The Missing Manual for Men's Health and Longevity with Dr. Myles Spar

Ready to soundtrack your summer? With Red Bull Summer All Day Play, you choose a playlist that fits your summer vibe the best. Are you a festival fanatic? A deep-end DJ? A road dog? Or a trail mixer? Just add a song to your chosen playlist and put your summer on track. Red Bull Summer All Day Play. Red Bull gives you wings. Visit redbull.com/brightsummerahead to learn more. See ya this summer.

Study and play come together on a Windows 11 PC. And for a limited time, college students get the best of both worlds. Get the Unreal College Deal, everything you need to study and play with select Windows 11 PCs. Eligible students get a year of Microsoft 365 Premium and a year of Xbox Game Pass Ultimate with a custom color Xbox wireless controller.

Learn more at windows.com/studentoffer. While supplies last.

Ends June 30th. Terms at aka.ms/collegepc.

You have one new message.

Ring, ring, ring, ring, ring.

Translating. Disney and Pixar's Hoppers is now available on Disney+.

You could say that again.

Critics are calling it Pixar's funniest movie ever and a wildly entertaining ride. Blizzard potato. It's certified fresh and verified hot. Woo!

Now we party.

This is incredible!

Wow, I am clearing the rest of the day.

Disney and Pixar's Hoppers Now available on Disney+.

Rated PG. I'm JJ Virgin, PhD dropout— sorry, Mom— turned 4-time New York Times bestselling author. I'm a certified nutrition specialist, Fitness Hall of Famer, and I speak at health conferences and trainings around the globe. But I'm driven most of all by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information that I uncover with as many people as I can. And that's where you come in. That's why I created the Well Beyond 40 Podcast, to synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode, we'll talk about what's working in the world of wellness, from personalized nutrition and healing your metabolism to powerful aging and prescription-free Prescriptive Fitness. Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100. Don't miss an episode. Subscribe now at subscribe2jj.com to start unlocking your healthiest, most energetic self. Want to listen to the show ad-free? Head over to subscribe2jj.com and start your ad-free experience today.

So I know we usually talk about women's health and women's issues on Well Beyond 40.

And I also know that we all have special men in our lives. And so today I'm gonna dig into men's health and give you the kind of operating manual on how to help them get healthier. I have the perfect, perfect doc with me today. It's Dr. Myles Spahr. He went to the Michigan Medical School, worked as a humanitarian for Doctors Without Borders, And that really kind of triggered his appreciation for lifestyle and community, as well as, uh, the personal engagement, each person's ability to achieve their goals in health and life in general. He has internal medicine training. He has training in integrative medicine at University of Arizona Andrew Weil Center for Integrative Medicine. And he also established a free integrative medicine program at PQHQ in the LA area. He's board-certified in internal and integrative medicine and has now really focused on root cause medicine, Medicine 3.0, which you're gonna learn what that is. He's the chair of the American Board of Integrative Medicine as well. I wanted him to come on because he has really focused on performance, high performance. He's worked with NBA players, and high achievers all over the place. And what I wanted to bring him on and share was like, how do you talk about a man about his health? Because they tend to not be proactive, if you've noticed. And so what can we do to help there? And, um, what things should we be looking out for? And that's what you're going to hear today. And also, he is the author of the Optimal Men's health book and a TEDx talk as well. So we're going to put that in the show notes at jjvirgin.com/myles, and that's M-Y-L-E-S, but it will make it very easy for you to be able to have the conversation with the men in your life or even young men in your life and then get them started on the right path. So I will be right back with Dr. Myles bars.

Stay with me. This episode is brought to you by Google Health. Stop chasing someone else's definition of health. What matters is what's healthy for you. Google Health offers a new kind of coach built with Gemini for effortless tracking, sleep insights, and holistic coaching tailored to you. Visit googlestore.com to learn more and start start a new relationship with your health. Requires Google account, Google Health app, internet, and Google Health Premium subscription. Features subject to change. Availability and results vary. Not intended for medical purposes. Works independently of Gemini apps. Check responses for accuracy.

So good, so good, so good.

New markdowns up to 70% off are at Nordstrom Rack stores now. Stock up and save big on shoes, tops, dresses, accessories, and more must-haves for summer. Join the Nordy Club to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and Pick up at your favorite rack store for free. Great brands, great prices. That's why you rack.

Dr. Myles Spahr, welcome to Well Beyond 40. Believe it or not, we like have never really talked about men's health on this show, which is a disservice since we all have men in our lives and you are the perfect, perfect person to do this. So I am super excited to have you with us and where I'd love to start with is one way I think we can get men inspired and motivated is to kind of relate it back to performance, because I know you've worked with NBA players and executives. And when you look at any guy, especially as they're getting older, they, they worry about losing their edge and not being able to perform well. So what are some of the things that you've done with, say, NBA players and high performers that could translate over to you know, everybody else.

Yes. Yeah. Well, I think part of it relates to asking for help. Every professional athlete I've worked with has specialists that help them, right? They have coaches, they have trainers. They even have trainers for specific activities within their sport. So they'll have a— for basketball, they might have trainers that really work with them on doing jump shots and not spraining an ankle and knowing what's going on with their body at every point in time. And they'll have someone else that's working on other aspects of their body. They have ones that specialize in recovery, on supplementation, on nutrition. So again, looking for help, getting a coach doesn't mean you're weak. It means that you know that the best use of your time is not to do a deep dive in every single aspect of health and wellness. It's to find out who you can trust and then take advantage of that expertise and bring that on. Um, and I think the other thing is an acknowledgment among every really successful person, whether it's a celebrity or a professional athlete, It's having kind of a holistic perspective. And I don't mean a woo-woo perspective. I mean, for example, we looked at professional NBA players. We found that their shot accuracy went down if they looked at social media before bedtime because it affected their sleep. If they were revved up looking at social media and that sleep affects their performance. So looking at all the aspects of your performance and what do you want to win at in your life, maybe it's not being an NBA player winning a game, but maybe it's really winning at work or in your relationship with your kids, whatever. And then what needs to get you there and not being distracted by things that are going to pull you away from that and understanding what all would contribute to you winning at that. It's looking at stress again with basketball players. We looked at if they weren't focused, they would have a much higher risk of having an ankle sprain, the number one injury in NBA players, because they didn't really think about how to do that jump shot correctly and land correctly because they were distracted. So it's about learning that you control your reactions, doing breathwork, meditation, doing work on really understanding yourself and knowing how to stay focused, working on sleep, working on nutrition, all these different pillars. So I'd say the two things are getting help when needed from experts and really having a very holistic understanding of what contributes to performance.

I love that you framed it in terms of winning. Yeah, because those are like— I did this study with Alison Armstrong and she talked about the different words that you would use for like asking a man how they feel and they're looking at you like, what are you asking me? Versus what do you think? You know, and framing things about winning, you know, it changes, changes the game. There's so much talk out in the world of women's health about cortisol. Yes. And you just don't hear it in the guys' world at all. Like, how, how does a man identify this as an issue for them?

Yeah.

You know, and how do you make something like focusing on your sleep? Because I'll tell you, when I met my husband, he was sleeping 5 hours a night. I'm like, this is not going to work, honey.

Right?

Right. Right now I've turned him into like a major sleeper. Now he meditates like he does all the things, but none of that was like he— he slept 5 hours a night and he ran like crazy. And I'm like, okay, we're going to lift weights and we're going to meditate and we're going to get good sleep.

Like, nice.

Yeah, right.

Yes, yes.

He wouldn't have done it on his own. I saved his life. I always remind him this.

Yeah, yay, good on you and good for him. Um, yeah, I think so. You started out asking about cortisol, and so that does play into all this. I think one key point for listeners to understand is cortisol is toxic to your brain. Literally, it's toxic to your— toxic to your brain. It kills brain cells. It decreases something called BDNF, brain derived neurotropic factor that's very important in growing brain cells. We know, you know, when I was in med school, we learned, well, you're born with your brain, that's it. No, the brain continues to grow, and you can continue to develop what's called neuroplasticity— more synapses, more pathways, hopefully in good ways and not in bad habits. But to do that, you need this BDNF. Cortisol is toxic to that. And the ratio of cortisol to a male hormone that women have as well, but are especially important to male, called DHEA, is actually very important. And DHEA protective for those brain cells. So the first thing to know is if you have too much cortisol and not enough DHEA, both of which can be measured, then you need to adjust that by affecting your cortisol and getting it down by managing your stress better. Some guys mistakenly feel that, oh, when I'm really stressed, I'm really productive and I need that adrenaline. Guess what? No, nobody is. You may think you are, but you don't think creatively when you're in fight or flight mode. You think, how do I get out of this? And just get out of it and not think more broadly. So typically, if you think about it, sometimes you can't think of the most obvious— like an escape room. If any of your listeners did escape rooms, the people who are most stressed can't think creatively of how to figure out the solution, whereas the people that are just chill, we'll get this, we'll figure it out, they are able to think creatively. Because when you're stressed, that takes away brain energy. So It is a myth to think high cortisol is making you productive. It's like someone on crystal meth thinking they're getting a lot done when they're actually just running around not getting a lot done. So that's the first thing. And then I think what is contributing to high cortisol, it's not managing stress in a mature way. So looking at breathwork, looking at meditation or mindfulness, there are millions of great apps that can just help you tone down that stress feeling, which is cortisol. And measuring it. Everything's about measuring. That's— and we'll get to that, I'm sure— but part of this Medicine 3.0 is really measuring how you're doing, and that's where we should be in 2025. So you can measure something called heart rate variability, or HRV. You can measure that on an, on a, a smartphone, or use a device like an Oura Ring or Whoop band or an Apple Watch. And that's a great measure of how your cortisol, your sympathetic nervous system is, and then you can try experiments to lower your nervous system, which is gonna lower your cortisol. You can try sleeping more like your husband to see how that affects it. You can try breathwork, you could try journaling, prayer, you could try doing a sauna, try different things cuz it'll be different for everybody. What affects it, maybe even supplements. But I think the key is assessing where you're at with your stress response and your cortisol. And then trying things out and you'll see how much more productive you are, not less productive.

And since you brought it up, Medicine 3.0.

Yes.

What is this?

What is that?

Yeah.

What is it? I think, I think it was Peter Attia that kind of made it famous, but it's become kind of the thing that we're all working towards now that are more cutting-edge, modern clinicians that are really trying to help move our field of medicine and healthcare forward. So Medicine 1.0 was kind of very early before we really even understood the germ cause of disease, right? Then Medicine 2.0 was like, oh, there are these things called bacteria, they cause disease, let's develop antibiotics. It was amazing in creating the ability to treat acute disease, all about treating disease though. And that's why we are great at treating acute disease, because Medicine 2.0 got us there— intensive care units and emergency surgeries to open a blood clot and put in a stent and all these amazing, amazing developments. But there wasn't much focus on prevention and how do we participate more as individuals in our own health. So Medicine 3.0 is the evolution of that, saying, well, let's try not to need all those Medicine 2.0 interventions by actually looking at what can we do, how do we participate in our own health, by what we eat, by what supplements we take, by how we exercise, how we sleep, how we manage stress, in the name of prevention. And I would say in a proactive way, and then measuring it. So important in this Medicine 3.0 is using metrics. And that's a very guy thing. Again, stereotypically, right? With every man I work with, I have some metric tied to what their goal is. What's their individual goal they're trying to achieve, and how are we going to measure it, and how can we show where they're moving in that direction? And if they're not, then how do we hold ourselves accountable? So it's really looking at measurable goals, working a little bit to stay healthy so that participation and being very preventive-focused.

So in Medicine 3.0, like, what are the labs and things that you're measuring and looking at to give you this information? I'm assuming it's not like the old stuff that they used to do, right?

No, no. Yeah. I mean, honestly, the old stuff you get in your annual physical is actually based on what insurance reimburses, not on what would help you. And I know that kind of sounds like conspiracy theories, but it's just the absolute facts. I actually have a TEDx talk on this that talks all about this, that it's all about what was done to see if you're really sick and need to get treatment right away. But if you're really looking at prevention and looking around the corner and staying well, you need to do a deeper dive. And it doesn't have to be crazy expensive, honestly. But there are certain labs like, for example, the number one killer of men and women is cardiovascular disease. A regular lipid panel is literally going to miss the majority of people who are going to have a heart attack. The majority of people who have a heart attack have normal cholesterol. So you need to dig deeper. You need to look at other particles that are like cholesterol that increase your risk. So these are called, uh, ApoB is a big one, or something called Lp, and then inflammation markers like CRP. So I would absolutely add those 3 to a cholesterol panel. ApoB is all of the particles that are dangerous for heart disease, that are like one of the things you see in your lipid panel called LDL, but much more expansive. And they're looking at the number of those particles and all of them all together, not just the one you see in that LDL that increase risk. Lp is a marker of genetic risk. I don't know if your listeners remember Bob Harper, who is the host of The Biggest Loser, fit guy, young, and had a heart attack. His cholesterol was fine, but his Lp was off the charts. And actually, I contributed to a New York Times piece on this of why aren't we all getting Lp. I mean, look at this. That would have identified him before he had his heart attack as being at risk.

Thankfully, it saved them a lot of money. I mean, here's the thing, like, I'm— it's— I'm listening to this going, okay, if the insurance company is doing this because they're trying to do risk-reward and save money, they actually are not saving money by not looking at these things.

No, I know, I know. You can make yourself crazy trying to make sense of it. It doesn't make But so getting that Lp, again, it's not crazy expensive, but ask for that, especially if you're over 40, for sure. And then also looking at—

well, you only have to do that once, right?

That exactly. I mean, you can follow it over time only if you're doing very aggressive interventions or some injectable medications to lower it. So, but other than that, you're absolutely right. And then inflammation. Okay, so we know most disease, including early cognitive changes and Cardiovascular disease is all related to inflammation. So you want to measure what is your inflammation like in your body. The best way to do that is through something called CRP, C-reactive protein. Again, not crazy expensive, really important because if you have, let's say, normal cholesterol and normal ApoB and Lp, but really high inflammation, you're still going to be at risk and you need to do that. And there's a lot you can do and we can talk about that if you want to. I'm sure you've had episodes on decreasing inflammation. And then the last thing I would say is for cardiovascular disease risk, looking at actually has that risk expressed itself by getting some kind of scan, if possible and if it's accessible to you, of the arteries or in your heart to see if you already have blockages. So we can go into that if you want.

But then the scan you're talking about specifically is what, like a CT angio or what?

CT angio, ideally, because that looks at what's called soft plaque and calcified plaque.

Um, can you talk about the differences between those? Because I think this is super important.

Yeah, sure. So yeah, so, you know, heart disease happens when you have a plaque in your vessel taking blood to your heart and it ruptures, explodes, and causes a blockage of blood flow. That has to do with inflammation and a plaque being there. That plaque could be hard or soft. So there are coronary calcium scores which are helpful that look at the hard plaque to see, have you had plaque buildup over years that's been there so long it gets calcified? And that's certainly helpful and good to get to see, have I had issues for a while that I need to make sure I address The newer, even better, is one that looks not only at that hard plaque, but what's a soft plaque? So you can think of it as newer plaque. It hasn't been around long enough to get all calcified, but it's still there and can therefore rupture and cause a heart attack or stroke if it's in a blood vessel leading to the brain. So it's a more expensive and invasive test. But if you're at risk based on first doing those tests and then you see you're at risk, then investing in a test like that can be really helpful., to know where you're at. And I think what can help you decide what all testing you need is doing a genetics test. And that's kind of where I like to start, just to see where do I need to focus my attention? Do I have risk of diabetes and I need to test for that? Do I have risk for heart disease? Do I have risk for Alzheimer's? Where are my, my kind of weak spots genetically? Which doesn't mean I'm predestined to have a problem, but it means I need to work a little harder to attenuate that risk and do a little deeper dive in that direction.

This episode is brought to you by State Farm. You know those friends who support your preference for podcasts over music on road trips? That's the energy State Farm brings to insurance.

With over 19,000 local agents, they help you find the coverage that fits your needs so you can spend less time worrying about insurance and more time enjoying the ride. Download the State Farm app or go online at statefarm.com.

Like a good neighbor, State Farm is there.

So changing gears over to my favorite subject of all. Yes. And that is muscle. Uh-huh. You know, I'd love to address muscle and testosterone, those two things. Yeah. But where, where does muscle come into this? Because again, when I met my husband, he was— I'll tell you a little interesting story that you can unpack is he'd always been a runner. And a very tall, uh, lanky guy. You met him. And we went and did DEXA scans a couple years ago, and his DEXA scan for an athletic guy who eats healthy— and he would go work out, but I was like, I kind of felt like he was phoning it in, but I wasn't going to say anything, you know. It's like no profit in your hometown. But, um, his DEXA scan was 25% body fat.

Wow.

Okay, so normal weight, if anything a little on the light side, and you know, 25% body fat. I'm like, honey, you're skinny fat. Yeah, you know, he kicked it into gear, and what he did was, um, his testosterone was sitting at around 300, he cranked it up to 900, and then we did everything else, like upped his protein, like added, like upped his weight training, everything. Got him from 25% down to 10%.

Nice.

And what was cool was he dropped 27 pounds of fat and put on 24 pounds of Amazing. I wish we'd done one intervention at a time because it was 8 months. I always tell people testosterone had to do like a good part of that, right? Because there's no way you're putting on that amount of muscle and, you know, in 8 months unless your testosterone's really gotten kicked up. But I love, love you just to unpack that, talk about the role of muscle, because here's the thing that, that made me crazy about this. You go to the typical doctor's office, you step on a scale. He was normal weight. He looked— you would never have suspected this.

Right, right, right.

And, you know, the difference is insane. But no one would have ever known unless they were looking at body composition and, you know, and then unpacking. And again, they would have kept his testosterone at this lower level.

Yeah. So insane.

Have at it.

All right. I'm going to talk about muscle and then we'll get to testosterone. So muscles, hugely important, right? Especially in the last, I don't know, 5, 10 years, we've seen that loss of muscle mass, which is called sarcopenia, is correlated with early mortality.

Okay, but stop right there because here's my issue with sarcopenia. Yeah, we don't even have a really good clinical definition of it and no one's looking for it. Like, how are they looking for it, right?

No, it's a great point. But in general, I would say doing like a DEXA scan and looking to see what is your muscle mass versus your fat mass. And for guys, it's different from women. They have higher general fat mass. Um, under 15% is really— should be the goal. So your goal isn't just like your husband, not on the scale. That's not going to help you. It's what your waist circumference— if you can't get a, uh, DEXA scan, or through a DEXA scan, or another— they have the dunking ways to measure your body.

Oh God, we had to do that in grad school.

Yes, exactly.

Horrible.

I know. So try to get— yeah, DEXA is the gold standard, and they're not that expensive. But yeah, under 15% is what you kind of want to go for. But the reason this is so important is That amount of muscle mass is number one, important for longevity. Number two, it's actually hormonally active. Muscle is not just blob tissue, just like fat tissue and just— but muscle actually makes myokines. They make hormones that affect your heart disease risk, your liver, your testosterone, your pancreas, insulin resistance. The big issue right now, we're all metabolically dysfunctional and we all have high blood sugar and insulin resistance. And the more muscle mass you have, the more insulin sensitive you are. The less muscle mass, the more insulin resistant. And that's directly related to things you've probably heard about on JJ's podcast here, AMPK, and all of these, these inflammatory mediators that are actually favorably impacted by more muscle mass. So number one, it's not just about having your beach body, it's about your longevity and your health.

That's a side benefit.

That's right, exactly. The, the most— and that's why you need to work out your lower body and do your legs, guys. That's the thing, guys.

No, I know, biceps and chest, biceps and chest. I'm like, come on, come on, you have giant muscles in your legs.

And so you're not going to get all these benefits of muscle mass just from your chest and biceps, right? Back especially, and quads and your glutes. Don't forget this. So anyway, so muscle mass is important for metabolism and for testosterone production. Okay, so it's, it's this like positive cycle. The more testosterone you have, the easier it is to build muscle. The less muscle you have, the lower testosterone, and then it's harder to regain that muscle. It's this kind of vicious cycle or positive cycle depending on which cycle you're in. So absolutely assessing where you're at hormonally with your testosterone and and your estrogen are really important as you're trying to build muscle. Testosterone helps you build it. It's what's called androgenic. Um, estradiol, which we have as men— we have less than women, but we have some— should also be checked. The biggest mistake I see around testosterone is guys will get their testosterone checked and they'll say, oh, my doctor said it was fine, but all they had was just a regular testosterone check. So for women listeners out there, if you're thinking about your husband, your father, your son, anybody, and you're wondering what's going on and their body isn't looking great and they're depressed and they're losing muscle mass, check a hormone level, but check not just total testosterone, check what's called free testosterone or bioavailable testosterone. Not that hard to do in addition to testosterone, but that's really, really important. And then also check an estradiol because a guy will have the same issues with high estrogen that he has with low testosterone. So we start with that, and then if it's in the 300s, like your husband, that's very, very low. What also makes me crazy is—

but here, Miles, I've heard this is normal. I can't tell you how many times I, I literally had someone DM me on Instagram, they said my husband's testosterone is 300, the doctor said fine.

I'm like, ah, no. Okay, yeah, so like two things with that. One is, yeah, you know, for some labs it might be considered normal, but guess what, the normal range on labs It's about the average of the men who went there and got a testosterone drawn, which is not healthy and not optimal. You want what's optimal, not what's just normal by that LabCorp or Quest Lab. Okay. And so we know that 300, 350 is low. It is not optimal at any age. The other thing I would say is that that doctor probably told that person is, yeah, testosterone declines with age. You just deal with it. Well, that's like saying, oh yeah, you get a cataract when you age. Just deal with it. No. You get the cataract fixed, you get the cataract taken out. You don't just deal with it. You don't have to just deal with testosterone declining. Yes, age is the number one cause of lower testosterone, but it doesn't mean you just deal with it because it has impacts. In fact, low T is associated with mortality as well. So getting it treated— and we can go into that if you want ways to treat it— but it's absolutely important in longevity, but also in muscle mass and in making sure you don't get metabolic syndrome and heart disease and all these other downstream effects.

And where are you trying to get it to?

Well, so that depends on— you aren't just treating a number, you're really, really treating the symptoms. So if you have a guy, symptoms of low T, for example, are obviously some sexual issues, low libido, sexual dysfunction, ED, erectile dysfunction. But it can also be things like moodiness and not able to put on muscle despite working out, gaining more fat mass. So fatigue. So you're looking at, at what point you get those symptoms better by giving T, but generally the upper third or so of the range. So we're talking like 700 to 1000 for total testosterone levels is generally good. You're not— if somebody still doesn't feel great at 1000, you're not going to make them feel much better at 1500. There's something else going on. I don't buy it that, that they would— they would have a testosterone issue if it's in that range. But typically the upper third— and I don't agree with labs that say, oh, a normal range for a 30-year-old is different from a normal range for an 80-year-old. No, optimal levels are optimal levels no matter the age. We— it's safe. And this big study just came out last year called the Traverse trial. Trial, very big study showing once and for all that even in older guys at risk on testosterone, there was no increased risk of using that testosterone if they needed it to get them into a normal range. It did not increase risk of cardiovascular disease. So it's safe and improves quality of life and improves exercise, improves bone health. A big cause of frailty in aging is bone issues in men, just like women, and low T contributes to that. So it's very important to normalize it.

You know, you look at this and it's the same with, um, women and hormones that go— but all of health problems happen when these hormones go down.

Mm-hmm.

Yeah. So why are we sitting here afraid of this?

No. And for women, didn't we learn a lesson with women? For years we made the mistake of trusting those trials that came out in the '80s that said, oh, don't use hormone. Hormone is terrible and dangerous. And finally, in the last 10 years, we've realized, oh, we really did a disservice to women in poo-pooing hormone replacement. It has a lot of important effects and if done correctly, is really actually healthy. Same thing with men. Like, we don't need to relearn the same thing.

Now, I know that, that the guidelines have shifted a lot. Like, years ago it was any man going on testosterone also needed to go on like something so that it didn't convert to estrogen. So where are the guidelines now with that?

Yeah. Yeah. I mean, basically you want to measure your estrogen. So testosterone gets converted to estrogen. It's being an enzyme called aromatase. And so Some guys will need a blocker of that enzyme. This is where the genetic test can be helpful. It can tell you, are you a guy who's more prone to converting testosterone to estrogen? If I give you testosterone, you're just going to convert it all to estrogen, in which case I have to give you a blocker. Or are you somebody that doesn't overconvert that? So there aren't guidelines on, on testing for that genetic test, but that's where we can get to this personalized level, right? Where I can know for Jim, I give him testosterone with a blocker. For Ted, I don't need to. To, but it's so generally the guidelines are to at least test estradiol and then retest after you start testosterone to see if it's gone up. And if it's gone up, you block it. Some guys will make the mistake of blocking it too much. We do need some estradiol. We don't want zero. It's important for bone health, for heart disease. And some, like, guys who get roids in the gym, frankly, that aren't as healthy and reputable, they might hear from other guys at the gym, oh, and take this blocker you want to get your level down to zero. That actually isn't healthy. You want to get it down to a healthy level. So that would be between 10 and 40 for men for estradiol. Um, if it's much over 40, you could have symptoms, but you don't want it under 10 because that actually is dangerous.

Now, you mentioned briefly about brain health. I don't know the statistics for men. I've been paying attention to the statistics for women, and they're pretty high. I think women are a higher risk for dementia and cognitive decline.

True.

But what is the risk for men and what can they do here?

Yeah. Yeah. So of the top 10 premature causes of death, so preventable cause of death, men win at 9 of them, but women win at 1, and that's Alzheimer's. So Alzheimer's— die more often of Alzheimer's than men do. So that is true. But men do get Alzheimer's and they get early cognitive changes and the, The thing we know now is a lot of that is due to inflammation in the brain, and it has to do a lot with blood sugar in the brain. David Perlmutter talks about type 3 diabetes, and he's, he among others, looking at how blood sugar in the brain, getting rid of blood sugar, actually the enzyme that gets rid of blood sugar competes with the enzyme that gets rid of plaque in the brain. And so if you're working on getting rid of blood sugar, you're gonna have more plaque. We now know there's a lot more than just plaques that weigh into dementia. There's a big tie-in with metabolic issues that we hear about with heart disease and risk of early cognitive decline. So what I would say to keep it simple is anything that's going to help the heart is going to help the brain because you're going to help blood flow and you're going to help inflammation. So I would really think of those together. If you want to get more kind of nuanced, there are some specific supplements and nutrition regimens that can really contribute if somebody already knows they have bad genes around Alzheimer's, or if they're having some early cognitive changes even early Alzheimer's. There's Dale Bredesen wrote this amazing book called The End of Alzheimer's, how you really break down and see based on lab tests what particular issue does that person have contributing to their dementia and what should they be doing with sleep or stress or inflammation or blood sugar. But for the most part, anything that helps heart disease around blood flow and inflammation is going to help brain health. And one quick interesting thing, JJ, that I found out that I read about recently. So it used to be that guys' number one concern in terms of longevity and getting older was around prostate cancer, and now their number one concern is brain health and early cognitive decline, even more than prostate cancer.

Hmm.

So it is top of mind, no pun intended.

So should we— if someone did have, say, you know, the APOE4 genotype, yeah, should they be more proactive, or would it be that being insulin sensitive and exercise and sleep and all the things would be enough, or would they want to go farther than that?

Yeah, great question. Yeah, I would go farther. It depends to some degree if they're what's called heterogeneous or homogeneous, right? So you get two genes— I know your listeners know that— one from mom, one from dad. If both are this E4 copy, then you're at about 10 to 12 times a risk of early Alzheimer's. So I get more aggressive with my patients like that, which basically means you're absolutely dialing in sleep, dialing in stress, Exercise, hugely important, but also looking at specific supplements and diet. So supplementation, there are supplements that really help boost what I just said earlier, this brain-derived neurotrophic factor, BDNF. There are supplements that can help things like, um, citicholine and phosphatidylserine. And I love mushrooms and not—

me too, right?

Yeah, but especially lion's mane and And these are called nootropics, and they're absolutely shown to really help with cognition. The most important thing is to use your brain. And so learning a language, constantly doing something that builds those new pathways that I talked about, that's a huge one. But the exercise is a big thing I think that we forget in people that are at higher risk, because the more you exercise, like I said, you're going to promote growth factors all over the body and in your brain especially. So I think that's a big part to include. And just being really aggressive with that.

Yeah, when you look at cognitive decline, the— and you could only pick one intervention— exercise beats everything hands down. Yes, hands down. Yeah, which makes me so happy. Yes, I was like, I finally feel like the exercise physiologists are getting their due here. Yes, you know, you're always the low men and women on the totem pole. Now it's like every single longevity marker, we're like, exercise, exercise, exercise. No, it's true.

And I would just say, just to clarify, to break it out into the various types, right? I know your listeners know this, but it's looking at not just the cardio, which a lot of people focus on, and that's hugely important.

That it's hugely— but I think it's actually the least important of all of them.

Yeah, I mean, I think strength training, like we talked about muscle and how you stimulate growth factors, how muscle is, is hormonally active, it will stimulate brain development. And then flexibility to prevent falls, and then core strength. So like, those are 4 really important pillars. And you could do some things that touch all of them. Yoga can touch a lot of those things, right? It's a little bit of strength, bodyweight resistance strength. It's certainly flexibility and certainly core. Pilates touches a lot of those, but you got to incorporate all those elements.

I love that. Yeah, that's why you could just do high-intensity functional training, you know, and get everything. Absolutely. And get the HIIT and get everything else. All right, so to put a bow on this, yes, you're going to give our listeners one thing that they could go back to their favorite man in their life and say, this is the one thing I would love you to do, what would it be?

I can only pick one. Oh my God.

Okay, well, one, one, one.

I'm— I mean, I think it's, it's— I would say measure. I would say measure is the number one thing. And then I want you to measure when you're going to start an exercise program, get your body fat down to 15%, measure your stress. Um, so I think like finding what matters to that guy and measure how it's moving and then coordinate interventions to move that mark.

I think that makes a ton of sense because first of all, I'm, I'm a big measure person. Like, what you measure and monitor, you can improve. But especially in the male psychology, yes, it's hugely effective. Yeah. And again, it was the only way— like, the way I got my husband to do— to, to you know, to get moving on this stuff was taking him to get a DEXA scan.

Yeah. And it incorporates this competition a little bit and gamification a little bit. Really respond to. But the other last thing I just want to say, and you can totally edit this out, but we didn't touch on it. So important is relationships and connection. And we don't talk about that enough with men. I think women talk about that. That's hugely important. We learned in COVID, men didn't do well in COVID because we didn't have nearly the relationship.

What is up with you guys, though? Like, here's the thing. I watch— I watch watched my husband, all my guy friends, and they just don't— like, women have such a different way with relationships and talk through all our stuff, and guys, like, they don't do it.

I know, I know. I, again, I think it's an embarrassment in front of other men, but that's why it's like a shoulder-to-shoulder thing with guys instead of face-to-face. So there are activities you do with a guy that will help you. Then suddenly, as you're helping him with, you know, with his deck, you can be like, hey, I'm Speaking of wood, as opposed to just confronting him with it.

It was funny when I had, you know, when I had people one-on-one, I would do all the nutrition and fitness stuff, but I would get them out working out and then it was like, blah, blah, blah, blah. Okay.

All right. Exactly.

Yeah. None of the stuff you could ever ask them just flat out, they wouldn't tell you. But then, you know, once they're ready to talk, same with my sons, once they're ready to talk, it's coming out.

Yes. You never know when it's going to happen, but you got to be there.

Now you've written a book that's the perfect, like, manual for men. Tell us about it.

Sure. It's called Optimal Men's Health, um, and it's really an easy-to-read kind of list of things to look for, things to talk to your doctor about, what kind of labs, like we've touched on, you should be getting. And really my toolkit around how, you know, because men love a toolkit, around what you can do to really get into this idea of how I stay healthy as long as possible.

Perfect. And the TEDx talk that you did, what's the title of it? Because I want to link to all of this in the show notes. Oh my God. Well, we can just look for Dr. Miles Barr again.

I have to look that one up. It's been a while. Change your annual checkup to a check-in and live longer.

Oh, it's a whole—

catchy.

There you go. Catchy. Checkup to check-in. So Okay, we'll put both of those at jjvirgin.com/myles. M-Y-L-E-S. Right. Yes. M-Y-L-E-S. And thank you so much. All the women here, thank you for giving us the tools to get the men inspired in our lives. And just keep doing your stuff. We need you out there.

Thank you so much. I appreciate it. Great to talk.

Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great and are built to last. Check me out on Instagram, Facebook, and my website, jjvirgin.com, and make sure to follow my podcast at subscribetojj.com so you don't miss a single episode. And hey, if you're loving what you hear, don't forget to leave a review. Your reviews make a big difference in helping me reach more incredible women just like you to spread the word about aging powerfully after 40. Thanks for tuning in, and I'll catch you on the next episode. Want to listen to this show ad-free? Head over to subscribetojj.com and start your ad-free experience today. Hey, JJ here, and just a reminder that the Well Beyond 40 podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional channel, make sure that you do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.

Ryan Reynolds here from Mint Mobile with a message for everyone paying big wireless way too much. Please, for the love of everything good in this world, stop. With Mint, you can get premium wireless for just $15 a month. Of course, if you enjoy overpaying, no judgments, but that's weird. Okay, one judgment. Anyway, give it a try at mintmobile.com/switch.

Upfront payment of $45 for 3-month plan equivalent to $15 per month required. Intro rate first 3 months only, then full price plan options available. Taxes and fees extra. See full terms at mintmobile.com. The most memorable gifts aren't found, they're made. Zazzle is a custom marketplace where you pick any product, a mug, a card, a tote, a phone case, and make it personal. A photo, a name, an inside joke, the kind of gift that actually fits the person. That's what 30 million customers have been coming back to Zazzle for over 20 years to find. Right now, save 25% on your first order at Zazzle.com. That's Zazzle.com. Make it ZA-mazing.