3 Steps to Better Men’s Health | Jesse Mills, MD | UCLAMDChat

Good morning, dr. Jesse mills, here director of UCLA’s, mins clinic thanks very much for tuning in. If you’ve, been here before for some of my webinars in men’s, health welcome back! If you’re new to this welcome today, our topic is going to talk about ways to improve your health in a simple fashion.

As a man, you may not know this, but June was men’s health month, but rather than way to hold 12 months for another men’s health month to roll that roll around. Let’s! Let’s. Rewind here pretend, like you,’re, going to learn about men’s health month as it is June, even though we are here in July, and we’re still going to learn some good good topics today.

Ways to make this next year, your healthiest, yet so three steps to better men’s, health and they’re, going to be very easy steps. I think that’s, the most important thing about this. Whatever I teach with whatever I talk with my patients, it’s all about things that you can start doing today, you don’t have to wait necessarily to see your doctor.

We’re, going to help you through this process, but get proactive about your health. Now, as always, we talk about this. It’s very important for you to login to twitter and use the hashtag UCLA md chat.

That will get you to me and i’ll, be able to answer your questions on a live format and hope help lots of people all at the same time with one question. So how do you avoid your neighborhood friendly urologist as nice as we are? Not everybody wants to go see us, so what I want to do is I want to do this entire lecture with the framework of what you can do to stay out of my office, but also remember that we’re only a phone call away.

So if you need extra help, we’re, always here to help you out. So we’re, going to start with a little outline of what we’re going to talk about. We’re, going to build a plan and then we’re going to set that plan into action.

That’s. What the next half hour is going to be all about. So what can go wrong? How do the wheels come off in men’s? Health? Well there for things we’re, going to talk about today and three easy ways to improve all of these low testosterone.

This happens as a guy ages, as you, man hits the age of 40. Roughly forty percent of us will have low testosterone and that number gets higher the older we get so by the time when our 60s and 70s well over half of these men will have low testosterone.

I can affect everything from sex drive to erections, to bone health, to energy, to mood to how quickly you’re thinking and processing. So this is not just a problem that is in the sexual health realm.

This is a men’s, health problem, so we’re, going to learn about low testosterone. We’re, going to learn about how to improve it. Now you can do it without setting foot in my office and then how I can help you.

If you need my help, we’re, going to talk about erectile dysfunction. We talked about this before, but essentially erectile dysfunction. Again is not just the fact that your penis isn’t working properly.

It can often be signs of more serious health issues, more important cardiovascular health. So if we can prove our erection health, we also probably will improve our cardiovascular health. So let’s. Keep that in mind as we go through our three easy steps: prostate enlargement to CP me right, so the older we get the harder it is to urinate.

Sometimes we’re, getting up more often at night, and sometimes we’re, not getting that same force of stream. We used to get when we were younger, and so all of these things we might be able to improve with some lifestyle modification as well as management from your friendly urologist and then.

Lastly, what is the deal with prostate cancer? These days, there’s, a lot of controversy, both in the literature and medical literature on TV and even at your primary care physicians. They may tell you that screening for prostate cancer is passe, that we don’t, do it anymore and that the risks of screening are worse than the benefits from being screened.

So I’m, going to try to bring a little bit of logic to that from a men’s, health perspective and what that really looks like where we’ve been and where we’re. Going in prostate cancer risk assessment and screening, so why do I do this? So men’s? Health is really all about the whole man.

It said by this hard. It’s about his brain and, of course it’s. About the organs that I’m, most responsible for his kidney, his bladder, his penises, testicles, etc. Right, so all of this we can train back to what’s happening in the country as a whole.

What we found is that, as we age and as the country matures, we’re, finding a much higher incidence obesity than we had before this isn’t news to anybody, so I won’t, spend much time on it, But the public health issue here is that obesity is causing more deaths in this country than cigarette smoking.

So part of that, probably, is that cigarette smokers that we’re doing this earlier in their lives, already died off, and so now that they’re gone and smoking is so much lower of an incident. Now we have a lot more people with obesity and they’re, struggling with the same global conditions that affects cigarette smokers.

So what are those conditions? Heart disease, diabetes, small vessel disease, which can lead to anything from kidney damage to, of course, lung disease? To of course, erectile dysfunction, so those are the common consequences of obesity and it gets worse and worse the longer and the the more that we move forward into the future.

It’s, easy to find food. It’s, easy to find high caloric density food and it’s hard from a patient perspective, to know what to do to turn that around and that’s. What I’m, going to try to simplify a little bit for you today, so the health risks of obesity, worse than the health risk, from being below the poverty line below below alcoholism and below smoking.

Obesity is above all of that in terms of overall global hell’s, the risk and shortening your life right life expectancy goes down with with obesity as well, and when you think about it on a population basis, we don’t see A lot of morbidly obese people over the age of 75 80 in this country, so that’s, something to think about the next time that you’re in a public place.

So the three steps to better men’s, health. I want people to learn about eating, moving and sleeping. So those are our three steps: food movement and sleep – that’s. What we’re going to work out today and we’re, going to look at how to break this down into easy ways to change habits that you’re doing today, I guarantee you’ve woken up, So you’ve moved today.

Well, maybe you didn’t, go to sleep last night and you probably already had something to eat. So if we can tailor this conversation into eating, moving and sleeping, we’re, going to be in better shape there’s, our fork and knife, alright, so a call to action.

This is what I want you to do as patients before you even get to my office and then, when you get to my office, will get into the details of how to make this better. So what we know about food is that we eat too much of it.

It’s, pretty much that simple. If you spend time in the minutia in the details of a high-carbohydrate diet and a low-fat diet or a low carbohydrate and a high that diet or too much protein or too little protein or micronutrient, this or micronutrient, that it all boils down to the fact that If you start to eat fewer calories, you’re going to lose weight.

There was a great study that just came out in the Journal of the American Medical Association earlier this spring. That showed something as simple as a twenty-five percent reduction in caloric intake will allow people to reduce their body mass index to reduce their weight by over five percent a year that’s better than any weight loss drug out there.

So, just that simple lifestyle, modification of taking whatever you eat today, whether it’s, high fat, low fat, any of that and just pushing away when you’re. Seventy five percent full that’s, going to result in weight loss right because we’re one big engine or a caloric machine.

We take in calories. And what do we do? We burn calories. So if you take in more than you burn that extra energy gets stored as fat, so if you do simple things by just increasing low density or high density and low calorie foods, so the best example that is vegetables there’s, lots of fire Fiber to bulk you up there’s, also lots of water, especially in fresh vegetables, to bulk you up and they’re very few calories.

So just replacing more of the meat on your plate with vegetables is a simple way. We’ve, been preaching weight loss for decades and it works it. Doesn’t have to be complicated. You don’t have to count every calorie until you get to the point where you ‘

Re really really struggling to lose those extra five to ten pounds. What about sugar? Simple sugar? We’ve known again for years and years is probably one of the most dangerous aspects of the American diet.

It’s, so easy to take in sugar, whether it’s in a potato chip, whether it’s in a soda, whether it’s in anything, even a pasta sauce. So you get out it’s added sugar! It’s, so easy for your body to metabolize that eventually into fat, that that’s.

A great way to reduce calories is just by eliminating any added sugar to whatever you eat. So again, I haven’t even talked about adkins diets. I haven’t talked about paleo diets. I haven ‘ T talked about the Ornish diet, any of that stuff, because if you just take a few of these suggestions, you’re, going to start on that pathway to losing weight.

That’s going to improve all of these things. We’re, going to talk about what about movement, so we all know we should be doing 30 minutes a day of exercise that’s good for our art. If you do real exercise, in other words, you ‘

Ve got to break a sweat in order to say that you’re, getting your heart rate up that’s. The only way you burn calories here’s. The depressing thing about movement, however, what we’ve known also is that it takes a lot of movement to burn a little bit of calories, so your average bagel, not even with cream cheese, but our average bagel has about 200 to 240 calories.

Most people, if you walk a mile that burns about 100 calories 80 to 100 calories, so in other words for every bagel that you eat you’ve got to walk about two and a half miles, so movement alone is not enough.

It circles back to eat you’ve got to eat less. You’ve got to eat more efficiently in order to really lose weight, but movement is good for your heart and therefore it’s, good for your sexual function.

As well and then we’ll, get into a good stuff of movement here in a second and then sleeping is one thing that we don’t do enough of. We are constantly bombarded by data overload and most of us spend time in bed with our TVs or laptops or devices, and the average American sleep day is eroding more and more every every day we move forward.

So what we do know – and the clinical studies prove this – is that we need at least seven hours of sleep and most of us, don’t, get anywhere near that most of us are in the five to six hour range and that’s simply not enough, simply not enough.

Alright, so let’s. Go back to. There are four tenets of what we’re talking about with eat moves sleep today we want to first talk about. Is our testosterone levels? So how do you get your testosterone levels up potentially and not even come into my office, so a few different ways to do it? There’s, the easy way in some ways in terms of the quick and easy, and that’s.

Bariatric surgery, so if you’re morbidly obese and you go through bariatric surgery, either a gastric sleeve or a gastric bypass, you will have testosterone levels go up and it happens for two reasons.

One thing about the more fat cells we have on our body that signals our body to produce more estrogen and the more estrogen a man has the less testosterone he has because the estrogen feeds back into the brain into the pituitary gland to settle down the signal To make more testosterone down into testicle, so what happens? Is you get an inappropriate balance between your testosterone levels and your estrogen levels, and that leads to easier ability to store more fat, because that’s? One of the things estrogen doesn’t us.

Is it’s, a fat storing hormone? So if you lose a lot of weight, either through surgery or through diet, as we’ll talk about here in a second, then your testosterone levels will go up, maybe not naturally, but at least they will go up without medication.

Dietary does the same thing: if you lose three percent of your body weight on an annual basis, then your testosterone levels will also go up and – and there are a lot of good studies to show that so one way or the other either you’Re, reducing your caloric intake through surgery or you’re.

Reducing your cleric intake take through diet. Your testosterone levels can go up with the proper nutrition. What about movement? So we do know that testosterone levels go up with activity. The more exercise we get.

The higher testosterone levels get up it. Doesn’t really matter how you do it, whether it’s, weight lifting, as we talked about in this study here, showing band exercises or even just running bicycling.

Any way that you can get your heart rate up is going to improve your testosterone levels. Now sleep is a big big one for testosterone. We need to be asleep as men in order to recharge your testosterone, and the reason for that is quite simply, our pituitary gland has to go to sleep and for it, when it goes to sleep is when it does its work in the testicle.

In other words, when a man is in really deep REM sleep, his LH, which is the hormone that improves or that signals to the testicle to make testosterone LH levels will surge. So they’ll, send a huge signal down to the testicle to make more testosterone.

So if you never get into that deep REM, sleep, you’re, never going to get your testosterone levels up to normal. We see this in men that work, overnights and shift workers and not getting consistent sleep that their testosterone levels go down and lower your testosterone levels go down often the worse.

Your sleep is so becomes a vicious cycle. If you’re, not sleeping you’re, not making testosterone. If you’re, not making testosterone, you’re, not sleeping as well, either so eat move sleep. Keep those things up, keep your testosterone levels up and let’s, see how you do before you get to my office.

So how do you do that here’s? The practical aspect of how you improve sleep, and – and this is all based on science – called sleep hygiene, which is basically making sure that you keep your sleep patterns vary consistent.

You want to go to bed at the same time roughly and get up. At the same time, every day, whether it’s, the weekend or not, you’ve got to get out of that. Your high school and college mentality of partying all night sleeping until noon the next day and getting up and doing it again it’s, really not good for your pituitary gland.

It’s, not good for your testosterone, so you want to get those seven hours, as we talked about at least eight hours, probably ideal. You want to go to bed when you feel sleepy, even if it’s, not normally within your.

Your normal routine, you may have been more exhausted that day and you may need a little extra sleep if you can’t sleep, and this is one that I’m guilty of. If you can’t sleep after 20 minutes get up, walk around, do something that will stimulate you to the point where you might get a little extra exhaustion to be able to actually fall asleep and get it right.

So I’ll. Let you read the last of these. This is all from the American Academy of Sleep Medicine website as well, but they’re, very simple things that you can do again without ever coming into our office to talk about it and they have critical critical health ramifications for you, both in testosterone And general health all right, so we’ve done the testosterone story.

What about erections? So when a guy comes to my office with all of these men’s, health complaints? The reason he’s in my office as a urologist is because he’s, probably having sexual difficulties. So what can you do before you get there, and what can I do to help you once you get there? Well, weight loss is critical, so the heavier we are, the diff more difficult.

It is for us to get our erections up it’s, because the the fat depositions that can lead to plaques on both our coronary arteries, as well as in our penis, get worse, and we don’t get the blood flow. We need to get a good erection, so weight loss, weight, loss, weight, loss and then what about eating supplements are their supplements that are out there that actually do help with with your erections.

So there are a couple: there are a couple that have actual randomized control trials. You would have to look at the dosing on them, but basically there are these three l-citrulline, which is an amino acid, so it’s a naturally occurring protein precursor that your body will convert to nitric oxide and nitric oxide is the hormone that that Expands blood vessels opens up blood vessels into the penis.

To get you, the blood flow you need to to establish a good erection. Maca is a herb. It’s, a root herb from the hillsides in the mountains of the Andes, so it’s been used in South American medicine for four years and again shows that it has some weak ability to open up those blood vessels and do Essentially, what citrulline does, as well as what some of the pharmaceutical agents that we have been using for almost 20 years in this country and then? Lastly, Korean ginseng has that same property of opening up blood vessels, and these really are have their weak effects.

And you have to take a lot of them to see that, but that’s. The supplement basis for almost any over-the-counter medication that you’re, going to take that says it’s, going to improve your erections. What about the ones that don’t work at all those are listed below yohimbine is something we don’t see very much anymore.

It actually has some cardiotoxic, meaning is not good for your heart effects, not good for your blood pressure. So we really don’t, recommend it at all in urology, but again it’s over the counter. So it’s, something that you may want to be wary of before you purchase any of these supplements and then the thing that has the best title in the world that probably has the least effect is something called horny goat weed it’s actually being studied in mice, and they think that it may have a very, very, very weak signal as what we call a phosphodiesterase inhibitors and again.

The phosphodiesterase inhibitors are what the medications like viagra and cialis and levitra that you are probably very familiar with. But again, at the levels of horny goat weed, you’d, have to take to see the effect of what one of those medications that I can prescribe is massive.

You probably choke on it before you got an actual good dose of it. So great name, not such a great product, but that’s. What you’re, going to do to eat, lose weight, eat properly and then maybe some of those supplements.

What about movement? I love this. This is great so remember. I was saying earlier that movement is probably not going to let you lose a lot of weight unless you’re, really really pounding it on a daily basis and getting miles and miles of exercise on your in your home.

Gym or on the road or on your bike, not a great weight loss, but it improves blood flow movement is key for improving blood flow, including blood flow to the penis. So, just by putting guys on a monitor to extra exercise, program % of men will improve their erections to normal, with purely exercise alone.

That is physician, monitored and here’s. The great thing it’s, never too late. So, even in guys in this study was done in men over the age of 65, but men with ed that were sedentary that started. An exercise program even later in life had a much higher improvement in their ability to achieve normal erections than the guys that continued to sit on the couch, so moving easy to do get more of it.

However, you want to do it. I don’t care, whether it’s, speed walking whether it’s, getting on a bike, whether it’s swimming anything that gets that heart beating faster, is going to make it more efficient and therefore is Going to make your penis work better to stronger erections through movement, what about sleep sleeping your way to better erection sounds easy.

You go to bed you get up in the morning. You have an erection. Well that’s. What we used to do as men and some of us are still lucky enough to do, but not all of us. So when you start seeing it your morning, erections or not as robust as they used to be that’s.

A signal of a couple of things – one is: it goes back to that testosterone story. You’re to have good erections, you need to have high levels of testosterone and that testosterone surge that happens with those seven hours of sleep.

That is a good signal to the penis to release nitric oxide and have a good morning, erection or a nocturnal erection, so that’s. One thing: it’s, the other. The other thing is that again fully chart recharging.

Your brain will allow you to have an increased libido, increased enjoyment of life, an increased ability to get in a spontaneous erection purely by just turning the brain off for a while letting the stress of the world go by and getting that seven to eight hours of Sleep so it’s, pretty easy and again you have to be in that deep sleep to really really get good directions and in good, spontaneous erections as well.

Alright. So what about prostate health? We’ve gone through testosterone. We’ve gone through erectile dysfunction. So now we’re, going to focus the last few minutes on prostate health. So how do you keep it healthy? What do you do to eat? Well, we don’t know a lot about nutrition, specifically in terms of this, for you go on a high vegetable diet or if you go on a high fat or a low fat diet with overall urinary function.

But what we do know is that there is a supplement Chris certain which has been studied over for over 10 ters. That does show that it reduces inflammation in the prostate. If you look at any of the men’s, health formulas that you can get over the counter, most of them will now have Corsair 10 in it and in fact, most of the time they’ll have the letter Q in their Title so something like BP, q, max or q flow, or I’m just making these up.

I don’t even know what’s out there, but I know that so. Therefore, i’m. Not i’m, not sponsoring any one of these, but if you have quesada and it look in the label that actually has some pretty good randomized controlled data.

What about saw palmetto everybody comes into my office. Is I’m on saw palmetto, it works it’s, not quite enough. What else can you do, and I say well, you can continue to take, saw palmetto. The randomized control data show no effect over placebo, no effect over placebo.

What’s? The placebo effect of saw palmetto it’s upwards of forty percent, so in other words, if you think you’re, taking something that’s going to help your urinate, you have a forty percent chance that you’re right, you could be taking a green M & amp M and thinking.

If somebody’s telling you that it’s, going to make you pee better, it probably will so I don’t discount the placebo effect, but if you want to save your money, then spend it on something that score Certain in it, which has good data and not on something that’s up on that on it, but again, probably not going to make it worse.

So if you swear by it, please swear by it and let’s, get on movement and obesity and bph. So we know that a heavier a guy is then the worse as urinary symptoms are. We know this in women as well, but essentially some of this tends to be the amount of weight that you carry around your abdomen, pushes down on that bladder and actually can cause a signal of more frequency.

So if you lose especially this gut weight, which is bad for the heart bad for your gut bad for your erections and bad for your prostate, you’re, probably going to have easier time. Urinating may be able to sleep.

Better may not be able to get up as often to urinate at night either, so so. Weight reduction in general can improve the symptoms of a benign and growth growth of your prostate or bph. What about sleep? This again is a tricky one, because if you’re waking up all the time to go pee, then you’re, not getting the sleep.

I just asked you to get so that’s, something that is a little trickier, that’s, often something that you do need a urologist help with be. We need to figure out whether this is a medical problem or a surgical problem that we can correct and that’s.

The key thing here so this you’re a little bit, not on your own on this one. In terms of making your symptoms better, I do recommend early intervention. If you’re getting up more than a couple times at night to urinate, if you’re noticing that you’re going to the restroom every every hour, every half hour and you don’t, have a Great stream, those are all things that I would check out check in with a urologist and get that evaluated before we just look at only lifestyle modification, but we do know that that the better you sleep, if we can control that urination, then your prostate overall is Going to thank you for it as well.

Okay, so here is the this is one of the trickier things that we’re going to discuss, because this is something that confuses not only patients, but it confuses physicians, especially even urologist. There’s, a lot of controversy about what we’re going to talk about here.

I just want to break it down into some simple things for you to think about, because one of the things that we know in medicine that has really changed over the years, even since I was in medical school almost 20 years ago – is that we really want Patients to share in the decision-making process when we call this a medicine shared decision-making and that’s key because, as a physician, I can tell you my experience.

I can tell you the scientific literature, but I can tell you what you’re thinking and I can’t tell you as a patient. What is the most concerning thing to you? So what you want to do is you want to find an open-minded physician that’s, willing to listen to you about your prostate and whether or not you do get PSA screening, but let’s.

Go into the controversy. Let’s, get into what made this such a hot topic over the last three or four years, and also what is the? What is the fallout of that? What is actually happening to patients in 2016 as a result of some of the changes in recommendations? So there’s a there’s.

A government organization called the United States presented of Preventive Services Task Force and it’s made up of physicians. Interestingly enough, this USPSTF had no urologists or oncologists on it.

In fact, the lead author was a pediatrician, so calls into question a little bit about the findings, because again they were just looking at the literature which is pretty condemning against PSA screening and not having that personal clinical experience with patients that they were seeing actually dying.

In prostate cancer, and for better or worse, that’s, always going to judge you as a physician when you say your patients suffering from a condition. But the bottom line is after looking at all the data, since the early onset of PSA screening and in the late 1980s was that they found that screening for prostate cancer got their lowest possible screening rating at adi, meaning that it should not be done.

It recommends against screening for prostate cancer, in that the harms of screening outweigh the benefits of screening. So that means maybe I shouldn’t even get it screened, that’s, what the literature is showing and that’s.

What actually, what’s really been happening over the last few years, since those recommendations came out a few years ago, so the American, your logics Association or the AUA, my professional organization? What do they say about this? Well, we took this to heart because obviously we looked at the same data and and the conclusions you make from those data can be very misleading, but also do look as if PSA screening across the board may not be the right idea, and what we found is, If you really look at the history of PSA screening, when it first came out in the late 1980s and early 90s, we were, we were screening every man, whether he was 85 or whether he was 50 years old and what we really have to adjust is.

We have to adjust our screening based on a couple of things. We have to adjust it based on how old the patient is. If the patient has a family history of prostate cancer and then what I think is probably the most important thing is: what is that patients overall life expectancy? How long is that guy going to live, because the thing we know about prostate cancer is it is not a disease that will kill you immediately.

It is not an aggressive cancer on a day to day or even week to week, pathway it’s. More like a year-to-year pathway. So if I see a man that’s 55 years old – and he is not the poster child for men’s – health – he is obese, he’s, smoking.

He may be on oxygen. He may have some some life-threatening illnesses, maybe already has another cancer say: lung cancer or colon cancer. That is a guy that’s, not going to benefit from prostate cancer screening.

And yet, if you look at the original data that were put in to that prevented task force recommendations, even those guys were being screened, so it’s really hard to see that we’re, making a benefit. If we open up that fishing net to get all of those men so because of that, what we know is that we can probably safely stop screening men once they hit about age 75, because that 10 year life expectancy goes down dramatically.

The closer we get to our 80s, so if a guy is under 55, which is kind of our new cut off, it should be individualized, meaning that you do not not offer therapy or I’m sorry screening to those men if a guy is A very strong family history of prostate cancer that can be a predictor that he not only will get prostate cancer, potentially a more aggressive form of the disease, so individualized, meaning.

I ask you, you ask me your benefits. We make a shared decision about whether to go through screening, so what’s actually been happening outside of my office and outside of urologists office everywhere we’ve noticed about a thirty percent decrease in prostate biopsies.

Well, that couldn’t be a good thing right I mean. Maybe we did too many biopsies before and now we’re being smarter about the biopsies that were performing. That also could be a bad thing, though, because when we are by op singh men, we’re finding they have higher volume, meaning there’s more disease within their prostate, and it has a higher aggressive score.

So that means that those guys probably had prostate cancer a few years back, we’re, not getting screened until they came to our offices and we perform screening. So we’ve had what we call a stage migration of this cancer based on the fact that we’re not doing as many biopsies and at the level of the primary care and those are primary care.

Colleagues are the ones that have to process all these data and come up with a recommendation to take care of you the best they know how we’re, saying that the screenings have gone down dramatically. So really only about 8.

2 percent of men are getting screened for prostate cancer as of 2012 so and that that statistic is continuing to stay pretty low. So there may be a lot of men that would benefit from screening based on that individualized approach that are not getting it and those are the men that we’re, seeing in our offices with potentially advanced disease.

So again, I don’t, have a huge recommendation, other than talk with your physician, and what are your own wishes about? Whether or not you want to be screened, because, quite frankly, some men don’t want to know, or some men don’t care and they just want to live their lives and that’s.

A completely valid assessment and one that I certainly wouldn’t stop on as a physician guiding you through that treatment pathway all right. So let’s. Put this all together, let’s, think about what we’ve talked about, so knowing who you are is probably the most important way to figure out how you want to eat.

So if you’re, a guy that needs to eat a lot of meat or a high-fat diet, then you’re, probably not going to do well with a cardiac diet, focused on extremely high carbohydrate, extremely low fat. You’re, not going to stick to it and and again the guy that I want to reach out to right.

Now is the guy that’s. 25 30. 50. 100. Pounds overweight. If you’re five to ten pounds, overweight, you really don’t have a lot of risk factors and the diets that I’m, going to really recommend. There may be some data that you’re, going to get a better push when you get down to that level.

But if you look at the United States and as a whole, we all could stand to lose some weight. It may be upwards of 30 pounds plus so for that, for your first 30 pounds figure out a diet that you know that you can stick to and comply with, because that’s, the one that’s going to be the most Successful for you and before you buy a book and before you look at a nap or anything else, figure out who you are and that’s, going to be the right thing for you and remember that if you just reduce your caloric intake by Twenty-Five percent a day you’re, going to lose weight and eventually it’ll come off.

This is not a quick fix. It took you years and years to put on that weight and acquire all of these health factors and health risks associated with obesity. So give yourself a break, give yourself a good few years to get down and sustain it, because that’s going to be.

The key is sustaining that weight loss over long period of time move. So what if you don’t have time what, if you cannot possibly get 30 minutes into your day? I love this new idea. This is something called high interval or high intensity interval.

Training. Dr. zooming Tabata, is the other name. You’ll, come across to bought the training it’s great for the person that travels a lot. It’s great for the guy that doesn’t have an hour to give to the gym, and essentially what we know is that if you are pushing yourself to the point where you’re short breath and your hearts Beating out of your chest for just a few minutes a day for 26 minutes, you actually burn a higher level of fat than you will.

If you do a sustained 30 or or an hour of moderate exercise a day when I go to the gym, I always look at the guys around me and look at the guys that are very kind of lackadaisically doing the bench press or they’Re on the elliptical doing this and barely moving and not breaking a sweat, and I feel bad for those guys because they’re.

They’re thinking. They’re doing with their doctor, told them to do. But you really, if you’re, not getting some intensity in your workout, you’re, not doing anything other than sitting around in your chair with your basal metabolic rate.

You don’t, lift that up until you really start hitting it hard, and these are all calisthenics, so the Tabata program or any one of these high interval intensity training is, is very much something that is portable, push-ups and sit-ups and calisthenics things that You learned when you’re in junior high school.

If you do them with enough intensity is going to help. You drop that weight once you’re able to tolerate that. So again that’s. The caveat here is that you do want to certainly make sure that you don’t have any impending health risks that could make high intensity training, not right for you, but it you, don’t have to be a triathlete.

You don’t have to be an iron man. To do this, you just have to have the will and a little bit of time in your day and then sleeping. I think we hit go to that American Academy of Sleep Medicine site download that keep that on your bedside, because these are the things that you can do very simply to make sure you’re.

Getting the sleep you want, but remember don’t. Do this by yourself! That’s. What I’m here for I’m here to help you a men’s, health specialist! We’re here to help get you the goals that you need to maintain your health as long as you can and make sure that you’re doing everything you can to live as long as you want and healthily as you want Along the way, so that’s, what we’re here for that’s, what the men’s clinic at UCLA.

Does we’re multidisciplinary, comprehensive program that will evaluate your nutrition? Your exercise status? Your hormone, your sexual health, your reproductive health, whatever it is, that needs that you need to be the best that you can be, that’s, why they’re here for and that’s, my job.

So thanks very much for your time we’re, going to open it up to our Twitter and see if we have any tweets coming through. Please let me know perfect, so we’ve got three. I will grab the iPad and see what we’ve got going on here so perfect.

I love that. Is there a specific workout routine that you recommend, as the gold standard is high intensity interval training versus hour-long power yoga. So I think we hit that before we came in there’s, nothing I recommend other than what do you like to do for me.

I hate running on a treadmill. I can’t. Do it drives me crazy? I get bored so i avoid that, but i know that i’m: ok lifting weights. I know that i’m, ok running outside. So what is it that you want to do as long as that heart rate is getting up to about eighty percent of what is maximum for your age and that’s? A pretty simple calculator.

Most of the gyms have those little index cards. You can do the apps online to see where that is. But basically you know if you’re in your 40s. You should be getting your heart rate up to about 120 to 140 and sustaining that as long as you can, which means, if you’re running and you’re able to have a full sentence.

Conversation when you’re running, that intensity is not enough to get the calorie burning and the muscle mass that you want to put on from a good long run and and sustain that weight. The other thing i will say about movement that it didn’t mention that i discounted the caloric benefit of movement, but we do know that muscle mass is expensive calorically, so, in other words, the more muscle you put on the more calories you have To consume in order to maintain that muscle mass, so there is a little bit better of a benefit to too especially weight training in terms of weight loss to have that weight come off because your body will convert that fat once it goes through its its carbohydrate Storage, which was called glycogen storage and you get into fat burning.

You will convert that eventually in the muscle mass and so so yeah. The goal here is what workout routine. Do you like to do anything that gets that heart rate up that’s? Great by me, power, cycling, powerlifting, I don’t care just make sure that you enjoy it.

You can keep with it. Second question I drink soy milk daily. Does soy milk produced too much estrogen for men hampering testosterone, that’s? A tough question: the answer comes in the literature, and that is that if you’re just drinking soy, milk and you’re.

Keeping your soy intake down to say a very small portion of your overall diet, probably actually a little bit beneficial, but soy is a phytoestrogen there’s, a couple of molecules in soy that we know do get converted or your body treats them like.

Estrogen, so if you have that estradiol balance or imbalance between how much testosterone and how much estrogen you see, it can affect things like libido and it can affect things like testosterone, because you get lower testosterone synthesis if your body has higher estrogen levels.

But you have to eat a lot of soy in order to get to that way. So I don’t recommend cutting also out of your diet. If you look at the Asian diets that are high in soy, there are some protective aspects of soy.

For example, in men, estradiol is associated at a certain level with being protective against your heart, so heart disease rates might go down a little bit. If you have some soy in your diet because of that estrogen compound, there also may be some data, although it’s not great, but they have some data that show that that it may have some preventive measures against prostate cancer as well.

So so, just don’t go overboard, but eating a relative amount of soy. If you’re looking at protein supplementation, so soy milk, I don’t. Consider that supplementation. I consider that you’re having a whole grain oatmeal or a whole grain cereal that you’re using soy milk instead of dairy Calvin milk.

I don’t think that supplementation. But if you’re drinking soy, shakes and high soy protein intake, as opposed to relying on way sources, then that might be starting to push the edge. So I think in moderation.

So he’s, absolutely fine and it may actually have some health benefits and then lastly, is masturbation bad for testosterone and boy. You know the answer to that is it probably has no effect at all, so we do know that frequent sexual activity probably increases sex drive and I say good begets more good.

So if you rely on masturbation for sexual release, then it probably has no effect on your testosterone. There’s. A lot of old, probably poor medical data, as well as anecdotal evidence that frequent sex can in decrease your testosterone.

That’s. Why boxers traditionally don’t have intercourse for a few weeks before, because they want to build up that mojo. They want to build up their testosterone levels, but there’s, really no evidence that it does that at all.

So again, I wouldn’t. Consider that any kind of hamper to your testosterone levels. All right, I’m, going to give the iPad back see if we have time for any more questions, but I think at this point this webinar is concluded again.

Thank you very much for tuning. In again, I hope you learned something simple eat move sleep I can’t, make it simpler. You’re already doing it, but think about it. Every time that you do it from now on, every time you eat something.

A do. You really need to eat it and what are you eating and how much are you eating tues? Did you move enough today or do you need to get up and take the stairs instead of the elevator, simple, simple things, and then cash get some sleep and we all need a little bit more of it.

So make sure you’re. Getting those seven hours and that’s, a pretty good framework for building a Men’s Health Foundation and then please reach out to your men’s. Health community see what we can do to help you make you as good as you possibly can thanks very much again, dr.

Jesse mills, director of the men’s clinic at UCLA. You

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