Functional Interventions for Men’s Health in Aging and Prostate Cancer with Dr. Geo Espinosa

We’ve been eager to put together a podcast on men’s health – prostate cancer, low testosterone, foundational vitamin and botanical supplements, nutritional interventions – and folks, it’s finally here! There’s a wealth of GREAT pearls to bring into your own practice from this month’s interview with our guest Dr. Geo Espinosa, ND. Dr. Geo is a long-time friend, a fellow naturopathic functional medicine physician, and a (if not “the”) definitive voice in urology and men’s health. His passion about men’s health helped him bridge the gap between conventional and naturopathic medicine. Together we discuss how to engage men in self-care, specific nutritional interventions to support men’s health, laboratory panels and optimal ranges, and some of his favorite vitamins and botanicals for his male patients. There’s a ton here, so settle in and take notes! We hope you come away from this podcast with some ah-ha moments and additional tools for your clinical toolkit – I know I did. Listen, learn, and if you would be so kind, leave a review on iTunes or wherever you hear my voice. Thank you! ~DrKF

Functional Interventions for Men’s Health in Aging and Prostate Cancer with Dr. Geo Espinosa

Why do men die on average eight years earlier than women? And how do you support male patients with prostate cancer, low testosterone, or prostatitis? Dr. Geo Espinosa is a naturopathic functional medicine physician, a leading expert in urology and men’s health, and author of the best-selling prostate cancer book, Thrive, Don’t Only Survive. In this episode of New Frontiers, he talks with Dr. Fitzgerald about all things related to men’s health, including dietary interventions, supplementation, laboratory panels, and how to engage men in their own self-care.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today of course is no exception. I’m thrilled to be chatting with my long-time friend and fellow naturopathic physician Dr. Geo Espinosa.

Let me give you a little bit of his background, you’re likely familiar with him already. But for those who have not listened to Dr. Espinosa, he is a naturopathic functional medicine physician like myself, but he is a recognized authority in neurology and men’s health. He’s on faculty at New York University Langone Health, he’s also on faculty with me over at IFM, he teaches in the AFMCP. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books, including the best-selling prostate cancer book, Thrive, Don’t Only Survive. He’s the Chief Medical Officer and formulator at the male focused nutraceutical company XY Wellness. He also co-founded and writes on the popular male health website DRGEO.com.

Dr. Espinosa, welcome to New Frontiers!

Dr. Geo Espinosa: Kara, such a pleasure, thank you. Finally we made it happen!

Dr. Kara Fitzgerald: Finally, we made it happen! Yeah, it’s about time, we hunker down and talk about men’s health.

Dr. Geo Espinosa: That’s right.

Dr. Kara Fitzgerald: My apology.

Dr. Geo Espinosa: It took you a while, we matter too, you know.

Dr. Kara Fitzgerald: Yeah, I know. When I asked you, I said, “Do you know”, when I emailed you, I said, “I don’t know that I’ve really had a men’s health podcast.” And you emailed me back and five seconds and you said, no, you haven’t, fyi.

Dr. Geo Espinosa: Well, I’m happy to be here.

Dr. Kara Fitzgerald: I got a really quick response.

Dr. Geo Espinosa: That’s right.

Dr. Kara Fitzgerald: Talk to me how you ended up focusing on men’s health.

Dr. Geo Espinosa: You know what, it’s something that just found me. So while I was training in naturopathic school doing my clinicals, for some odd reason, and it could be I don’t know, the universe, it could be luck, whatever, I just kept seeing a lot of men, and they wanted to see me. Meanwhile, the other student clinicians were seeing more women. So I said all right, but at that time, I wasn’t thinking of men’s health, I was just thinking, all right, these are all the patients I have, let me do another prostate exam and keep it moving.

Then shortly after, while I was still in school, I did an internship in a urology office here in the Upper West Side in Manhattan, and I just quite honestly became fascinated with men as patients, and I became more curious, certainly to figure out male conditions, but even to figure me out as a man. And that curiosity has not ended 20 something years after, in terms of really figuring out the male gender, biologically, hormonally, endocrinologically, psychologically, I’m really fascinated with the whole thing.

So after that, I did like a fellowship at the Columbia University Department of Urology under Aaron Katz for five years, and I really honed in on everything that has to do urology and men’s health. I really honed in on the conventional and medical approaches a lot, to the point where I was in the OR and things of that sort. And then I transferred over to NYU, where I am now at the Department of Urology and have been there for 11 years, again doing what I do.

So I think at this point, I have a good grasp of both sides very well, which I think is really important, because when patients do need a medical treatment, whether a pharmaceutical or a procedure, I think that I’m able to say yeah, look, we tried everything here, I think you need to move on and do the next thing.

Dr. Kara Fitzgerald: That’s such a gift! What a gift, a beautiful body of training, an enviable body of training, in both natural/functional medicine and then the larger community.

All right, well let’s cut to the chase. We have a lot to cover, I likely will just have to do a part 2, or get you on for a blog, this is just such a rich area and we’ve got a lot. So men die earlier a lot, a lot younger than women, eight years you said. Why is that?

Dr. Geo Espinosa: So when we put suicide aside, because suicide is a big component of it, and men, when they try to commit suicide, they’re oftentimes successful, when women often try, they’re not successful. So women would drink a bottle of pills and still survive, men would throw themselves off the bridge or shoot themselves. So putting that aside, men are more predisposed to cancers than women and they die from cancers more than women. Heart disease is more of a common scenario for men more than women, though after menopause, it kind of somewhat equates itself, but men would die from it more often than women.

Why is that? Well, we could always look at the hormonal element of things, in terms of testosterone and things of the sorts, but that’s more theoretical, and these are decent theories. For example, men are more aggressive when they have very high testosterone, and they’re very irritable and aggressive when they have very little testosterone actually. I always say, in men with andropause, let’s just call it that for now, whoever they are prior to that change in hormone, they’re 10 times more that afterwards. So if they’re an aggressive type, they’re going to be very aggressive with more testosterone, or they’re going to be very aggressive when their testosterone is depleted.

In general, men don’t see doctors, they don’t want to, it’s too vulnerable, it’s too risky, too uncomfortable, so if like a limb is falling off, then they’ll go. Women seem to be more proactive, they go, they get checked up more often. That’s changing little by little, particularly when men find a functional medicine doctor, I think they’re more open to our type of medicine than not.

But in general, I think those are the reasons, women tend to take better care of themselves and are more on top of things from that perspective than men.

Dr. Kara Fitzgerald: What are the statistics on cognitive decline, Alzheimer’s, is that higher in men?

Dr. Geo Espinosa: No, so the only one thing that a particular condition is higher in women than men is Alzheimer’s. So while Alzheimer’s does exist in men, and my high school football coach had it and died from it or with it, the only one out of the top 10 conditions that afflict humans that affects women more than men.

Dr. Kara Fitzgerald: All right, what might be thinking about as providers to engage men in self-care?

Dr. Geo Espinosa: Men don’t care about health, we have to be honest and straightforward with that, and I’m always honest and straightforward with that with men and my patients. Let’s be honest, we don’t care about health, it takes one to know one. You care about performance, performance is more important than anything else. And then you start caring about your health when something happens that interferes with your performance, whether it’s in the boardroom or the bedroom, or when you’re facing mortality.

I find that, because I see men and I see their spouses, that men are just more fearful about certain things. So while we actually tough in general, as a whole, and we are CEOs more often than women, and we look like we’re kicking butt and often times they are, I find that there’s an imbalance in courage with men. What does that mean? That means that they are super courageous in closing the deal, and that’s a drive, and they want to lift weights and some of them want to run marathons and do the business stuff, but they’re super weak, we are super weak and not so courageous in certain elements, and facing our mortality is definitely one of those things.

So this is one of the reasons why I actually enjoy working with men with prostate cancer, because there’s a good chance that once a man is diagnosed with prostate cancer, there’s a very good chance that they won’t die from it, but they still got diagnosed with the C word, so now they’re like, oh shoot. These are the best patients because they really do a good job in taking care of themselves because of their diagnosis.

So men have to be diagnosed to be healthier, it’s the bottom line.

Dr. Kara Fitzgerald: Right. You know what’s interesting, what it’s making me think about though, like how we could engage men, is if it’s performance driven, like I’m looking at epigenetics these days, and we ran a cool study that showed some reversal of biological aging. And as I’ve been getting into gerontology or the anti-aging science, the top scientists are really mostly men, there’s less women, and the top anti-aging bio hackers tend to be men, and there’s this really intense male energy in the field, I find it so interesting. But it makes good sense, I mean they’re really gunning for mortality, or immortality, excuse me, and there’s a high level of motivation for men to do it and get it right, it’s kind of extraordinary, you know intermittent fasting, ultra-marathons, et cetera.

And I guess I’m having a little epiphany, Geo, that you’ve obviously had a long time ago, but if we presented our medicine in a way that sort of tapped that energy, and perhaps we would really engage men in health, would you agree with that? What do you think, or no?

Dr. Geo Espinosa: Yeah, I would agree with that. I think there’s a little bit of a shift going on, and I’ve seen it and acknowledged it myself, but I think in general, look, it’s driven by tech, people in the tech field. So there is a little bit of a shift that at least many of the people that I’ve seen have bought into. The thing is that they’re just too busy, they’re trying to make more money and provide for their families. So my main message to men, and I get it, again I’m one, providing for our families, this is just natural, this goes back from thousands of years, we go hunt and bring the food, so that’s sort of how we’re wired evolutionarily, and I get it.

But in order for us to do that well and do it in a long game? So the conversation is how do we do this in the long game, not just to provide and then that’s it, and god forbid something happens, no, how do we do this so that we can do it way beyond the age of 65, 70, 75, 80. I have a patient 88 who’s still working and loves what he does and is very good at what he does, and everything he does, his daily regimen is such and is such a disciplined manner that he’s able to perform well. And I’m all on that male optimization, male anti-aging bandwagon, I’m loving all of it.

I think if you ask me, hey, what’s your mission? I think my bigger mission is, so most people would know me as a prostate doctor at this time, just because I talk a lot about it and see a lot of prostate cancer, BPH, prostatitis, and those kinds of things, and hormones and things like that. I think what my mission in my work is, how can men live longer and better as they age, not decline, but actually live better as they age. And we see this happening more often. And I think that prostate issues and erectile disfunction and low testosterone is what gives me that opportunity to work with these guys.

Dr. Kara Fitzgerald: Right, yeah. That’s right, yeah, it’s powerful what you said, get diagnosed with the C word and chances are you crack open. Well, I’ve got a lot to talk about, but before we jump into talking about testosterone and prostate health specifically, give me just some basics of what you’re thinking about with men’s health. Like you know, what’s a foundational, solid lab panel that we want to look at, what’s a foundational decent diet, et cetera, foundational supplements that you would be thinking about with most of your male patients?

Dr. Geo Espinosa: So just smirking because I’m, all right, how do I condense all that into a few sentences…..

Dr. Kara Fitzgerald: I know right, into a sentence. Let me put the cherry on top here, in a way that’s going to be doable, so that a man is actually going to say, okay, I’ll take this lab slip to Quest, okay, I’ll take these three supplements or whatever, like what are your core thoughts here?

Dr. Geo Espinosa: So, what I would with a man, I do this with men all the time every day, so the panel looks like this, there’s a simple lipid panel, and I know we can get into an NMR, lipo-profile and things of the sort, and we can get into lipo-A’s and things like that, I think that what I’m trying to accomplish is two things. Number one, what is the data that I need that, with that data, I can make changes with what I prescribe to help them get better? So it’s very important, sometimes I feel like we can just order labs and we don’t really do much with that lab, I try to function with intent when I order labs. The other things I’m trying to do is, what’s the labs that I need to get, along with giving me important data, that I can also have a conversation with their practitioner about their, either they may have a GP or they may have a urologist.

And then with the other data that I think it’s important to make changes and to prescribe and to see how they’re doing, that I can’t talk to their GP about because they don’t know about. So this is their functional types of labs, the functional labs, whether it’s Genova or different types of urine tests, checking for hormones and things like that, DUTCH test, and things like that.

So as a just off the cuff panel, I think that lipid panel, hemoglobin A1C, so you want to look at insulin resistance of course and everything that has to do with that, hemoglobin A1C, insulin, fasting glucose. You want to look at testosterone, free testosterone, SHBG, estradiol. You want to look at PSA of course, PSA and free PSA, that’s the one that could be another conversation, because there’s a lot of controversy with PSA, but the bottom line is that it is indeed helpful. We could talk about that for another two minutes later on, but PSA, free PSA, free percentage PSA. I look at IGF-1. Yeah, I do look at IGF-1 because it’s been closely linked with prostate cancer, so higher IGF-1 linked to prostate cancer, so I do look at that.

Dr. Kara Fitzgerald: Can you tell me, I mean this is interesting as far as longevity as well, we don’t want it either too high or too low, do you know your reference range off the top of your head? If you don’t, you could shoot me-

Dr. Geo Espinosa: Off the top of my head, I would say that I would probably say something ridiculous, oh, wait, that’s free testosterone, that’s not IGF-1. So off the top of my head, right, that’s not that one, so I would hold back from giving you that range.

Dr. Kara Fitzgerald: I’ll ping you on it later and folks will just pop it in the and, in fact, we’ll actually capture what you’ve just said. And if there’s anything else you want to add, we can pop it in the show notes, and if you have any papers that folks can reference, you can always throw those our way as well and we will put them on the show notes.

Dr. Geo Espinosa: Sure, sure, absolutely. I think I said estradiol, the thing about estradiol if I may, I may jump around and digress, but I think it’s important to note that as it relates to men’s health, one would think hey, lower estradiol, better, period, end of story, you want that testosterone to estrogen ratio to be significantly wide. And what I would say is that, estradiol is actually a very important estrogen, very important hormone for men, as testosterone is an important hormone for women. So estrogen in men, it helps with bone health, it helps with cardiovascular disease, it helps with even cognition, along with testosterone. So you want that range to be between 20 to 30, that I know from the top of my head because I do that all the time.

And I’m emphasizing that, really you want the testosterone to estrogen ratio to be about 20 to 1, roughly, and then you want the estrogen level to be between 20 to 30, roughly. So there’s good data to support that that’s a very healthy range for me, as opposed to if you have it at 10 or have it lower. I see a lot of our practitioners that are prescribing aromatase inhibitors, and maybe that’s the right thing to do in some cases. But I think that this is not the estrogen limbo in men, how low can you go, the lower you go, the better it is, this is not that, this is not that.

Dr. Kara Fitzgerald: Right, I appreciate that.

Dr. Geo Espinosa: Yep.

Dr. Kara Fitzgerald: Yeah, we always just tend to be concerned about elevation. Absolutely, I appreciate that nuance, good.

Dr. Geo Espinosa: I look at cortisol, again I look at cortisol, I want to know what their stress levels are, and then I do these other tests that I find to be helpful, this dried urine test-

Dr. Kara Fitzgerald: Oh, you do the DUTCH panel?

Dr. Geo Espinosa: … I do, mm-hmm (affirmative).

Dr. Kara Fitzgerald: So if you’re doing a DUTCH panel, are you doing just the salivary cortisol and the cortisol awakening response?

Dr. Geo Espinosa: Mm-hmm (affirmative).

Dr. Kara Fitzgerald: Okay.

Dr. Geo Espinosa: Let me just be clear, in my practice, maybe I do nutritional panel, but I don’t do much more than that, because at some point it becomes a little bit, I’ve learned through experience, I don’t know what your practice is, but too much of that, then I find that there’s not a whole lot of change that I do. I really want to get the information that will encourage me to do something, that if I do that then that will change, number one their numbers, but more importantly, their health and how they feel.

So I don’t do a whole lot more than that in my practice.

Dr. Kara Fitzgerald: Good. Yeah, it sounds like a good, smart collection of laboratory assessments. We do, if you’ve listened to my podcasts before, you know I’ve talked to Mark Newman at DUTCH and we’ve got some blogs on DUTCH, so people can circle over to those if you’d like to learn more specifically what Dr. Geo is talking about with that urine assessment. I was going to ask you about it specifically, I was curious about whether you were considering metabolites and so forth. I’m going to skip doing a drill down there, because I think we’ll just get in the weeds really quickly, because we’ll just geek out too much and I’ve got other questions for you.

So diet, a core supplement protocol you might be thinking about, basic exercise prescription, I just want to finish up on these.

Dr. Geo Espinosa: Yeah. All right, let’s dive right in. Diet, so what am I trying to accomplish with diet? The longevity component is always there, and I’m trying to help them with whatever they’re coming in with. Typically, they’re coming in with either prostate cancer, or low T, or BPH or prostatitis, so what’s the one diet that gives you the most bang for your buck in that regard? It is the Mediterranean diet. So I’m a big fan of the Mediterranean diet, I think it works very well, I think they do better with fish.

One caveat is that… well, there’s a decent amount of fat in the Mediterranean diet. I think that men with low testosterone need more fat that those with normal testosterone, so them eating a little bit more fat, whether it’s whatever, MCT oil in their coffee, or more fish. Mediterranean diet has a decent amount, but I think it’s actually really important. And I don’t think it’s just me, I think there is some research to support that, it showed that a low fat diet was correlated with low testosterone. I think in general, it would be like a Mediterranean diet, nothing sexy there.

What I would say is this also, men with prostate cancer, I would not do the ketogenic diet in men with prostate cancer. That’s a very important point, because a lot of people are prescribed keto, because they’re reading Siegfried’s work in Boston and so forth, which I think is excellent work, most of that work is related, reading great books, Tripping Over the Truth and things like that, great books, but they’re really focused more on glioblastomas and brain tumors, not prostate cancer. Prostate cancer is a whole different beast. And so what people tend to do is extrapolate, well, if it worked for this cancer, it has to work for that one, not really. Prostate cancer is not a glycolytic type of cancer like glioblastomas or pancreatic cancer, so it wouldn’t work in that scenario, in fact you can make matters worse.

Dr. Kara Fitzgerald: I’m going to guess if it has been published on, keto being contraindicated in prostate cancer that it’s limited, would this be more what you’ve observed over your years, or?

Dr. Geo Espinosa: Yeah. So I’ve written, let’s see… I sometimes forget what I’ve written and where is it published, but it’s certainly not in journal. I think I’ve written a little bit in Natural Medicine Journal and there have been blurbs there, I wrote something extensive on my blog on DRGEO.com about it. But what I did is put the pieces together, so what are the pieces? Is prostate cancer a glycolytic type of cancer like glioblastomas, where there probably ketogenic diet does work and that’s most of the research? The answer is no. Then you look at the other research suggesting a high fat diet is actually, fat, and of course, there’s different types of fat and so forth, but it seems like there’s more of a correlation of fat being problematic for prostate cancer in terms of making the disease worse than it is for brain cancer.

So then you kind of connect all those dots and you see what you see, because initially I drank that Kool-Aid, I was all about the ketogenic diet as well, I drank that Kool-Aid, I said well, it has to apply here. And what I did, and I now to some degree regret it, but this is why it’s called a practice, what I did was well, if it applies there, of course the Warburg effect is involved in the prostate cancer, of course it is. And I did, and I saw situations like not work out. Not to mention that this was a very difficult diet for people, and I said, hang in there, or try harder, and it was just not the right thing. So I saw that, I witnessed that clinically.

Dr. Kara Fitzgerald: Wow, okay. That’s valuable. Let me just ask you a couple of things, so you’re leaning towards higher fat, certain fats, but you’re not going full tilt keto, and I’m sure it’s obviously low glycemic, just all the beneficial pieces of the Mediterranean diet. I just want to ask you now, while we’re talking about prostate cancer and fat, what your position is on flax oil? There was, I don’t know, what seemed to me to be really poorly conducted research implicating flax or alpha-Linolenic acid in prostate cancer. And then also DHA and EPA has been somewhat vilified in relation to prostate cancer. What are your opinions there?

Dr. Geo Espinosa: All right, I love it, because I’m actually for my next book, I’ve been working hard on that particular topic on fats and prostate cancer, and particularly omega-3s and prostate cancer. I think you’re right about the fact that the correlation between alpha-Linolenic acid and prostate cancer, that’s sort of dubious. What I think is happening there however is that, when you look at flax seed oil, I think is very sensitive, so it’s very sensitive to heat and air and oxygen, things like that. So I think that unless someone does a really good job and keeps a tight lid, right container, doesn’t leave it open on the counter, I think that flax seed oil might be fine. There’s a Budwig Diet for prostate cancer from way back in the day, early 1900s I want to say, from Germany, where it’s really cottage cheese and flax seed oil mixed together and that’s what they ate, that was a holistic dietary treatment for prostate cancer.

Fast forward to now, what I would say is, eat the flax seeds, there might be some benefit with the flax seed, as opposed to just the flax seed oil, you don’t have to kind of cover your nose and just take the oil, not necessary, flax seed is easy. More data to support, at least correlation, in terms of there are some benefits there. I have people eat flax seeds prior to their prostatectomy, when they need prostatectomy for example, why? Because the data show that people, they looked at molecular tissue before and after, so they looked at the biopsy tissue, they had them taking flax seeds, did the surgery, they looked at prostate and they saw some regression of prostate cancer post prostatectomy in the group that consumed flax seeds.

So I look at that information, flax seeds is the right thing, and I don’t have them take or consume flax seed oil.

Dr. Kara Fitzgerald: Sure.

Dr. Geo Espinosa: With regards to fish oils and prostate, I laugh, because it’s like, man, really?

Dr. Kara Fitzgerald: I know.

Dr. Geo Espinosa: It’s a lot of things we have to talk about. And almost daily I’m answering a question on fish oil, which is what promoting me to write a whole paper on this.

Dr. Kara Fitzgerald: You go, and we need it! We need it. I actually talk about this in the Immune Module for IFM, and every year for the last 11, well just briefly I mention it. I’m ready to put it to bed, but it will stay in there because it continues to be an issue. So yeah, go ahead, I’m glad you’re going to write about it, say what are your thoughts.

Dr. Geo Espinosa: So here’s the deal. As it relates to omega-3 fatty acids and prostate cancer, it all stems from a 2013 paper in the JNCI by Brasky et al, from Fred Hutchinson out West. So they looked at, what they did is they looked at the blood samples from the SELECT Trial, they looked at their plasma levels. The SELECT Trial was like from early 2000s. So, they have all this data and they looked at data from the SELECT Trial, and they made the association of hey, those that had more DHA and EPA in their blood had more aggressive disease by about 70%, more aggressive, what disease? – prostate cancer.

So that was the kind of the conclusion of the story, and then the media took off with that, and it sort of became, it’s not correlation, it’s causation. I can’t tell you how many emails I answer. So omega-3 fatty acids cause, this is kind of how it’s interpreted, prostate cancer. And not only prostate cancer, advanced prostate cancer. All right, I have to dig deep.

Bottom line is this. God, there’s so many holes in that paper, it’s not even funny. One is, aggressive prostate cancer. Well, they included Gleason 7 as aggressive prostate cancer in that group. So if they had a Gleason 7 prostate, so Gleason is a way, not Jackie Gleason, Gleason score is a method of measuring the grade of prostate cancer, and how aggressive it can be. It goes from 6 to 10, the higher the number, the more aggressive it is, so a 9 and a 10 is very aggressive, a 6 is not much. Gleason 7 is intermediate, it’s not considered aggressive, and that’s by the D’Amico classification, it’s not considered aggressive cancer. So they included that as aggressive prostate cancer, that’s number one.

Number two, they looked at plasma levels of EPA and DHA. So plasma levels is like, if I eat a piece of fish today, plasma levels will tell me my omega-3s in my blood within the next 24 hours, not within the next several years or months. So they didn’t look at red blood cells, that’s number two Number three, the study suggests that those who ate more trans fats actually had a lower risk of prostate cancer. And omega-6s, which an imbalanced ratio between omega-6 and 3 is one of the potential contributors to prostate cancer, which is much of our diet in the Standard American Diet. So that was another hole in that. And those with higher omega-6s in their blood, also had higher risk of prostate cancer.

Anyway, it was interesting that this was even published, but the bottom line is that… and then now of course, fast forward even seven years after, we know it’s not only the prostate cancer benefits from omega-3s, which I think there’s a decent amount of data to support that, the cardiovascular benefits are really clear by now, so much so that there’s two pharmaceutical drugs that’s really a fish oil, or at least EPA. So I think that caused a huge disservice to men, because now men were freaking out and saying, well, I don’t want my fish oils. Meanwhile, cognition and all the other benefits, anti-inflammatory benefits from EPA, that’s so important, they were not consuming.

Anyway, I could go on and on about that, the bottom line is that, no, fish oils are not contraindicative for prostate cancer. The opposite is true, fish oils are actually beneficial for prostate cancer. And of course, omega-3s from fish oils are beneficial for multiple other things, including cardiovascular disease.

Dr. Kara Fitzgerald: Awesome. And then flax seed is important, take is as the whole seed or I’m assuming ground? Can you just tell me how you would recommend dosing that, like how much ground flax seed is a good idea to take daily?

Dr. Geo Espinosa: You know, I just tell them two tablespoons once or twice a day, mix it with whatever, smoothies, whatever salads. So two tablespoons.

Dr. Kara Fitzgerald: Okay, perfect. Thank you. I just really appreciate that. I’m thrilled to hear that you’re just going to tackle this kind of pesky irritant on the health scene, and something that we get pinged with. Okay, basic supplements?

Dr. Geo Espinosa: Yeah, so basic supplements. I’ll tell you my top five or ten, let’s just say across the board. So what gives men their most bang for their buck, regardless of their disease and maybe their dosing will change-

Dr. Kara Fitzgerald: Give me some basic dosing ideas as well, because everybody is going to ask me and I’m going to end up bugging you about it afterward. So your top 10 with some dosing idea, go.

Dr. Geo Espinosa: So, vitamin D, 5000 units a day, I do 4000 to 5000 units a day. So I’ll go to a little bit of why, but with vitamin D I think it’s just across the board, even from a testosterone perspective, anti-cancer benefit, cardio, now during the pandemic it’s pretty clear, et cetera. I like 4000 to 5000 a day, I measure and I see what their numbers are. What I notice is that people who take it not only with food, but take it with fat, and I still find that I don’t think that’s emphasized enough, it’s a fat soluble supplement, it’s a fat soluble vitamin. It’s not take with food, it’s not take with food, it’s take with fat. So if you give 5000 units and they eat that has some fat, the absorbability is much higher so then you see their blood will be 40, 50, or 60 nanograms per milliliter depending on size and things like that, and I’ve seen people taking 5000, it’s still below 30. So I think that the issue there is absorbability and they’re not just taking it, they say yeah, I’m taking it with food, they’re not taking it with fat. So that’s that.

Zinc, I think that if you were to put a gun to my head and say, what’s the number one mineral for men? That’s like asking me which one of my kids I love the most, but if you press on it, you’re like, I would say zinc, I would say zinc. Why? There’s hormonal aspects to zinc, zinc seems to kind of stimulate the Leydig cells in the testicles, it helps with the production of testosterone. It’s good for the prostate, I think the second area in the male body that has the most zinc is the prostate, associated with prostate cancer at low levels, et cetera. 30 to 60 milligrams a day, more towards 60 if I’m using it for testosterone production. I may give about a milligram of copper at 60, and probably not any additional copper before 60, or under 60 milligrams a day.

Magnesium. Again, the other important mineral, that’s why I said, what’s the most important mineral?

Dr. Kara Fitzgerald: Yeah, that’s right, magnesium is up there.

Dr. Geo Espinosa: I know, I know. And it’s not necessarily gender specific as you know, just very important, about 300 pathways in the body that magnesium uses. Certainly for sleep is one of my go to, a lot of my patients have sleep issues, so magnesium is important component of that. If they have a history of kidney stones, of course I work in urology, so all these kidney issues are sensitive, I’m sensitive to all these kidney issues, I give them mostly magnesium citrate, particularly if there’s calcium oxalates. If there is no history of kidney stones and things of this sort, glycinate, malate, some of these companies may have like three in one, and I think those are fine. That’s magnesium.

So there’s some botanicals that I’m a really big fan of, curcumin is the king for men. Why? You get a lot of bang for your buck with curcumin, you get a lot of bang for your buck. Good for the prostate, the prostate easily becomes inflamed.

So I’m going to digress just for 30 seconds real quick. Patient comes in the office, 62 year old male, he has urinary symptoms. He says, well, my doctor said it’s a prostate enlargement, so he gave me some meds for prostate. Not always true, just because they’re 62 year old male, it doesn’t necessarily mean that it’s a prostate issue, it could mean that they have overactive bladder. Or it could mean that it is squeezing on the urethra, but it’s not because they have BPH, it’s because they have inflammation and that the transitional zone, which is the area around the prostate that surrounds the urethra, that area is inflamed, and that may be squeezing. So it’s not necessarily a big prostate, because I’ve seen big prostates and have felt big prostates that have no urinary symptoms, and vice versa.

So I would say is, for curcumin, anti-inflammatory, one of the most potent. Anti-cancer, one of the most potent I would say. Good for brain health and prevention of Alzheimer’s, you just get a lot of bang for your buck by reducing chronic inflammation, and curcumin to me is one of the strongest.

Dr. Kara Fitzgerald: What kind of a curcumin product are you recommending and how are you dosing it?

Dr. Geo Espinosa: … The curcumin wars you mean? Longvida, Sabinsa, Meriva? The curcumin wars I call them. Listen, I use a variety in a supplementation. So at XY Wellness, we formulate a couple of things for men, and I use C3 Curcumin Complex. I love Meriva for example… sometimes I have them take three types, depending on what I’m trying to accomplish. So joint health is very important for men after a certain age, so I give them a glucosamine. I do have interest in XY Wellness but not in other things that I may mentioned. So if it’s okay with you, I’ll just give people exactly what I use. So for joint health, I give them Glucosamine/MSM Joint Comfort from Pure Encapsulations. I love that product, and I do three pills twice a day, that has curcumin in it.

So I may do three different types of curcumin. But my bias, and again, it’s just my bias because that’s what I’ve used is C3 Curcumin Complex. Look, I’ve looked at the research in terms of one better than the other, one is absorbed more than the other and all that kind of stuff, again, you need to have it with a fat. You need to have curcumin, if it doesn’t have bioperine and I don’t use bioperine necessarily, curcumin that I use has lecithin from sunflower oil. Bottom line is, have it with fat, and you need to have it with fat.

Dr. Kara Fitzgerald: And I know there’s much debate on whether it has to be activated in some way by the microbiome, and it’s actually a secondary metabolite that’s doing the heavy lifting in circulation. But I agree with you, I use a variety of different ones. Yeah, we won’t drill down here too much. If there’s something that you would recommend folks read, I’m sure people would be interested in learning a little more about the C3 form that you’re using.

Dr. Geo Espinosa: Yeah, it’s Sabinsa, great research, Meriva, great research, Longvida, great research, BCM-95, great research. Look, I’m also a formulator so I see the behind the scenes, and I’m like really, like this one costs 25 times more than the other one? I can’t use it, it’s not a viable product. So you got to keep that into mind. I mean the clinician doesn’t care, you just want to prescribe the right thing, but sometimes that’s what goes into my mind, so I want to see good research. All of them have good research to support that.

Dr. Kara Fitzgerald: Sure, yeah, right. But it does need to be affordable. Yeah, keep going.

Dr. Geo Espinosa: Glucosamine, so you’ve seen great papers on I think BMJ, showing again, association. Look, people poo-poo observational studies, I don’t. The reason that we know that cigarette smoking is bad for you is from observational studies. So I don’t necessarily poo-poo it, particularly when I’ve been in academic centers for a long time, I see how hard it is to randomized trials with drugs, with drugs, where there’s a lot of money behind it and everything. So to look at the end all, be all randomized trial and only go by that, I think in our world is not a great approach, so I do consider a nice observational study that’s powered nicely with thousands of people, particularly if it’s prospective, I do find value there.

So with that regard, I saw that glucosamine reduces the risk of all-cause mortality and has actually cardiovascular benefits, so we all take glucosamine and prescribe it for joint health, which even randomized studies have shown to be beneficial. Well, now there’s a side benefit that seems to help with all-cause mortality, and there’s some benefit there from a cardiovascular perspective as well.

Dr. Kara Fitzgerald: That’s pretty interesting. Okay, so we’ll grab that from you, we’ll get that paper for the show notes folks. Okay, keep going.

Dr. Geo Espinosa: Yeah, glucosamine is up there, and it just became, I think that’s a 2020 thing for me. I think that before 2020…

Dr. Kara Fitzgerald: It’s so old school of you! Sorry, it’s a great molecule, it’s been around for a long time. Yeah, you’re bringing it back.

Dr. Geo Espinosa: … No, no, no. In terms of top 10 for me, that’s a 2020 thing. I’ve been using it for 20 years. But glucosamine associated with joint health, period, end of story. It’s like saw palmetto? Prostate. Meanwhile, saw palmetto has been used for centuries for urinary problems in both men and women. So we’ve all created these links and these connections that may not be totally accurate. But in 2020, when I saw all this other research as it relates to longevity and cardiovascular, I was like, oh yeah, glucosamine, top 10 for me.

Dr. Kara Fitzgerald: Cool.

Dr. Geo Espinosa: Botanicals, so adaptogenic herbs are one of my categories of herbs, of botanicals. So ashwagandha is slowly winning that war, that battle, in my own head anyway, at least from a male perspective. Love my rhodiola, I mean love my rhodiola. Love my ginseng, ashwagandha, cordyceps, by the way cordyceps. Mice studies it’s shown, and again, this is mice studies but, it’s shown to actually activate Leydig cells in men. Why is that important? Leydig cells are testicle receptors but with LH that starts the production of testosterone. So you want enough Leydig cells, and you want them to be very sensitive to testosterone, so cordyceps tends to do that.

I would say, and I’m not saying necessarily that cordyceps is one of the top 10, but hey, maybe in 2021 it may work its way up there. But ashwagandha, ashwagandha is. Benefits with cognition, benefits with testosterone production, it seems it’s an adaptogen, so it seems like it doesn’t necessarily raise testosterone in men that, they just had a prostatectomy and I don’t want their testosterone to go sky high, it doesn’t do that, but in other men along with other protocols, it seems to help. It seems to help with fertility, it seems to help with stress, it seems to help with just natural energy, and a recent study shows that it seems to help with better sleep at night.

So ashwagandha, it’s up there, it’s up there for me.

Dr. Kara Fitzgerald: Good. And you would you dose that?

Dr. Geo Espinosa: Ashwagandha, 300 milligrams b.i.d.

Dr. Kara Fitzgerald: Okay.

Dr. Geo Espinosa: You can go 500 b.i.d., but I go 300 b.i.d. for the most part.

Dr. Kara Fitzgerald: Okay. Do you prescribe a D with K2?

Dr. Geo Espinosa: Yes. Let me just say, I prescribe K2. So it’s either one formula, I’m a fan of Designs for Health OmegAvail with D3 and K2, but either I do it separately, but together somehow, yeah.

Dr. Kara Fitzgerald: Okay.

Dr. Geo Espinosa: Actually, I just formulated something, we call it Better With Age, and it’s going to come out later on, and I have K2 in it with D and a few other things. So yeah, I am a fan of K2.

Dr. Kara Fitzgerald: Good, yeah. I figured you are. I’m just thrilled about your supplement company, XY Wellness, I look forward to-

Dr. Geo Espinosa: Thank you.

Dr. Kara Fitzgerald: … to learning more about it. All right, so what else? Is there anything else on the… do we a couple of more here? Where are we, I haven’t been keeping count.

Dr. Geo Espinosa: So I lost count, but man, I got more, I got more. I got more. So I like L-citrulline a lot, I like L-citrulline a lot. Why? Promotes circulation, a vasodilator, important for what? Important for lowering blood pressure, in fact, it’s shown to lower blood pressure in studies. What else? Well, what men care about which is erections and male sexuality, so it helps with that. So I use it quite a bit for male sexuality, improve circulation, and as a side benefit, it does lower blood pressure.

You got to be careful when you prescribe it however, because L-citrulline, sometimes you get a patient and their blood pressure is like 90/60, maybe 1 out of every 1500 patients, you get patient, and that’s your normal blood pressure. You give them a lot of L-citrulline, they’re going to feel a little woozy, they’re going to feel a little woozy. And I’ve seen that maybe a handful of times, so you want to be careful with that. But L-citrulline, a lot of bang for your buck, a lot of bang for your buck.

What L-citrulline does is kind of, it keeps arginine available, so it doesn’t get metabolized. So I like L-citrulline for arginine purposes, more so than oral arginine itself.

Dr. Kara Fitzgerald: Okay. So you think arginine will be metabolized and eliminated or used elsewhere, but L-citrulline keeps sort of like a background stash for use.

Dr. Geo Espinosa: Yeah, that’s right. That enzyme arginase is in the liver and in the gut, so then it’s highly active and citrulline kinds of bypasses them and just keeps arginine in the system.

Dr. Kara Fitzgerald: Okay, good. That’s great.

Dr. Geo Espinosa: Yeah. I like maca, maca is from the family of broccoli, and it’s like a crucifer actually, chemically wise. So these glucosinolates and things, sulforaphane and things like this, they have benefit as well with regards to maca. Sexuality, I think it’s fine, I think that it’s overly hyped, let me just take my maca and that’s it, I’m going to be a stallion, it’s not quite there in that regard. But I think it can promote and it can help with testosterone production, not only in men, but in women as well, I’ve read in research, that it helps with increasing testosterone in women.

My issue with maca is that you need a lot of it. So when you see a formula with it, there’s not enough of it there, you need about 1000 milligrams two to three times a day, so that becomes a little bit tricky. So you need a decent amount. I add it to smoothies and things like that.

Dr. Kara Fitzgerald: Okay. So you recommend the powder, and you just adjust it that way.

Dr. Geo Espinosa: I do, yeah. Correct, yeah I do.

I’ll end with this because we could go on, omega-3 fatty acids, we were talking about that before. I think it’s top 10, I think EPA/DHA are super beneficial.

Dr. Kara Fitzgerald: Let me just ask you about maca before this train leaves the station. Would you use it in place of like diindolylmethane if you’re looking at estrogen metabolites, would maca do the trick for cleaning up steroid hormone metabolism?

Dr. Geo Espinosa: No. I think DIM, I would use DIM for that purpose, as opposed to maca, or I would use both. Yeah, that’s a great question.

Dr. Kara Fitzgerald: I don’t think there’s any research on it, I actually hadn’t thought of it until you just gave a little background on it.

Dr. Geo Espinosa: That’s right.

Dr. Kara Fitzgerald: All right. Yeah, go over to omega-3s.

Dr. Geo Espinosa: Omega 3s, I myself take about eight pills a day of omega 3s, honestly. I think omega 3s are a great, great thing. You got the EPA anti-inflammatory, good for blood vessels, good for heart. DHA, amazing for the brain, I do feel better right now, COVID, snow, no sun, indoors, man, I need a lot of DHA to keep me happy, and vitamin D, and other things. So I do it, I have to take it. I think it’s super important, my kids take it, all my kids take it. My eight year old takes it. I think omega-3s are super important supplement.

Dr. Kara Fitzgerald: All right. So what are we going to do here? Were you going to add anything to that? Tell me dose, for men’s health, how are you dosing EPA/DHA, what’s your recommendation?

Dr. Geo Espinosa: So as a combined omega-3, we do 2 to 4 grams a day, as a combined omega-3, 2 to 4 grams a day. Of course, that depends on numerous factors. The size of the pill, many men don’t care for that but some do and they’ll say, these are horse pills, and then just more quantity of pills. As you know, some patients look, I take I don’t know, I take about 26 pills twice a day, myself, some patients are not going to do that. It always depends on what their starting point is, what they’re willing to do, what they want to do, and what therapeutic thing you’re trying to accomplish.

So if I really need to help them with their urinary problems and their pelvic pain or prostate cancer, I may have to do, I don’t know, 2 grams of fish oil and really hit the curcumin hard, like 4 grams or so, or 6 grams a day, depending on what I’m trying to accomplish. So that’s kind of the approach there.

I’m going to say one more botanical, I could go on with this by the way, I’m going to say one more botanical. This is where I live, in my head, every day of my life. Anxiolytics for men, anxiolytic botanicals are very important, why? I don’t know, every New Yorker, it’s not a matter if you’re type A, it’s a matter if you’re type A1 or A2, because everybody is type A in New York. So they’re highly sympathetic with regards to their central nervous system. I think that is one of the things that is causing us to have urinary problems. So you need these anxiolytics to keep them calm

So I would say is that things like Scutellaria, it’s one of my favorite, and Melissa, lemon balm, those are my two favorites within that regard. That’s an underrated botanical for men with urinary problems, that I think men can use. And then if they have prostatitis, I do kava. And I learned that from Eric Yarnell who is amazing, I’ll say he’s probably the other men’s health naturopath in the country, and he’s a herbal medicine guru. So kava is really, really good for men with prostatitis.

Dr. Kara Fitzgerald: Yeah, his textbook is out of this world, if you can get it. I don’t know if there’s an updated one, but that was our urology textbook, and it’s great, it’s really useful.

Dr. Geo Espinosa: Yeah.

Dr. Kara Fitzgerald: Or at least it’s a useful starting point, I know it’s pretty old at this point, but-

Dr. Geo Espinosa: He has a newer version now.

Dr. Kara Fitzgerald: Okay, good. You know, it’s interesting, just kind of thinking about this protocol, or at least some of your favorites, men might be good candidates for some of the custom pre-packaged supplement companies out there, so you can just do your grab and go packets. They ping us every once in a while, these companies, and I’ve really never, I’ve used them rarely, but I could see in terms of just making it easier, something like that might be useful.

Dr. Geo Espinosa: It’s funny you say that, because that’s actually what we, within the next three months or so, we’re transitioning to, at least at XY Wellness, with packets.

Dr. Kara Fitzgerald: Are you really going to do that?

Dr. Geo Espinosa: Yeah. So what we’re trying to do there is, particularly for the prostate cancers, it’s kind of sort of three different types, men on active surveillance, men who’ve had treatment, and men on a hormone deprivation therapy. So for each we’ll have packet and I think that will be useful for them.

Look, I open up all these bottles every day, it’s a pain, it’s a pain in the butt, there’s no question about it, and I feel like I’m a very motivated person. Somebody who’s slightly less motivated, they’re not going to do that, or they’re going to struggle, even though that’s the right thing for them to do.

Dr. Kara Fitzgerald: We’re really kind of coming over to the, we’re basically at the end, we’ve talked for about an hour. And we could, we could continue to go, I’ve got lots of questions to ask you, but I think we need to do a part two. But I also want to just again remind people of Dr. Geo’s resources, his website, his books, he wrote a book on integrative sexual health through Oxford University Press. And again, we’ll link to his work on the show notes.

What do I want to sum up here with? I don’t know, do you want to talk a little bit about-

Dr. Geo Espinosa: Yeah, I’ll give you and the audience a little bit of a summary here. Look, here’s the reality, I don’t care if your clinic says, The Institute for Women’s Health, you’re going to see at least 30% men, that’s where we’re going with it. Why? Because men want what you have to offer as an integrative functional naturopathic doctor. So that’s the trend that I’m seeing right now. Even if the title of your clinic is like, For Women’s Health, that particular office will see 30% men. Embrace it, men are awesome, men are loyal. What you’re going to see is your female patients will go to three different naturopaths. Men, if you’re their doctor, you’re their doctor – period, end of story.

So I think you’ll enjoy it. Yes, you may feel like, I don’t know what to do with it, high PSA, is this PSA high? Embrace it. Consider me a resource, DRGEO.com, I think there’s good information there. I’ve even gotten on the phone with a few colleagues who are trying to figure things out, not that I’m able to do it with hundreds of people. But I think there’s a decent amount of information or resources out there to get you going and for you to be successful with your male patients, they’re going to want your services. Particularly if you’re done good for their female spouse, what’s going to happen naturally is, hey, can you see my husband? Can you see my son?

I think it would behoove you to embrace it, it’s a wonderful group of people, just in general, as a gender. And we need good healthcare and good doctors, in general.

Dr. Kara Fitzgerald: Well, thank you for that. Yeah, my experience working with some men, I mean my practice is mostly women, but I do have I would say maybe 30 or a little bit above 30% men, and I agree. I think there’s much we can do, and people who come here are motivated, and interested in this.

I just want to circle back with you in some other medium and have a discussion or do some writing on testosterone and prostate health. So, people listening, just stay tuned for that, we’ll tap Dr. Geo on his thoughts there. I think it’s important for us, and you’ve got a lot of pearls. So we’ll keep the conversation going in another medium.

Thank you again for joining me today, it was just great to connect with you.

Dr. Geo Espinosa: My pleasure. Thanks so much for inviting me, it was a lot of fun. Thanks so much Kara.

Dr. Kara Fitzgerald: Absolutely.

And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible, through the years, without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies that I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.

And one more thing? Leave a review and a thumbs-up on iTunes or Soundcloud or wherever you’re hearing my voice. These kinds of comments will promote New Frontiers in Functional Medicine getting the word on functional medicine out there to greater community. And for that, I thank you.

Dr. Geo Espinosa is a naturopathic functional medicine doctor recognized as an authority in urology and men’s health. He is faculty and holistic clinician in urology at New York University Langone Health and faculty for the Institute for Functional Medicine. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books, including the best-selling prostate cancer book Thrive, Don’t Only Survive! He is the chief medical officer and formulator at the male-focused nutraceutical company, XY Wellness, LLC. Dr. Geo is the co-founder and writer of the popular male health website, DrGeo.com.

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