Episode 89: Reversing Low Testosterone in Men: Testing, Treatment, and Lifestyle with Dr. Alan McDaniel, MD
Show Summary:
Today, we are happy to have Dr. Alan McDaniel join us, an esteemed expert in the field of endocrinology, allergy, and chronic fatigue.
In this episode, we shine a spotlight on a topic that affects many men worldwide: low testosterone. Dr. McDaniel brings a wealth of knowledge and experience to our discussion, having dedicated his career to unraveling the complexities of hormonal imbalances and empowering men to regain their vitality and well-being.
What exactly are the underlying factors that contribute to low testosterone levels? How do lifestyle choices, environmental factors, and even emotional well-being impact hormonal balance? These are the questions we will explore as Dr. McDaniel takes us on a journey through the multifaceted nature of low testosterone, uncovering the root causes that often go unnoticed in conventional medical approaches.
Join us as we uncover the root causes, gain practical tools for rebalancing hormones, and embark on a transformative journey toward reclaiming your vitality and optimal health.
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Full Transcript:
Dr. Alan McDaniel
But as the SH VG goes up, it makes your total testosterone look just fine. Thank you very much, but it actually reduces the free testosterone. So now you if your doc is not paying attention if he's only measuring a total not a total free, he's gonna miss the fact that you are missing the active form of testosterone which is the free form that goes into cells that goes into the nucleus that connects with the androgen receptor and drives DNA. And just say all your total testosterone is fine, and it's not.
Dr. Andrew Wong
Welcome to the capital integrated health podcast. I'm your host, Dr. Andrew Huang. Today we are happy to have Dr. Ellen McDaniel join us. He is a good friend, esteemed functional medicine expert in the field of Endocrinology, allergy and chronic fatigue. In this episode, we shine a light on a topic that affects many men worldwide, low testosterone. Dr. McDaniel brings a wealth of knowledge and experience to our discussion, having dedicated his career to unraveling the complexities of hormonal imbalances empowering men to regain their vitality and well being. What exactly are the underlying factors that contribute to low tea? How to lifestyle choices, environmental factors, and even emotional well being impact hormone balance? These are some of the questions we'll explore with Dr. McDaniel today, as he takes us on a journey through the multifaceted nature of low testosterone, uncovering the root causes that often go unnoticed in conventional medical approaches. Join us as we uncover the root causes, gain practical tools, rebound some hormones, and embark on a transformative journey towards reclaiming your vitality in optimal health. Welcome, Alan to the podcast. Thanks so much for coming on today.
Dr. Alan McDaniel
Where do you thank you so much for inviting me? It's a pleasure. Yeah,
Dr. Andrew Wong
so to start, we know that you're an expert in functional endocrinology, and let's kind of just talk to our listeners. endocrinology is certainly a pinball machine. I would say that, that, you know, we don't always know where the balls you know, going to end up even. But let's talk about tell our listeners a bit about what drew you Alan to become a physician, and then especially an integrative functional doctor, and then what do you enjoy most about about what you do? Well,
Dr. Alan McDaniel
thanks to Andy, I think is really dharmic. I really never seriously thought about much of anything else. I think I was put into the right family, my mother's family every other generation as a physician, going back a long time. My father and his father were engineers. So they gave me that nice little obsessive compulsive ability to look at details and then put it together in the big picture that I needed. And I really never had a serious plan to do anything besides medicine. I got into functional medicine, because my surgical training taught me that a surgeon should always know two or three approaches to the same problem. If the anatomy is different, if something stuck down, you got to go the other way. And that has been enormously useful in working with my patients in the clinic. In the about 1987, I was looking at allergy, because I'm an ear surgeon and allergy causes most chronic ear disease in my opinion. And I then had several patients that made me look at the yeast connection, which was my serious intro into, you know, integrative complementary medicine. It turns out that that was actually a fantastic diet for insulin resistance, which is 40% of Americans, which is why once I started doing it, I was feel it. It was the most amazing treatment. And so I haven't looked back since I've just gotten more and more integrative it's so much the lid, it's hard to tell if I'm on the cutting edge or on the lunatic fringe sometimes. I think means we're doing it right.
Dr. Andrew Wong
Yeah, absolutely. Yeah. I think there's always you know, progress that happens at the margins and at the margins of innovation. So you're an integrative intergenerational physician who sounds like started out as a surgeon and now you're really working with with patients and you're working with, I think the public too, in terms of education to to ideally avoid and prevent surgery. It sounds like because that's kind of what happens when when you kind of address the root causes of that a lot of times people don't need surgery,
Dr. Alan McDaniel
right? I started doing allergy work because I was convinced that I couldn't reconstruct an ear and make it better than the ear God put there in the first place. Yeah, and since the original error went bad, I had to get rid of the cause of the problem. So I did really aggressive Alhaji work. And I got great results, nice compliments from my anesthesia staff, for instance. And then that got a lot of my patients over problems I didn't even ask about like chronic fatigue. So then chronic fatigue patients started coming to see me. And that was my intro to endocrinology and nutrition, where I am stuck to today. So I'm not, by any means trained to be an endocrinologist, I'm off the tailgate. I'm just self taught. I'm not a researcher, but I am a bit of a scholar, I've read a lot. And with my patients permission, so we try thing. And when it works out, I try it again. So you're I am
Dr. Andrew Wong
your you're a scholar, you've published a lot of articles. In fact, the reason why that we got together is because I started reading this article that you written in the Townsend letter A couple years ago, and lo T. And I was so blown away by it. I was like no one ever, you know, explained it that way, especially in that unique Allen style that you have. And I was like we need to, we need to get you to talk. You know, I know you've talked with us a lot here at CH and talk to you personally. So yeah, I really wanted to appreciate and express gratitude for your mentorship. Friendship.
Dr. Alan McDaniel
Thank thanks. It's really a privilege. You helped me fulfill my dharma, I have a little dharmic statement on my computer. I learned, I teach. I help practitioners help patients. And at this stage of my life, that's my main focus. And I'm really grateful that you guys honor that and can hear what I'm saying. I'm a slow learner, I'm slow on the uptake. And so I have to really understand something to be able to get it and I think that helps me explain that.
Dr. Andrew Wong
Awesome. Well, thank you so much, Alan. Well, let's go slowly, also and deeply into this rabbit hole topic of low testosterone and men now. Now, we talk about testosterone a lot. You know, it's very, I think, you know, popular in the mainstream media, let's say but let's let's talk about from a scientific perspective, why is testosterone so important? What does testosterone do in the body? How does it function in the body? Well,
Dr. Alan McDaniel
testosterone is incredibly important it in utero it develops the fetus into an anatomical male. And in utero, it also directs the development of the brain to be more disposed to things like rough and tumble play. It is anabolic, so it builds up a body in both male and female children because both of us have testosterone. It helps to develop our bone density or muscle mass our cardiovascular system, in adolescence, testosterone is the precursor for women's estrogen. And in men, we have a different amount of testosterone and more importantly, maybe a different ratio of estrogen, testosterone. And so in the unit and yang of endocrine development, we get more again, we get more bone density, more muscle mass, more aggressive smacking down attitude, more libido and bone marrow stimulation. Testosterone connects to the androgen receptor in the nucleus of our cells. And that is a DNA transcription factor that drives the running of programs that give us a robust masculine body. And through non genomic receptors, like in the brain and sigma one receptor, just Asteron gives men a more aggressive, more optimistic attitude. Like I say rough and tumble you watch boys and girls playing you know, there's a little difference in the rain. And then they're in non completely not related to receptors. Testosterone in the tissues is converted to estrogen. So in the bones in the lining of our blood vessels, the endothelial in our joints are Cartlidge, testosterone is converted to have really high levels of estrogen in those tissues, which further the function and maintain those tissues in a healthy fashion. So this to Asteron is one of the big things that helps to create and develop and maintain healthy sexually dimorphic bodies means men and women look different and act over.
Dr. Andrew Wong
Got it? Got it. Thank you for translating that to, to English. They're that. And so it sounds like just a follow up on that though, Alan that that loads that that testosterone rather is important. In both men and women, not all all humans, it sounds like Absolutely.
Dr. Alan McDaniel
Yep. There are a few unfortunate souls who were born without androgen receptors or without estrogen receptors. And, you know, they don't do that. Well. And I think people with absolutely none probably don't do at all. So it's, you know, hormones are important. I learned that
Dr. Andrew Wong
Yeah. Well, let's, let's go into kind of defining what is what is low? And I think, obviously, we know, in functional medicine, there's what is considered the standard range or the conventional range of what is low. And then there's also probably what's considered, you know, sub optimal or, you know, considered conventionally low normal, but then it's sort of suboptimal. So how does how does Allen How does Dr. McDaniel here define? Low testosterone?
Dr. Alan McDaniel
Right, it's like art, you know, I don't know how to define it. But I know when I see it. Well, the first choice is that there are a whole first thing I tried to do is look in the literature and act like an academic and act like I know something. And it's every different study for last 20, or 30, or 40 years has used a different definition. I personally like the European male aging study. They define low testosterone in the context of a man who has about three symptoms. So and that makes sense if if fellas coming to us, we don't go out on the street and hand out orders for blood tests for every man that walks by us. We wait until they come to us with complaints. And so you know, symptoms, obviously is a key piece of it. And the EMA study looks at symptoms, but they draw cut offs of blood. They call a low total testosterone less than 320 nanograms per deciliter. And that's right in line with the old Framingham study that's been going on forever. Up in Boston. They showed that 324 is right at the lowest two point fifth percentile of their bell curve, which is two standard deviations below normal. And then the Europeans define a low free testosterone, which I think is the most important measure considerably, as less than 64 pica grams per milliliter is determined by the liquid chromatography tandem mass spec method, which is the new one. And a lot of us use the immuno assay, which, if you do the unit's conversion, the EMA cut off is 8.7 pica grams per mil in the immuno assay. So a lot of our older patients that come in, they're normal at 6.5. And the in the range of normal is 6.4 to eight thean. Those guys are probably low. You know, the big advantage by the way of doing free testosterone is it is broken down by age brackets. If you're looking only to total testosterone, then you're comparing, you know, my 30 year old son to his seven year old father, you know, the it's all lumped together in the same pot, whereas the free testosterone is not only the biologically active testosterone, so it's clinically the most relevant, but for our convenience, it's also broken down into decade groups. So a man in his 20s to 30s is going to have this value is normal. A man in his 70s 80s is going to have their normal
Dr. Andrew Wong
does the testosterone level Allen effect things like athletic performance, sexual performance, drive vitality, all of that?
Dr. Alan McDaniel
Absolutely. When you drop down, when your total testosterone drops below 430 nanograms per deciliter, people will have pretty reliably reduced libido. So there's some nice studies out showing cut offs of symptoms at different levels of testosterone. Like if you get down below a total testosterone up to 100 Oh, man, you're gonna start to get depression, apathy to life, loss of optimism, less energy, they don't work as well. They can't sleep as well. That memory and concentration. I mean, who knew? So it's dosterone give guys good luck. Mission. I've raised three teenage sons. Okay. Just last year I made a mag like squirrels. Yes, but actually, it preserves the brain and keeps us intact and protects us from things like Parkinson's and dementia. Okay, so just ashrams, good stuff.
Dr. Andrew Wong
So a lot of sub questions that has swirling around my head right now. So, let's, let's talk about the chicken or the egg question. You know, we know that, you know, 80% of people or more in the US have metabolic syndrome, you know, insulin resistance, ate meat, maybe maybe I think you said maybe a little bit less. But it depends on the study. I guess, too.
Dr. Alan McDaniel
I think there's pretty good data from Ann Haynes, that 40% of us are insulin resistant by heredity. And the problem is that the standard American diet has taken even people who don't have a strong genetic predisposition, predisposition to insulin resistance, and made us insulin resistant by inactivity, and lack of sleep and chronic stress and really bad
Dr. Andrew Wong
diet change and toxins and in the diet to right
Dr. Alan McDaniel
and in the environment, and environment and endocrine disrupting chemicals.
Dr. Andrew Wong
So someone has metabolic syndrome and has weight loss resistance, you know, can't lose weight or gaining weight and we test their, say their labs and they have low tea, low testosterone. That's a chicken and egg question that I have for you, which is that is the low tea contributing to the metabolic inflexibility that causes the blood sugar and insulin issues or is it because is it that because someone has excess belly fat and they're the adipocytes are converting that successor into estrogen stealing that away?
Dr. Alan McDaniel
I'm looking at the lifespan of a human from consent option to dead. The first thing that comes is a genetic predisposition to insulin resistance. Most 18 year olds have prodigious testosterone, although I'm seeing a few of the few teenagers not so much. I've seen a 13 year old type two diabetic. My practice it's dreadful. Yeah, so but people usually start with pretty good testosterone and then as their diet and stress. Stress depresses the production of testosterone. It's part of the normal protective response. When we're really stressed, we don't want to waste the raw materials to keep us alive. By making hormones that help us reproduce what you don't want to do anyway, when things are really bad. So then the production of testosterone drops, the raw materials for the use of testosterone are diverted to cortisol and aldosterone to keep us alive. And the stress leads to insulin resistance, which truly snowballs it makes an avalanche. So it causes excessive production of insulin, which is an energy storage hormone. So we get fat. And as we store energy, we increase our visceral fat which increases the enzyme aromatase, which converts the testosterone we are still making to estrogen, so that you are right, the 40% and men with metabolic syndrome and 50% of men with type two diabetes have low testosterone and elevated estradiol because they're losing their tea to estrogen, which really works against us, and it's why a lot of fat men need a bro. You know, because they're making so much estrogen they can get breast enlargement and prostate enlargement. And it is a it's a it's a massive it's a cluster fornication. But I think the genetics for insulin resistance and a bad diet and lifestyle, probably are the initiating, they're the triggering, and it's just testerone is is just the the victim.
Dr. Andrew Wong
It's the tail. Yeah, yeah, I think so. Oh, got it. Okay. Thank you so much for that clarification and going. That's just my opinion. Don't take it to the bank. It's an expert opinion. We'll take it. We'll take it. We'll take it at least to a local bank. You have
Dr. Alan McDaniel
Marlin bank, would you call me an expert because I, you know, my credentials are just I do it. Okay. Yeah.
Dr. Andrew Wong
Yeah, yeah, experience is the best teacher though, you know, so yeah.
Dr. Alan McDaniel
If you keep your eyes open, there's a lot of mainline knowledge as to who must who should have a lot of experience and they say things I think they're incredibly naive. So, you know, that's what makes incarnation so interesting, and I think maybe why we have to come back.
Dr. Andrew Wong
Like that like that. Alan, let's talk about one of the one of the questions that I think is generated from the EMA study. Come Given that you may, which is that what are the common symptoms of low T? What what are those symptoms that people typically look at? Well,
Dr. Alan McDaniel
I think I mentioned the mental symptoms starting when total T drops below 430 libido go down, okay? Okay. When testosterone drops below 200 Then you have the, the effect the depression, the enjoyment of life optimism. You have lower energy, less productivity at work, people get sleep problems and then cognition, memory and concentration and planning starts to get flaky. genital urinary symptoms include fewer and weaker erections. As a guy I know cause leaners not boners. There's reduced serum volume, a semen volume. With lower sperm count people get prostate symptoms for a variety of causes. Okay, it's not just low tea by any means. Breast Enlargement I mentioned earlier is aromatase converts testosterone to estrogen redial and then the physical problems are because of the lack of the trophic function so that muscle mass and strength and athleticism are all reduced. The broken bones from loss of bone density, arthritis, loss of support of art, which men get hot flashes, vasomotor flashes when they have primary testicular dysfunction. Hot flashes are caused by the pituitary hormones that drives the gonads produce sex hormones. So the British actually produced this in a study done way back in the 50s, when they infused with women with LH and FSH and gave him a hot flashes. And then low hemoglobin is another consequence of the loss of the tropism. The bone marrow just doesn't make as many red blood cells. And then there are other actions. But I would recommend you, your viewers to the atom questionnaire, the androgen deficiency in the aging male, you can Google it, I've got a website here. But nothing is more boring than reading long websites off of off of it. Just Google, low tea questionnaires, or Adam a DM questionnaire. And there are a few references that are academic from the early part of this century. And then I think 2017 2018 practices, start putting it on line, so you can pull off your own copy. And it's pretty, it's pretty handy.
Dr. Andrew Wong
Thank you. Thank you, Alan, definitely check out that add a questionnaire. We're always looking to get to the root cause here. So let's discuss the causes of low testosterone. You mentioned high cortisol stress, poor diet, what are the kinds of calm and just to summarize for listeners root causes of low tea?
Dr. Alan McDaniel
I've got a little list. Thank you for sending me your questions ahead of time. Stress is huge. I mean, stress. Stress is a normal part of the stress response is the blocking of the production of sex hormones. That luteinizing hormone is just blocked. And so not only do the testicles not convert cholesterol, to pregnenolone, to progesterone to DHEA to Andrew Christine Dion. But LH also takes the precursors over into from progesterone to the DHEA. An interesting day on so the loss of LH is really big. And stressors include the lack of sleep. Some of my patients, like I'm crazy if I think they should get more than five and a half or six hours of sleep,
Dr. Andrew Wong
even sleep apnea. Yes. Oh, abs that's on my list. Yeah,
Dr. Alan McDaniel
absolutely. Sleep apnea is a horrible band it of of our quality of life, because we don't even know what's happening. We wake up feeling like crap, and have no idea that we've been awakened. Every time we get into Stage Three sleep. It's like going into a restaurant sleep apnea, you know, you should have five stages to sleep 1234 And then REM sleep, and you have four cycles of that a night and you're good to go. Maybe five, and sleep apnea. As soon as they get into stage three. It will wake us up. So we go ch 123123123123 all night we never get into REM sleep. And it's like going into a restaurant and ordering a meal. And they bring you water and maybe some rolls and then you get up and leave and you go to another restaurant and you order a meal and bringing maybe water and you get up in here leave and you've you've been in a restaurant all night. You've never gotten a meal. And let's say
Dr. Andrew Wong
you're saying you're going to Olive Garden all the time. Sorry for the garden out there.
Dr. Alan McDaniel
Their service is bad Other than that, yes,
Dr. Andrew Wong
but absolutely great service there. So
Dr. Alan McDaniel
and then you know, the adrenal glands. Also, when we're stressed, the adrenal glands need the same precursors that we use to make this not Asteron sex hormones, they need the same raw materials to make cortisol and aldosterone to keep us alive. So the body the stressed body, like any sensible householder, when money is short, you put it into the things you absolutely need to stay alive, food on the table, heat, the, you know, the electric bill, the water bill. And so to start sironen estrogens forget about it. Our bodies just programmed not to do that. And then of course, we also mentioned the standard American diet, with our fast carbs, and all of the huge amount of insulin that we produce. Because of that causes us to be obese, and people who are obese have a 10 times higher risk of low testosterone than people who are not obese, that goes from 0.4% to 5%. With obesity, and 50% of diabetics have low D 40%. of people with metabolic syndrome, you're mentioning it Lotte. Genetics make a big difference. About 40% of us, as we mentioned, are insulin resistance which exaggerates the problem caused by our crappy diet. And then aging. You know, aging doesn't inevitably cause problems. But it is strongly linked to low tea for a variety of reasons, most commonly, is because our hypothalamus change this, you know, women have menopause because of hypothalamic changes, and then we all act surprised that men have women applause for the same reason. Now it's not right, how about late onset hypogonadism. Because the the, the rate of oscillations, the vibrations, they call it pulse, the tau function changes, it becomes more sensitive to inhibition by even a small amount of testosterone. And so, hypothalamic hypogonadism is, is the main cause of men with late onset hypogonadism. Second cause is that the testicles are changing, we are losing Leydig cells, 70 year old men have a testicles that are accidentally 70% The size of 18 year old men just from the loss of some of the leading cells that are the key players. And then with age, our liver makes more sex hormone binding globulin, which takes the amount of testosterone that we can make, and Hoover's it up, which is great, because the liver doesn't break it down and the kidneys don't pee it out. But less of it is available. So 99% of that testosterone is found as hBg it's out of the picture, your body can't use it.
Dr. Andrew Wong
And Alan why why? Excuse me? Why does? Why does the liver as we age make more shpt sexual? I don't know. I was hoping you would know that no one knows the answer to that. But someone someone does, but maybe not human. So
Dr. Alan McDaniel
how cool. All causes you to make more sh speech.
Dr. Andrew Wong
Okay. Okay. So bourbon would not be a good idea here. Yeah,
Dr. Alan McDaniel
maybe that's why I don't like it. No, it's not a great idea. But as the SH VG goes up, it makes your total testosterone look just fine. Thank you very much. But it actually reduces the free testosterone. So now you if your doc is not paying attention, if he's only measuring a total, not a total free, he's gonna miss the fact that you are missing the active form of testosterone, which is the free form that goes into cells that goes into the nucleus that connects with the androgen receptor and drives DNA and just say, Oh, your total testosterone is fine, and it's not okay. And so, there are opiates. You know, we have an opiate problem in this country, and opiates. How many people have chronic pain in this country, prodigious numbers, opiates disrupt the receptor factors that drive the production of sex hormones. So something like 30 to 40% of men taking methadone have low testosterone. And there are other endocrine disrupting chemicals we talked about. I mean, there's a reason the alligators in the Everglades have been having decreasing penis size for decades. It's pretty bizarre. I was a zoology major in college. And then there are a few causes that we need to think about and look for our patients shouldn't worry about but prostate cancer will make fragments of testosterone that will go to the brain and block the production of the gonadotropin releasing hormone. And the fragments are too small for us to detect On a blood test for testosterone, so it's, it's an invisible problem that keeps you from making testosterone caused by a prostate cancer that may not be detected with a PSA. So, and also pituitary tumors can squish the gonadotropic cells and so you just make two little LH and FSH because you got to put two Attari tumor in there so Okay, those are unusual but I think that we Doc's should keep it in mind when we're working up a guy.
Dr. Andrew Wong
Yeah, yeah. So so check prolactin level two.
Dr. Alan McDaniel
Yeah, that's that's the most common Well, you know, ask them if they've had any headaches or vision changes and honest to god, what new patient hasn't had headache, you know, two thirds of them do, but it's it is something to consider and I will definitely look at LH and FSH, right. Definitely, I think so if you've got a pituitary tumor squishing them, you're gonna your LH and FSH are gonna be inappropriately low for a guy with low T.
Dr. Andrew Wong
So because otherwise if someone had low T and it was coming from say that the testicles the LH should be high
Dr. Alan McDaniel
right. Now the pituitary in the brain should be flogged are going to go down there. Come on, come on. But but the problem is, of course, the hypothalamic had gone and you'll see a total testosterone 280 and LH and FSH of 2.02 point. Yeah. inappropriate. inappropriately low. Right. So yeah, that's, that's why Yeah, that's why we get the big bucks, you know, because we have to think about these things.
Dr. Andrew Wong
Yeah. Yeah. Well, at least until AI comes out, right? And then bourbon at that point,
Dr. Alan McDaniel
you know, garbage in garbage out, look who programs AI, it's all going to be the American thyroid Association, the society. Now they're coming around. Okay. I mean, finally, in 2020, they published a paper saying, hey, you know, you guys, maybe you should think about using some T three. I've been using it since 1991. Right. So they come around, but it takes a generation? Well, that
Dr. Andrew Wong
kind of goes along with the clinical research that shows that What's it 17 18.5 years between the time of scientific discovery and clinical bedside treatment? You know,
Dr. Alan McDaniel
that's more optimistic than either I read through 30 years, you know, Jeffrey bland paraphrases Max Planck, when they asked him, How is scientific progress made her professor and he said, One funeral at a time. So as the old guys die out, we get progress. And I'm an old guy now. So I'm hoping you guys pick up the torch, and you can get going to show Mr. stuff.
Dr. Andrew Wong
Well, we'll, we'll follow your lead for sure. Thanks, Alan. Well, I guess I wanted to ask you also about the relationship between toxins, Alan and hormones. What is the relationship there? Especially, I was wondering, are there certain toxins, the plastics retaliates, or things like that, that or, or root causes of low tea, you know, men, and maybe even a women, if we could get to that, I guess, I wanted to also ask you, if you don't mind, or some of these causes that you are mentioning as low, low T causes in men also low T causes and women as well.
Dr. Alan McDaniel
It's, that's, let me see if I can keep those questions in order. The first thing I'll say is, is endocrine disrupting chemicals are abundant. And I don't know as much about them as you might think I would, because I'm the past president of the American Academy of environmental medicine. So I shouldn't be just all over that. But it happens, that that's not my bailiwick. And I have found that I treat the problem as I see it. And that particular source is so hard to test and found so hard to get rid of. I don't spend my patients money doing that. And unfortunately, my heredity is Scots in German. And you know, except for maybe the Chinese we are the cheapest people on the earth. Funny, funny, it's so you know, we know the estrogen receptor is it's been called promiscuous it'll hook up with them or anything, as long as you have two Oh H groups about that far apart. The estrogen receptor loves it. And it can you get it into a problem. It's very much like that we see in giving women phyto estrogens, or in giving women synthetic patented versions of progesterone called progestins, like Provera. You know, the stuff attaches to the receptor, but it does so in an unpredictable way, sometimes loosely and it gives you just a little stimulation, so that they'll call a phyto, estrogen and adaptogen that opposite person who doesn't have any, but it will compete with proper estrogen. And so it's actually an anti estrogen in that response and the progestins will just glue themselves like Provera, methyl methyl progestin, will glue itself to the progesterone receptor, and strongly stimulate it and can't get it off. And so that I know that must be happening with androgens. And with androgens, there is we mentioned the yin and yang balance between androgen Yang and estrogen minion, you know, pretty clear from reading the the Chinese traditional medicine descriptions. And it's, what it is, is we're going to dam soup, we're in a mess, our society is saturated with chemicals. And the best that I know how to do it, is to measure it and then do what we're talking about, or what we will talk about to try to restore a proper balance. And I would love you know, I do try to get my people to have a decent diet and lifestyle and take the proper supplements. And if someone has the ministry to get onto an organic diet, that's fantastic. But don't breathe when the bus drives by. It's, you know, we have a real problem in this country, we have gazillions of chemicals, and none of them had really been safety tested, except by giving you know, a shovel full to a mouse and mouse peed on it. So it must be safe.
Dr. Andrew Wong
Yeah. It's sad, you know, there's so many unregulated chemicals and a lot of them are ubiquitous in the environment now. So I think when they do those, you know, fat tissue biopsies or something that basically everyone is
Dr. Alan McDaniel
toxic 100% It was hit Styrofoam in the fat 110 SERESE.
Dr. Andrew Wong
So crazy. So how can men Alan, we can talk about now restoration
Dr. Alan McDaniel
of we were we were talking about women's? You asked you mentioned Yes,
Dr. Andrew Wong
yes, yes. Let me just say that make sure we do that,
Dr. Alan McDaniel
too. It's faster, and it's made from DHEA. And for a healthy young woman, half of the DHEA comes from her adrenal gland. Thank you adrenals and half from the ovaries. And a lot of women have their ovaries removed still. And so those women in menopause now in menopause, woman's testosterone level doesn't change much. It drops a little bit, you know, 5% and 10%. And their estrogen drops down way low. In fact, a menopausal woman has less testosterone has less estrogen, less estrogen than a man in her same age.
Dr. Andrew Wong
What Why does the testosterone stay the same or about the same because it mostly
Dr. Alan McDaniel
comes from? Well, it stays the same because a healthy young woman makes her Astro dial from testosterone. And a menopause. The ovaries run out of eggs. So they stopped making inhibin D and they become resistant to FSH and the brain is resistant, actually, the brain is so sensitive to estrogen and now that even a little bit of estrogen will inhibit. That's a very interesting theory that I think is totally true on menopause. And so a woman basically is set up to make the same amount of testosterone she always made, but she now can no longer converted to estrogen dial, the aromatase has gone away. Okay. And so women, if, however they've had, and that's why you can find pictures of menopausal women on the internet with a with a nice moustache, I've got one in my slide set, because the testosterone stays the same, the estrogen goes away and their ratio starts to look like a man now. And so you give them a little estrogen. Everything is back in balance. Now some of my women do need more testosterone, usually because they've had their ovaries removed, so they've lost half of their supply. So you can make it up with about five milligrams a day of DHEA or maybe 10. I don't have any women taking testosterone. I've never given one of my women testosterone because I haven't needed to just a little bit of the right precursor at the right time today. Didn't go they should be fine.
Dr. Andrew Wong
Perfect. Thank you so much. And now switching back to the men, men with low T how do we improve men's testosterone levels naturally?
Dr. Alan McDaniel
Well, the best best way I've got is actually pretty simple. Diet and lifestyle. And then nutrition. Okay, and if that fails, you throw into Some prescriptions, but that's not naturally. Exactly. So naturally, I want my man to get eight hours of sleep a night. And if they snore in they stop breathing, gonna get treated for sleep apnea because sleep apnea is incredibly stressful. And I want my man to exercise for 30 minutes daily. And if they just don't have time, oh my God, that's too difficult. Do burst exercise three minutes a week. There's a brilliant BBC film last 51 minutes. And it's done by a doctor Mosley, who was interested in his cardiovascular health. And so he made a little journey around Britain talking to experts. It's a free video a free view on Vimeo, just Google BBC, first exercise, mostly Vimeo, and you don't even need to consider the video pops up. And it's a little bit of exercise vastly improves insulin sensitivity, which really reduces belly fat body fat, and improves testosterone levels. Also, let's face it personal work. I mean, I think everybody, my, my therapist says that everyone who incarnates in this world is a hero. And you know, some heroes get PTSD and they're not treated. So I think all of us need to do some personal work and develop a spiritual walk. I mean, church is awesome, helps me meditation is awesome. I don't do it as much as I should get the meditation timer I have, you know, but chilling down. The stress response in your brain is huge. Get the GABA levels down up, get get the glutamate levels down, just be thou chilled. And then a diet of course. You know, we a good diet is described in three scientific ways. One is low glycemic index, eat food that doesn't push up your blood sugar very fast or very far. Number two is eat slowly accessible glucose. So when we eat a carbohydrate, which we should I think everybody needs some carbohydrates but it should be a carbohydrate that is something other than pure glucose. There are about 24 different sugars. Glucose is just the one that tastes the sweetest practically, you know, oh, and so eat instead of white, golden brown flaky stuff like grits and white potatoes and popovers we should eat broccoli, and carrots, and red peppers, you know, eat red, green, purple, yellow, orange vegetables, squashes. Those have complex carbohydrates that are digested slowly that are not pure glucose, and they enter into our bloodstream slowly. And last thing is related to this, which is the diet should be low insulin EMIC index. So the the Aussies came up with this concept in 1994. And we want to eat food that doesn't require our body to make a whole bunch of insulin to deal with the sugar load that we got. So the low glycemic index implies it slowly accessible glucose implies it, but to really do it, you have to lay off the non nutritive sweeteners like Splenda, NutraSweet, stevia, stevia, all of these things provoke the release of insulin by a reflex and it makes us fat so anyway, but good diets for us our shorts, beans and ravens insulin resistance diet, the Mediterranean diet, the Japanese traditional diet, Mediterranean, Paleo ketogenic and the Canada which is how I got into it. The Candida diet is a great diet for people with insulin resistance and it leads people well but I had no explanation for in 1988 So all of those things are useful and then I throw some supplements. for what that's worth.
Dr. Andrew Wong
Thank you. I just wanted to just re emphasize to our listeners that the glucose or the glycemic index versus the insulin anemic index, that they are different you know, sometimes people can have a low GI food but it might it might actually a low glycemic index food but it might actually raise the insulin it sounds like
Dr. Alan McDaniel
absolutely I mean, Splenda is zero. Yeah, glycemic index food, but it's got a massive insulin macindex I have a patient who explained on her 30 minute insulin was 147
Dr. Andrew Wong
and stevia to sorry for all you stevia lovers out there you know, that's that's another one that tastes good and has 00 carbs zero sugar but but sounds like it's going to raise that insulin portal.
Dr. Alan McDaniel
It's because of a reflex our bodies beautifully made when we put something sweet earth and we start to eat it you Our paleo body anticipates reading sugar. So it would like to have a little insulin ready when the sugar arrives in the bloodstream. It's like the French, a French author said it's like riding a bicycle. When you come to a turn, you start leaning before you get into the turn, so you don't fall off the bike. Yeah, the turn and the body does the same thing by producing insulin. As soon as your tongue tastes something sweet. It goes from the Gustafson receptor through the quarter through the the lingual nerve to the quarter timpani down to the vagus nerve, and it pops out glucose. It's the same way the Lipton stimulators work for diabetics. It's the same receptor
Dr. Andrew Wong
a C or E and T background coming out there with the anatomy there. Well, I've
Dr. Alan McDaniel
yet operated on quarter temp and he's a lot when you're in the ear. So you try not flip back and
Dr. Andrew Wong
it's good, good, good. That's a good thing. That's a good thing. Let's get into supplements a bit. What supplements do you recommend once people are doing the nutrition stress management lifestyle? What supplements are you thinking there for low tea?
Dr. Alan McDaniel
Well, I mean, there's a just a few general supplements, I think, in Louisville, Kentucky, all my patients probably need a multivitamin twice a day, once a day twice a day. Because you pee it out. Okay, so quickly. So you take it twice a day, your body gets two shots at the brass ring of vitamin C 500 milligrams of each meal, vitamin d3 of anywhere from 6000 to 10,000 a day depending on your body size. And I like a little calcium, magnesium zinc mixture from solar array. It's just a good natural thing. And they'll do other tests to see what they might need. But those are kind of my basic right after the handshake. Also, right after the handshake I give all of my patients and this was set out on my desk when I still had new patients coming in
Dr. Andrew Wong
side as well. Yes. Nice,
Dr. Alan McDaniel
desiccated adrenal bovine cortex. And the key is neonatal because the babies are born with all the nutrition in the adrenal cortex that their mother can give them. If you take an old bull like me, my my adrenals bagged out, no. And you take the adrenal from cows that have lived out their useful time and had been put on a railroad car and take into a feedlot and turned into leather and send you there's no nutrition left in it. So that gives our body the nutritional cofactors that our enzymes need to convert cholesterol to the sex hormones. And that happens in the adrenal gland, which is why the adrenal cortex but it happens in the gonads, big time that happens in the brain or brain makes neurosteroids That melawan our mood neurosteroid stimulate the same receptor that a valium does, and Prozac and also our mitochondria. Our mitochondria make their own steroids. They have their own sidechain cleavage enzyme. So if you provide those nutrients to our mitochondria, then they can give us better energy, if they've been lacking in the American diet that is sadly lacking in nutrients. You know, we eat the muscle. If we were intelligent, we'd eat the whole animal.
Dr. Andrew Wong
Yeah. No, no, no, that's really great. And I've definitely tried. Definitely some of our people here. I've tried that that per your recommendation. So I want to thank you for that the site design seems like a game changer for people.
Dr. Alan McDaniel
I asked my patients, what's the best thing you're doing? And a lot of them say this site is design at
Dr. Andrew Wong
design. I want to ask you about integrative modalities. So acupuncture bodywork, would that be helpful for low tea,
Dr. Alan McDaniel
I would put that under here. It couldn't hurt if the patient can afford it. Yeah, you know, if there's a I got my people around here are not rich. I'm a middle class guy. And I see middle class patients who don't have a huge budget. You're in Kentucky. Yeah. Yeah. Yeah. And so, but I grew up in DC, you know, middle class neighborhoods. So I try to gauge what I asked people to do based on what they can do and prioritize. DHEA is my next supplement. That's a partly made precursor. And the beautiful thing about it is, is you drop it in behind the roadblocks that are erected by stress, stress blocks of production of LH, and LH converts 17 hydroxy pregnenolone to DHEA. And so you give DHEA you just bypassed that person's stress response, and now you can fill their testosterone pathways distal to the obstruction of stress. So DHEA has been really good to me. I'll give I'll use Berberine over the calendar to improve insulin sensitivity, reduce obesity, we produce insulin levels. Kreisman blue passionflower 709 100 milligrams today is too great aromatase inhibitor and Natural aromatase inhibitor, there are other ones out. I've got a friend who's a naturopath and he always tells me something that I can never remember. And it will keep you from losing your testosterone to estrogen. Okay, and one of my patients absolutely loves it and refuses to use anything else, even though it's a fraction of the cost, okay? I received indole three carbinol is a product in the cruciferous vegetables, broccoli cauliflower that all the kids ate. And what it does is it directs it, it puts toxic waste into environmentally friendly containers, testosterone is converted to estradiol is converted to estrogen is converted to either two hydroxy estrogen or 60 in alpha hydroxy. Estrogen which is a bad actor, and has a lot of strong estrogen stimulating effects. And so the i three C keeps you from making the 16 Alpha Hydroxy is from and so it neutralizes the effects of the waste estrogen that comes from the testosterone you're giving your fellas and I think personally, I believe it's going to protect your prostate from enlargement on it. I saw palmetto I'm sorry. Go ahead.
Dr. Andrew Wong
Sorry. Yeah. Back to the DHA for men. What is your dosing there?
Dr. Alan McDaniel
Normally 25 milligrams at bedtime. If you have a guy in his 70s and 80s, I've had to drop it down to five. Because what happens is they start making so much testosterone and get crunchy. Oh my god, they get so irritable. And you know, their wife will bring him in by that you're thinking something with him. And so you nificant just a little bit. Okay. There's a few studies that show 50 milligrams of DHEA can give some guys an edge. Don't honestly really don't give guys more than that I've tried and tried and try and all you get is problems too much. DHEA goes to the androgen receptor, and it is a weak agonist that blocks the androgen receptor so that your testosterone and Dihydrotestosterone can't get to it. So it works against you. And then the and the DHEA also goes to your skin. And remember that local conversion of testosterone to other stuff well in your skin, the hair glands, the sweat glands, the skin is very active and making steroids. Oddly enough, I guess it's because we make vitamin D at a cholesterol, but the DHEA is turned into DHT in the skin. And so you get, you know, outlaw hair growth and a lot of acne, especially all over the back. And it's damned unconfortable. So, you know, hold the DHEA to 50. And I think, really, very few of my guys take any more than 25 at bedtime. I like it a bedtime because overnight while you're sleeping is when you're making all your steroids. When you go to bed. testosterone levels are the lowest they get all day. When you wake up in the morning, they're the highest they get all day. And so of course, we're expected to perform our husbandly duties at bedtime when our testosterone is low. But you know, life's unfair, it's
Dr. Andrew Wong
easy to switch it around into the morning. It sounds like it's a good idea. Yeah, that's great. And if
Dr. Alan McDaniel
you get enough sleep, you'll be working in the morning when you wake up before your alarm and have some energy to do that.
Dr. Andrew Wong
There you go. Okay, yes. Great advice here, all the men out there, just back to the labs for a second. So if the testosterone is lowest at night, and highest in the morning, do we want to check the testosterone for lab work in the morning? Is that great question.
Dr. Alan McDaniel
No, I don't think so. Well, yeah. I mean, look, if you ask the experts to The Endocrine Society, they say, oh, and the neurologists, they all say, testosterone should be checked at nine o'clock in the morning. And I've I've had a lot of kids, and I know you don't check the kids when they're making happy noises and everybody's getting along well, you check the little beggars when they're quiet. That's when you need to check the kids because they're up to something. So I checked my testosterone levels in the early afternoon. I don't check it, you know, four o'clock before the lab closes. I'm a big believer in mid dose, you know, if you have a peak and a trough, I don't test it at peak. I don't test it at trough I tested about it in the middle because that's about the average a person is going to have that day. So it when I test thyroid treatment levels, I will often test the sex hormones at the same time and I test my thyroid the same way between doses so it's usually around noon so that's when I tested
Dr. Andrew Wong
Okay, around noon or one or something. Okay, got it. You were talking about salt Palmetto before let's
Dr. Alan McDaniel
just mentioned supplemental really is an herb that I give to women instead of men. It's but for men it's, it's good for symptoms of proselytism lower urinary tract infections but not for the reason most people think something better was a five alpha reductase inhibitor. So it blocks the conversion of testosterone to dihydrotestosterone. But that's not really why it works in the prostate. It also contains chemicals that relax smooth muscle. And the prostate symptoms are usually caused by lack of nitric oxide stimulation and problems relaxing your smooth muscle. So, you know, the best treatments for prostate isn't is not dutasteride. Really, it's Cialis, and so on.
Dr. Andrew Wong
Or maybe nitric oxide supplements then would be Yeah, and that's on my list
Dr. Alan McDaniel
of things that I use is L arginine, l citrulline. And B, those three guys really restored nitric oxide synthesis. You can get a product called Neo 40. Or you can just go to Vitamin Shoppe they carry l citrulline. And,
Dr. Andrew Wong
yeah, are you into the salary nitric oxide test strips what we see
Dr. Alan McDaniel
now, they A guy came in lecture today I am and handed it out and 95% of the people in the audience had a bad nitric oxide test. And this is a big group of integrative practitioners who were doing all the stuff. So I had a hard time thinking that the test was as accurate as the speaker claimed. Personally. Maybe he's right. I mean, maybe
Dr. Andrew Wong
it's either either either it's kind of Yeah, everyone is low, or, you know, it's showing that it's low anyway, but it's yeah, it's an interesting issue.
Dr. Alan McDaniel
It is interesting. And so that's it for the over the counters that I use, and then medications, if, if we're getting no joy, you know, and medications, we need
Dr. Andrew Wong
joy. Yeah, we need joy and enjoy. So
Dr. Alan McDaniel
Metformin is a lot less expensive than Berberine. And it works as well or better. You know, an Astra result, one quarter tablet every other day or every third day, it's like $10 a month, even if you don't put it on your insurance, it's a lot cheaper than crisis. And then Clomiphene is fan tastic to restore the normal hypothalamic pituitary ganando stimulation, bring the LH FSH back up to normal or slightly high, and bring the testosterone to a really good range. I'm stalking
Dr. Andrew Wong
these medicines, Alan with your patients, or they'd like one at a time and see how they do clomifene and
Dr. Alan McDaniel
define what you mean by stacking, you can give them all at the same time.
Dr. Andrew Wong
Well, I don't mean playing Jenga, that's another thing. But yeah, either either you can give them all at the same time all at one time, or do you stack them in a way where you're slowly adding them if they're not getting rich?
Dr. Alan McDaniel
I, I'd say sequentially isn't a better word than stack. But, you know, the, one of the basic rules and therapeutics I think, is try not to do two things at one time, because it's something blows up in your face. You'd like to know which one it is correct. And my patients tend to be fairly sensitive. You know, they've been sick a long time, and they're kind of puny. So I look at the lab in the indications now. In the December 2022. This is the most recent December issue of Townson, I put in an article on restoring testosterone secretion in patients with late onset hypogonadism. And so it talks about all the other stuff besides giving testosterone and it will give the details and how I treat it and why I treat it and how much I use. What so it's I think it's a really good article. I think you'll like it. If you haven't
Dr. Andrew Wong
picked that up. It's a free download online. Is that when they started converting to from paper to online, or is it still is it still a paper?
Dr. Alan McDaniel
It's the one that was the next to last issued in January.
Dr. Andrew Wong
My email and shout out to Jonathan Cullen and all the work that he's done and the whole editorial staff and I know you're big on that too.
Dr. Alan McDaniel
I'm a big fan of theirs. I'm not a big part of it, but I'm just really lucky that you read a
Dr. Andrew Wong
lot of articles for them for sure. Yeah, yeah.
Dr. Alan McDaniel
I said my old chairman sent an article into the journal urology was
Dr. Andrew Wong
nice how they weren't.
Dr. Alan McDaniel
I just wrote it for the boss, you know, the show what I was thinking and so he thought, Well, this looks like it could be published and it was dumped on should I say
Dr. Andrew Wong
didn't didn't fit inside the box didn't fit in
Dr. Alan McDaniel
the needs of the journal. Okay. Okay. Okay. So I'm really lucky that Townsend is publishing but the the the other book Clomiphene is a SERM. It's an estrogen receptor blocker, and what it does, it acts in the brain for a sec. hormones the same way, low dose Naltrexone acts in the brain. For cortisol, it blocks the receptor for a little while. And the brain says, Oh, I have to push harder. And then it pushes up more LH and FSH. And when you've got the situs, I might need to provide all the nutritional cofactors. And you got the DHEA to provide the precursor or even if not, then oftentimes, the body will just crank it right up. This dosterone is my I've got a slide I could show you. It's getting late. But testosterone is my last resort. And true to say right now in my practice, which is striking is I've gotten old, I'm trying not to see new patients I don't and so, but I don't have anybody taking testosterone, either topical injection, sublingual, anything in my practice, there's one guy who's gone out to get pellet implants from a doc because he wanted to have Supra physiological bonuses, which I have found in the literature is dangerous. So that's that's a final comment that maybe we can say before we close is that you know, too much is too much. And it shortens your lifespan too little shortens your lifespan, too much shortens your lifespan, there's a reason the average is average. And the reason is that gives our ancestors the best survival
Dr. Andrew Wong
chances. So that's a great closing point now and it sounds like you've been able to really help your patients and get that testosterone up to, you know, optimal without going overboard even without giving them you know, quote unquote, hormone replacement and medication testosterone,
Dr. Alan McDaniel
guys with total testosterone in the six hundreds and free testosterone well up into the 20s with an immuno assay, doing nothing but Clomiphene. And nutrition, guys.
Dr. Andrew Wong
Oh, that's great. That's so great. Thank you so much. Well, and I, we should say one more thing about that, because if someone is, say, 20 or 30 years old, and they're trying to have kids. You know, I know, there's a question about if someone has testosterone, exogenous ly that would suppress their pituitary hormones. And then that would lead to functionally them not being fertile, potentially.
Dr. Alan McDaniel
Yeah, that's right. Yeah, I mean, yeah, I always think as Sean Connery will shrivel your balls to the size of raisins. You know,
Dr. Andrew Wong
it was at one of his movies are just just the Great, good accent and you should go to Hollywood. And
Dr. Alan McDaniel
thirdly, but it's there are a lot of articles on young men with primary hypogonadism and treating them with LH and FSH. And if you have an older guy, you can restore his fertility with Clomiphene. Right, easy, breezy. And then you know like that. Yeah. So you're saying fun stories, kind of
Dr. Andrew Wong
skip them all. So we don't want to shrink our balls like raisins. And in terms of going to that breakfast analogy, we want to have a good amount of testosterone, but kind of like the bowls of oatmeal. Three little beers in the oatmeal. We don't want to have a cold oatmeal or hot. Oh, we want to have a just right,
Dr. Alan McDaniel
right? It's in my women's hormone replacement lecture, I have a slide that talks about the people who argue that women should have hormone replacement or wreck because the risk of complications, the lower your estrogen level, the higher your risk of complications. But the people who say that estrogen replacement is a bad idea are also correct, because the higher your level of estrogen, the higher your rate of risk of complications. So what I like to do is find the valley, where's the lowest part where you have the least risk of any complication? And bear in mind that this is off the baseline just a little bit, so there's no place where there's no risk? And we're all going to die? You know?
Dr. Andrew Wong
What is the balance between yin and yang? It sounds like is what we're looking for there. Absolutely. Thank you, Ron. Yes, the Dallas, thank you so much for coming on today. Alan, this has been a really enlightening conversation about low tea. And thank you so much for offering your wisdom to you know, all of us here in our community, we really appreciate you.
Dr. Alan McDaniel
Well, Andy, I think you're really an awesome physician. And you've made a really good practice with smart people giving great medical care in my hometown, which I really appreciate.
Dr. Andrew Wong
Thank you. Thank you. So we have one more question for you, which we kind of do as a bonus, if you don't mind. So we have a question on basically, we talked about cheap Scots and Chinese a little earlier. So we're gonna talk about how to make integrative health care more accessible, what can we do to focus on the small steps that we can improve our health so we kind of love to hear from you. You know, we're, we're in an inflationary period right now. You know, or, or money probably can't even buy like a cheap plastic toy now but things like that. But what is one thing under $20 That you feel has personally transform your health that you know maybe listeners can can take practically and it doesn't have to be about low tea. It can just be about any really anything. Well
Dr. Alan McDaniel
don't want to dissemble I've had some photos disease and low thyroid and when I first started taking it, armorer thyroid was less than $20. For 100. That was really good stuff. Yeah, I think the best bargain that we can do right now is a good diet and lifestyle. I mean, absolutely no sugar, no starch, really cool. With the fruit diet. It's, it's more, it's more expensive. Unfortunately, shopping in the periphery of the supermarket is more expensive, you have to buy good vegetables, you have to buy some meat that you don't have to buy a lot of meat, you should buy some buy eggs, you know, but cut, avoid the packaged in the hand and attend and stuff that is in a bag and last for six years on your
Dr. Andrew Wong
butt. But that more expensive and regenerative organic whole foods is really the best return on investment that we could have. So in a way, it would save money over time with people that see their health care bills and stuff like that.
Dr. Alan McDaniel
It really does. I'm I went on to a Canada to type diet in the late 80s. And I'm 70 right now. And don't feel it except when I had to have my hip replaced for where I fell in and during ice skating repeatedly. The second time got me after seven years of degeneration. So seven years and two falls after. But I think I'm in pretty good metabolic shape. And I see patients who are a lot younger than I am who are in tough shape. And that's I think the best bargain you can do is is good night myself. It's hard to walk. The first 10 steps are really hard, but it's cheap to go out and walk around your neighborhood for a mile walk for 30 minutes every day. It's cheap to go to bed on time, turn off the TV, turn off the blue lights, you know, leave a nightlight out. So if you have to get up and go to the bathroom, you don't turn on the light and ruin your melatonin. So diet and lifestyle.
Dr. Andrew Wong
Being aware of that. Thank you so much, Alan, thank you so much again.
Dr. Alan McDaniel
Great to see you. And God bless you, man. Thanks for the good work.
Dr. Andrew Wong
Thank you, too. Thank you. Thank you so much for joining us today for this episode of the capital Integrative Health podcast. A quick reminder that the information we share on this podcast is meant for educational and informational purposes only. It's not a substitute for professional medical advice, diagnosis or treatment. We highly recommend that you speak to a qualified health care provider before making any medical or healthcare decisions. If you enjoy this episode, please take a few moments to subscribe and leave us a review. Your reviews help us reach more people and continue to offer innovative insights and information to better optimize your health and wellness.