Tommy Wood ED transcript

Written by Christopher Kelly

Aug. 23, 2016

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive Podcast. My name is Christopher Kelly and today I'm joined by Dr. Tommy Wood. Hi, Tommy.

Tommy:    Hi.

Christopher:    I'm excited to have you back. All of the episodes that get the most downloads are all yours. People love you. I've just got back from the Ancestral Health Symposium and everyone says, "Hey, I listen to your podcast, all the ones with Tommy Wood. He's great." So, thank you so much for the content that you've been giving me.

Tommy:    That's very nice to hear. I'm glad somebody's listening. That's good.

Christopher:    A lot of people are listening. I can't believe it. I just checked the download number and we're up to 79,000 downloads by now. People that have been sharing this content, telling their friends about it, posting on social media, thank you so much. I love you to pieces. You've made this really worthwhile and it just brings me so much joy to meet people who've been listening to the podcast. Thank you very much for that.

    For all the people who are new to this podcast, I should explain briefly that I'm not a doctor. I'm a computer scientist. I have an undergraduate degree in electronics and computer science. Two years ago, I quit my job at a hedge fund to start a functional medicine practice. And functional means, as opposed to dysfunctional, one that doesn't work. Dr. Tommy Wood has an undergraduate degree in Biochemistry from Cambridge University and he graduated as a medical doctor from Oxford. And he's now just finishing up his Ph.D. in neonatal neuroprotection in Oslo, and will be coming to the US very soon.

    Yeah, he is my chief medical officer. We are on Nourish Balance Thrive, which is the name of our practice. I employ a registered nurse. Her name is Amelia. And then I also work with my wife who is a food scientist. And then the CEO of Nourish Balance Thrive is also a medical doctor and a pro mountain biker. I thought I'd just sneak that in there for all the people who are new that don't know what Nourish Balance Thrive is.

    And to make money, we do one on one consulting with mostly athletes. We use functional medicine tests -- they are urine and blood and stool testing -- to find out what's going on inside athlete's bodies. And we charge an hourly rate. We have a program that maybe we'll talk about later on. We also make some money by selling nutritional supplements. So, if you're buying nutritional supplements from Amazon, you would really help me out if you buy them from me, if you've been enjoying the podcast, thank you very much. And, I think, that's it. That's how way we make money.

    So before I go any further, I have to give you an explicit sexual content warning. If you're listening to this podcast with someone you'd rather not then maybe now is the time to listen to another podcast and you can listen to this one later one. We are going to talk about erectile dysfunction. So, maybe I should just leave a brief pause here and continue. So, Tommy, maybe we should start with my story and the reason why I was motivated to do this podcast.

    I don't really know how much detail I want to go in here but let's just say it was the original reason I was motivated to go to the doctor. So, there's a joke that says men only go to the doctor when they've got a pain in their chest or their penis doesn't work. And for me, it was the latter. That was what originally motivated me to go to the doctor. And I had a terrible time with that. I had a lot of other symptoms, obviously, and it was so awful I was persuaded to quit my job and start a functional medicine practice.

    But it's a really interesting sign, isn't it, a canary in the coal mine, if you will, that a lot of things are going on when you have erectile dysfunction. So, maybe we could start with a broad overview. Can you explain exactly how the process of obtaining an erection work?

Tommy:    Yeah. So, well, basically, it usually starts in the brain. So, you have been turned on by something or you are sexually excited by something or someone and then there's a nerve signal via the parasympathetic nervous system mainly by the vagus nerve which goes down to some nerves in the pelvis which then go to the penis and you'd get a release of acetylcholine and then as a result of that nitric oxide which people probably have heard of as a vasodilator which opens blood vessels.

    And it does that by acting on receptors which increase something called cyclic GMP and then that causes smooth muscle relaxation which then allows the blood vessels to fill with blood and then that essentially results in your erection. So, there's kind of multiple steps along the way where things can go wrong. And that's kind of part of the issue of trying to figure out what it is that's maybe causing erectile dysfunction. That includes not being able to get an erection but also not being able to maintain an erection for as long as you'd like to. And that's sort of parts of the diagnostic criteria of erectile dysfunctions.

    So, there's multiple places and, depending on, particularly the athletes we work with, there are a number of potential places where that flow of inflammation say from the brain down to the penis can go awry or just not function correctly. And then it's usually I have to do a little bit of digging and talking to somebody to try to figure out what's going on.

[0:05:07]

Christopher:    And when this happened to me, I honestly believed that I was probably the only one. But I don't think that's true. And so can you talk about the prevalence of erectile dysfunction?

Tommy:    Yeah. So, we were talking about this paper a while back now. It was part of the NHANE, so the National Health Nutrition Examination, in the United States, which they've been doing for decades now. And largely took a food intake, calorie intake, micronutrient intake and things like that. But they also do some other questionnaires along the way and one was about erectile dysfunction. I think they only looked at 2000 something men. And they try and cover a fair or average population so they can then extrapolate to the larger population of the US.

    And they found or they supposedly found that 18.4% of men over 20 years old had, could either only sometimes get and maintain an erection or never manage to get and maintain and erection. And so if you extrapolate that up to the population of the United States that time, that's over 18 million men. So, that's quite a few people.

Christopher:    Quite a few? 18 million? It's a fifth of men over the age of 20.

Tommy:    Yeah, absolutely. And I'm saying that I think the numbers are going to be going down for a number of reasons and I know particularly in periods of my life when I've had a lot to do, very stressful time as an undergraduate, as a medical student, always working very hard as an athlete either as a rower or training for Ironman or ultra marathon competitions. And sometimes your body just doesn't do what you wanted to do. And I think particularly in hard charging athletes who also have stressful lives, family lives, stressful jobs. I think there's a big possibility that it's happening to people more often than you think.

Christopher:    And when I read the review papers that you sent to me, and I'll link to all of the research that we did ahead of time for this podcast, there was something in the etiology of erectile dysfunction that popped out with me because this is what I thought was originally wrong. And it was the amount of time spent cycling, as in bicycling. And I thought that maybe the saddle -- I was doing 20 hours a week of training at that time, made some sort of trauma to the soft tissue, and maybe that's why I was unable to achieve an erection. I think that was probably not the case. Would you agree?

Tommy:    Yes. So, people do talk about that. I think there is because little direct pressure on that area. I think it is a risk factor but I don't think that means that everybody who goes cycling is going to be a risk. I think they've also shown something very similar both in terms of ability, sort of erectile function, and then also sperm function and sperm health and things like that in runners as well. The problem seems to get worse the more time you spend running. So you agree to the training volume.

    So, it's probably as much to do or more to do with the amount of stress you're putting on your body and the amount of time you're actually spending doing high volume exercise as it is that sort of direct pressure on the area.

Christopher:    Well, let's get into this then, the broad categories of erectile dysfunction. And so we came up with these -- No, I'll be honest, you came up with these categories before started. And those are neurogenic, psychogenic, endocrinologic, and cardiovascular. So, let's drill down into those one by one. What do you mean by neurogenic?

Tommy:    So, neurogenic is basically to do with the nerves or the parts of the body that are then going to be controlling, they're going to be controlling this whole system. So, I think, somewhat they're kind of -- I mean, the very simple ones that are definitely neurogenic will be things like trauma. So, if you have somebody who has a complete transection of the spinal cord due to some kind of accident then they're very unlikely to be able to receive, achieve and maintain an erection. Though there are ways to get around that.

    So, you can inject things into the penis so that you can get an erection and then you can have a more active sex life. And those are not regularly used but for people of that situation those things are used. And then similarly you might have some kind of autonomic nervous system problem. This is something we talk about more and more actually. There's a few things we talk about more and more as we learn more about how the body works. And the autonomic nervous system, the balance of the parasympathetic nervous system, that's mainly the vagus nerve, with the sympathetic nervous system, particularly as we develop some kind of chronic disease or chronic stressor, those two get out of balance and it's usually to the detriment of the parasympathetic nervous system. And that's what essentially drives the initial, sends the message to the penis to get an erection.

[0:09:59]

    So, you can damage the vagus nerve particularly if people have elevated blood glucose, they have type II diabetes or type I diabetes, if it's poorly controlled then you can damage the nerves then you might damage the vagus nerve. Because of that poorly controlled blood glucose and that can cause problems. But then anything, there's multiple things in terms of stress, circadian rhythm disturbance that metabolic problems, chronic metabolic problems that can lead to just an imbalance of the two sides of the autonomic nervous system and that may then cause problems as well.

    If you go higher up, this kind of encompasses maybe both neurogenic and endocrinologic. But you could have problems with the pituitary gland. The pituitary glands basically create most of the signals to then create the hormones, most of the hormones in the body. So, we're talking about thyroid hormones, sex hormones, growth hormone. And if, particularly in athletes, if they've had multiple concussions, often down the line you'll see something called hypopituitarism or panhypopituitarism depending on how bad it is, and you start to lose or you produce less of those precursors that then tell the body to make the hormones that you need.

    So, often people who had a history of concussions may need actually some hormone replacement. So, that's kind of endocrinologic but starting within the nervous system. And then slightly more ethereal than that or slightly harder to pin down is circadian rhythm disturbance. We know, particularly data from women but I'm certain the effect will be the same in men. I did try and look at the effect of shift work on erectile function. I couldn't really find anything. That doesn't mean it doesn't exist.

    So, if anybody has seen a research on shift work and the effect on erectile function, please send it to us. But we know that women who have disturbed circadian rhythms, shift works, swing shift, they have effects. Their LH and FSH, which are the hormones released by the pituitary gland which then go and dictate the production of estrogen and progesterone and that can also directly affect like the circadian rhythm and the ovaries themselves. That's mainly done from animal work but we kind of feel like we have a rough idea that this important circadian rhythm in all the cells in the body and that's driven from the brain and actually the genes that control them are highly conserved across most species.

    We know that women who are on shift work are more likely to have miscarriages, more likely to have premature, give birth prematurely. And these things can be affected both by the light and food cues that we get but also by certain endocrine disruptors. So people talk a lot about the phthalates and Bisphenol A and things like that in plastics which are endocrine disruptors but there are also certain metals and things we get exposed to that cause endocrine disruption and they can then affect the circadian rhythm of the sex hormones and then that can cause downstream problems.

    These are kind of things that we're being exposed to all the time. And each one individually, it's maybe not such a big deal but they could sort of add up and that might be part of the reason why people start to develop erectile problems as we sort of go through life. That's neurogenic.

Christopher:    We probably lost all the women by now. But just in case or in case there's men who are interested for female function, do you ever sense for how some of the problems that you've just spoken about and how some of the problems that you will speak about affect female physiology? So, one of the things I'm really interested in is the connection between mechanical function and sex drive. I've certainly heard women say that I would rather mop the floor than have sex. How are these two things connected?

Tommy:    There's definitely a general consensus that -- I mean, there are two fairly distinct parts of this which are kind of connected from the brain down to the genitalia essentially. So, you have the drive from the brain, from the gray matter that becomes sexually aroused and then the body then responds. And, I think, there's a larger, generally considered to be a larger psychological component in women than there is in men. I don't think there's many people that I know that would disagree with that.

    But that doesn't mean that there isn't a psychological component in men as well. There is an important psychological component. But you have two separate parts. So, first, the brain needs to become aroused and then the genitalia needs to respond via some nervous and hormonal signals. So, the two can essentially be separated and we know that -- So, in women, whatever it is that's causing the disturbance could have a psychological effect or an actual physiological effect on, say, the hormones or the function of the genitalia, how they respond.

    And it could be the same thing, absolutely be the same thing in men. If you go to like psychogenic erectile dysfunction, this is often tied to mental health problems, stress or performance anxiety. People kind of talk about that quite a lot. But I think that's generally fairly rare. There was this new paper that just came out that we're reading today where particularly in younger men -- I mean, in reality, men of all ages, if they have some erectile dysfunction or they're unable to maintain erection with a partner, you have to go into real history of what else they're doing that's sort of part of their sex life.

[0:15:16]

    So, in this particular case, we are talking about porn and porn addiction and how that affects the psychology of sex. Because then if you're used to getting sexually aroused by pornography then actually when it comes to a real person in real life maybe what happens there is not the same kind of things that you're getting aroused by online and then there's a bit of a disconnect there and your body doesn't respond as maybe you'd wanted to.

    And a lot of men who have psychogenic erectile dysfunction there is often a sort of things like stress and performance anxiety. But these guys were [0:15:52] [Indiscernible] increasingly as we increase our ability to access pornography is increasingly a disconnect between what you're sort of doing in your spare time and then what you're trying to do with your partner. Does that make sense?

Christopher:    It does make sense. It would appear that pornography might be like added sugar. You probably want to avoid it for the most part because if you don't, palate maybe adjusted to this new artificial level of stimulation that maybe no good when you're trying to consume something that's not a real life thing like a blackberry or normal sex.

Tommy:    Yeah, yeah, exactly. That doesn't mean you can't. Maybe it's something you enjoy with your partner rather than on your own. This is kind of something that, I think, we've seen a few times in people we worked with, kind of connected to this, is even men need the connection to the other person they're with be it male, female, transgender, anything, your partner. So you need to have that connection.

    And we see a lot of people who are very hard charging athletes who are often type A, have very successful jobs and so they spend, they work 60, 70,  80 hours a week, then they have 20 hours of training a week, and then they're competing at an Ironman at a different country every month. We've seen that once or twice. And even if they're not complaining about the time sometimes we see we have these questionnaires and they include whether you'd be interested in sexual activity, whether you enjoyed sexual activity.

    Because there's incredible canary in the coal mine. You often see that people are either aren't having it or aren't enjoying it. And maybe it's the fact that you're just trying to do too much. So, you're never at home. You're never seeing your partner, never seeing your kids, and so you start to lose that connection and you stopped being interested. And, obviously, the partner needs to reciprocate. So, if you're always somewhere else then they're not interested in you then you're never going to achieve that connection either.

    So, often it's really worth looking at all the things that are feeding into your lifestyle currently and training is really important. And that all sort of come some of the stuff later on. But the volume of what you're trying to do is maybe affecting your sex life as well.

Christopher:    And, of course, training wouldn't be the only thing that would cause you to lose that connection. It could be just traveling for work. I think it's even possible to live under the same roof as your partner and still lose that connection. When people have kids and they have busy lives then you're just kind of going about your daily business and you pass each other in the corridor and you don't even touch or look at each other anymore and suddenly you've got no connection. It's just like you're living with someone from the office. It's just totally different.

Tommy:    Yeah. Yeah, absolutely. And you definitely don't need to be away from your partner for that to happen. You're absolutely right.

Christopher:    So, where does stress and performance anxiety fit into this?

Tommy:    Well, I guess, they have kind of two different functions. So, performance anxiety could just be the acute, a very acute thing. So, particularly, if you've had issues in the past or you're with a new partner and you want to perform well, there's always a possibility that then that can sort of override the sort of the sexual arousal that is happening at that time. Additionally, I think, and we didn't put this in the list, but thinking about it, if you're often with your, if you're with your partner and you're on a date, have a few drinks, and obviously alcohol is a central nervous system depressant and then can affect sexual function as well.

    Sometimes you kind of get nervous, have a few too many drinks and then that can affect it too. In terms of the stress, again, that's a very sort of ethereal concept because everybody responds to stress differently. Different stresses will cause different responses in different people. But over a longer period of time this could be both psychological stress from work but could, we could use the building physical stress for whatever reason, poor sleep, again we come back to training, and then this can have effects on the hormones in the body.

    So, cortisol goes up, testosterone goes down, particularly the ratio between the two and also these other sex hormones estrogen and progesterone even in men can then have a significant effect on erectile functions.

[0:20:00]

    So, any kind of total too much stress on the body will eventually lead to a failure of erectile function. And some stress is good. We talk more and more about the effect of hormesis. So, some exercise is good, actually challenging your body occasionally is good and we know that's good for erectile function as well having some of that but then too much can take any other direction.

Christopher:    So, that brings us on to the endocrine system. Let's talk about hormones.

Tommy:    Yeah. So, obviously, the most important one to talk about, I think, is testosterone. I do kind of find this strange obsession with having more testosterone. Everybody seems to be taking testosterone boosters. Many people are taking exogenous testosterone. And we do know -- So, say, if you're trying to perform well both cognitively, so say in the business world or academic world whatever, and in the sports world, if you're taking androgen steroids, you can and will, not necessarily, but you absolutely can get a performance benefit particularly both sort of in terms of the cognitive, being more focused, more aggressive, but then additionally in terms of recovering from training and things like that.

    But that doesn't necessarily mean that more testosterone is always a good thing. Unless you actually have some identified issue then more testosterone isn't necessarily better particularly if we're talking about just sort of moving up and down within the normal range. And there's another study that we looked at recently which is that men who are more engaged in family life tend to have lower testosterone. Because it's part of that kind of that pair bonding, part of the sharing came from the family and you don't know whether it's cause or effect so you don't know whether men with slightly low testosterone are more likely to engage in the family or whether actually being engaged in the family unit decreases your testosterone or it could be a bit of both.

    But if you want to be somebody who's, again, connected to your partner, connected to your family, maybe more testosterone isn't necessarily a good thing. But we do know that in men whose testosterone levels drop, so particularly as men age or, again, calorie restriction, over training, sleep deprivation, all of these can decrease testosterone, and then equally they are associated with erectile dysfunction.

    The effect of testosterone on erectile function is kind of thought to be relatively binary. So there's like a level that you need to achieve and then above that more isn't better essentially. And it's not, when I was kind of describing the physiological process earlier, there's nothing in there which testosterone definitely affects. So, it kind of will have some effect in the genitalia. I think it's definitely going to have an effect on the initial arousal process because we know that men with low testosterone are more likely to be depressed and when you're depressed you're much more likely to have an erectile dysfunction. So, it kind of affects the whole system. But no sort of individual point can you sort of specify that that's where testosterone is causing problems.

Christopher:    What about drive as well? We talked about how the mechanical function is different from the neurological, the drive. How does testosterone affect sex?

Tommy:    Yeah. I think that's where it has its biggest effect. The cognitive effect of having low testosterone are your central, just your ability to become sexually aroused by things, people, things around you is going to decrease as your testosterone levels drop. So, I think, that's sort of the psychological effect of low testosterone, are going to be a huge part of that rather than just purely physiological.

Christopher:    And then let's talk about the role of diet here. What happens when you under eat?

Tommy:    This is, again, this could be over eating or not eating enough for the amount of training that you're doing. It basically has -- you have both sort of short and long term hormone signaling that tells the body how value energy store levels essentially. And those run often -- And so a lot of it runs through the thyroid gland and the thyroid hormone and thyroid hormone is really important for signaling to the gonads to help produce sex hormones.

    As your calorie intake drops your thyroid hormone tends to drop and that's going to affect testosterone production. And we kind of see this. I talked about this study a lot. There's a very nice study on army rangers where they were sort of, even though they were thinking that they were eating 4,000 or 5,000 calories a day but were still under eating by 2,000 or 3,000 calories a day and that's sort of rocking every day and out in the wilderness and they're only sleeping four hours, they're training ten, 12 hours a day and they're only sleeping four or five hours a night, and within a couple of weeks their testosterone drops precipitously, below 300 to 200 nanograms per deciliter which is kind of somewhere where we think the [0:24:49] [Indiscernible] in terms of the effect on erectile function.

    And that's kind of -- you can imagine somebody who's working hard, training hard, actually doing that almost accidentally and then now seeing an effect on their sexual function.

[0:25:04]

Christopher:    And this is a really common thing that we see in our practice, is people under eating. And it's really easy to do on a high fat ketogenic diet. You don't feel hungry anymore and then all of a sudden you're only eating 1200 calories and that's not good for sexual performance.

Tommy:    No, no, absolutely not, because the simplest way to think about it is the fact that in order to expend the energy that is required to reproduce you need to have the energy available in the environment to support that offspring, if you go back to sort of the traditional evolutionary stance on things. And people often talk about this being mainly a factor in women in terms -- because we see something called the female athlete triad, particularly women who over train, under eat and their periods stop and also they lose bone density and things like that.

    But it's kind of you can think about it as the body wanting to just spare itself and it's going to stop cycling and you're going to stop having periods because you can't support a fetus if you don't have enough food available. Actually, a very similar thing can happen in males. You're just telling your body that there's actually not enough energy around to support new life. So, males will shut down our reproductive function until the food is more plentiful again.

Christopher:    Yeah. Ancestral health lens is really a powerful one, isn't it? Why is this happening and what is it for, are two very interesting questions with nearly all problems.

Tommy:    Yeah, absolutely. There's going to be plenty of things that sort of happen in the modern world that you can't exactly line up with sort of an evolutionary stance on things. But actually having some idea of why the body responds to the environment in the way that it does can really sort of allow you to figure out what it is that's going on.

Christopher:    Let's talk about the relationship between cardiovascular health and erectile dysfunction.

Tommy:    Yes. So, I mean, this is really important particularly we don't see that many people who have sort of overt cardiovascular disease. But, I think, we see a lot of people who have the potential to develop cardiovascular disease in the future. And we know that even sort of hard charging very high level athletes aren't protected from cardiovascular disease. And that's probably because of high levels of inflammation, maybe problems in the gut, scarring of the heart and things like that that we know that you can get with very sort of extended periods of exercise.

    But erectile dysfunction is one of the best predictors of future cardiovascular disease and, I think, the reason for that is that it's probably so many things are required to get a healthy functioning erection. And many of those start to go with a lot of things that, I think, are going to potentially cause cardiovascular disease. So, as you get metabolic problems and your blood lipids go, become  deranged, your triglycerides go up, HDL drops, all of those things are associated with worse erectile function in people who are in that state.

    So very low levels of aerobic exercise are then one of the best ways to reverse erectile dysfunction. We know that the two are tightly linked. There's a number of potential things there. So, we talk a lot about endothelial dysfunctions. That's basically the cells that line the blood vessels. They're very important. Their health is very important both for preventing atherosclerosis but also for sort of they dilate and respond appropriately to signals that tell them to respond.

    And the tissue down the blood vessels down to the penis are very sensitive to this. So as soon as you start to get some issues there, they're not going to respond to -- well, first of all, they're not going to make as much nitric oxide because you get down regulation of the enzymes that [0:28:50] [Indiscernible]. You're not going to get as much released in response to the initial stimulation. Then the vessels weren't responding the same way so you don't get the same amount of dilation, the same amount of blood going into the penis.

    And that kind of vascular health is something that people are really worried about particularly strokes, heart attacks. But actually where you may start to see the effect first is in your sexual function. So, as soon as that starts to happen, again, talk about the canary in the coal mine, that's where you can start to see it. And then that's a good indicator that it's time to do something about it. And one of the ways -- I think what happened, done to you from your doctor was that you got prescribed Viagra.

Christopher:    Right. And it worked very well. I love to make fun of the drug and say, "Oh, the drugs don't work," but in this case the drugs worked fantastically.

Tommy:    Yeah. And in that scenario, so say if you have some low level vascular disease, you have--

Christopher:    C reactive protein of seven.

Tommy:    Yeah, yeah, exactly. You have this high inflammatory burden. It's coming from somewhere. It's definitely affecting the health of your blood vessels. They're probably also affecting the health of your nerves and your brain as well. That kind of inflammatory burden has a huge effect on mental health as well as all these other things.

[0:30:07]

    But Viagra is going to overcome that problem because you got some endothelial dysfunction, you're not making enough nitric oxide, Viagra comes in and it's going to sort of just bypass those problems and then you're going to get your erection and you're going to feel much better. So, yes. But then if you have some regular reasonably active sexual activity maybe then that can be part of building back your cardiovascular health.

    But if you're just relying on Viagra, you're not dealing with the problem that caused the issue in the first place, I think, that's one of the main reasons why you might be unhappy with just getting prescription in this case. Obviously, that scenario, you'll feel much better, function much better, be much happier. But if you're just sort of taking a drug to cover up the symptom and then not actually dealing with the problem, eventually the drugs can't solve everything.

Christopher:    And, I think, in this case, the drugs can be addictive, not in the classical sense but in the sense that you get to a point where you think if you don't have it you're going to have some kind  of performance anxiety.

Tommy:    Yeah, if you don't have it with you then that's what you need and then maybe you didn't need it but when you have that kind of mental block that's going to stop you then relaxing into the moment as you might have done otherwise and then that can cause problems as well.

Christopher:    Okay. So, we've got this far, erectile dysfunction. It seems to be associated with much bad. So, what the heck are we going to do about it? Do we need to go back through that whole list and talk about all of the things that you have to do to solve this problem? Or can you summarize it? How do our programs help for erectile dysfunction?

Tommy:    Well, when we are working with people, I think the standard workup that we do -- So, we do some sort of comprehensive blood testing which looks at red blood cells and also hormones, thyroid hormone, and we do all the cholesterol and all that kind of stuff, basically electrolytes, calcium. And that kind of gives you a basic picture of metabolic health. But then we often do stool testing, so the urine organic test. That's really nice for looking at things like inflammation or maybe even some imbalance of neurotransmitters which are maybe causing problems.

    And again, we often look at people's stool test because often come to us either fatigue or problems like that but there's often digestive complaints as well. And there might be something going on there. You can usually pick -- So, if say somebody came to us either with some erectile dysfunction or they weren't maybe enjoying sex or initiating sex, again, we do some hormone testing based on urine. You could see if somebody had low testosterone or an imbalance in testosterone and estrogen or maybe their cortisol is really high.

    And a lot of it can be tied back to some kind of toxic exposure, inflammatory stimulus. Again, it could be an infection. It could be work, life stresses. We talked a little bit about circadian rhythm. It could be an imbalance of those because of things that are going on in their life. So, with a good history and then sort of even just in the functional medicine world as you'd call it, I think the test that we do are on the more basic side. We don't go for all the big fancy stuff because often people will send us other tests as well that they've done elsewhere in addition to the ones we've already done. And they don't give us any new answers. I think that's kind of--

Christopher:    It's interesting that, isn't it?

Tommy:    We see that all the time. There are so many things you can do you can pay hundreds of thousands of dollars for. It's nice to kind of get confirmation that what we're thinking based on the other test is right. But they don't often really add that much information.

Christopher:    We've done a good job of distilling this thing down to its core.

Tommy:    Yeah, exactly. We know what works. I think we've done some stuff that doesn't work and we [0:33:45] [Indiscernible] and we brought new things on board which continue to work. And it's just kind of like an interesting process of the test and then the treatments that kind of work and they sort of evolve as you go along and new things happen and things either work or don't work.

Christopher:    And, I think, our model is very gut-centric. I think in this case it is justified because patients with IBS are 2.12 times more likely to develop erectile dysfunction according to this paper that I found. I think that was certainly the case for me. The inflammation that I had was coming from my gut. I just needed to fix my gut. That's true in nearly everybody that we see, that they have something going on in their gut and that is the root of the issue.

    It's not just the inflammation. When you have a bunch of bloating and your belly is blown up like a basketball, that's not conducive to sex. It really isn't. So, you can have all kinds of things or feeding forwards or feeding back into each other to create the end result which is not good. So, let me ask you this. If somebody signs up for our program and they do all of the tests and they work with me and do two week sprints and I play those cards that you've had a large hand in designing, when we put the Kanban board up in front of them and we create a to do list.

[0:35:05]

    And the person moves those cards from the to-do to the done column and then we go around again in another two-week sprint. And maybe you don't have to do those back to back. You could wait a while and recover and then go again and do another round. We fixed all the problems that we find on the lab results, as we always do. We don't find things that we can't fix. And assuming that the person has no spinal cord injury, no pituitary injury, nothing that really can't be reconciled, what do you think our chances are of having somebody recover as I did and do away with erectile dysfunction?

Tommy:    I think they're really good. Like I said, it's not something that people not often their first complaint but it's sort of like often lagging in the background there. I think when people do -- and it's not something that people are often that open about or are willing to talk about. And you can kind of -- So, a way you can catch it is on the multiple choice questions because it's must less -- you don't have to actually sit there and say, talk about exactly how good your sex life is because you can just click. You just click a button.

    And you can see that that stuff picks up and that stuff improves. I maybe been focusing on the gut and we're not really talking about sexual function but you can kind of see that all those things improve. Like you said, we are often very gut-centric. That seems to be a big problem in athletes. But we also do a lot of other stuff talking about sleep and stress and getting outdoors and connecting with people and stuff like that.

    Maybe we treat something in the gut that wasn't really causing the issue and actually it was your circadian rhythm was screwed or you weren't dealing with stress properly. But to be honest, for me, I don't really care which it was that fixed you as long as you feel better. And that kind of combination of work and things has really been sort of doing the magic for us in the people we work with. So, that's kind of what we've stuck with and all of the strategies that we help people build into their lives to sort of deal with those things, not just treating infections or whatever, they sort of continue to do them and they become part of their lives and it builds resilience to whatever problems that might happen in the future.

Christopher:    Yeah. I never really know what was the one thing that did the trick. Maybe it is not just one thing that does the trick. You've got someone that is unable to sustain an erection and it's maybe making them slightly depressed and certainly very unhappy, then who cares which thing it was that fixed the problem? You just want to throw everything you've got at that problem and find the solution and then maybe once you're feeling fantastic you can try experimenting with reintroducing some of the things.

    Try staying up until midnight and having a bottle of wine every night and see if you can still get an erection. If you can then great. Those things are working for you. I don't care. I don't really have any horse in this race. I just want to make people feel good. Yeah, it's not a very good engineering approach. I can't tell you. People want to know what was it? Was it the wheat? Can I do the test and tell me it was the wheat and that's why I couldn't get an erection? No, I very rarely can pinpoint the exact cause. But, as you say, do we really care?

Tommy:    No. And I also don't think that having people do some gratitude or some meditation or making sure they get some good sleep hygiene, I don't really feel like that's sort of like a big onerous task. And almost all of that is free as well. It doesn't cost anything to do it. It's not a big ask and it's almost certainly worth the results.

Christopher:    Well, if you have questions about the testing, you can come to the front page of my website. It's nourishbalancethrive.com. You can book a free consultation and have someone talk to you about the type of testing that we do, the process. It's really quite easy to do. The only test that requires a trip to a lab is the blood chemistry but everything else you can collect at home and then send samples to the lab using prepaid FedEx mailers. And then the results come back to us electronically.

    And then I can get you on my video conferencing software Zoom and talk about the results and then we can populate your Kanban board with a list of to-dos and go ahead and get started on the Sprint. I'm super duper confident about being able to fix other men with this problem. I would happily refund all of the money that you spend on my time if you do not get results for this. I can't give you back the money that you spent on testing and mass spectrometry is quite expensive. Unfortunately, that's just a fact of life at the moment.

    But certainly, if someone pay for my time and didn't get the results that they want, I would gladly give them their money back. I'm really confident about that. So, yeah, come to the front page of my website and book a free consultation. I feel like we owe the women a podcast now, Tommy. This has been a very male-centric episode. Do you think there's anything here that we've discussed today that would be, especially in terms of the solutions, would be inappropriate for a woman? Is there anything that we've missed there?

Tommy:    No. I really don't think so. So, obviously, there are more moving parts in terms of female physiology particularly reproductive physiology.

[0:40:07]

    But in reality, the things that we do to identify those problems and start to treat them are very similar. So, if you feel like some of the supplies, some of this sexual function of you're struggling with sexual function or arousal and that might be linked to any of the different things that we talked about, I think that's still very relevant to women as for men. And we work with, obviously, we work with women as well as men. This isn't a sex-dependent process.

Christopher:    That's what I love about this thing. As much as I love the mechanisms, I love going on to the Khan Academy and looking at cyclic AMP and endothelial function and nitric oxide and all of that good stuff, but you really don't need to understand that in order to be healthy. There's only a few things, diet, exercise, stress, sleep, nutrient status, you want to be free of infections. There's only a few variables that need to be in the right place in order for you to have optimum performance and longevity and just generally be awesome, which is just the coolest thing in the world. There's so many symptoms and problems but not that many solutions. I think that's absolutely amazing.

Tommy:    Yeah, absolutely. And there's plenty of tweaks that you can get further into if you want to talk about specific nutrients and genetic snips and all that stuff. That does become important for some people. But in terms of the stuff that we need to do to perform well as humans, actually, it's simple but it's not easy necessarily. So, you still have to -- there's still a process that you have to sort of build into your daily life so that you're actually taking advantage of these things. But actually, what those things are isn't necessarily very complicated.

Christopher:    Well, awesome. This has been great, Tommy. I really appreciate your wealth of knowledge as always. I think there's really no one else out there that has your both experience as a doctor and then also talent as a researcher and ability to speak publicly. So, I'm extremely grateful for you. Thank you very much.

[0:42:03]    End of Audio

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