The 5 Step Guide to Shrink your Prostate , (Even if you are 80)

So, welcome. Picture this. You go to sleep. Uh, you fall asleep and then wake up again in a couple of hours. Or if you're, uh, a female, you wake up a couple hours because your male partner woke you up. Um, your wife, your husband woke you up. And the husband is waking you up because he's got to go pee. He's rushing to the bathroom. You get there. You're the flow is weak. You push and you can tell, you know, there's still some left there. You really, as much as you had felt a need to pee, you really didn't pee that much. No matter how many times you try, your bladder just never really feels empty and there's always some left there. And by morning, you know, you're frustrated. You're it's still tired and you're wondering, is this how life is going to be for an old man? Uh, as we say all the time, growing old's not for sissies. And this is clearly one of them. It sounds like a funny story, but when you lose sleep, night after night after night after night, you get diabetes and metabolic disease. It only takes one night to create 48 hours of, uh, increasing pre-diabetes or diabetes, insulin resistance. Um, loss of sleep has been demonstrated to have a huge negative impact on health.

So, in today's show, we're going to see if we can change that. We'll show you how you can just use an easy five-step guide for shrinking your prostate. And yes, even if you're 80 years old, this can still work. Hey, Sus, you ready to join us? Absolutely. Um, I'm honestly feeling like I'm not the expert on this topic because I haven't dealt with this. That's true. Uh, uh, but I have seen plenty of people and patients dealing with this and we have gathered some of the best recommendations we have seen from the evidence and from the practice and whenever we help people with this problem. You have your own stories with this, which is more like prostatitis rather than, uh, uh, prostate hyperplasia, which we'll explain. Well, I have LUTS, too. Oh, yeah. Which is related to that. Would you mind explaining what LUTS is? Lower urinary tract symptoms. Uh, what we just described here, getting up to go to the bathroom at night is one of the key ones. It's one of the most important ones. And there's a nucleus in your brain that helps you go to sleep. Um, it, it feeds on a chemical which I, I'm blanking on right now. A chemical that helps you sleep. By the time you sleep through to about midnight, you lose some of that need to go to sleep. Now, why do I go into that? Because your bladder always fills up when you got this problem. And it's like three or four hours after midnight, you have to get up, walking to the bathroom, going through this episode, totally wakes you up, and then you can't go back to sleep because your brain is not geared to go back to sleep after you wake up early in the morning. How common is that? You know, you talk to our patients, too. It's like huge. You see it all the time. And yes, I've had that for years and years and years. Yeah. Yeah, that sounds awful. I gotta say, it is awful. And if you're dealing with that, like it really messes up. You mentioned sleep. It really messes up your sleep. And when you have sleep issues, it really messes up your metabolism as well. So, we, in a big way. Prostate issues are sleep issues. Yeah, definitely.

So, so let's go through some of those five steps that we gathered for you guys so you have an idea and see what else you can do to improve those symptoms and and also let's talk about shrinking your prostate because there's a specific caveat that I want to mention before we move on on the steps. I want to show you an image. This is the same image we showed like two weeks ago. And, uh, this is a prostate, inflamed prostate. And we mentioned two terms, um, on one side, prostatitis, which is an inflammation of the prostate, usually because of an infection. And the other one is hyperplasia, uh, what, what, uh, they call BPH, right? Uh, but prostate hyperplasia. And hyperplasia basically just means that every cell in your prostate gets enlarged. It grows. And as it grows, it gets to that point where it can, uh, block the urethra, which is where the urine goes from the bladder into the outside. There's one problem here, though. You need to identify if, um, how big of a problem is that your prostate is too big because you can have either a big prostate that is not necessarily causing blockage versus a small prostate that is growing into the inside and really causing that blockage, even if the prostate is not that big. So whenever we think about, okay, if I shrink my prostate, that's going to solve the problem, maybe yes, maybe not. That's why I go back to another word. Dr. Brewer mentioned another acronym, LUTS, lower urinary tract symptoms, because we are going to be focusing on solving those. To me, I don't know what's better. Dr. You're decreasing the size of your prostate, but still having issues, or even if you don't decrease the size of your prostate that much, that you're no longer dealing with the lower urinary tract symptoms, like, uh, feeling that you haven't been able to empty your bladder or going up at night to go pee. As a patient myself, I've got a very strong opinion on that. Go ahead. Symptoms by far, right now. Uh, there is a case to be made sometimes. Sometimes you can get both. You can shrink your prostate and at the same time minimize the symptoms. That will be a total win. So this, this is the first step that you need to to consider. And I know, uh, uh, uh, a lot, a lot of people will say, well, yeah, I'm already doing this. Maybe, maybe not so much. And we need to figure out what's the best way to do it. Moderate to intense exercise. Uh, it has been shown that it reduces the symptoms of lower urinary tract symptoms. And this is the one about prevention because sometimes we are talking about people who already have the problem and then we get these comments of people saying, hey, what about those who don't have the problem and want to avoid it? From what I saw, exercise is probably the best intervention to reduce the risk of developing BPH and LUTS up to 25%. So this is.

Let me interrupt and make a comment. Despite the fact that you sometimes don't spell "risk" very well. I'm just now seeing that I'm blaming AI on that. I write it and AI still has some problems cleaning up the, uh, the text on it. Uh, I apologize for that. You're going to see some of that. I apologize. That's okay. And you look a lot better today. I love that background and the new hairdo. But you mentioned earlier, you said, you know, I feel like because I'm young and I haven't lived through this, I'm not so much of an expert. I'm an expert on having the symptoms, but I will say this, uh, in reviewing the background research that you did for this, it's excellent. Uh, something, for example, like this exercise that just sounds like mom and apple pie. Good to have, nice to have, but maybe it makes sense, but not really well documented. Every one of the things that you're bringing up today are very, very well documented. Yeah. And, and we do the best we can with the resources that are out out there, right? Uh, sometimes you find some really good studies, sometimes you have limitations on the studies. Um, but I, but I, every number that I put on this deck, I'm, I'm, I'm trying that it's backed up at some paper that really, uh, makes the case out of it. And I'm going to put those on the description, uh, of the video. Um, so, so going back just to exercise real quick, if you're not doing resistance training, if you're not doing high-intensity interval training, if you're not at least, uh, jogging or running 75 minutes, uh, uh, a week, then you have some work to do, either, either if you have the symptoms or even if you don't have them. So, let me ask you something else. Why? What's the mechanism for exercise helping prostate? Uh, to, to me, I think it's, it's, it's multifactorial, multifactorial in this case. Like, on one side, exercise is one of the most anti-inflammatory interventions that you can do. It, you're going to, you're going to burn glucose. You're going to minimize, uh, oxidative stress. You're going to minimize inflammation and inflammatory cells going around the body, especially in the prostate. And you also train some of the muscles that are around the pelvic area. Although there are some specific exercises for that that will be better in that regard. Okay. But having, having strong muscles, uh, really improves your metabolism in a big way. It really does. So where you're focusing on is metabolic disease and, uh, inflammation associated with that. Yes. And we're kind of spoiling the beans on this one, uh, in regards to the mechanisms, but we did a show like two, three weeks ago where we went a little bit deeper into the connection with the between metabolism and prostate, though. But yeah.

All right. Uh, so next one. Uh, if we talk about metabolism, we cannot stop talking about foods. So there are some specific foods that you might want to try or consider just because, uh, uh, there's a couple of papers that have shown that when you have a lot of intake on both zinc and lycopene, you can get improvement on LUTS and even some reduction in prostate size. And I put as a short list of, uh, some of the low-carb foods that you can consider for that, from pumpkin seeds, beef, lamb. They, they, they specified it has to be lean meats. I know they have some issues with, um, uh, with fat on that, which we might not agree, but the beef, it's important. Uh, the guava got in there into the list. I thought I removed it. Uh, the guava does have a lot of lycopene, but it also has a lot of sugar. So I don't really, I don't necessarily agree too much with the guava. But the other ones, yes, red bell peppers, tomatoes. Yeah, great options. Cheese, eggs. Yeah. Let me respond to your comment about lean beef. So, do you think in the studies that they did, that they actually proved lean beef was the thing? Uh, I don't, I'm not, I don't think necessarily it was like proving it was more like, uh, which is the low-carb food that has the most zinc content. And if you do, if you do lean and you do fatty meat, I, I think they both have similar zinc content. They are, they're just some, a lot of most of the studies you're going to find there that are nutritional nutrition studies, they are going to assume automatically and they're going to work, uh, based on the assumption that high-fat diet raises cholesterol, raises cardiac risk. That's why it's so hard to find studies that will say, oh yeah, it's good to eat, uh, fatty meat. That, that's my point that, you know, a lot of what we do is help analyze the the evidence and one of the recurring problems is that the researchers, the the people that develop the studies and carry them out make assumptions and, uh, they're not even aware of the assumptions. They don't question the assumptions and that will carry right through into their reports. And if you listen to their report and repeat it without actually questioning and looking for those assumptions, you can, you can help propagate misinformation. Correct. Uh, yeah. So, uh, and we're very good at at questioning some of those items. Um, I think the main point will be the zinc. Like if you, if you don't want to be taking a thousand supplements and a zinc supplement will be an extra effort and you can do this. Yeah, go ahead. But, uh, if you want to do a zinc supplement, it might work. But I didn't find any studies, uh, using zinc supplement specifically. Um, all right.

So this one is not necessarily to shrink the prostate, but that's why we mention, hey, what's better to shrink the prostate or improve the symptoms? So this is one that hits manhood, I believe. Uh, to me, uh, I, I don't know how you do it, but going to pee and not doing the standing up, it's like that's a man thing, you know? And then once you need to sit down to do it, I mean, it is better physiologically, it's better. You move some of your muscles up there, release pressure, there's no doubt it's better. Uh, uh, but, uh, you, you might have a beef with doing that, pun intended, uh, but it really, it really proves the point. Uh, there, there are some easy changes that you can that will help with that. Double void, which is a little different from Kegels. So double void, what it means is you go pee whenever you want to do it, then just, just wait for 20, 30 seconds, relax, and then try to pee again, trying to get off that residual residual urine that it is in there, pushing your pelvic muscles onto it as well. That also helps. And of course, avoiding fluids, uh, two hours, sometimes I do recommend four or even six hours before going to bed, uh, if that's the driver and the problem that is making you waking up at night because you, you really need to go to pee. Uh, Dr. Burr, do you have any additional comments on this? Um, I, I was surprised when we learned this one about sitting to pee. I agree. I, I, uh, always noticed that that was it was the more manly thing to stand. Uh, but in this age of iPhones, I have found myself doing that more often because I sit down and, uh, read my iPhone while I'm waiting for my bladder to empty. I didn't know that I was doing good for myself. Oh, well, there you have it. And, um, there's this, um, do, do you remember what, what's the product that, um, made famous, uh, the guy we work with, Poopy Puppy? The unicorn? At basically, it's basically Potty Potty Squatty Potty. Squatty Potty. Squatty Potty. Can you explain that a little? If anybody is interested, you should go, you should look up the commercial. This was a four-minute video for a potty, which basically, um, when you sit, your knees go up higher, so you get into more of a squat. I'll let you go wherever you were going with that. Jesus. No, just saying like, uh, it helps with, um, releasing colon pressure, pooping correctly, better, but it also might help with peeing as well, just because of the position. So, yep. But more than anything else, it's a hilarious commercial. Oh, yeah. And it made Daryl Eaves his career. Daryl Eaves. Yeah. I wasn't, I was hesitant of mentioning Daryl, Daryl in the show, but, yeah. Anyhow, good.

Uh, so there are a couple of supplements. The last time we discussed this on the comments, somebody was saying, "Oh, to me, it was so palatable that makes the trick." Uh, somebody mentioned Pygeum africanum. There are a bunch of supplements out there. And just like in any nutrition supplement research, there are challenges on that one. For suppl, and you can kind of take a screenshot of this one if you want, take a picture so you know you see the doses in there. These are not necessarily stuff that we do recommend on a daily basis. We do see some of that and we kind of, uh, explore those with patients who are interested on them, but I wanted to give you kind of a rundown of the most popular ones. So, Saw Palmetto has some evidence that shows that it might help. The problem is it's usually small studies and there's some challenges in there. And there's another meta-analysis out there that showing that it might not be as good. But if even if a meta-analysis says that it's not that good, doesn't mean that there's not people that will not get help with it. So some people really get improvement. Beta-sitosterol, some randomized control trials shown some improvement on symptoms. Doesn't shrink prostate, but that's what we were talking about, like what do you want? And there are some people who have something that is called hypercholesterolemia, which they cannot tolerate certain fats. This is beta-sitosterol is kind of a fat type, and they cannot tolerate that. It's a very small percentage of people, but if you're dealing with that, probably this is not an option. But it has shown some benefits. Pumpkin seed extract, probably the one that has a little bit more of the best results. Uh, IPSS is basically an International Prostate Symptom Score. And a couple of trials that have shown that pumpkin seed extract actually helps minimizing symptoms. Uh, Pygeum africanum and stinging nettle, they have some studies supporting some of the evidence. I, I didn't see like significant side effects for any of these ones. So even at low doses or the doses that are out there, probably are safe. But of course, as usual, gotta be careful with whatever you take, right? Uh, have you tried any of the of any of these? I don't think so. Dr. I've tried Saw Palmetto and really didn't get much from it. You know, you and I were discussing that when we were discussing this video. You've been recently learning South Carolina culture and pointed out that, yeah, the, um, the scrub, the pal, the palm tree or palmetto tree is the South Carolina state flag or or is on the South Carolina state flag. And I said facetiously, yep, that's why men in South Carolina don't have prostate problems. But the reality is that's not true. A whole bunch of men in South Carolina have prostate problems. I'm one of them. And Saw Palmetto is kind of sketchy in terms of helping. There you go. So that's what I was saying, like you have some stories, people saying it really works. There's some cases that they say, yeah, probably doesn't. You never know until you do it yourself. MJ saying it, it really helped him. Exactly. So I mean, yeah, I don't think those are necessarily the solution though. Just like with medications, which I have a list of medications here that I'm going to show. Um, the, the one problem is not not dealing with what's really causing the problem or really caused the problem. So, uh, uh, but still, it might be some from some help while you change all of the other stuff. So I don't, I don't, I want to just do a quick rundown on this. So there, there are at least at least two or three medications that are out there on the market. Alpha blockers, which is your classic tamsulosin or alfuzosin. Um, they do relax the prostate. And we talked about the alpha receptors on the previous show. Five alpha reductase inhibitors, like finasteride or dutasteride, that also block DHT, dehydrotestosterone, which is also linked to to increase prostate size up to 20, 26%, 25%, but it takes like, like months to to see that. If you combine tamsulosin with dutasteride or one of your favorite favorite ones, tadalafil daily, not just for erectile dysfunction, but also relaxing the smooth muscle on the prostate and reducing the LUTS symptoms. You, you were saying no. I was just saying, uh-huh. LUTS. And it's got a great side effect. [Laughter] A beneficial side effect for sure. Uh, it can also lower your blood pressure a little bit. So you got to be careful whenever taking that. Make sure that, uh, you're not dealing with very low blood pressure or you're not on multiple blood pressure medications. That's a problem with, with, um, um, tadalafil daily. And I didn't do a slide on this one, so I, I feel like I should have, but I, let me do a quick rundown on surgery because even though we're not surgeons, I have a couple of numbers here that are interesting for you to to know. TURP, which Warren Crow is mentioning on the comments as well. TURP, resection of the prostate, which is considered the gold standard for this. Like, you really, you just go there and, and remove the prostate. It can remove up to 60% of the prostate issues. Has a success rate of 80 to 90%. The problem is, up to 60 to 70% of people might have some side effects, and including retrograde ejaculation, which is basically the semen goes back into the bladder instead of going out. So, uh, there, there are problems with the surgery treatment. I have seen cases of people who have reported significant success. People who said, yeah, I mean, I exchanged one problem for another problem. So that, that happens with any surgery intervention like that. Um, do you have any thoughts on TURP? Yeah, actually, uh, I, I've actually seen it a lot less in my patients recently. It, it used to be just assumed that that was going to be the fix. And as you pointed out, too many people came back from that procedure saying, "Well, it fixed this, but it created another problem." And I'm not sure I would do that again. And I think men are listening. So there's another intervention, uh, that's called HoLEP, holmium laser enucleation of prostate, which is basically the same thing as the TURP, but this using a little bit more, uh, uh, recent technology with laser. It's supposed to be a little bit safer. It can reduce symptoms up to 90%. Seems to be very successful. Uh, uh, of course, and a urologist will be the one to to explain a little bit further on any of those more, uh, interventional surgical procedures. And there are others like Aquablation, which is a robotic system that uses some high-velocity water to remove the tissue, and Aquablation therapy, which is minimally invasive and also can reel surgery in those processes. So you had, you had a couple of, uh, uh, interventions, some surgery with the urologist that might help with that. Uh, but of course, it's like it can be kind of scary. And as in any surgery, there's no guarantee that everything is going to run do well. That's, that's why even though they have high success rate, and if you're, you're hesitant of doing surgery, you got to take a look at this last slide that I have for you over here, which is about the importance of metabolic health. So what we do know about metabolic health is high glucose, insulin resistance, and obesity are closely associated with large prostates and and LUTS and lower urinary tract symptoms. And intensive lifestyle weight loss, especially in people with type two diabetes, has shown significant benefits on lowering urinary tract infections. Problem is, there's, there's still not enough research on ketogenic, low-carb diets and prostate issues reduction. There are some studies on mice that have shown some promise, but the logic will be like, if if higher glucose, insulin resistance, obesity, diabetes are drivers of this problem, managing those is very likely going to help with them as well. Um, want to, want to add something to this, Dr. Burr? Sure. Uh, as I, you know, we all, I always keep saying, everything goes back to your metabolism and metabolic health. And, um, I remember one of my very first shows, I talked about, um, about this issue. One of my friends was a prostate cancer survivor, and he talked to me later. He said, "No, you're all wrong. This is all." And he mentioned hormones and some cancer treatments and stuff like that. And the bottom line is, it's sort of like so, so many other things with metabolic disease. The vast majority of the medical community is just not looking. Um, another comment about this is the mechanism. So, how does, how does metabolic disease cause prostatic hyperplasia? So, so to do a quick rundown on on the show from two weeks ago where we go a little bit deeper into that, high insulin stimulates a couple of hormones, including IGF-1, insulin growth factor, and and that also causes, uh, prostate growth. High insulin also stimulates, uh, the liver and decreases some hormones related to testosterone, which trigger that testosterone gets converted more into DHT, dehydrotestosterone, which is very closely related to enlarged prostates. Visceral fat is another one. High insulin increases your visceral fat, and your fat overall increases the amount of estrogen that you have over there, and, and also estrogen is associated with enlarged prostates as well. So you have, you have a couple of different mechanisms that are associated. Most of them hormonal and, and, uh, yes, testosterone, especially specifically dehydrotestosterone, plays a big role on this, but it can be increased or driven by high insulin. So, um, at the end of the day, it's insulin and insulin-like growth factor, the IGF-1. You mentioned, um, they are, you know, there's another hormone called growth hormone. People that are, especially bodybuilders, have been seeking that. I think it's more of a black market access. But then there's another way that, uh, bodybuilders are accessing it sometimes and don't even know it. And that is eating a high-carb, high-glycemic diet. You see that with a lot of bodybuilders. They think, "Oh, I'm getting energy from the carbs." And what they're actually getting is a major boost of insulin. Insulin is probably a more effective growth hormone than growth hormone. Correct. So that's, that's what. And insulin-like growth factor is the same thing. And the IGF-1 is the one that you'll see mentioned much more in prostate hyperplasia for sure.

All right. So, uh, we don't have Aspen today. Uh, before we go to the Q&A, let me see if I'm able to to put some of those water balls. I have never done that. If I, if I don't know how to do it, we're going to have to go ahead and continue without the water ball. Yeah, it, it's, it's easier to talk to patients than manage these things. Yeah. Um, yeah. Well, it seems like I'm going to fail on this one. As usual, not much of a co-host. No much. No, no much surprising here. While, while you're diddling around with that there, we've got some really good questions. I'm going to go ahead and deal with one of them. How, how about that? Yeah, go ahead. Go ahead. JMK is always getting in there with some really good questions. One of the things he mentions is is active surveillance including molecular studies. Is that now the state-of-the-art? So, uh, when it comes to treating most prostate cancers, um, I think the the term there is treatment. That maybe the key term. So, yes, it's a really good point, JMK. I appreciate you bringing it up. Um, basically what, uh, there's some, there's some internal baseball here or internal concepts and terminology that I think that are important to bring out. And the active surveillance is actually just watching the the cancer as opposed to going in and cutting it out. I remember when, um, PSA, pardon me, I don't know what's going on in my throat. I remember when PSA, prostate-specific antigen came out and that was what, 20 something, maybe 30 years ago. We thought, oh my gosh, now we've got something we can, uh, find out what's going on. When this goes way up, you go in, you check the prostate, if you see anything, it's a cancer, whip it out. Well, what you ended up finding was a whole bunch of men with incontinence of feces, incontinence of urine, uh, erectile permanent erectile dysfunction, a whole bunch of problems from the surgery from losing their prostate. But we didn't see any impact on the death rates or mortality rates associated with prostate cancer. Why? Well, it, it became really clear that there are very different types of prostate cancer. You know, people before this time, people mostly assumed that there's only one thing in prostate cancer, and that's not true. There are multiple different types. Some are very aggressive and can kill you and will kill you, and those it doesn't appear were actually impacted that much by the surgery. Meanwhile, the guys, most of those cancers were not that aggressive killer type. And so, all these men were getting cancer, uh, treatment, cancer surgery, and ending up with the problems associated with it, but nobody was getting saved. Um, we could have, would have known that. A lot of folks, for example, in the preventive medicine community said, "Hey, wait a minute. Before you go down this path of doing all this surgery, think about the reality. If you're 50 years old and you die of something else, you've got a 50% probability of having prostate cancer. If you're 60 and you die of something else, you've got a 60% probability of having prostate cancer." And we're talking about during, uh, autopsies after death, 70-year-olds, 70%, 80-year-olds, 80%. So what did that mean? It meant that, um, there were a ton of prostate cancers. They were happening, but they weren't causing death. So, men were just living with them. And again, had we taken a closer look at the data before we picked up the scalpel, we, uh, might have, uh, saved a whole lot of problems for sure. So, what's going on now? The back to JMK's, uh, question is that they're saying, look, let's just be much more active in terms of surveying, follow this, and one of the things he's pointing out is using molecular studies. Um, so all of this is a nod to saying, hey, let's just watch it and make sure that we're not seeing significant incontrovertible evidence that this is going to be one of those killer cancers. To the doctor's defense, you know, it's difficult for a male patient to say, "Yeah, I got prostate cancer," and not want that thing out. So, you got a lot of emotion like this in this, just like you do in everything else regarding health. Well, did you find the, uh, the water ball, Jesus? I did. Do you want your water ball? Let's, let's try it. See if you can actually. [Music] [Music] Look at, look at, look at how young you looked on those pictures. Yeah, I know. I've gotten very old working with you. I've gotten old in this age. Yeah. Not that we don't recommend it. Working with a 30-year-old Mexican doctor. That's a bad idea. Uh, all right. Let's, let's go see some of these questions. Uh, Terry Bolt, keto resolved most of my BP, but still a little high. So, back on meds. Stayed less than 120 of different alpha blockers that can be used for both BPH and mild hypertension. Which is the best choice and why? For alpha blockers. I, I think I think you go a little bit more for, uh, tamsulosin, don't you? I do. Uh, maybe I'll get us banned for this. As I've mentioned many times, I'm a patient myself and I started off when first recognizing my LUTS and the potential opportunity here. I started taking the tadalafil, 5 milligrams, and for a couple of years, that worked and helped, uh, immensely. It still does help, but, uh, since I, we didn't get into my long history of, uh, prostatitis, after another bout of that, I decided I needed to add tamsulosin. And at this point in time, the addition of tamsulosin to the tadalafil has just been a real winner combination. Now, uh, you brought up something a few minutes ago. Uh, tadalafil can lower your blood pressure. Tamsulosin was originally developed for lowering blood pressure. I have a high blood pressure, uh, problem. I'm, you know, I'm 68 and I've had metabolic disease most of my life. So, I end up having to juggle my, my blood pressure medicines and these. When I take them, I don't take the tamsulosin every day. I take it like once, sometimes twice a week. I do take the tadalafil, 5 milligrams, once a day. And I have had to back off on my blood pressure medicines when I'm when I'm taking those. Interesting. So growing old is not for sissies. You got to learn how to juggle your medications as well. I really want to avoid all of that. Uh, I, and let me tell you, there's another thing for what which tamsulosin is really good and I have used it on those cases. Uh, people who have kidney stones and they have stones going through the urethra and causing issues and pain because of the kidney stone passing by. Tamsulosin is really good for that. Of course, you need to talk to your provider before taking that thing. But if you are somebody prone to kidney stones, whenever you have pain because of that, other than other treatments, tamsulosin can help as well. I've got a major kidney stone story too. I didn't try. I didn't know to try. I wish I had. Probably the research has been more recent in that. I don't know which one was kind of the oldest, like, but, yeah. Yeah, I have used that, uh, multiple times for patients. Uh, Nepa Gandhi, hello. I am new here. I am from Nepa. I am Dr. Nepa Gandhi from Kolkata. Is that Kolkata? I don't have my glasses on. Sorry. I don't know if this is the same as Kolka. Kolkata dental surgeon by profession. Yeah, I haven't seen anybody from Kolkata yet. Thank you so much for letting us know, Dr. Gandhi. And we love, we love dentists. You guys are the ones who can catch a lot of these issues just by looking at people's gums and teeth. Yeah, great. Dentists should be a major part of the cardiovascular prevention team. Yep. Take ads. Someday I'm going to say that correctly. G. And good morning from Kerry. Is that North Carolina? Yes. Yes. Good morning. Uh, Terry Bald for JMK. Uh, thought the subjects there were obese. I don't know any studies for those that are normal weight. Lots of studies know showing keto for prostate cancer. I would, I would like to go into the research on prostate cancer because I, I, I, I saw some stuff like omega-3 is helping with prostate cancer, not necessarily for BPH. Um, yeah, we'll, we'll be glad to see some of that. I, I missed original James' comment though. Um, Harvey OBS, please click the like. Yeah, like button. Yeah. Robert Pinsky, time to listen really helps and gives you time to find a solution. You have to do something before your bladder thickens and stops working. Yeah, there's this, there are other stuff like, um, how do you call that? Overactive bladder syndrome. Yeah, is that right? Well, where you have like, it comes to an specific, even neurological issues with the bladder as it progresses. You see often people with spine injuries that develop, uh, prostate issues and bladder issues. So it really can be a tricky subject. By the way, I checked it out. Dr. Gandhi is in Kolkata, which is evidently the same as Kolkata, according to ChatGPT. Oh, fantastic. I, I appreciate the clarification. Hopefully, and hallucinating talking about Dr. Gandhi. Dr. Gandhi, pink guava is sweet, but not the white one inside. Rich source of vitamin C. Yeah. And, and we, and as we say with all fruits, sometimes we get kind of a people from the side that say, yeah, no fruits at all, just because of fructose and glucose. I get it. Then you have the people who do Mediterranean diet and they're saying, no, you need to eat fruits because of vitamin C, vitamins, minerals, antioxidants, and water on them. Fair. At the end, I think you and I are a little bit from Switzerland, where we say, depends on the on the fruit and depends on how you manage the fruit, depends on how much fruit you eat and what you do if you get a blood sugar spike on those. Jesus, are you saying it depends? Man, that's kind of the one of the my biggest regrets because I have, I have to say you were right like a thousand times already. But, uh, to, to, in my defense, I was pushing you into take a stand and you never take a stand. You, you always say it depends. H sometimes I wimp out too much. Yeah. Uh, all right. Um, let me see if there's another member question. And if you, if you're a, if you're new to the channel, we usually answer members' questions first. You know what member is in there because they have an icon on here. Uh, if you want to become a member, just click on the button that says become a member, join next to the subscribe button, or, um, I don't know if I can find that graphic for you guys. Um, maybe this one. Yeah, it's a little bit small though. Or just click on the subscribe plus button. It really makes a difference. There you go. Right there. Um, so it, it really makes a difference, uh, for the channel. It supports us and also it helps us, uh, kind of a have some organization skills over here with the stuff that we that we answer. And also if you want to become a patient, just call 859-721-1414. We'll be all be able to help you out. I have a train passing by on my background. I don't know if you can hear that. Want to explain a little bit more why they should call to the practice of the room. Well, maybe I should explain that you've got a train right outside your your door, but you only hear just a little bit of it when you weren't talking. So, um, the, the point behind the channel is to is to help people live longer and most of all live more healthy. I had a patient, uh, just yesterday, who said, "I'm not so much interested in living longer. What I want to do is have a healthy life much longer." And, you see that in some of the longevity literature, what they talk, they're talking about is, um, what rectangular, rectangularizing, uh, your, for you to say, your health span. Yeah. Easy for me to say, huh? In other words, if your health is on the vertical axis and your lifespan is on the horizontal axis, you're not getting disabled over and over and over again with a, you know, a leg disability, a hip disability, a heart disability, and then, you know, bedridden, and then you die. That's not a great way to live. You know, you're healthy, you're having a great, uh, life, you've got a lot of, uh, options in terms of how what you do, and then you die. Now, uh, the most common cause for that is unrecognized, or the most common cause for these disabilities and even early death is unrecognized. It's something where if you look, even in the, the country with the most expense by far in healthcare, it's still unrecognized. Uh, and you start looking at those, the, the expenses, the doctors that are that are there, the science is really clear, the doctors don't know how to diagnose it. And I assume that most of you know what I'm talking about. It's unrecognized metabolic disease, pre-diabetes, diabetes. Um, again, three-quarters of docs, it's not my opinion, it's not my thoughts, it's, it's, it's shown in the science and the, the research has been done because it's such an important issue. Patients don't, uh, know that they have metabolic disease because doctors don't know that they have metabolic disease. So it gets, it gets masked as a primary problem in a bunch of different areas. Where, where does it impact it? Well, we just talked about it, causes prostate problems, for example. It causes, it's the number one cause of, it is known that it's the number one cause of eye disease, number one cause of heart disease. Um, most people are beginning to say it's actually, uh, Alzheimer's is actually type three diabetes. It's the number one cause of kidney disease, kidney failure. So it's a very important disease and unfortunately, three-quarters of the healthcare professionals, three-quarters of docs don't know how to diagnose it. So, um, I tried golf and travel for my retirement. They just didn't work very well. So, I decided to, uh, to pick something that was bigger than me in terms of what I did in my retirement, and it's this channel. Um, I was at a, a prevention conference that cost a lot of money one weekend and said, "You know what? This information is not private. It costs me and the other attendees a whole lot of money, but it should be available, uh, to everybody for free." But at that point in time, there was a, a new thing called YouTube, and I thought, you know what? I'll put, I'll see if I can start putting some of this stuff on YouTube and see if anybody's interested. So, that's where it went. Now, the next big development was the sh, the shaky paper. I was wondering if you were trying to get me to shut up or what. The next big. Yeah. So, uh, to Jesus's point, uh, I've never, uh, pretended that I, my production value was that good. In fact, that's happened over the past couple of years. We've gotten training, we've gotten resources. Um, and it's amazing. It's true that content is king, but if you don't start improving your production value, it just, the information doesn't get out there. Um, people have responded. They've been very excited about what we've provided. Uh, a lot of people wanted to be seen as patients. So, uh, we started that until it just got to where, uh, there were too many patients to be seen alone. And so, then we started bringing in help. And now we're at a place where we're able to offer, uh, health coaching. Uh, uh, we're able to offer prescriptions for anybody in the US. We have patients all over the US, all over, uh, the world, from the Middle East to Asia to South America. And, um, if you'd like to be a patient, that's the number to call. Yeah, that's the longest ad I have ever seen. But the whole, the point is Dr. Burr walks the walk, walks the talk. He has dealt with this. You had your own frustrations with the current medical system, as most of our patients. And if you're looking for for a team that will listen to you and and and help you identify what you need to do in regards to lifestyle changes, and we have nurses and we have Dr. Burr, who's licensed on all 50 states for medication, uh, when, whenever dealing with medications, give us a call. I think we'll, we'll be happy to help you out. Um, all right. So, so, so that said, enough, enough, uh, ads. Let's go to questions. Our friend Raquel missed us at the low-carb conference. I had a, I had a family commitment, Raquel. We were, we had bought the tickets, we were ready to go and all excited, and the family went out. Yep. Yeah. And I, I didn't want to go on my own. I felt like I, I needed Dr. B to be there. So, I had to cancel too. Terry bald. Uh, oh, no. This is the, this is the previous one. Let me go here. [Music] Well, I think Oh, yeah. Here. This is a little bit off topic, but I don't know. What do you know about this? Does ascending aorta increase as we age? If it's borderline around 50, the size will remain same as we get older. And what causes ascending aorta disease? There's a little bit more vascular health, not necessarily related to plaque, but what do you know any about this? I don't think I can answer that question effectively. I can talk about some aortic aneurysm issues, but I don't think it's responding exactly to Kureshi's question. What, yeah, and, and I mean, we don't see that very often. Like it's a, it's, it's not a common issue. A common disease usually has to do with aortic, uh, issues, either plaques that get ulcerated or aortic aneurysms or aortic dissections, issues with the vessel proper of the aorta. And, and from what I know from that topic is most cases have some genetic components. There are some, there's some trauma here and there. Uh, yes, high blood pressure, I think is one of the major factors as well. But it's not, it's not really common to see this, and it's hard to treat it. It really is hard to treat. I will go down a very geeky bunny hole regarding aortic, aortic aneurysm. Um, my friends Brad Bale and Amy Denine wrote a book called Beat the Heart Attack Gene. They were referring to the gene 9P21. That for the geeks, that just means the ninth chromosome, the P21 area, uh, that they, and then they called that the heart attack gene. That gene has been around and known about for a long time. Originally, it was thought of as a cancer gene. It was associated with a couple of cancers that once you get to the end of the story are associated with metabolic disease. Uh, then it became known as a heart attack gene, and now more recently, it's become known as a metabolic disease gene. But there's another twist on that story, and it's not really clear why, but it's also something that impacts the connective tissue that holds the arteries together. So, uh, somebody like myself who has the 9P21, uh, mutation gene or disease gene needs to have, uh, at least one ultrasound of the aorta. Now, this is more the descending aorta to make sure that you don't have an aneurysm. And that's one of the things that, uh, can be done with a CT. Um, so it turns out that people with 9P21 disease gene get a double whammy in terms of cardiovascular disease because metabolic disease is the biggest problem impacting arteries. But then you've got this second thing where 9P21 also impacts the structure of the gene of the.

artery itself. So that's my geeky bunny hole for the day. All right, that and the advertisement. Uh Brenda, well then my dad had prostate cancer for about 20 years. Doctor said told doctor told him that he will die of anything else first. He lived to be 18 days shy of his 91st birthday. We didn't discuss that much of prostate cancer but yeah, prostate cancer is usually most common cases are very slow growers. Problem is there are some types that can be very aggressive. They go to your bones, especially your spine, or they go to your lungs, and they can cause really, really bad issues. Go to your liver as well. So there are some types that are very aggressive though. Yeah. What's that? Sorry. Sorry. Go ahead. No, no, no, that that's it. But thank you Brenda for that uh story and sharing that. That's that was basically what we're talking about that prostate cancers most of them don't go in. Yeah. And and and the screening right after 60, after 70, like how how how useful is to just getting consecutive PSAs testing and all that stuff. We discussed that on the other video a little bit. Terry Bald, the gray stubble makes you look older. What what's a stubble? What's a stubble? This stuff, the the unshaven look. I I have seen some of that like what what are your thoughts? What what does your what does what does your wife prefer? Uh I think she likes it better shaped. She said and and guess what? She says it makes me look younger. So you're now in contempt. Something going on there. Contempt, but uh there's plenty, there's always reasons. Well, let's not turn this, let's not turn this into a relationship conversation. Terry Bald, thanks for added discussion of kidney stones since I have them before keto uh where where I had a high uric acid. Yeah, for sure. Uh it helps it helps taking out the stones uh when other treatments are not helpful. It takes time though, but uh it doesn't relief, it doesn't relieve the pain. It's not a painkiller. It just helps the ur do you pronounce that correctly? Urethra, urethral, ureter, ureter to expand and and the stones can pass by. Um I wish I'd known that. Nepad Gandhi, thank you. Chris Linky, I've been low carb for a long time. Eat once a day. Probably five years ago. Five years. Will a will my sugar levels ever get back to normal? That that more more things here. They get down into the 80s before I eat, but they can get very high, 160 early A.M. Uh that that's a phenomenon we have we have seen before like whenever your glucose goes too high when fasting, even doing low carb diet. Um do you do you want to go further into why why does that happen? Yeah, it's hard as you know it's uh we don't have enough information even on Chris's story to say exactly what's going on. That could just be a very aggressive uh dawn effect. But I doubt it. I mean, I've never seen a lot of I haven't seen lot dawn effects going over like 120. Dawn effect is when, you know, we have a dial uh pattern on our cortisol and cortisol increases in in the dawn between uh 4 and 6 a.m. And that sometime that'll hit our liver and make our liver dump sugar into the bloodstream. That certainly appears to be what's going some of what's going on with Chris because it's hitting him early in the morning. But again, I just don't see I've never seen it that high. So, it um makes you wonder how big Chris's liver is, for example, in terms of how much glycogen's in that liver and how long it's going to take to work burn that glycogen out. Yeah. There there are some other stuff that can happen. Um, some people will call this kind of insulin resistance. I'm not so sure about it unless you you're able to test it with an OGTT, but as as your metabolism and your muscles get used to use less glucose and more protein and fat, they cannot they usually don't handle that much glucose. That's why it's so important to train your muscles so they're able to manage that glucose without need the need of using insulin. And the second part that I will say is if there's stress cortisol related issues that also can cause that increase on on blood sugar in the morning and also sometimes uh the body can create glucose out of protein and that can be another factor involved. It it's it's hard to predict which one is it. I I'll be worried about seeing levels of 160 on on baseline when fasting. I am too, just because it goes over 140. So, it really it really needs to be kind of a take a closer look at what's going on. I agree, Chris. Uh I think I mean uh Jesus, I I would love for Chris to give us a call. Yeah. And maybe just enhancing the the physical activity. Maybe he's already very active and if his muscles are are are really really active. I I will argue like similar to those who do uh uh who are lean mass hyperresponders have high levels of cholesterol and then they in in put some glucose on their system LDL goes down. I think we could make a case where uh adjusting what type of low carb diet you're doing can help it. As long as you're not doing the standard American diet and you're not doing 35 40% more of your calorie intake coming from carbs. Some people do a very restrictive low carb diet and a very restrictive low carb diet might not be the best for everyone. Good point. Another thing that I think about when I hear just the facts that Chris talks about is how much is he actually eating and just overall caloric content on his keto diet. Yeah. Yeah. And and I wonder how many, you know, how much and how many cheat days he has. Just too many too many variables. Yeah. And he exercises so he will will probably he this is kind of the stuff we do in the practice just to give you kind of a an input on that we ask for a dexa scan, we ask for lab results, we do ask for uh CINT carotid intima media thickness to analyze the arteries. We go through the lifestyle, we we spend extensive time discussing lifestyle components to try to understand whatever is going on because even though you have on your physiology book what's what's supposed to be, uh usually there people have variations on the way they metabolize this stuff. Um I was reading, you will you will be glad to see this on on the last trip I went to the US, I had some time where I didn't really have much Wi-Fi connection and I decided to go back and read Guyton's physiology and I went through the insulin and glucose chapter and you would argue that Guyton is probably one of the is the medical book for physiology. Yeah, it is the standard text for physiology. Was the standard text for physiology is how the body works for those of us who are listening to us talk about Dr. Geekspeak and when you go through medical school, there even when I went through it with way back in Hippocrates time, he was the head of the class, by the way. It wasn't that old. It was about 30 to 40 years ago when I went through med school and Guyton's textbook of physiology was the one that was there. Yeah, so I went through the full chapter yet again and it it really has some gaps. Like it it was hard enough when I was studying med school, I that it was on your time as well and and it even though it is hard to understand some of the processes, I went back in there and it really has some gaps on the way protein, carbs and fats get metabolized. Gaps. I guess there's just too much that could not you cannot feed that all of that in one book. So I had to go into other other research papers to to look to to know further. So, it's it's really interesting. Anyway, uh I think that's the show for today, guys. If if if you like the show, share, subscribe, become a member. That's really helpful. We posted a video on Monday about foods that silently raise blood sugar. Take a look at it if you haven't. And this uh Saturday, we're expecting to put out a book uh another video about blood pressure and arteries that you probably are going to like want to watch. All right, Dr. Brewer, want to say hi? Uh welcome back. Much. As I used to say, thank you for your interest. Yeah, that's good.