gonna cause some weight gain, let's see what happens, you know. Again, it's difficult because I understand.


Ben:    That’s a heartbreak.

Tommy:    I understand the mentality. You know, that was my first foray into training, was 18-year-olds, gets dumped, wants a 6-pack so that the girl will love him again. All that kind of stuff. Turns into overtraining, under eating. I’ve been there. I understand it. I know why that happens. But if we can slowly get people to work around that mindset maybe by showing them what happens if they change stuff, maybe something good happens and then they get erections again or they actually enjoy their training or they are nicer to the people they work with, you know. All of that stuff happened to me when I started to eat more and train less actually. So, I think that’s a nice experiment to do.

Ben:    Thank you for indulging. I just have a ton of respect for your view of that world. So, I just wanted to try to get a peek into it.

Tommy:    Oh, awesome. Well, hopefully everybody enjoyed our sort of random side track at the end here. Dr. House, this has been amazing. Thank you so much for joining us. I really hope people go to your website, read some of your articles. You know, they really are good. Loads of research. Loads of references of people that dig into that stuff. It’s been really great. So, thank you so much for your time.

Ben:    Yeah. It’s been an honor. Thank you.

[1:04:48]    End of Audio

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