The 5 Biomarkers Every Man Over 45 Should Be Tracking

Welcome to The Dr. Ashley Show. I'm Dr. Ashley, and today I'm very excited to share an episode with you where I have the privilege of interviewing Dr. Tracy Gappin. Dr. Gappin is a physician and the founder of Peak Launch, which is the operating system for precision performance medicine. After 25 years as a board-certified urologist, he left traditional medicine to build a performance-focused model that helps leaders have even more energy and focus, strength and resilience so they can feel better, live better, and lead better. He's also the creator of the Peak Launch Institute, which trains physicians to deliver this model at scale. Dr. Gappen is also a TEDx speaker and the bestselling author of Male 2.0 and Codes of Longevity. He's been featured on NBC, Entrepreneur Magazine, and many podcasts. He's widely recognized for his work at the intersection of medicine, performance and leadership. Dr. Tracy Gappin, thank you for coming on the show. I've really been looking forward to our time together.

I'm excited to be here with you today.

Will you share with us, so I've been reading all about you and you were this really busy, successful urologist and you left traditional medicine to dive into performance medicine to help what highly functioning people have better energy, more stable mood, just feel better, live better. Will you share with us how you transitioned from being a urologist into performance-based medicine?

Absolutely. Yeah. So I was running a very busy surgical practice doing robotic surgery and grinding and, you know, so focused on my patients, on my career that I really neglected myself. Like, like most doctors, you know, we put ourself last and it finally caught up with me where I hit a wall one day. I am 40 years old and I wake up one day and I'm 30 pounds overweight. I feel like I'm stressed out. I'm not sleeping well. And, and it's all my own fault. You know, I'm not eating well. I'm not exercising. I'm not taking care of myself. And, and I, I was really neglecting every aspect of my health because I was so focused on my career. And so my wife convinces me to go see a doctor myself. And it was a very eye-opening, vulnerable experience to be on the other side of that interaction on the cold exam table, wearing that thin little paper gown that, you know, that one that barely covers some really important real estate, if you will, if you know what I mean. And so that experience was eye-opening for me because this doctor who I respected in the community, his only recommendation for me was I needed a statin. That was it. He just wanted to prescribe a statin and then, yeah, you just need to lose weight. And my labs were a mess and I knew I needed help and, and obviously needed to lose weight, but there was so much more to it than that and a statin. And so I was determined just out of a sense of fear to figure out what do I need to do and, and what does healthy really mean? And, and. Here I was, a Men's Health expert, and you know, in air quotes, I, I didn't know what to do either.

If weight loss has left you exhausted, crampy, foggy, or frustrated, this message is for you. I'm Dr. Ashley Lucas. I've spent 17 years helping people lose weight, and what I saw again and again was this: people were doing everything right, but their bodies were struggling. Metabolism slowed, energy crashed, headaches showed up. That's why I created Dr. Ashley Wellness, not for quick fixes, but to support your body while you change it. Our approach is rooted in real science, clinical ingredients, and respecting how the body works naturally. Visit drashleywellness.com. Use code YOUTUBE10 for 10% off your first purchase or 20% off your first subscription order with free shipping. Plus, enjoy a 30-day money-back guarantee. Back to the show.

And so I went back to school and I spent almost a decade learning epigenetics, you know, the science of how our lifestyle affects our body. Functional medicine, studying peptides and hormone optimization and, and all the science around longevity medicine. And what I was able to do was really turn everything around and get healthy, lose weight, get in shape. But more importantly, Ashley, I found my purpose and my passion in life again. I, I was excited about medicine again. I was on the verge of leaving medicine entirely. Entirely at that point. And so I started offering some of these, uh, services, the, these, uh, uh, approaches to my patients in my urology practice. And I started seeing real results. And, uh, I'm an entrepreneur at heart and I, um, decided that I had to follow my heart and follow my passion. And so after many years of preparation and preparing and, and procrastinating as well, uh, I left urology. I, I left my very lucrative surgical practice and I started from scratch, start from ground zero again and, uh, built Gap Institute, which is now Peak Launch. And, um, and my single focus is to really help high-performing entrepreneurs and founders and executives and leaders like myself, like all the people who I see struggling out there, um, be, um, the leader they're supposed to be. And that may be on the racetrack, that may be, um, at sport. It may be as a father like me. It was all about how can I be the best father for my kids was my big focus. You know, to me that's what peak performance is all about. And so it's helping leaders have better energy, better focus, better strength, resilience, so they can feel better, live better, and in fact lead better.

For you, what were the top 3 things that you had to shift right away, or the top 3 things that also created the biggest impact in your health personally?

Great question. Yeah, first of all, I think mindset always comes first and I think it's about, um, living with intention. It's about setting consistent habits. Um, It's about, um, you know, just the, the peak state of gratitude and of positivity and of, of setting your, your every day. Like, what's your, what's your, how do you wake up every day? What's your routine? What does it look like? Are you instantly getting on social media, swiping and looking at emails, or are you being really intentional about how you start your day? And, um, and so mindset's the, the big one. I think habits is the second one. How do you establish daily consistency in your life? And we all, talk about what we're supposed to do, and most people know what they're supposed to do. They know the basics at least, but why don't we do it? Why don't we prioritize sleep? Why don't we move more? Why don't we get out in the sun? Why don't we, you know, get rid of the chemicals and toxins in our food and, and, and focus on eating clean, organic foods? And why don't we do all the right things we're supposed to do? It's because it takes consistency. It takes setting up daily habits. And so I think that's a big part of it for me as well. And then I think it's the individualization. I think the third part of it is you know, there's so many influencers online telling you what you should do. Mm-hmm. Whether you're on Instagram, Reddit, whether you're on Twitter, Facebook, you see all these people and, and these experts are, are telling you what you're supposed to do when in fact we're all different. We have unique biology, we have unique genetics that really affect how we're going to respond. And so yes, there's a lot of, of generic things, recommendations that we should all be doing. But beyond that, there's so much more that comes down to our unique physiology that determines that. So those really were, I think, the 3 big things that I learned along the way.

For you, what does your morning routine look like?

So wake up, I'm a big coffee guy. So coffee, I, I will never give up coffee, but my genetics tell me that I'm okay. I can drink coffee without caffeine. Oh, there you go.

Free.

Yeah. So free pass. There you go. I do HRV screening. So 6:00 AM, I'm on the couch with my coffee. I do my HRV strap. So, you You know, I'm big on data tracking and so I really recommend everyone measure your HRV every day. And, and I love Oura for sleep. I love Garmin for, for fitness. You know, Whoop is good for recovery, but when it comes to HRV, you want a chest strap specifically to measure apples to apples. And so morning, uh, in a very, um, rested, calm state, same time, same place every day, you measure your HRV. So I'm on the couch doing that and I'm setting my intentions for the day. I journal, I'm listening to music. That's very powerful music that, that moves me. So, um, you know, find music that, that that is powerful for you. And then journal. And when I journal, I'm focused on what are my intentions for the day, how do I feel, and what am I grateful for? And it's simple. It takes 10, 15 minutes to do that, to, to, to document that, to journal that. It takes 2 and a half minutes for your HRV screen. And by then I'm ready for my second cup of coffee.

Wow. There we are. There you go. Will you explain to those of us who aren't familiar with HRV? What is it and what are we looking for and why not yet?

Sure. So HRV stands for heart rate variability, and a lot of people don't know what the heck that is. That's really a surrogate, a measure of your internal stress levels. So what I mean by that is we're all stressed. Some people want to admit it, most people don't, and that's okay. You can actually measure it. You can measure it with, you know, salivary cortisol testing. Saliva cortisol levels can tell you how stressed you really are, or you can even measure it day to day with a wearable, uh, with such as a chest strap. What we're looking at is the balance in your parasympathetic and sympathetic nervous systems. Really yin and yang. It's, uh, it's, it's the devil and the angel on your shoulders. And not that one of them is good or bad, it's that you want a proper balance and you want to be, um, parasympathetic dominant is called where you're in a rested state. That means you're resilient, you're repaired, you're recovered, you're able to deal with anything that comes your way. You're in a very dynamic state. Whereas if you are in a very sympathetic state, which is low heart rate variability, so high heart rate variability, HRV is good. Low HRV means you're in a stressed state. Your body is not recovered. You may be sick. You may be overtraining. It may be from alcohol the night before, maybe from poor sleep. We don't know. A lot of stressors to our system, not necessarily just psychological, worried about kids, finance, marital stuff, business, et cetera. Stress could be anything. Gut microbiome issues. It could be toxins. It could be poor sleep. It could be the food that you're eating is not right for your body. But what that'll tell you is if your system is in a stressed state, especially when you can compare from one day to the next. So for example, I will see with my clients a dramatic drop-off in heart rate variability after alcohol the night before.

Yeah.

Drinking just one drink. Mm-hmm. I'm not here to tell you you can't ever have a, have a glass of wine, have a drink, whatever. I, I'm not here to, to tell you to be prudent and, and completely abstain. However, when you see the data, the data doesn't lie. And if you're trying to burn muscle, excuse me, burn fat, if you're trying to build muscle, if you want to have better energy and focus and be able to perform at a high level, you see directly with the data how these behaviors are affecting the way your body's working. And it, and it really drives you to make better decisions. And so I could talk till I'm blue in the face on, on the, the, the harmful effects of alcohol. But when you can see how it's actually impacting your physiology, that's when people will start to again, go back to the, how do I create consistent habits and how do I, how can I find workarounds to, to, you know, practice better lifestyle behavior.

Mm-hmm. So if you find in yourself that you have low HRV and it's starting to trend, like it's starting to trend down, will you then find yourself adjusting your habits, pulling back, kind of pulling the discipline back in to see it go back up?

Yeah. You know, I use it as a diagnostic tool. So what I mean by that is, is just throwing out random numbers here. And, and by the way, your, your heart rate variability, the number doesn't matter. People will say, well, well, mine's 50, what should it be? And I, I would get out of that. You wanna think of more of How can I optimize it over time? Gradually improve it. But when it's 50, 52, 49, 53, 20, that's where it helps you look at, okay, what the heck did I do? What caused that? What's going on in my body? What do I need to do differently? And you can simply look at what, what happened, what preceded that. You can start to really understand what works for you and what doesn't and how your body responds. Same thing, you know, we do a lot of blood sugar tracking with our clients, not diabetics. Anyone should be doing blood sugar tracking periodically.. And when you do that, you'll see data where your blood sugar's nice and consistent and this massive spike for 3 hours. And it's simply a matter of what did I do? What did I eat? What was it that triggered that? So now you can know how to, you know, how to modify your behaviors or what you're eating or what you're doing on a daily life.

Yeah. It's so surprising with those CGMs, the continuous glucose monitors, and they will vary from one person to another so significantly. So what you are eating versus what your neighbor is eating. Will have a totally different response. So that's definitely an interesting tool to utilize.

I agree with that. Absolutely.

Will you share with us, I mean, you've, you've talked a lot about the healthcare model being broken. Yeah. Will you explain what that means to you and what you feel we should do instead if we really care about our health?

Sure. Yep. So when I went to that concierge doc, 13, 14 years ago now. I had low testosterone, I had low thyroid, I had low DHEA. My lipids were through the roof. My blood sugar control was very poor. A lot of other bad numbers as well, but those are the key ones I'll focus on here. None of those were important to him because I wasn't in a disease state. I didn't have a diagnosis code for that. There's no illness, sickness to treat. And so the problem with, with sick care medicine is number one is very reactive. We're waiting for a diagnosis. When, when you have a problem, when you have, you have a kidney stone, when you're in a heart, heart, when you're in a car accident, when you have a heart attack, you need acute care medicine. You need cancer treatment. It's great. But when we're talking about on a day-to-day basis, how do I optimize? How do I improve the way I show up every day? My mental focus, my concentration, my mood, my energy, my ability to go to the gym and actually see results, my ability to sleep better, all of these things that we care about so that I can be the most present and engaged dad for my kids. Primary care did nothing for me. Medical, you know, the traditional medical system has nothing for me. And so it's reactive, it's passive. It's, it's simply focused on treating disease. The other issue really focuses on hormones. So I'm a big believer in the massive impact that our hormones have on the way we the way we perform, the way we function. And for men especially, we are experiencing what I call a testosterone epidemic. Yeah. Levels are about half what they were 20 years ago, half. And they're dropping by about another 1% every year. And so not only do men's testosterone levels drop as we age, we know that, that levels go down by about 1% every year, but we have also seen that a 53-year-old man today has a free testosterone level that's about half of a 53-year-old man 20 years ago. And so we are being compared, we are being measured by this range, this reference range, which is based on the crummy population, which is not even where you want to be, where you need to be. And so great flaws. It's overwhelmed. Doctors are, are miserable like I was that were, were, um, were disillusioned, frustrated, were controlled by the pharmaceutical, um, and insurance systems. And it's, other than acute care medicine, I think it's really failing.

Mm-hmm. I agree with you. Why are men struggling with low testosterone? Why is it at half the level that it should be?

Sure. And what's interesting about this is not just the US, there are actually, uh, 3 big longitudinal studies that looked at this. The big one, the male Massachusetts aging study in the US here, there's one in Sweden and Finland. So it makes you wonder, why is it worldwide, not just in the US? And, and the answer to your question in short is A lot of lifestyle stuff. It's, it's stress, it's poor sleep, it's sedentary lifestyle, it is poor nutrition, it's, you know, lack of sunlight. All these things can contribute. In my opinion, what the literature clearly supports is endocrine disruptors. So toxins, chemicals in our environment, chemicals in our food, chemicals in our drinking water, in our personal care products that are everywhere. We're like, we're bathing in this soup of endocrine disruption, if you will. And, and that's really crushing testosterone. So to define that, just to be clear, the listener knows endocrine disruptors are any chemical toxin, toxicant that impairs hormone production or hormone function. And we're talking about like glyphosate is one people have heard of, but atrazine's in our drinking water. It's in a lot of the foods that we're eating. You have phthalates and BPA in, in plastic, you know, water bottles, plastic sports bottles, plastic food containers, our personal care products like our, laundry detergent, our deodorant, our soap, our shampoo, our sunscreen. They're loaded with all these chemicals and we're absorbing it through our skin every day and is clearly impacting hormone production, hormone function.

So are there any great apps out there that can help people figure out what type of products they should be focusing on?

Oh my gosh, absolutely. So I love the one by the Environmental Working Group. It's called Healthy Living. It's a little green icon and it's free if you like free. It's a great app where you can actually go into the store, into Target, Walmart, wherever, and scan the barcodes of products and you'll see all of the incredibly harmful ingredients and it'll shock you and you'll, it'll make you wanna switch your deodorant and switch your laundry detergent and your soap and your shampoo, for example, to better cleaner products.

Yeah, I've done this a while ago. It seems overwhelming at the beginning, but you're gonna find your products that you love, that you stick with. I mean, sunscreen, right? So many chemicals in sunscreen that we put on our kids, but there are a lot of great brands out there now, uh, that are much healthier. So what do you think all these men who have low testosterone should do? Should everyone be on testosterone therapy? Can they increase their testosterone through improving sleep and doing compound exercise movements and all these things, eating more boron, or do they just need the hormonal therapy?

Great question. And of course there's nuance around this, so it really depends. So first of all, I, I really urge every man who's listened to at least get tested. You don't want total testosterone so much as free testosterone because free testosterone is that which is unbound to other proteins in the bloodstream. It's bioavailable for your body to use. So that's first and foremost. And generally you, if you're using LabCorp, your target for that is around 20, which will look like at the very top end of the range. Again, those ranges are wrong, they're skewed based on the the population level decline. For a Quest lab draw, it'll be 100. So just be aware your, your target is, I'm sorry, 200, excuse me. So either 20 on LabCorp, 200 on Quest is your target. And most men you'll see, you know, LabCorp, they'll come in with a free T of 5. It's incredibly low. Okay. So to answer your question, let's say your free T is 5 and you did every lifestyle trick, hack, habit that you can think of to improve testosterone. And those are specifically strength training. Improving sleep quality, getting sunlight, focusing on clean quality, you know, personal care products like we talked about, clean nutrition, mitigating stress, all these things that we can do that are impacting testosterone. You may be able to get that 5 up to maybe 8, 9, maybe even double it all the way up to 10. Yay. Again, your target is 20. And so that, that's the problem is that there's still such a long way to go. I have a client who is a, a very well-known influencer on, on IG. He's the guy who is running on the beach, he's holding his He's got muscles everywhere and he's always got his shirt off and he's flexing, he's working out and he's crushing it in the gym. Like he looks like a, like a maniac. And his free testosterone is 5 and he's doing everything right. Like he, he looked like, I don't know what else I would even tell him lifestyle-wise. So that's the example of how lifestyle can only get you so far. Mm-hmm. And the scary part that I didn't bring up about the endocrine disruptors in our environment is there's clear evidence. Of a transgenerational effect. What I mean by that is there's evidence that the endocrine disruptors, the toxins, chemicals that grandpa got exposed to, which were not nearly as much as we have now, left marks on his DNA, which affected sperm, which affected testosterone production. Dad was exposed to even more damage that got passed on to the men of this generation that we're now passing on to our children. And so it's becoming an exponential profound impact from prior generations that you can't undo by simply strength training. So to answer your question, you know, when it comes to whether we need to prescribe TRT or not for men in general, there are a lot of different things that we can do. TRT ends up being the best option for a lot of men. And you know, there's a lot of fear, some misguided fear around the risk of causing heart disease, heart attacks, causing prostate cancer, and they're all really unfounded. We know without question that men with low testosterone, first of all, have a massively increased risk of having heart disease at an early age. And when you correct that, when you give testosterone, that reduced comes down dramatically without question. Numerous studies show safety of it and benefit when it comes to not only quality of life, but also risk for heart disease as well. So to answer your question, a lot of men, yes, TRT is the best option, but there's certainly other options as well.

What other blind spots besides low testosterone seems to quietly drain the energy and focus and strength from men that they should be focusing on as well?

Yeah. So one of the other issues that traditional medicine is missing is the impact of our gut, right? We know the microbiome drives our entire body. It, it controls our immune system, neurotransmitters in our brain, hormones, metabolism. Everything is in some way affected and controlled by the gut. And I'll tell you, in all the leaders, high performers I work with, nearly all of them have issues in the gut, whether it's dysbiosis, whether it's leaky gut, whether it's issues with digestive function or poor detoxification and all these complex things that people are hearing like, well, I don't care. Those things directly impact your energy and your brain function and your metabolism and your ability to build muscle and your sleep quality. And all of these things that we really care about are in many ways directly driven by the gut. And so with everyone we work with, we'll test the gut. And most people who have major gut issues have absolutely no symptoms. So we're not talking about cramping and irritable bowel and irregular habits and anything like that. We're talking about systemic inflammation that is actually driven driven by issues in your gut. And so it's getting, uh, people to recognize how those symptoms, those, those issues that maybe we are able to compensate for and adapt to are actually directly affected by the gut. And when we fix the gut, a lot of those issues can be improved.

Can you give a few examples of common symptoms people might be experiencing that's stemming from the gut?

Yeah, so great example. One of my, uh, clients, race car driver, he found that, um, he came to me because he was having issues with focus. He was on the racetrack, you know, going 200 miles an hour and he felt like something was off, like brain wasn't working like it should. We found with him that he had massive dysbiosis, which means basically imbalance of the good bugs, bad bugs. Okay. Simple as that, that you want this nice diversity of healthy bugs in the gut to control production of the, of the, the hormones you need and really help, uh, protect your gut wall, if you will, and help with digestion. He had major gut issues that led to leaky gut, which is breakdown of your gut wall, if you will, to keep this simple. He had food sensitivities, Ashley, to bananas and coffee. Two things he had.

You would be so sad if this were you.

He had food sensitivities to bananas and coffee. Now those aren't bad foods, right? Guess what he was having for breakfast every, every single morning with his protein shake? Bananas and coffee. We made that one little switch and it was like overnight, he said like a light switch went on and suddenly like his focus and his reaction time and everything changed and he, his racing performance improved. And the guy goes out and he sets a Guinness World Record for endurance racing shortly thereafter. Like no, no lie. True story. I take all the credit for it. It was all me. He did nothing. He just showed up. It was all me. But, but the reality is how these things that you don't even realize, and he had no gut symptoms at all. He's like, my gut's fine. Why am I doing this stuff? It's— we don't even realize we adapt and compensate and overcome for major issues under the surface. And so take-home messages for, for, you know, we work with men and women, but my passion and heart is, is men's health. And what I find is most men— we're simple creatures, creatures of habit, like I was, you know, focus on my career, I'm fine. Yeah, my energy's a little low. Yeah, I need to lose a little weight. We have no idea how far we have fallen because we don't want to look under the hood. And so get tested, get some basic blood testing, some functional tests, and you'd be shocked at what you find.

What do you think about fecal transplants?

Yeah, so there's amazing literature, published literature on the benefits of fecal transplants. I was actually just sharing this with my wife over the weekend. Studies that show, like in animal studies, you could take like, like an obese rat, for example, an obese mouse. Yeah. And, um, and do a fecal transplant from a healthy mouse. And that mouse will lose weight. It'll become a healthy, you know, in insulin sensitive, basically blood sugar controlled and lose weight. And, and so there's a lot of evidence for that in humans as well. A lot of ongoing studies is still early on, but a lot of the literature suggests that it can help with immune function. It can help with, you know, autoimmune disease. It can help with a lot of systemic inflammatory issues and there's promise for it. I know a couple centers that do a lot of great work with it. And so it's, it's really on, I would say, the cutting edge. And for those of you out there who have struggled and nothing else has worked, that may be something to look at as kind of a last resort for, for certain complex chronic diseases.

Yeah. Pretty interesting. And we had a little party last night and we were talking about fecal transplants, of course. Yeah. At, at dinner. Totally great conversation at the dinner table. And yeah, we were talking about this lady who really had, struggles with mood and anxiety and depression. And the one thing she did was a fecal transplant and night, like night and day, there it is. Yeah. Or it really is the, you know, symptoms that we don't think are related to our gut at all, but absolutely. There is definitely that connection. Absolutely.

Great. Yeah. Yeah. It's pretty powerful. Um, I, um, I think it's super compelling for people who specifically don't respond to conventional therapy. Like we do a lot of gut protocols and, um, and I think it's when those don't work, when you're like, hey, You know, we need more that, I think that's a great next step. I don't know that I recommend it as first-line therapy, but it's a great option for people who have failed other stuff.

Yeah. You test over 100 biomarkers. What would you say are the top 5 that most men should be paying attention to but aren't?

Yeah, so great question. We, we look at over 100 blood biomarkers. I would say if you look at genetics and functional tests, we probably look at over 5,000. So we do a lot of, of, of complex testing. But I think your question specifically the blood testing, so I'll, I'll stay there for a moment. When it comes to cardiovascular health, the one that is most important is ApoB. Apolipoprotein B is the single most important marker for, for your lipids. Much more predictive of risk than LDL, HDL, total cholesterol kind of stuff. So ApoB, the second one I'd say would be Lp(a). Lp(a) is a subtype of LDL. It's a very atherogenic particle, meaning it's very prone to promoting development of plaque, of vascular disease. The reason Lp(a) is important is about 30% of the population have an elevated Lp(a), and when that's the case, you're at massively increased risk for early development of heart disease, vascular disease, stroke, and early mortality, in fact. So a great example of this is Bob Harper, fitness trainer for the TV show The Biggest Loser. I think he's probably, um, uh, most people may not be aware of him anymore. I'm dating myself here, but he was around for a long time on this TV show. Epitome of good health. He's a great fitness trainer. He looks like, like, you know, uh, he's super healthy. Age 51, the guy has a heart attack and almost dies. And you ask yourself, how does that happen to a guy who's that healthy? And for him it was Lp(a). And so everyone needs to know your Lp(a) and if that's a risk factor for you. Uh, again, I talked about testosterone earlier. I think free testosterone is so, so important. Most people are looking at total. You gotta be looking at the free. So I really emphasize that. Blood sugar control. Most people don't recognize how important blood sugar control is. Not just diabetics, but everyone needs to think about blood sugar control. We call it, we use the fancy medical term insulin sensitivity, but that basically means how well you're regulating your blood sugar. And it's important because if you want to build muscle, if you want to burn fat, if you want to have high energy and be able to perform, you know, all day long and be able to perform at night for your partner, blood sugar control matters. And so you wanna measure it. And fasting insulin is really what I believe is the best way to measure that. So fasting insulin is, is measuring your insulin level at a fasted state, much better than fasting glucose, which doesn't tell the whole story. Hemoglobin A1C may argue is a, is a longer, better version of that as well. More of a long-term marker of that as well. But that would be number 5. So I don't wanna use up all 5 on this one. So I'm gonna say just fasting insulin would be number 4. And then I, I think CRP, looking for signs of systemic inflammation, you know, highly sensitive CRP would be, would be number 5 that I think would be a, a great one for everyone to get tested. Give you some basic indication of the systemic inflammation that most of us have without even realizing it.

Those are great. If we go back to testosterone just for a second, we've been talking about testosterone for men, but testosterone for women is just as important. Where should our numbers be for us ladies?

Yeah. So again, I would focus on the free, even for women, I would care about the free and somewhere between 5 and 10, I think is a good target for the free for women. And most women are nowhere close to that. Most women are, you know, maybe 1, 1.5, you know, 2. And, and most doctors don't want you that high. Most, most will say, oh my gosh, that's way too high. And so definitely important for women as well. You need it for cardiovascular health. You need it for mood and energy and sex drive and, and, and building lean muscle. We all need it, especially women.

Yeah. Yeah. I mean, I, I share that because I just had mine tested and it was at zero. So not ideal. It, you know, it happens to all of us. And I focus on, on my nutrition and everything.

And yeah. And what's, what's scary about that is, is you go to your OB-GYN, you don't need testosterone. Oh my God, that's harmful. You go to your primary care, you don't need testosterone. That's for men. Like you, They shun it. They don't even, they don't even look at the literature and understand the physiologic benefit that it provides for you. It's not about being a bodybuilder. You're not. And, and first of all, you know, women think, oh my gosh, if I go take testosterone and I go do strength training, I'm gonna become this big, huge buff, you know, wrestling maniac bodybuilder. You're not, it's, you're simply not like to get to that level, it's a whole different ballgame. So every woman needs to be strength training. Every woman needs to be getting, you know, at least 0.8 grams of protein per body weight or per pound of body weight. And most women need to have their testosterone optimized. It's such a common situation what you just described where you have low T and, and you're just told you're fine.

Yeah.

Yeah.

And then, you know, as we age, our muscle mass just depletes naturally. And here my testosterone's zero. We're just fighting an uphill battle, you know? So, yeah, I will be playing around with testosterone to see the difference that I feel. And I'm grateful to have been tested for it. We are talking about nutrition just shortly, for around 0.8 grams of protein per pound ideal body weight. Is that the amount that you advise just across the board for most average individuals?

Yeah, anywhere from 0.8 to 1. And I, I think that, you know, there's the, a lot of this battle online right now, these influencers going off on whether that's too much. And you know, you can think of mTOR when you, when you're eating protein, you're shutting off, turning on mTOR. And, and so, mTOR is a longevity gene. And so are you shortening lifespan by ch— turning off, turning on mTOR when you want it to turn off? I think it comes down to, we know without question that when you build lean muscle, without question, you're better off. It improves blood sugar control, it improves metabolism, improves hormones, improves longevity without question. We know that muscle is the organ of longevity and you cannot build muscle without adequate protein as a building block. Amino acids are the building block for protein muscle synthesis. And so you need adequate supply. And the, the recommended daily allowance by, you know, by our government, by ADA, by all these organizations is just way too low. It's simply too low for you to build muscle. And so yes, it's 0.8 to 1. And, and what that really means is it requires work, it requires planning, it requires preparation, and it's a lot more protein than you think.

So it really is. Yeah.

Effort. It really is. Yes. And so you want to think about, you know, for a man, typically that means at least 150 grams of protein per meal, which means about 50 grams per meal times 3. If you're doing 3 meals a day, I don't recommend 1 meal a day, by the way. I recommend 3 meals a day. And that means 50 grams per meal, right? For women, that's around 30 to 40 grams per meal. And so, you know, 1 egg, for example, 6 grams. A chicken breast is about 30 grams depending on the size. You know, Greek yogurt, 12 grams. You can start to know the protein concentration, you know, amounts for each of and you can start to assemble what, what the heck am I gonna eat today to get to my target? And a lot of the nutrition stuff can be really simplified down to if you just do that, if you do nothing else but get the protein in, you're satiated, you're full, you're not gonna want to eat the crap. You're gonna, yeah, you're gonna, you're gonna meet your requirements and you're gonna feel better and you're not gonna want to eat the bad stuff. And it takes care of so many problems. Now, that's not the only, I don't wanna be that simplistic, but start with that. For people who out there who are struggling and they don't know where to go, just start with your protein and you'll find that the other macros of protein and fat and the, and total caloric intake and everything else that starts to get overwhelming, it's, it's so much easier when you just focus on protein first.

It's very true. If I were to ask you what the biggest nutritional mistake is that you see most people making, is it not getting enough protein or is there something else there that you would pair that with?

That's a great question. I, I don't know if I have one single thing, but I think that's a big one as well. I think dogma. I think dogma would be probably what I'll come to first. What I mean by that is there's all this banter and nonsense online around whether it's paleo or keto or carnivore or Mediterranean or vegan or plant-based or, or whatever. And, and people will espouse a certain diet or nutrition approach and find arguments for why it's the best one and the only one you should be doing. And, and, you know, they're shooting all over you by making you think that whatever you're doing is wrong. And In reality, based on your genetics, your body's very different than everyone else and what you need, what's right for you is very different. And so I, I really believe in the concept of testing and, and, and try different diets and go through the functional testing. Use your genetics. Your genetics can tell you so much about what your body responds best to. And not get stuck in the dogma of it can only be one way because it just simply Doesn't have to be.

No. What would you say is the top supplement most every man should take?

Creatine.

Creatine.

Same for women? No. Women as well. Yep. At least 6 grams a day. Some people are, are battling over whether it should be 10 or 20 right now. I think that there, the jury's still out. There's no literature on that yet. It's all, it's all opinion and, and, and speculation. It may be that 10 or 20 is better, but for now, at least 6 a day I think is, is, is important. I'm a big believer in, in multis. I know a lot of people say multis are a waste. It's kind of like going to get an oil change. I look at multis like, you know, when you get your oil changed, there's nothing wrong with your car, right? It's not broken. You're not fixing something. You're doing that so that you can prevent any problems, that you make sure your oil is fresh and ready and that your engine's functioning as best. That's kind of how I think of multis, how it's like you're giving your body all the micronutrients that it needs, knowing that they all may be topped off, but if there's any that aren't topped off or any that low, you're gonna catch that. You're gonna over— you're gonna be able to address it preemptively, proactively. Unless you're measuring your micronutrients every day, you have no way of knowing. And so I love a, a consistent daily multi for that. I, yeah, there's a lot of the supplements that I take personally, but I think ba— you know, from then on, from there, I would really suggest testing to know what your body needs.

Yeah. Yeah, generally when we have anyone coming in, uh, to work with us and if they have more than 30 pounds to drop, I think a multivitamin, multi-mineral is just a good way to cover basis, you know? Um, so I'm right there with you. And for creatine, do you like it from the muscle perspective of helping to maintain muscle mass, also brain health? Is that why you're recommending that?

Exactly. Yeah. Brain, muscle, vascular support, all of that. Yeah. I, I, and I don't think it has to be right after workout. I think it can be any time of the day really. Yeah.

Okay. If someone can only change one thing today to start improving their metabolic health, what would it be?

Ooh, one, just one thing. You're limiting me. Can it be what you, one thing? Can it, can it be just what you're, all of it's like just so overwhelming.

Yeah. What, what would it be?

Nutrition? Yeah. I mean, we, we've talked about a number of things here, but to, to, to share something different that people haven't heard here is I really believe that of all the, the, the lifestyle stuff that we could talk about as it relates to weight loss, especially as it relates to energy and hormones is, and building muscle is actually sleep. So the time you build muscle is when you sleep, you make growth hormone, you peak around midnight when you're asleep, you should be sleeping. Testosterone and hormones are, are typically produced more at night. Than any other time of day. That's when your body repairs. That's when, again, you're building muscle autophagy, clearing away, you know, cellular debris. A lot of these repair processes happen at night. Your brain, the clearings of the glymphatic system, which is really the, if you will, the, the fluid around your, your brain cells that, that you have to clear away the cellular debris that accumulated throughout the day. That's happening when you're sleeping. So many things happen when you're sleeping. When you don't get good quality, that's the keyword, quality sleep. You have poor blood sugar control, you have high cortisol stress hormones. So now you're storing fat, breaking down muscle. You are, um, you're destroying neurotransmitters in your brain. You're turning off hormone production. A lot of downstream negative consequences. Um, you are in a catabolic breakdown state. It affects your mood, it affects your cognitive function, it affects everything throughout the day. You're now gonna eat crappy foods because you're less motivated and less driven and less confident, and you feel like crap and you just want that comfort food and there's so many things that happen downstream by getting one poor night of sleep. And so if you focus on emphasizing sleep quality, I think so many things take care of itself from there.

Dr. Gappin, you're the perfect person for me to ask this question to. So I'll share with our clients how important sleep is and they say, well, I wake up in the middle of the night and have to use the bathroom.

Oh yeah.

What do we tell these folks? So, and then sometimes they have trouble falling back to sleep as well. Mm-hmm.

Yeah. So I've heard this question for my entire career as a urologist, and I'll tell you, most people think, oh my God, I woke up because I had to pee and now I can't fall back asleep again. Now the whole night's ruined. I will submit that having to pee is not what actually woke you up. Now our brain has a reflex. Our brain has a reflex that when you wake up, the first thing that actually gets triggered is I have to pee. And you may have a little bit in there, but most people when they wake up in the middle at 2 in the morning, it's typically 2, 2:30 in the morning, right around there. You wake up, you have to pee, and your bladder's half empty. It's not full. During the day, you wouldn't think twice about peeing at that point. And the answer is, is not your bladder, it's cortisol. So let me explain. So we have sleep cycles, right? We go from just above the surface of the water, if you will. To REM sleep, which is just below the surface where you're still arousable to sound, your dog barking, your spouse kicking you. That's when you dream, rapid eye movement sleep. And then you go into deep, light sleep and deep sleep, which is non-REM sleep, right? And then you come back up to the top again, you do REM again, you do the whole cycle all over again. And you go through about 4 to 5 cycles like that per night. Each cycle is around 1.5 hours or so. At the top of each of those cycles is when you're arousable. That's when you're almost awake, right? You actually will have micro-awakenings without even realizing it throughout the night. You have micro-awakenings. When you have a high excess cortisol, when your, your, your system is stressed, that's the opportune moment right there where your head pops up above the surface and you wake up and now you're awake and now the brain kicks, I gotta pee and now shit, I'm awake. I can't fall back asleep. I gotta go pee. Now I'm thinking about what I should have done yesterday, what I need to do tomorrow. And it's the stress and it's the perseveration. It's a cascade of events and it's 4 o'clock and you're still up thinking about what you could have, should have, would've said at that conversation yesterday and what I gotta do tomorrow. It's all freaking cortisol. And so this is a great segue back to where we first started the conversation about the impacts of stress and cortisol on our whole system and how when you can measure that and start to understand it, you can now regulate cortisol better so that it actually will improve your sleep quality. I swear to God, 90% of the time you're waking up at night when you think you have to pee, it's not because your bladder, it's because of cortisol.

Interesting. That's the root.

That's the root.

Thank you, Dr. Gappin, for coming on the show. I am so grateful for your time and you sharing your expertise. Will you tell us where we they can find more, learn more about you and your services?

For sure. Thanks so much. So gapinstitute.com, that's gapinstitute.com. And if you'll go to gapinstitute.com/launch, L-A-U-N-C-H, I have a high-performance health handbook for the listeners and an ultimate peptide guide and a lot of other great gifts there for you as well.

Awesome. Thank you so much.

Thanks, Ashley.

All right, you guys, I hope that you got a lot of helpful information from that episode. I loved it. Dr. Gappin is a wealth of knowledge. If you're watching this on YouTube, please drop any kind of comments, feedback that you have in the comment section below. Make sure to subscribe so you don't miss another video. If you are listening to this on a podcast platform, please leave your review. It matters. I read them all. In all, it helps us reach more people to create positive impact in the lives of others. Thanks you guys so much. Remember, you got to step up to make the change. Lead with your heart, train your mind, and do not negotiate with your body. I'll see you next time.