Erectile Dysfunction & Brain Health: Parkinson's, Alzheimer's Link

This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside.

Hello there. Welcome to the episode. Today we're going to talk about sexual function and the brain. And I am here with Dr. Ken Charlan. He is a board certified neurologist, functional medicine doctor and, and an author of the Healthy Brain Toolbox. He is based in Ozark, Missouri. He is the foremost expert in Parkinson's and Alzheimer's and anything related to the brain. But on top of that, he's a great person and a great doctor. Welcome, Dr. Charlan.

Well, thank you, Dr. Charlan. It's great to be on the show.

Yeah. So today we're going to talk everything for ed, erectile function and also the brain and the connection between the two. Now, before we started, you had mentioned about the connection between Parkinson and Ed, and I found that fascinating as well too, because a lot of us don't think about how is the penis connected to the brain and vice versa, and which come first? EDA come first and then Parkinson or Parkinson first and then eda. So can you give us some more information about the connection?

Oh, yeah, that's a great intro. Thank you. Well, first of all, I think if we were to do a little bit of wordplay and I said, ann, what do you think of when you think of Parkinson's disease? Probably think of somebody who's sort of shuffling along and rather shaky and they have a tremor. And that is true. Um, that often is sort of a presentation of someone with more advanced disease. But we do call Parkinson's a movement disorder. The interesting thing about Parkinson's disease, however, much like say, Alzheimer's, is a long, what we might call preclinical period, meaning before the person develops a tremor, before the person develops that shuffling gait, these motor symptoms, they may experience a whole variety of symptoms that we don't intuitively associate with Parkinson's. But in fact, it is very much part of Parkinson's disease. And they are going to get Parkinson's based on these things. And in fact, erectile dysfunction may herald, may precede the onset of these motor symptoms. They can, it, of course, continues. But in terms of which comes first, the chicken or the egg? In fact, erectile dysfunction may herald the onset of the more familiar symptoms of Parkinson's.

How is that? What's the connection?

Well, again, I think it's important to realize that when we become aware of a spectrum of symptoms, in fact, we could probably apply this to most any disease. We might want to discuss diabetes, for example. Well, before the person has an elevated hemoglobin A1c or fails a glucose tolerance test, we know that they are becoming increasingly insulin resistant. And one of my big gripes when it comes to diabetes, because it's really a gateway disease to other disorders like Parkinson's, like Alzheimer's, that we use terms like predictions, prediabetes. And in the conventional medical clinic, the doctor says, well, you're pre diabetic. And it's almost like saying it's okay, but I just want you to know you're pre diabetic, you're not diabetic yet, so you don't really have to change anything, but you're moving in that direction. But you and I know that's a very serious problem. Even in that stage. I often say there really should be a pre, pre diabetes because before that blood sugar is going, the insulin levels are going up, then the blood sugar is going up and then it's so high that by the way, the house has burned down and it's too late to call the fire department. Right? So we need to be thinking of diseases that affect the brain. Parkinson's, Alzheimer's, als, multiple sclerosis, Huntington's disease as really starting at the cellular and subcellular level, meaning what's happening inside the cell. And realize that these changes evolve over a long period of time. And what's the wonderful part about this is we are in the age of precision medicine, meaning that we have the ability to identify these changes at a very early, even potentially preclinical stage and put together interventions that may altogether prevent the person from ever developing Parkinson's, Alzheimer's, Mississippi. But to speak very specifically about Parkinson's, some of these non motor symptoms that Harold the yawn set up, Parkinson's, loss of the sense of smell, what is called REM sleep behavioral disorder, which is kind of like acting out your dreams in your sleep, could be talking, could be very active, jumping up, punching, taking a dive off the end of the bed. I've had bed partners have to separate and stay in different rooms because the REM sleep behavioral disorder is so bad. Changes in personality, changes in gut function, particularly a long history of constipation often heralds the onset of Parkinson's and then the erectile dysfunction that we're talking about. So I don't want your listeners or viewers to believe that if they have erectile dysfunction, they're destined to get Parkinson's. But if they're having REM sleep, behavioral disorder, constipation, mood changes, loss of sense of smell, they may well be. And regardless, I'm sure your message has been if you have erectile dysfunction, it did not fall out of the sky and just happen. There's still a reason for this and we still have to address the factors that contribute to erectile dysfunction, which, by the way, I'm sure as we get into our conversation are very similar to the factors that contribute to, to why a person gets Parkinson's.

Yes, I would love to touch upon that. So what you're saying is that if you have ED and then you have these other symptoms like loss of sense of smell and then during sleep, and you find yourself being hyperactive when you're sleeping. And you mentioned a couple of other things too, other symptoms. So I remember the REM and lots of sense of constipation.

Those are the big ones. Smell constipation, that's a weird combination of words. But anyway, the REM sleep, behavioral disorder, and changes in mood or personality, changes.

In mood, personality and ED at the same time, you probably need to see a neurologist. But is there any test that you can do serum wise in the blood that will kind of give you some hint that you may have Parkinson's?

There absolutely is. Now, the caveat with the three tests that are currently available is that what they're really identifying is shared pathology. And what I mean by that is that Parkinson's disease is really part of a group of disorders. Before we started our recording, we were touching on a related family of disorders that falls under the same umbrella as Parkinson's called multiple system atrophy, or msa. We would also include things like Lewy body dementia, primary autonomic failure. All of these disorders have certain commonalities. They share an abnormality in that a protein called alpha synuclein tends to accumulate in the brain tissue as the disease evolves and becomes clinically apparent. Now, this alpha synuclein, if we turn back the time and go back to the original descriptions of Parkinson's disease and the early light microscope studies of the brain, it was known that there was an accumulation of something. I don't even know if it was really known initially what it was, but you could see it under the microscope. And they called them Lewy bodies. That's where, like Lewy body dementia comes from. What are the Lewy bodies composed of? Well, they're composed primarily of this protein called alpha synuclein. And it.

Okay, can you spell that? Alpha what? Alpha.

So alpha synuclein is S, Y, N, U, C, L, E, I, N, Alpha synuclein. And not only does it accumulate in the brain, but it may, in fact, in a significant proportion of people, if not all people with Parkinson's, actually start in the digestive tract and then work its way to the brain by way of the vagus nerve. It's also found in the skin. So I'm going to do a little commercial promotion here, but there's a company called cnd. Charlie, Nancy, David, Life Sciences. It's. Among the directors or head of the company is a neurologist named Dr. Todd Levine. And I know Dr. Levine, and he and a couple other people started this company because they were aware that. That this alpha synuclein could be easily identified in something as simple as a skin punch biopsy. And so now if I need to confirm a diagnosis, I will invite the patient to my clinic. This is covered by insurance. And what we're talking about is numbing up an area of skin in three different areas. One is by the ankle, one is by your knee, and. And then one is sort of in that bony protuberance at the back of the neck, sort of toward the base of the neck. That's called the C7 process. And we numb up that area. It's about the size of a nickel. A little lidocaine with epinephrine, and then the skin punch biopsy instrument looks like a pen where the ballpoint comes out. That's hollow, just like the pen, except it is a cylindrical blade instead of just being the hole where the pen tip comes out. So we press that blade on the skin, we twist a little bit, pull it out. There's a core of skin about the size of the tip of this pen. And then we put it in, you know, like a formalin tube and send it off to CND Life Sciences. They look at it under the microscope. If folks want to go to that website, it's a very good company, very good test. I don't get any money from them or anything to promote them, but I really believe in. The test is very well published, very well validated, but you can actually see pictures of what the alpha synuclein looks like under the microscope. That tells us, in more contemporary terms, that the patient suffers from Something called a synucleinopathy. So we are moving away from calling, say Parkinson's, Parkinson's disease and identifying these diseases, and not historically, which is where Parkinson's comes from, because it's named after James Parkinson, but by what it actually is, which is a synucleinopathy. These proposals are in the works at the very high level of where thought leadership, the international movement, Disorder society and so forth lays down. This is how it's going to be moving forward. These are the new definitions, these are the new standards. So you can measure alpha synuclein in the skin, you can measure alpha synuclein in the spinal fluid with something called a seed assay. The only advantage of that, other than the it's an inconvenience to have a spinal fluid test, but it can be quantified. Unlike the skin. The skin, we just say it's there, it's not there, more or less, but because it can be quantified. If you have a drug that will reduce the amount of alpha synuclein in the brain to treat Parkinson's, you want to know if the drug is working. And you can measure that clinically and. Or you can measure that by way of a laboratory test, meaning the seed assay. So that we want it disease modifying therapy. We want to know if the numbers are going down over time.

So are you supposed to have zero and then just elevation or there's like a baseline level of the alpha nucleon.

And as well try to. Yeah, these fantastic. The answer is that in many of these diseases, whether Alzheimer's, Parkinson's, als, many of these diseases have a characteristic protein that seems to be closely linked to the disease. We refer to amyloid protein in Alzheimer's, one called TDP 43 in ALS, one called the Huntington protein in Huntington's disease. And then alpha synuclein and Parkinson's. We sometimes call this a proteinopathy, O, P, A, T, H, Y. But in fact what we discover is that these proteins are really normal proteins in the brain or in the body. They serve normal functions, but under certain circumstances that we define as disease, instead of serving their normal function, they accumulate and they appear to be associated with the degenerative process. So normal and not normal is. It depends. They should not accumulate, they should not lead to neurodegeneration. So you probably always have a certain amount of alpha synuclein, but it should be soluble, it should be dissolvable. In other words, it should not linger, it should not lead to neurodegeneration.

Gotcha. So thank you I didn't even know about that. So there is a skin biopsy and you said a blood test or a spinal, spinal flu.

There will be. The NIH has a lot of money, the Michael J. Fox foundation also to grant various companies research dollars so they can develop blood based biomarkers for Parkinson's. And this is most definitely in the works. Another company we work with very closely here is called Octave Bioscience. It's Octav. They have a blood based biomarker test for Alzheimer's and they were awarded $10 million from the Michael J. Fox foundation to do the same for Parkinson's. But there are other companies out there doing similar work.

Now. How prevalent is Parkinson's? How common is it and what are your chances of getting that?

Well, the prevalence of Parkinson's, meaning how common is it is about a million individuals in this country, in the United States. So it's really a fraction of the numbers of people say affected by Alzheimer's, which is around 7 million or so, about a million with MS, for example, with ALS. Much smaller numbers, probably around 20,000 or so affected today by ALS. But what's interesting is that the rate of rise, the number of new cases of, of Parkinson's is really exceeding the rate of rise of new cases, for example, of Alzheimer's, which I recently read is actually going down in terms of new cases. We're still in trouble with that because the numbers are so big and we're going to have a hidden epidemic on our hands. You have 50 million potential Americans over the next couple of decades affected by Alzheimer's. The health care dollar cost, cost of that is massive. So we're not in the same place with Parkinson's, fortunately. But we still have a big problem with a million people and a large rate of rise for the most part thought due to environmental factors. So we feed our environment and we're paying the price. Just for very, very brief clarity. And there is another test. We don't need to get into it, but it's called a DAT scan or dopamine transporter scan. Just so the folks listening know that there are basically three commercialized tests that we can use to confirm the diagnosis.

I'm glad to know that there is some testing for Parkinson's. My father had Parkinson's and It was in 2005. He had the severe one, the tremor, and he couldn't walk, had to take a very high dose of medication. So that's very close to my heart. So the connection there is that it ED can precede Parkinson's if You have these other symptoms as well. How about ED to Alzheimer's? Because ED is the blood flow. It's the blood flow disease. Decreased blood flow and blood flow is related to inflammation, endothelial inflammation. And you had alluded to earlier that a lot of the risk factors for Parkinson's and possibly even Alzheimer's is probably related to heart disease, which is related to endothelial inflammation, which is related to eating. So it's kind of like all make that circle. So is that the basis? Is that endothelial inflammation?

So you're asking a couple different questions, and I apologize, I don't know the exact prevalence of erectile dysfunction in Alzheimer's. I'm sure it's quite common. And to your point, when we think about disease from a root cause perspective, then we're really talking about some common factors, whether we're really focusing on erectile dysfunction, which I'm not an ED expert per se, I know a fair amount about it. But I'm sure you would agree that it's probably an extremely rare thing to have isolated ed, meaning there's no other cause, there's no other factors. You just have ed and that's it. Because it's usually tied into metabolic syndrome, it's usually cardiovascular disease. Of course, there can be psychogenic factors that are very important as well, and we can talk about those. But to your point, you and I have probably used the term diabesity. And in our everyday professional career or in talking on the podcast and so forth, we do have this epidemic between being overweight and obese. I think it covers 50% or so of all Americans. We have an epidemic of diabetes. Kids are being treated for things that pediatricians never train for. High blood pressure, cholesterol, type 2 diabetes, insulin resistance. And really, if you want to, while certainly we could talk about environmental factors and all kinds of things, if you want to boil it down to what is really the lowest hanging fruit, what is the biggest issue out there that contributes to Alzheimer's, Parkinson's, als, ed? It's gotta be metabolic syndrome, in my opinion. It's gotta be. This is a major, devastating, devastating epidemic that we're in. And I think while I certainly like, you know, I'm excited about all the possibilities that the various semaglutides and tirisepatides and this and that offer and the future with these compounds that. That appear to do so much more than just treat diabetes, lower insulin levels. It's sort of ironic that we spend decades feeding ourselves as Americans, junk food, and then we turn around and develop expensive drugs so we can continue feed junk food. I mean, it's a crazy notion. How about we just eat real food and forget about the drugs, Right?

Oh, yeah, exactly. So define what metabolic syndrome is for our listener.

Well, formally, I want them to at least think about three or four different things. Usually it's insulin resistance, which, by the way, isn't always, in the purest definition, diabetes. Because I always define, I tell people, look, your pancreas secretes insulin in response to a meal. It acts as a key to a lock, and that lock is the glucose transporter. So when your body secretes insulin, it drives the glucose in inside the cell. And that's helpful when it comes to, say, making energy. But just like we were talking about alpha synuclein and amyloid protein, which can be normal in certain circumstances. You can have too much of a good thing. And so too much glucose inside the cell leads to the formation of advanced glycation end products, which leads then to oxidative stress, chronic inflammation, and ultimately cell destruction. So insulin resistance, meaning that as a person's discretions or what, all the factors that lead to diabetes go up and up and up. The cell is trying to protect itself from too much glucose. Inside the cell becomes resistant to the effects of glucose. Initially, it just means that your pancreas is pouring out more and more insulin in order to manage your blood sugar levels until it reaches a point where the insulin resistance is so great that your glucose level go. So there's sort of pre. Pre diabetes, meaning before you ever see, you could have a glucose level on a blood test of 95. And so, you know, maybe it's a little higher than optimal, but it's still pretty normal. And you wouldn't think of 95 as diabetes, but there's a big difference between a glucose of 95 and an insulin level of 5 and a glucose of 95 and an insulin level Of 40. So insulin resistance, high blood pressure, another one, dyslipidemia. I know everybody probably listening to this show, they don't like statin drugs. It's common in holistic circles. But the reality is you can ignore the statin drugs, and that's fine. And I'm not a big fan either, but we have to meet people where they are as well. And if you're that inflamed and have that much oxidative stress and that much dyslipidemia, the risk of taking a statin drug in the short run and is probably much lower than the risk of walking around with all of that Inflamed, oxidized cholesterol. You can make those lifestyle changes and follow a functional and regenerative medicine approach and correct that. But that takes time. So you have to gauge, you always have to meet that person where they are. And they're a 65 year old person with two stents in their heart and insulin resistance and dyslipidemia. They probably need to be on a statin drug if they're 40 years old. And so far, so good. But they're running high cholesterol. Maybe they need to work on those lifestyle changes first because they're not likely to have an event anytime soon and we have much more time to deal with that.

Right. So metabolic syndrome is high blood pressure insulin resistance. So what that means for our listeners is that when you eat, let's say pasta, your pancreas release insulin and then that insulin will drive the blood sugar into your cell and then the blood sugar in your blood will be low. But what happened is that the insulin gets released. Not a lot of things happen. They still have the high blood sugar and the insulin just hang there. It's kind of like a little insulin. That's why it's called insulin resistance. So metabolic syndrome, high cholesterol, high blood pressure and insulin resistance. And that is like a triad that create like an oxidative state, which is kind of like, I call it like inflammation of the blood vessels.

Right. I usually like to add the waist to hip ratio in there, the big belly that so many of us have, unfortunately, and I remind people that it's called visceral adipose tissue, and that is pure inflammation. It's a major risk factor for just about anything you can name, including ed. So if we, we're going to work on ed, and I'm sure you do this, you know, we have to address metabolic syndrome.

Absolutely. And that's actually sometimes even harder than even treating ed. We have many advances to treat ED now with your own thermostat, such as platelet rich plasma and high intensity shockwave therapy and Botox and now electromagnetic energy to at least four of those modalities. But the hardest part is reversing the metabolic syndrome, changing what you eat and then your exercise routine to lower your blood pressure as well as lower your cholesterol and then lower your insulin, because that's not something that you're born with. You acquire that from your lifestyle. But I find that that's even more challenging because like you said, we are, you know, 67% of Americans are obese. We are now sitting in front of the computer more than ever and it's just less opportunity to be active like we used to be. And food is so accessible. It's so easy to eat something out of a box and a bag rather than cooking it yourself. I myself today was eating some popcorn out of the bag because it was just more available. So with you being the neurologist, a specialist in the brain and a functional medicine doctor on top of that with your holistic comprehensive approach and I don't know how our listener feel. One of my scariest thing is to have Alzheimer's and lose my cognitive ability as I get older. And of course this is a show on erectile dysfunction but aren't always at risk for dementia Alzheimer's in some way when we get older. And what can we do to decrease our risk?

Well that's to some extent true. Age is the biggest risk factor for Alzheimer's. Yet we know of the blue zones where people commonly live beyond 100 and they're very healthy and vibrant and sharp minded. Of course there is a gene that anyone can be tested for. It's present in about a third of the population called Apoe4 and again it's widely available. It's usually in my world it's covered by insurance. And while it doesn't guarantee that the person will develop Alzheimer's and there are differences in ethnicity among different ethnic groups, for example, meaning how they're impacted by the presence of this gene. That being said, if you happen to be say European Caucasian descent, one copy of this gene triples your risk of developing Alzheimer's. Two copies, 12 to 15 times the risk. And yet what is this gene doing? This gene is actually making people much more responsive to things that drive chronic inflammation. It's kind of like having a sports car versus just a generic everyday vehicle that you drive to work is if you've ever driven a fancy car like a Porsche or whatever, man, you have to be so gentle on that accelerator because a little touch and it really goes. And I don't drive a Porsche. Yeah, but the point is that it's great if you live in a very inflammatory environment, meaning you're really at risk for infectious diseases that you're protected. But when we live as long as we do and we are more vulnerable to the effects of things that affect us kind of in smaller doses, but chronically over time, like air pollution, GMO foods and junk food and all the things that drive, metabolic syndrome, heavy metals, what have you, chemicals, chronic infections, all of those things that contribute to why we get sick then these APOE4 genes, instead of protecting you in the very short run, become that driver of chronic inflammation. So it doesn't mean that everybody's going to get Alzheimer's if they carry the gene, but on the other hand it's if you carry the gene, you really have to dial in that anti inflammatory diet and lifestyle.

Wow. Now how is that gene tested by the blood?

We used to do a cheek swab, but now we typically do blood. So it can be done either way.

Okay. So you can kind of test your risk factors so listeners listen to that. It's the Apoe 4, is that right?

Apoe 4. Right. There are many things to contribute. I don't know if you know Dale Bredesen is, but I know him quite well and he's done a lot of very nice work. People know the Bredesen protocol, but he has this expression where he talks about the 36 holes in the roof contributing to Alzheimer's disease. And that's because too often we say what causes Alzheimer's? You're like, well, it's not really one thing. It's a lot of different things. What causes ed? Well, it's really not one thing. It's many different things. And if we're really going to be root cause oriented, we have to try to identify those factors and help people to change whatever it is that's made them vulnerable foundationally at least.

So let's say a guy has ED and he work on his lifestyle factor to lower his blood pressure, eat better, lowers cholesterol and then so it's control his diabetes, loses a little bit of weight, loses some of that belly fat and increase his testosterone either through supplementation injection or to pellet through. Does that lower his risk of Parkinson's and eventually like dementia or Alzheimer's as well?

Absolutely, absolutely it does. And it's very clear that if you catch people in the earliest stages of disease and you treat them that way, that you can potentially reverse their disease. There are several papers out there. Dale Bredesen's group has published a few. I was one of the authors with Dale in 2018 on reversal of cognitive decline. 100 patients was the largest and may still be the largest published case series of reversal of cognitive decline. And about a third of those individuals came from Ozark, Missouri, from clinic. But Dean Ornish is very well known, kind of one of the pioneers of holistic medicine way back in the probably 90s when he first did his work, maybe in 80s, I don't know, just did, just published a paper in the last several months showing that when he put people through a very simple really diet and lifestyle program that he was actually reversing their Alzheimer's disease. He wasn't just improving their cognitive function. They were using biomarker based testing to show that amyloid and another protein called tau, tau, tau levels were going down. And we've shown that in our clinic as well. And by the way, circling this background to erectile dysfunction, sildenafil, the phosphodiesterase inhibitors have been known to have a very powerful impact on the brain. Not just of course, erection functioning. It's known that men in a large, sort of a retrospective historic study, meaning they just go into large databases and, and look at men who had been taking sildenafil or Viagra for erectile dysfunction and look at the prevalence of Alzheimer's disease among men taking this drug and is dramatically less. Dramatically less. And this has been seen in other studies and we are currently, I have a research site, we do quite a bit of clinical research. We're working with a company called aribio Ari Bio. They have a investigational product that doesn't have a name like a viagra. It's called AR1001, but it is a phosphodiesterase inhibitor and in the phase two trial with this product it reversed Alzheimer's disease, improving cognitive function up to 40% in people taking the drug. So I actually use sildenafil off label in my office as well. I combine it with oxytocin and a trochee which is for the Lister. It's kind of a dissolving tablet. And we are tracking their cognitive function. We're not only tracking their cognitive function, we're tracking their amyloid and tau levels over time. And I have cases of Alzheimer's reversal with these patients as well.

Okay, modern man, you are not alone and you don't have to suffer anymore. Ed can feel isolating, frustrating and even defeating. The endless guessing, the quiet shame, the weight of not feeling like yourself, it's exhausting. But here's the truth. You are not broken. You are not alone. And you don't have to figure this out alone anymore. The get wood now boost program is your step by step path to to sexual confidence and restoration. No more suffering in silence. No more trial and error. Just real solution, real result and the confidence you deserve. It's time to take back your power on your term. Let's get this journey started together. Check out the course@getwoodnow.com I'll see you there. Let's just Kind of dive into this because you're saying if somebody diagnosed with Alzheimer's, I assume, like, low dose, like sildenafil, 20 milligrams or how many milligrams.

I'm actually using this troche. It's a 60 milligram troche. I use half of the troche twice a day. So take 30 twice a day.

So 30 very well tolerated. Right, but it's combined with oxytocin.

Yes.

How many milligrams of oxytocin?

60 milligrams. They're both 60 milligrams.

Oh, so it's 30. 30. Even though you take it half. So they take 30 of the oxytocin, 30 of sudenafil, and you're seeing actually a reversal and improvement of Alzheimer's symptoms.

And there's data that this is effective for, potentially this is investigational, but there is data supporting this for Parkinson's as well. Because in the end, what is this doing? Well, I always say, you know, maybe doing things at the cellular level from this channel or that whatever voltage gated, whatever, or this receptor. I can't talk in that kind of detail. But if we think about blood flow, which is what erections are all about, if you're increasing your blood flow to your brain, you're bringing more oxygen, you're bringing more nutrients. But on the outflow side, you're also enhancing the elimination of toxins, including the toxic amyloid protein from the brain. So you're affecting both the inflow and the outflow of the brain and the very positive ways. And to me, it's not surprising at all that people's cognitive function is improving and their amyloid levels are going down.

Okay, so at that dose, it's probably not so effective if you have ED. Most men with ED require about 100 milligrams of Sudinophil, or even up to 120 to. Have any of these Alzheimer's patients been noticing sexual function when they're taking Viagra with oxytocin on a daily basis?

Well, let's look at it a couple ways. And I have to admit that. And you and I were kind of talking about this before we started recording that. Too often, doctors aren't asking their patients about these things. And because I have a multimodal approach, and many of my patients are also getting testosterone, which can have a very profound effect on neurodegeneration, of course, as well as erectile dysfunction. I can't really exactly tease that out, but we, of course know that, for example, cialis which is another phosphodiesterase inhibitor. There's a daily dosing of Cialis and you don't take the same dose on a daily basis that you would take if you use these drugs on an as needed basis. My patients are taking 60 milligrams a day of sildenafil, which may be on the lower side for acute erectile needs, if you will. But I'm not so sure that if you're taking every single day, kind of like taking the low dose daily Cialis. So I should be asking my patients, have you noticed a real improvement in erectile function? But I'm guilty as charged, I haven't asked them that yet.

Maybe you should. Maybe that's one of the reason why they're so compliant, taking it every day, because they're probably seeing maybe secondary effect. As you know, sildenafil, when it first came out, it was actually for pulmonary hypertension. It wasn't made for ED until they start finding out the secondary effect, why the men were liking it. So I wonder if these Alzheimer patients are observing something. Maybe they're observing more morning wood, maybe not enough for intercourse, but maybe some morning wood or some activity there that they normally would not have. It'll be interesting to find out though. But I heard about the study, but I haven't heard about mixing it with oxytocin, which really does make sense. Now, we talked earlier and you mentioned about the correlation between low testosterone and Parkinson S. Could you tell us a little bit more about that?

Yes, well, we kind of talked about those symptoms that often herald the onset of Parkinson's. And low T, of course, can present itself as a symptom. And we wouldn't typically call it low T at that point. It would be the person coming to you and saying, I'm not getting erections, my libido is in the trash can, I'm feeling irritable, I feel weak, I feel over the hill, I just have no energy. And then that turns out to be a, you know, that low T is a major contributing factor to that. But we do know, and again, well represented in the peer reviewed literature, that heralding the onset of Parkinson's in men, which by the way, about 80% of men with Parkinson's are affected by erectile dysfunction. But heralding the onset of Parkinson's is often an abrupt drop in testosterone levels. So in a multimodal approach, we do need to be checking testosterone levels in men and women, by the way, affected by Parkinson's and treating men and women, in my opinion, with Testosterone, Testosterone. Of course, the women may also get estradiol and progesterone and things like that. But I am a huge believer in hormone optimization. Hormone replacement therapy.

Right? How does hormone for men and women, when we say hormone, we're talking about testosterone for men and then testosterone, progesterone, estrogen for women. How does hormone optimization help with the brain?

So the important thing for folks to realize, and I always start, and this is a conversation I have with patients every day in my clinic, and I say, you know, I'm a neurologist and I'm prescribing hormones. That's kind of unusual, at least in your average neurology clinic. But the reality is that every neurologist should be doing this. And I would say you just go to a Google search box and cross reference, say, testosterone and brain health, or write what does testosterone do for the brain? And you'll be shocked and amazed. The thing about it is that these hormones, by definition a hormone, is a biologically active compound secreted by a gland released into your bloodstream that circulates around the body and has a distant effect on tissues, meaning it's not like a neurotransmitter, that those neurons are microns apart. And those neurotransmitters are very localized in their effect. But if you give someone an injection, even insulin, which is a hormone, and it will have a profound effect in tissues throughout the body. So these hormones are critical for brain health. They are anti inflammatory, they have antioxidant properties, they act as growth hormones, are involved in memory formation, memory consolidation. They're really, really critical. So it shouldn't be surprising that as women age and they go through menopause or some surgeon takes out their ovaries, that twice as many women are at risk for Alzheimer's disease as men. The prevalence of Alzheimer's is twice as great when it comes by gender for women compared to men. We need these hormones. Men benefit from estradiol. I don't give them estradiol, but testosterone. When we optimize testosterone levels, 800, 900, 1100, they're converting that, some of that testosterone, testradiol in their brain. So it's really, really important for the brain, but it's really important for the whole body, right? And I mean, the heart health, the bone health. How many women are told they have osteoporosis? Right? If only they were on hormones, they wouldn't have had osteoporosis in the first place. So it's really eye opening. And this is primary care for the brain.

I love that primary care for the brain, hormones. And I'm a big proponent of hormone myself because of really its functional effect and it's almost anti aging effect. And I've been on hormones essentially day one of menopause, as well as my husband, both of us are on hormones as well. And I'm like you. I believe that unless it's contraindicating certain cases, you should be on hormone because it's the same thing that your body makes that when you get older, around maybe past age of 50, your body's just not making this much and you just need to fill it up the tank a little bit more so you can have better quality of life. I know you can relate to this. How often do you see, especially female who are diagnosed with depression, anxiety, insomnia and even dementia when it's really most likely related to hormones?

Very common. And of course, in Parkinson's and in Alzheimer's, there are early onset or young, we call it in Parkinson's, young onset Parkinson's. So I have patients in their 40s with Parkinson's. And then there's more factors that contribute to why they have low testosterone. But they do often have low testosterone. I've had single male patients, professional individual in their 40s with erectile dysfunction going, oh, man, here I am, I'm still vital. I'm interested in partnerships, I'm interested in sexual relationships. I have Parkinson's and I can't get an erection. It's a terrible situation. So many people, even if they're not coming in with ed, because I'm sure, you know, low testosterone does not always immediately present with erectile dysfunction. There are people with low T who still get erections, but they're depressed, they're anxious, all kinds. And their doctors are putting them on, you know, everything from Valium to Prozac, when all they need was testosterone.

Absolutely. And I can't tell you how often this is more the majority. Where we would start, men and women, testosterone. And for women with estrogen and progesterone, that when they're on hormone, we get them off of their sleeping meds, off of their anxiety meds, they're depressed, depression meds. And then because they become more motivated, they're more energy, they're more active. So therefore they don't need their cholesterol meds because their cholesterol is improved, because they're more active. And then they are able to even get off of their diabetic medication because they feel more energized, they eat better, There was a patient I saw last week got out of his depression anxiety medicine that was he was taking for 15 years. And I just gave him testosterone a month ago. And he said he feels so much better, he stopped it. And he said he felt much better without his medication. And he was also taking the sleeping meds, Ambien for a long time. And it was interesting that before we started the hormone replacement therapy, he told me, oh, I don't know if I can get off of that. I've been on it for so long. And I said, well, you know, some of my patients able to get off of it. But you think about, next thing I know he decided to wean himself off of it when he was on hormone replacement therapy. But having said that, thank you for sharing your wisdom. And I have learned quite a bit of stuff, especially blood testing for Alzheimer's as well as Parkinson's. And I hope our listener enjoy that. I think you have to probably listen to this again and kind of slow down when Dr. Charlan talk, especially all the tests that he mentioned. We'll make sure maybe we'll have some transcript available as well too. So that way you can kind of follow along the blood test because oftentimes knowledge is also powerful because you may bring this up to doctor and maybe get this tested. And is this the blood test that you mentioned? Is that something that normal neurologists would order that you would expect to go see a neurologist? They would order these tests?

Yeah, I mentioned the blood test that you could do for the apolipoprotein epsilon or APOE4 gene. That is not a test per se for Alzheimer's. It's a test for a gene which increases the risk of Alzheimer's. But there is now a well validated blood test specifically for Alzheimer's. Actually, I was an author in the paper was published just a few weeks ago. The company is called C2N Diagnostics and the test is called the Precivity AD2P R E C I V I T Y A D for like Alzheimer's disease two the number two because it was a precipitate one or they just called it precipitate ad. But at any rate, this is a specific, highly accurate, highly predictive correlated meaning that historically the gold standard to get a very expensive, very complicated test called an amyloid PET scan or check the spinal fluid. And now this test had been shown to be equally accurate. Just a simple, relatively much less expensive blood test.

The blood test. Got it. Okay. It is a blood test. Okay. Wow. Is that covered by insurance or not yet. So no, it is okay.

I would just discourage folks who have absolutely no symptoms from getting a blood test, especially they're fairly young. Not that I'm certainly a root cause medicine doctor and believe in catching things early and preventative brain health and all that. But you know, sometimes you have to understand that first of all, what you're testing for are changes in the brain. And we would define Alzheimer's by both changes in the brain and the clinical expression of the disease, meaning difficulty with short term memory, people who cannot carry out what are called instrumental activities of daily living. And we know that there are people who can have Alzheimer's changes in, in their brain who will never actually develop the full blown disease. And if you happen to be, let's say you're 55 years old, no symptoms at all, and you decide to test yourself for those changes, you have to be very prepared, mentally, emotionally, psychologically for what that really means and also willing to do something about it. Because if you're just getting information, I would be very concerned at the impact on your life, your relationships, your family. But we certainly don't want to dismiss the importance of prevention. Regardless, you don't necessarily need the blood test to take the steps to prevent Alzheimer's or Parkinson's. You get your testosterone, you address that metabolic syndrome, right, that we talked all about, do all the other things that are important, sleep and exercise and so forth, and you could have a major impact on your risk.

Wow, that's a good way to end that, really. Eat healthy, exercise, sleep, don't smoke, and that will kind of carry you through as well. So if you do want to be tested and you do have Parkinson's or you feel that you have a loved one that has Alzheimer's as Well, seek out Dr. Ken Charlan. And where can our listener find out more about, about you and if they need to connect with you.

We have a wonderful website. It is functionalmedicine. Dr. Functionalmedicine. Dr. And we do have an opportunity, if you go to the website, to sign up for a complimentary 15 minute consultation. We'd love to learn more about you, make sure that it's a good fit, that we can help you. And we'd love to have you in Ozark or get to know you via telemedicine, which we also do.

Now tell us about your book. Where can they get a copy of your book?

It is on Barnes and Noble, but I think most people buy it on Amazon.com or right off the website as well. It's called the Healthy Brain Toolbox. Also have a companion book which is called Nourishment the Brain Tune Up Food Guide. Because Brain Tune up is our brain health program. We help people with Parkinson's and Alzheimer's and ALS and Ms. And so forth. Really change that trajectory.

Awesome. So make sure that you at least check out his book. And that's how we actually met. I think I even have a copy of your book. Having said that, I'm grateful, Dr. Charlan, for being here and sharing your wisdom and teaching us. And I hope that our listener will get a lot from this as well too. If anything, just know that if you take care of your body, your body, your temple, you may even avoid all these Parkinson's and dementia and Alzheimer's as well. Sometimes as simple as eating healthy, like following the Mediterranean diet, which is anti inflammatory diet, exercise, stop smoking and enjoy Mother Nature. Sleep well. And that will probably go a long way. Absolutely as well too. And it will even help with your ed. So having said that, we will see you in the next episode.

Thank you.

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Thanks for listening to the Sexual Health for Men podcast. If you love this episode then please take a screenshot on your phone and post it on Facebook, Instagram or wherever you post. And be sure to tag me and let me know why you like this episode and what you like to hear in the future. That will help me know what's great for you. And I would love to give you you the most incredible free gift designed to help you improve performance quickly. Go to my website@sexualhealthformenpodcast.com to get the book the Five Common Costly Mistakes Men Make When Facing Ed. I would appreciate if you subscribe, leave a review on Apple Podcasts or wherever you listen and just know that you can have sexual vitality for life. I appreciate you. Until next time.