February 21, 2019
[0:00:51] Podcast Sponsors
[0:03:59] What You’re About to Find Out in This Podcast
[0:13:02] Jay's Daily Routine and Why He Eats Only 3 Days Per Week
[0:19:52] The Cold-Filtration Whey Isolate
[0:24:22] Jay's Response to My Concerns About the Use of Metformin
[0:39:07] Podcast Sponsors
[0:41:55] Teas Instead of Metformin
[0:42:59] How to Go About Getting Metformin
[0:44:55] Berberine for Metformin
[0:49:42] Big Picture on Metformin
[0:51:49] Jay's Favorite Peptides and What to Look for When Choosing A Peptide for Yourself
[1:19:26] Why Armour Thyroid?
[1:24:23] Rapid Fire Questions on Testosterone
[1:26:09] Is there a risk of cardiovascular health if one supplements their testosterone?
[1:35:48] What's the best delivery mechanism?
[1:40:37] What are you taking with testosterone to mitigate the downstream side effects?
[1:49:08] What should you be looking for in reference ranges, and what should you be monitoring when you're on testosterone?
[2:00:34] Closing the Podcast
[2:03:08] End of Podcast
Ben: I have a master's degree in physiology, biomechanics, and human nutrition. I've spent the past two decades competing in some of the most masochistic events on the planet, from SEALFIT Kokoro, Spartan Agoge, and The World's Toughest Mudder, do 13 Ironman Triathlons, brutal bow hunts, adventure races, spearfishing, plant foraging, free diving, bodybuilding and beyond. I combine this intense time in the trenches with a blend of ancestral wisdom and modern science, search the globe for the world's top experts in performance, fat loss, recovery, gut hormones, brain, beauty, and brawn to deliver you this podcast. Everything you need to know to live an adventurous, joyful, and fulfilling life. My name is Ben Greenfield. Enjoy the ride.
This episode blew my mind. A lot of my episodes do that. I'm a blessed guy. I get to talk to very smart, talented people who teach me a lot of things every week for hours. I think that's one of my main forms of education, really, is having a podcast. I learned a lot on today's show. You're going to enjoy it. It's all about testosterone optimization but we also get into metformin. We get into peptides. This is a fun one, or as I'm prone to say, a doozy.
This podcast is brought to you by Kion, which is my playground for all things health and wellness. I made the most delicious chocolate coconut bar. It's got almond. It's got organic honey. It's got cacao nibs burned super clean. I tested it in the sauna. I tested it snowboarding. The heat, the cold during intense exercise. It's got just all organic rice and pea protein, baby quinoa, organic sesame seeds organic white chia seeds. It's got grass-fed gelatin in there. It tastes absolutely, well, to use this phrase again, mind-blowing. I'm breathing hard because I just went down my driveway to check my mail. I have a long driveway. I always sprint up it and then I ran down into my basement to record this for you, because I'm so excited about today's show. Grab that bar. It's at Kion. You get 10% off of it and anything at Kion. You just go to getkion.com. That's getk-i-o-n.com. The code that you want to use is BEN10. That's BEN10.
This podcast is also brought to you by something I am standing behind, and in front of right now. I'm actually sandwiched in between two of these light panels. I flip them on when I go into my office in the morning to read up on stuff and sip my cup of coffee or my cup of green tea. I flip these lights on. I strip all my clothes off and I stand there in front of them. They increase my testosterone. They work on collagen and elastin on my skin. It makes my skin all beautiful, even my booty. It reduces pain and inflammation in joints. It get on your thyroid. It can increase some of your thyroid activity. Photobiomodulation is pretty cool. You could go out in the sunshine but sometimes that's very inconvenient, especially if you're working indoors. You just need to flip these things on, need some targeted red-light therapy. This is all brought to you by this company called Joovv. You can get one of these panels, or even they're teeny tiny little travel one. It's called the Joovv Go. I travel with that one but I’ve got the big panels at home. If you go to joovv.com\ben, that's j-o-o-v-v-forward slash-ben, you'll get a nice little bonus gift if you use code, BEN, at checkout. You got to go to joovv.com/ben. Then, also, use the code, BEN. That's enough. We got a huge. This episode is a monster. We should get started. Let's do it.
Before we jump into today's episode with Jay Campbell, I realized that, as you're about to find out, this particular podcast may generate some amount of confusion. We discussed metformin, something that I have vilified in the past. We also discuss testosterone replacement therapy, something that I've also questioned the wisdom of in the past. I've been doing–since I interviewed Jay, quite a bit of research on all the different studies that he has been sending me. The question that I get after I release a podcast like this is, “Ben, what are you going to change? What do you do? What's your plan?” I'll summarize it as follows, and then listen in to the episode to understand what I'm about to say here.
A, regarding metformin and what we discussed when it comes to the safety of metformin, I still do not plan on beginning to supplement with the 1,500 to 2,000 milligrams of metformin that appears to be so popular in the anti-aging circles. Primarily that is because my current habit of using things like bitter melon extract, Ceylon cinnamon, apple cider vinegar, et cetera, seemed to be managing my blood glucose levels just fine. I do wear a continuous blood glucose monitor and have no concerns about my blood sugar. If I did have concerns about my blood sugar, however, or if I wanted to use metformin for some of the other benefits Jay and I discuss in this episode, like muscle gain or fat loss, I am no longer opposed to the idea of using metformin. I thoroughly went through all the research studies that Jay sent to me. For the reasons that Jay alludes to and in what you're about to hear, I think metformin is okay. I know people will also say, “Well, Ben, didn't you write one of the big articles on the internet that says, ‘The Dark Side of Metformin?‘” I did. One of the things that you will find, if you go and listen to my podcasts over the past 10 years, is I will readily admit when I find new research or when new research comes to light that what I've said before was not fully informed or more research has come out on it, and therefore, I will change my stance, I will change my position. I am not so dogmatic and myopic that I'm not willing to look at research and listen to what people are saying. In this case, it turns out that most of the research done on the deleterious effects of metformin were done on compromised patient populations with liver issues, kidney issues, or in people who were using three to five times, the recommended dose of it. I'll get off that soapbox.
We also talked about testosterone replacement therapy and peptides. I know you're going to ask me, “Well, Ben, are you going to start on testosterone replacement therapy and are you going to start on peptides?” The thing is I've already used peptides like BPC-157 and TB 500 and some of the others that we talked about in this episode. Regarding peptides, yes, I plan on launching into a pretty hefty stack of cognitive peptides, muscle-gain peptides, fat-loss peptides, anti-aging peptides, et cetera. I'll be monitoring my blood results over the next few months. I'm working with a physician already and will likely be using some of the very similar peptides that we discussed in this episode.
I'm also asked if I'm going to start on testosterone replacement therapy. If I decide to continue to race professionally, I will not. I cannot, ethically or legally, use testosterone replacement therapy. If I decide not to continue competition and those type of events, or when I stop competition in events sanctioned by the World Anti-Doping Association, et cetera, I will readily consider the use of testosterone replacement therapy along with the use of things like Ipamorelin and some of the growth hormone releasing peptides that we discussed in this podcast. Absolutely not opposed to it with proper dosing and monitoring. We just kicked that horse to death in this show.
Then, finally, thyroid. He discusses the off-label use of thyroid, even if you don't have hypothyroidism. When I finished up Ironman racing on a very heavy ketogenic diet, I had horrible thyroid values. I currently take about 60 milligrams of an Armour Thyroid per day and monitor my thyroid values. I am even considering, based on what Jay and I discussed doubling that up and bumping that up to closer to 120 milligrams of an Armour Thyroid per day. Simply, again, because I'm not opposed to the idea of better living through science. I've seen a lot of good data on it. I like the idea of supporting my body's hormone production as I age. Again, thyroid would be something I would lump into the category of testosterone replacement therapy, as something that once you start it if you stop you may actually see some amount of thyroid deficiency; but if you continue to take it, you're just replacing what your body isn't making. Again, I started on 60 milligrams of Armour Thyroid after being diagnosed with basically, borderline hypothyroidism. Self-inflicted from me putting my body through the masochistic wringer of very low-carb dieting, extreme endurance activities, and a lot of things I have foregone in the past. I realize I may have just opened up a big old can of worms and created more questions than I answered. But, hopefully, in this podcast episode with Jay, you'll discover a lot of the answers to those questions. Of course, you can go leave your own comments, your own questions, et cetera, if you go to bengreenfieldfitness.com/jay. That's bengreenfieldfitness.com/j-a-y.
[0:10:33] Guest Introduction
Hey, folks. Pop your metformin. Chomp on some nicotine gum. Grab yourself some testosterone. We're going to cover all those things and a whole lot more in today's show with a new acquaintance of mine, Jay Campbell. Jay Campbell. He's actually well-known in the men's physique world. He's a top men's physique competitor. He's also well known in the testosterone world, because he wrote what I thought would be yet another one of those bro-style testosterone manuals, but after reading over the past two days in preparation for this interview, I even tweeted this last night, it's like one of the most comprehensive and helpful guides to testosterone optimization that I've ever read. We're going to delve into some of the tricks and tactics that he gets into in that book as well because his real expertise is in manipulating and tweaking the human endocrine system. His website is fabfitover40 because apparently, he likes alliteration. The way that we first met was actually based on an article I published about metformin, the diabetic drug metformin that's used off-label for anti-aging protocols and other things that Jay can get into as we talk. I posted that article. One of my friends on Facebook sent me a link to Jay's video and said, “Hey, this guy has some of his thoughts about metformin and mentioned your article.” I went and watched Jay's video, which I'll link to in the shownotes. You can find them at bengreenfieldfitness.com/jay. That's bengreenfieldfitness.com/j-a-y.
After watching the video, I thought, he's got some really interesting thoughts on metformin. I'm always a fan of learning more and opening up discussion about things that I've been studying up on. I wanted to ask Jay about metformin but then once I got him on the schedule on the show to ask him about metformin, it turns out like he knows a ton about peptides and about testosterone and optimization therapy and has some really cool fat-loss, muscle-gain protocols. We just have a ton to talk about today. I should probably shut up Jay and welcome you to the show.
Jay: Ben, what's up? It's such an honor to be here. I appreciate the introduction.
Ben: Absolutely. Before we jump into metformin, I'm just curious because when I was reading your testosterone, you talked about your daily routine, tell me about your daily routine leading up to this point. It's 10:00 a.m. in the morning when we're recording this.
Jay: I followed a protocol, a book that I wrote. It's a fasting lifestyle where it's an alternate, every other day fasting. I eat when I train. Currently, I train three days a week which is Monday, Wednesday, and Friday. Sometimes, life gets in the way at Saturday, whatever. Then, I fast the other four days. I do that when I'm trying to lower my body fat as much as possible, usually for going on a trip. In fact, I'm going on a trip with my wife and some friends to a [00:13:51] ______ in a week and a half or so. I've been doing that since the early part of January but I do have a very militant regimented life. I wake up early in the morning. I have two daughters and then I have a bonus daughter from my current wife, Monica, who's an amazing person by the way. I'll have to throw a shout-out to her.
Ben: I like that, a bonus daughter.
Jay: She's the bonus mom to my biological daughters. I wake up about 6:00, 6:15. It depends. Sometimes a little earlier. I'm very, very regimented when I'm dieting like this. You know why I obviously want to talk a little bit about the book that I recently wrote that's called, “Guaranteed Shredded,” which is essentially like a 10x version of my metabolic blowtorch diet.
Ben: I read that too, by the way. I feel like I've just been inside your head for the past three days because I always, whenever I get anybody on the podcast, I like to go through all their works. Yes, “Guaranteed Shredded” was also really good.
Jay: Awesome. I appreciate it. I take metformin, a desiccated thyroid. Right now, I'm using Armour. My doctor scripted me Armour. I take the mushroom supplement, Lion's Mane, for cognition. By the way, I'm on a fast today. Today is a training day. We actually trained this morning at about 7:45. I didn't take a Lion's Mane, but I always take metformin and Armour. Then, I take my morning supplements, minerals. I take curcumin, turmeric. I'm trying to think in my head right now what other things I take. Obviously, I take Coenzyme Q10. Trying to think some of the other things that I have in brain, shift right now. I take the same supplement.
Ben: No, that's okay. You should have taken more Lion's Mane. You should have taken more Lion's Mane.
Jay: Actually, I take three capsules of Lion's Mane.
Ben: I know that eyebrows will have gone up on two of those things that you mentioned, metformin and Armour Thyroid. I definitely want to dig into why you would include those in your routine. Also, I noted that in your book, “Guaranteed Shredded,” you also get into how, even on a fasted day, you'll still work in these little meals. Specifically, a blend of protein powder and MCT oil. What's the deal behind that? Why are you squeezing those into a fasting day?
Jay: That's a good question. You don't have to. I put that in there in the book for people that need to lose a lot of weight. They may be somewhat obese or over fat. That's the fastest way. Essentially, the whole book, if we just start talking about that book, is based on metabolic flexibility. What I mean by that is that I try to incorporate almost every type of [00:16:28] ______ dietary lifestyle. Low carbohydrate. You're almost even in trace ketosis if you fast 30 to 34 hours. Once your body becomes fast adapted, there's obviously the higher essential fatty acids from when you're eating low carb. I would say high protein. It's incorporating a lot of different dietary approaches in seven-day week, depending on how many days you're fasting. To answer that question, MCT oil, medium-chain triglyceride oil, I find is the most palatable and also the most digestible bioavailable in combination with protein. If a person is fasting 18 to 20 hours that day and they do want to get something like 1,000 or 800, 1,200, whatever calories if you drink a couple of those shakes, you get pretty close. If you take three or four tablespoons of MCT oil, over 100 grams of fat, I think you're close to it, 80 or whatever. You can get pretty much a good healthy dose of essential fatty acids. I know you know about MCT oil, the medium-chain triglycerides, they're supposedly tissue sparing, and they can be, I guess. I just find it's the easiest for people to digest if they're going to cram down three protein shakes in like a four to six-hour period.
Ben: The bypassing of some of the processing via the liver as well and direct ketone production. They're pretty useful, plus they're–I think, most people know relatively non-insulinogenic. Obviously, you're getting a little bit of insulin with the protein. Essentially, what someone is doing, if I understand correctly from your book, if they're fasting and they want to still, let's say, maintain some amount of anabolism or avoid, especially if they're fasting as often as four days a week which you just alluded to, avoid a reduction in the metabolic reset point. They're fasting most of the day, then around like 6 p.m. or so, which obviously gives you probably good 18 hours or so fasted, having one of these shakes and maybe having another one around 8 p.m. or so.
Jay: That's exactly right. Like I said, for me now, I'm so adapted to the fasting lifestyle. I've been doing it for four years consecutively now. I don't even eat. I'll just go, for example, the last time I ate, obviously this morning, but the last time I ate before this morning was Wednesday night, my last meal was about 8:50. I got, probably, 33 and a half hours, almost 34 hours, before I ate this morning. I just didn't eat yesterday. Your answer is exactly correct. I find that people, they're not fast adapted, who are trying to make that diet work, it's best for them, especially if they have a lot of weight to lose to keep, like you said, their insulin signal suppressed and still get some caloric intake so that they don't feel weird. We can get into that later when we talk more about fasting. There's definitely an issue in the microbiota with people. It could be anything. Any pathogen, anything that can be growing in there that causes people to have those hunger pangs. They really want to be–feel like they're full and satiated. That's why I recommend that. Obviously, it also keeps carbohydrates out of the diet. As you said, there is a little bit of an insulinemic response with the protein, but as long as they've fasted 18 to 20 hours, it's not that big of a deal.
Ben: Speaking of the protein, I notice in the book that you recommended whey. A lot of times whey, for me, personally, doesn't really agree with my stomach that much. From what I understand, there are certain ways to filter out some of the immune-protective compounds that you'd find in whey. You mentioned that you actually recommend a cold-filtration whey isolate. What exactly is that?
Jay: First off, your question is a really good question because I actually have seen research from some of the people that run the food sensitivity companies. I have a friend, Paul Burgess in England, is really big into that. He says that 70% of people have an allergy or some form of response in their microbiome to whey protein. I say cold filter because I think it's just the easiest, how would I say it, from a process standpoint for a ubiquitous idea that most people have access to around the world, they can find that. Personally, I actually use True Nutrition. I don't have any relationship with the company, but I used to True Nutrition's protein because I've seen a lot of different label tests that they've had independently, and then of course, by themselves. They test out so high. In fact, it's a really good question because I don't even use a whey protein for the most part. I usually use a combination of egg and casein because, again, it's thicker. To me, I just feel more satiated when it goes down. It doesn't burn as fast as whey. Cold-filtered WPI right immediately, post-training, or even during training, or even pre-training, it's still decent as long as you don't have an allergy or reaction to it.
Ben: The cold filtration, just so you guys know, that's just this method of isolating the whey based on a molecular weight and the size. They use a cold processing environment. It's almost like microfiltration. I've done podcasts on wine before and how you can filter out a lot of the components of wine using microfiltration. A good biodynamic organic wine that's been microfiltered a lot of times agrees with people a lot more when it comes to headaches and histamine release, and stuff like that. Same could be said for whey protein. If you can find a cold filtered. I, for a long time, was actually using Mt. Capra's, because they do a goat whey and the goat protein's a little bit smaller, so the thermodynamics to the protein are a little bit better. I know they do a cold filtration, plus they're close to my house and I know the owner. It's this little goat farm in Central Washington.
Jay: That's awesome. Actually, True Nutrition has a P-protein band too for people that are vegans, vegetarians or people that try to avoid eating animals. Obviously, I don't have any judgment towards that. That's a whole another conversation. He has an amazing P-protein. The guy that owns True Nutrition. It's like 20 flavors now. Ton of vegans go there and get their protein. I think a lot of people get confused, and I don't want to wrap it all on this. You probably have heard this. A lot of people in the “vegan” world believe that hemp protein is a fully essential amino acid complex. It's not. There's a lot of misinformation online about that. The only one that's actually true essential multi-spectrum is P-protein. I had to answer that question a couple of months ago. I wanted to make sure that I fact check that it is true.
Ben: Not to be a show for my own products, but that's actually why I put P-protein in the Kion Energy Bar. It has a really good profile, but I wanted people who didn't want to do whey to be able to have something. What I do most of the time now, I've almost completely replaced all of my protein powders with a rice pea protein blend called MediClear. It's made by Thorne. It's expensive but, man, I use that as my primary base for my morning smoothies now. It's got curcumin and sulforaphane. You can almost feel it healing your gut and detox you as you drink it. Now, what I've been doing at night is I do an almost like a keto ice cream. I just take a bunch of chocolate MediClear and I blend that up with egg yolks, coconut milk, stevia, and sea salt. I don't even use an ice cream maker. I just blend it in my blender for about four minutes, and then toss that in the freezer in a little stainless steel bowl. Dig into that at night. It's absolutely amazing.
Jay: It's very awesome. That's great recipe.
Ben: We could probably go on all day about our routines and our smoothie habits but let's dive into what brought us together in the first place and something you already mentioned. You take metformin as do a lot of people. I think, a quarter of the folks in Tim Ferriss' Tools of Titans and a whole bunch of anti-aging enthusiasts. They're really on this metformin bandwagon. I wrote an article questioning whether or not that was a good idea because of some of the issues that have been brought up about metformin such as its effect on the mitochondria and its ability to be able to possibly limit some of the activity of the electron transport chain complex one in the mitochondria, some of the issues with the potential lactic acidosis. I talked a little bit about mineral deficiencies like B12 or vitamin deficiencies like B12, a little bit about the potential liver pass issue. Then, some of the gut discomfort that comes along with it. That was what I laid out as far as some of my concerns about using metformin as your primary strategy for glycemic variability, or even as an anti-aging strategy, because it's been shown to have an effect on a lot of these chronic diseases associated with anti-aging, and also seems to have a positive impact on cellular autophagy. You did a pretty informative video with your thoughts about metformin. I'd love for you to delve into and tackle some of these issues with metformin and what your thoughts on them are.
Jay: For sure. First off, I read your article, actually a full disclosure. Some guy, who's a fan of both of us, emailed me. It was like, “Hey, man, and blah, blah, blah,” and he just had bullet points. Quite honestly, dude, that's just—I'm like you, I just, “Oh, cool. I'll just make a video. I have 10 minutes right now.” I just hit the points. When I actually went back and read your article, I didn't really disagree with anything that you had in there. I'm not saying that to blow smoke up. I'm being honest. You didn't really have anything that was wrong. I will assess all these different points. First of all, the mitochondrial dysfunction. The first person that really went to market, so to speak, online was Dr. Chandler Mars. I actually met her in Vegas at a forum, which you were actually there as I was there in December. We didn't even get to meet each other.
Ben: Lots of physicians. I even released my testosterone talk before I'm on the podcast.
Jay: Yes, I listened to that. It's good. Actually, you were funny. They weren't appreciative of your humor.
Ben: Oh, man. So many straight-laced non-smiling doctors in the audience listening in that penis jokes. It was funny because I commented like, of all the medical conventions I've been to that one, in particular, seem to have a disproportionate number of jacked doctors on steroids.
Jay: These doctors are jacked.
Ben: Very interesting event.
Jay: It's funny because usually, my wife and I will joke because we've been going to the medical conferences for five years. Five years ago, you went to A4M or AMMG or any of them and there were just fat people, morbidly obese. It's just like, “Holy sh–What is going on? This is the medical community.” It's gotten better. Obviously, I would rather see somebody in shape with a lab coat than a fat person smoking 10 cigarettes. Bottom line, I did see the same people. As far as the mitochondrial dysfunction, Dr. Chandler Mars took three studies, or maybe it might have been two, and somebody could fact-check me. It's two or three. where it came from where it was all three of the patient population groups were morbidly obese diabetics, who were literally using anywhere from six to nine grams of metformin per day, which as you know, is like 100 times beyond, not 100, but it's way beyond a life extension dose.
Ben: For the audience, what would be a life extension dose? Or, what would be a dose that you personally take on a daily basis for metformin?
Jay: Great question. It really depends, I think, on body size. It also depends on your ancestry. I feel that people that are from ancestries closer to the equatorial plane need a less dosage because for some reason they have better insulin sensitivity and insulin regulation naturally, versus people who are big, white, I guess, Slavic Northern European who don't have the insulin sensitivity. I can take a higher dose. To answer your question–
Ben: Totally. We're just going to keep on rabbit-holing before you answer my questions. That's very interesting for folks because, as you know, when you go down to apply it, you can get away with eating more fruit when you're in the sunshine. That's like one big topic of T.S. Wiley's book, “Lights Out: Sleep, Sex, and Survival.”
Jay: That's awesome, T.S.? Very good. Very good. Check this out. My wife who has a mom who's literally, she's dead, God rest her soul, but she is from the southern part of Mexico. She was born on a ranch. She's very dark complected. Her dad is a white dude. She can only take 250 milligrams of metformin, AM and PM. That would be a very baby dosage. I take a gram AM, and a gram PM Just for the record for the audience, I've been on metformin for 17 years in a row. I feel like it's the most. I don't think there's anything that, at least that I know of in medicine right now, that has more bang for the buck. As you know, the medical community, the pharmaceutical industry is not going to promote it because obviously it can't be patented anymore now. Of course, they are working on some different drugs. Ryan Smith can talk to you about those until you're blue in the face. There's three or four of them. They're from the biguanides complex or whatever. Anyway, there's three of them in the route, in the pipeline coming.
Anyway, that study was then taken by Dave Asprey. He went all out against metformin. I feel like, from those two people, it filtered into the community that people think that mitochondrial dysfunction can be caused by that. Then, also, there was some information about lactic acidosis. Here's the thing about lactic acidosis. There was one study in the late '40s, also in a massively compromised population, patient cohort again. The patients were in end-stage renal failure. They were obese and diabetic. I always like to say is that we always have to be mindful that correlation does not equate to causation. That study, Ben, has literally infiltrated the medical community for 60 years.
Ben: These are all obese and diabetic patients. Now, the previous study that you alluded to, they were simply obese folks taking a lot of metformin, and this is a separate study.
Jay: Yes. I actually have this. I can send these studies. You have the links to them. I'm actually there in front of me I pull.
Ben: Yes, sure. If you email them over to me, by the way, I'll put links to all these in the shownotes, for those of you listening.
Jay: For sure. Absolutely, I will. On lactic acidosis, it's now been studied heavily in the last four or five years in the scientific community, and then also just in the research community in medicine. I wanted to read this to you. This is essentially how they say it now. “Elevated plasma metformin concentrations that can occur in individuals with renal impairment and a secondary event or condition that further disrupts lactate production or clearance which would be cirrhosis.” That's the liver problem. “Sepsis or hypoperfusion are typically necessary to cause any metformin-associated lactic acidosis, as these secondary events may be unpredictable and the mortality rate for MALA,” which again is metformin-associated lactic acidosis, “approach is 50%. Metformin has to be contraindicated in moderate and severe renal impairment.” All that means is you're not going to get, and by the way, last statement is that, “the reported incidence of lactic acidosis in clinical practice has proved to be extremely low, less than 10 cases per one million patients over the same amount of 60 years.” The bottom line is you have to have either liver issues or renal issues to ever even have a chance of this. In fact, three years ago, I forget what it was. Somebody in the AMA and then obviously the FDA, they approved metformin usage in people that have, I guess they're just like looking at where their level of acute toxicity is for renal impairment and based on where they're at they could still get prescribed metformin. It's really not toxic. It all, unless you're compromised. Now, the other ones that you talked about obviously, mineral deficiencies like B, vitamin B12 and folate. That is absolutely positively true. But I have been–I know you know Dr. Anthony Jay.
Jay: I did a podcast with them, I know you did one too. We did a live broadcast together and stuff. He analyzed my DNA, which he probably did for you too. He analyzed my DNA on air and I have the B Vitamin deficiency. Someone that is genetically predisposed [00:33:32] ______ for that B Vitamin deficiency who also then uses metformin has to almost double up on your B vitamin and folate. You're right, it absolutely depletes those two things. Again, I've been using a pretty strong dosage. I use Jarrow’s formulas like B Right. I have used other stuff too. You don't even use stuff from Vitamin Shoppe. I'm fine. Again, when I say I'm fine, I have my blood work. I do blood work twice a year. I have, since I started testosterone in when was it, 1999-2000. I know what I'm saying that I have no issues with it, that I don't have any issues with it.
Then, the same thing with liver issues, just to address that too. If a person is compromised through hepatic function, then metformin would definitely be contraindicated. I've even seen doctors, and obviously, I have a lot of great relationships with doctors now in the industry, who do prescribe testosterone to men and women who have fatty liver issues. It really just comes down to, I think, what that individual's level of being compromised is, depending on what are their issues, if that what disease etiology they have.
Then, the last one, we could really rabbit hole on this because I pulled up some studies on this. The gastric issues that people have is actually just from metformin cleaning up their microbiota. All of the new research that's come out in the last two years. Ben, the research is phenomenal on this. They are now saying that metformin is absolutely cleansing the microbiota. For people, they get flatulence, nausea, got discomfort, they're basically eating shitty diet, probably drinking too much alcohol, probably very acidic. The metformin is basically working their microbiome to cleanse it. They're feeling the response, which is like, “Gosh, what's going on inside me?”
Ben: That's very interesting. Metformin originally came from French lilac, also known as goat's rue, and was known in medicine for a very long time as having that side effect of creating some amount of gut discomfort. What you're saying is that that might be due to the fact that it's actually adjusting the biome of the human gut. Correct me if I'm wrong, but have you found that as someone's biome becomes used to, or even becomes balanced via the use of metformin that gastrointestinal upset seems to subside?
Jay: Completely gone. Let me read this to you. This is literally a 2019 study that just came out. Somebody actually sent this to me about, I want to say in probably November, it was pre-published or pre-released, but it just came out. “Metformin, the most frequently administered medication to treat patients with Type 2 diabetes has only recently been suggested to alter gut microbiota composition through the increase in mucin-degrading Akkermansia muciniphila, as well as several SCFA producing (short-chain fatty acid) microbiota. The gut microbiota of participants on metformin has now exerted alterations in gut metabolomics with increased ability to produce butyrate and propionate, substances involved in glucose homeostasis thus. Thus, metformin appears now to fully affect the microbiome, and an individual's metformin tolerance or intolerance will be influenced by their microbiome.”
Ben: This is very interesting because I know the gut lining of patients with Type 1 diabetes tends to show greater signs of inflammation, even more than what you see in celiac disease. This would be very interesting. It could not only have an effect on glycemic variability, but it may also be able to alter the biome.
Jay: I'm telling you it is. Actually, it's funny but I always felt that that's what it was doing, because in my many conversations with patients and people that I had counseled or talked to online, or whatever, they would say that to me, and they would be like, “Man, I had to kill it.” I'm like, “Well, dude,” it was a woman, I'm like, “Well, what are you eating?” Then, they tell you and it's like, “Well, of course, you're going to feel like that. It's telling you that your diet needs to be cleaned up.” I'm very, very confident that as more and more of this research now comes out about metformin, it will confirm that. I think you know both of the trials that are going on now, the TAME trial and then the MILES trial, there's already information it's coming out. If you know some of the moles and stuff that are involved in that. Both of these studies have been going on for 18 months. Ben, I've heard amazing things about metformin. The one thing we really have to talk about to, or two things, is that it protects the brain. It's extremely, extremely neuroprotective. It also improves vascular function, it cleans vascular pathways.
Again, whatever it's doing, whatever its mechanism of action is—there's a lot of theories. They really don't understand really what it's doing. I think you know that it does reduce mTOR signaling. It's very minor, by the way. I get a lot of throws that come at me, and they're like, “Dude, I can't use metformin if I'm not on testosterone, or I'm on anything because it's going to remember my mTOR signaling.” Yes, it does a minor effect.
Ben: They better not also fast.
Jay: Right. The reality is metformin is doing so many other things, both extracellularly and intracellularly, that is positive for you living a longer, stronger life. It's totally worth using. It's definitely not going to limit your muscle gains. Ben, you have some really smart friends that are bodybuilders. They told me a long time ago that don't listen or read anybody that says that using metformin is going to limit muscle gains.
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One thing I was going to ask you about too. Have you ever run into anybody in the community who's just using Goat's rue herb? Using the actual tea, or French lilac, or anything like that, instead of using metformin?
Jay: I do know some people. Again, they're not friends. I couldn't send you their thoughts. Some people in France that do you use the French lilac herb. I also do know that it's also been used in medical practices over there since way before metformin was even created for blocking glaucoma.
Ben: Oh, yeah.
Jay: Again, regulating insulin and blood sugar. I definitely read about that. I don't know anyone specifically dislikes using the actual roots.
Ben: Interesting. It's similar to NAD. Dr. Mercola's approached to that is he uses Pau D'arco Bark Tea which contains some beta-lapachones that almost act as a precursor to NAD. I'd be interested to see a comparison between Goat's rue herb used as a tea versus metformin. Although, metformin is pretty easy to get these days. Do you do need a straight-up physician's prescription or you just buy online?
Jay: It's actually a great question and people ask me this all the time. Actually, we created the chapter where I have metformin in the book, the TOT Bible, which we can talk about later when we get into testosterone, has an actual all of the researchers, Ben, I compiled–it's obviously out of date now because of the new stuff that's coming out. The book was released last year which is literally about a year and 10 days from now. I think it was February first. It has a whole chapter on metformin. I compiled all of the positive research. I actually created a part in there that basically says, “Use this. Go into your office and tell them the following. You say you want to use metformin because this is cardioprotective, prevents cancer, and is believed to stop the progress of neurodegenerative diseases such as Alzheimer's and dementia. It's also affordable and easily provided by your local blank and certainly, your pharmacies.” We were going to make it into a cutout and they could take it in. The bottom line is if your doctor is smart, they are in the cash pay side, they're not in the sick care system, [00:44:07] ______ script. But, if they don't, there's a really awesome online supplement or pharmacy called inhousepharmacy.vu, V-victor, U-underwear. It's inhousepharmacy.vu. You literally can buy 500 tablets. I think, their best dosage, again, Extended Release, you don't have to get Extended Release but I find Extended Release works better on most people, 1650 milligram tablet, which would be, for me I would probably split that up and do one in the morning one at night. It's $60 for 500 tabs. It will last you all year.
Ben: Interesting. Which one of your books, by the way, because I'll link to all your books on the shownotes, but which one of your books has that recommendation for the scripts to say to your doctor?
Jay: It's in the TOT Bible.
Ben: Okay, got it. That one's in the TOT Bible. You also mentioned, I believe, in the aggressively shredded book, alternative to metformin, that you would recommend as berberine. Is that something that you stack with metformin, or are you just recommending that if someone isn't able to get or doesn't want to use metformin to use berberine as an alternative?
Jay: No. I don't stack berberine. Being very honest and truthful, berberine, on paper, is very similar in its mechanism of action to what metformin does. Here's the issue I have with berberine. I'm very, very explicit and transparent about this whenever I talk about it, is that it's a supplement, so you're dealing with the typical FDA, not regulated. Who's really checking the manufacturers that create berberine? It's also, Ben, much more expensive than metformin is. When you compare the two from those two factors, it's really hard for me to recommend berberine over metformin. I also have to say as a caveat, I'm not in the supplement industry anymore, I was, I got out not for any specific reason I just wanted to focus on optimization. I had somebody–you know who they are, I'll not mention their name, who's a very high-level person in the food, in the supplement industry. He told me that he tested every single berberine product on the market. The results were, in his exact words, “not good.”
Ben: Do you mean in terms of it not having the amount of berberine specified, or it actually being laced with other ingredients?
Jay: No. I think, the former not the latter. Honestly, I don't know about the latter, but I definitely know it's the former. He said that the berberine amounts were like it was embarrassing, is what he told me.
Ben: That's interesting. In the past, I've recommended Thorne Berberine 500 as a berberine source. I'm curious if he tested that.
Jay: Honestly, Thorne is a really good, though. I've never ever known anybody from that manufacturer to complain. Who knows? He didn't tell me. I would tell you if he did. He didn't say it was that name of that product, but he did name some other ones. They are so well-known, highly sold products, though. It's just so much cheaper. Why would you even waste time? You can get metformin now legally, quickly, cheaply. It's way more effective. By the way, I didn't say this, and I wanted to say this so people know. It is–I went to fact-check it myself. It is the most studied medication in the history of the world. That's because we have diabetes. Diabetes is so prevalent. Think about how many people are affected by diabetes, and that would be the reason why.
Also, one other thing, too, about metformin is very important that you and I didn't talk about, and I find that this is important is, that most people who are diabetic who use metformin, they take metformin to block the insulin make or the insulin response, the blood-sugar spike from their shitty lifestyles and diets. The doctors even prescribe it. They say, “Okay, well you're about to go eat your 4,000-calorie lunch, pound two of these metformin at the same time within 15 minutes, blah, blah, blah. That's what a diabetician tells them.
Ben: It's great advice.
Jay: When you're a life extensionist like you and me—Exactly. When you're a life extensionists, like you and I are, you're taking it to, obviously, suppress your insulin signal as far and as epically as you can. Then, obviously, when you modulate your lifestyle, either be a fasting or ketogenic dieting, or whatever you do to further suppress your insulin signal, it's just an amazing supplement. My good friend, Jim Brown, he believes that there is a net tissue build-up effect of metformin. For someone who's on it for five years consecutively, if they stopped using it, say for two weeks a month or whatever, they would probably still get the similar effect as far as it's glucose regulation and insulin suppression, because, again, of that net tissue effect. I don't have any research or data to back that up but he's also been a longtime user of it and he's gone on and off metformin. He figures that he feels that after a month of being off of it that is when you lose the effects.
Ben: Interesting. I'm currently working on a book with a lot of anti-aging protocols. Damn you, because I'm going to take some of this research and please do also send me these studies that you talk about metformin.
Jay: Yes, absolutely I will.
Ben: I'm going to put those in the shownotes, but I'm also going to do, I always like to people always say, “Ben, this person you interviewed on podcast XYZ said something that seems to stand in stark contrast to what you've said.” Usually, I'll listen out to what that person has to say, then review the literature, then come to my conclusion. So, A, send me the literature, and, B, damn you because this could involve me returning to that chapter, the book for another hour and weaving in some verifications.
Jay: Sorry, Ben. I'll write it for you, bro. How's that?
Ben: That could work, have you write the sidebar. Big picture here before we move on to some peptide and testosterone optimization pieces that I want to talk to you about, would be if you have liver issues, if you have kidney issues, you may want to proceed with caution. Use proper dosing, not the mega dosing used in some of these studies that vilified metformin. Then, regarding the gastric issues, bear with it, it will likely go away as your biome adapts. Finally, regarding any vitamin or mineral deficiencies, consider supplementation with a good B vitamin or methyltetrahydrofolate source, and you'll cover those bases.
Jay: For women, for sure they need the folate just because they just need folate for other reasons and stuff. Yes, dude, that's a very, very good summary. I would say that most men should start at 500 milligrams, AM and PM. You're 175-pound bro, you're in decent shape, you're under 25 percent of body fat, that's what I would do. Women, half that dose, 250-250. Then, just titrate up as, like you said, as your microbiota gets cleansed, you become used to it, adapted to using metformin. I think, when I first started using metformin, I was like 500 milligrams for probably two or three years. Then, I was like, “I want to see what happens.”
Also, one other thing to mention is there's a Life Extension Foundation, the LEFers, they've got tons of internal research on metformin. There’re people at the LEF foundation that have been using three to four grams of metformin for 30 years. There's huge on that. They're just not really very out there. You could go into their forums on Life Extension Foundation, and there are some people that have spoken about that but it's like if you Google search that, you won't find them. Bill Faloon and the people that are behind that, I've heard him speak. I can't remember where. It was a long time ago. He would say that they had a lot of people in The Life Extension Foundation that were using three to four grams a day. That's a lot. That's a lot.
Ben: Got it. I'll leave together all these links and research. Again, folks, go to bengreenfieldfitness.com/jay. Don't tune out yet, because we have a lot of other things I want to talk to Jay about, specifically, in researching you and some of the topics I want to discuss in this podcast, I viewed a roundtable that you did on peptides with a few physicians. You, guys, talked about some very interesting peptides. I've discussed on the show before, for example, BPC-157 as one injectable peptide, or even an orally available peptide that could be used for healing the gut, for healing different tissues, if it's injected near a tissue site subcutaneously. I've talked about TB 500 as another one that's very, very useful for repair and recovery. When it comes to peptides, you guys discussed a lot of others. You and I were even talking off air about a new nootropic peptide called semax that I'm very interested in trying. What are some of your favorite peptides? Even ones that might fly under the radar. Can you fill us in on what you think people should be looking into and paying attention to when it comes to the best of the best for peptides?
Jay: Absolutely. First off, shout outs–props to Ben Greenfield because your article that you wrote on peptides, which I don't even know, is that like two years ago? When did you write that article?
Ben: I wrote two of them. One on BPC-157 and one on TB 500.
Jay: No. You wrote one bigger. You wrote a compilation of a bunch of different peptides. I think you were talking about GHRP 2 or 6, and stuff.
Ben: Yes. That one. So, more of the growth hormone stack peptides.
Ben: I wrote that about a year ago. I'll link to in the shownotes.
Jay: I linked to that article in the TOT Bible because we have a chapter in the TOT Bible called, “Agents of Change.” We, literally, every single one of these, the ones you just said, of course, TB, BPC and all the top peptides. We did tons of research what's available. Obviously, as you know with peptides, it's the future of medicine. There's just not that much research. What is there we put in that book? Great job on that article. I do know a lot about peptides. I've used pretty much all of them. I have not used some of the newer ones, like the ones that we were talking about on the roundtable last week. I have not used any of those nootropics like you. We're going to be using those. It seems like pretty soon.
This is what I'll say about peptides and what I know about peptides. Then, we'll get into which ones I think are the best ones. I think that peptides for the money, and again from a growth hormone releasing standpoint, are a great option, especially if you're in the United States where if you're an aging man or woman and you want to use some growth hormone analog to slow down your aging process, to improve skin vitality, deeper sleep, increased polyphasic sleep, yadda, yadda. It's impossible unless you're pretty wealthy, to get a script for a growth hormone, for actually human growth hormone, and a specific test if the doctor's on the up-and-up. They can't technically–a doctor cannot write today, Ben, a script for growth hormone for a person that says, “I want to do this. I'm 52 years old because it's going to improve my life quality.” They can't do that. You still have to pass a test. It's called glucose stem test. Then, there's one other test. If they don't pass that, if you don't fail, I say “pass,” but you have to fail it to qualify. It's like a concussion-type test. If you were a full-contact fighter or you were in the military or anything like that, cop, law enforcement, or fireman, or whatever, you might pass it because you probably have had issues where you've been affected. Other than that, you can't get growth hormone. I say that as a caveat because peptides are obviously the next best thing.
Now, here's my experience with peptides. I have been using peptides. I first started using Ipamorelin. We can talk a lot about Ipamorelin. I know a lot about Ipamorelin. Probably, in 2008. At that time, it was like you could not get these from any compounding pharmacy. The only place you could get them were obviously the research chemical companies. However, and I won't name the company, because they're long gone, but the company that I got Ipamorelin from was actually the back room of a “stringent quality-controlled pharmacy.” They were just doing it in the back office. This company was making the purest Ipamorelin. When I started using it, I was like, “Wow.” You definitely noticed it. I've used obviously human growth hormone at very low dosages as an experimentation through my life as a guinea pig, like you, to see what stuff works. I never really got anything out of growth hormone. Also, once I have my DNA mapped with Anthony, I have a lot of Neanderthal DNA. I also have high natural IGF-1. I probably was one of those people where I have to use a massive dosage of GH to really feel anything. I was like, “No, I'm not going to do that. I have some forms of cancer in my dad's side of the family.” I'm like, “I don't want to increase the risk of mutagenic tumor formation. I just avoid that. Ipamorelin, I used that—
Ben: Before you keep going in the Ipamorelin, we can't gloss over what you said about Neanderthal genes. Some people may have no clue what you mean when you say you have Neanderthal genes. What does that mean?
Jay: It means that if you get your DNA mapped and you get your haplogroup examined, and they drill down, there's a percentage. All of us have a percentage of Neanderthal. I have almost three times the Neanderthal percentage that the average person that does a 23andMe screening.
Ben: Geez. Do you sleep in a leopard skin unitard or anything like that? [00:57:36] Neanderthal ancestors.
Jay: I'm a knuckle dragger. I have family members, if they hit you, you're going to sleep.
Ben: There's this whole back story behind possible interbreeding between someone who is more Neanderthal-like and more anatomically modern humans. It's very interesting. It sounds stereotypical, but you could look at the people who have the higher number of Neanderthal genes and they are a little bit more mesomorphic, square jaw, high bone density, big hands. It's quite interesting.
Jay: Big feet? You know where we're going with this, Ben.
Ben: Yes, I know where you're going. Back to Ipamorelin.
Jay: I tried that when it first came out back in 2008. I used a typical dosage that you wrote about. I think it's 300 micrograms. We don't have to keep rabbit holding on at Ipamorelin, because I want to talk about tesamorelin. Ipamorelin is the only peptide as of now that does not disturb natural growth hormone production. Your endogenous–you can use Ipamorelin concomitantly with anything and it's not going to disturb your natural growth hormone production. Now, that said, a caveat, that's obviously as long as you're not abusing Ipamorelin. I've seen bros and bodybuilder guys talking about using it four times a day, like a boom dose or what they call a saturation dose, which I don't even know what that means anymore. I've read people that done that. I'm sure if you do that, then yes, you're going to disturb natural production of growth hormone. But, if you just use Ipamorelin 300 micrograms before bed and then maybe, if you want to extend it, do it in the morning too, same dosage, you definitely will have better sleep, better skin quality. I think, a little bit of improved fat loss. Again, depending on your diet and if you have everything else diluted and stuff like that. That's it. You're not going to have muscle gain. Again, people will talk about growth hormone releasing analogs and peptides and obviously, HDH too does have synergy with anabolic hormones. I'm sure that's true. Look at obviously professional bodybuilders. Those are guys who are using super-physiological levels of everything. You have no idea it's polypharmacy. Who knows what's going on? In what I'm at and where you and I are at, we're in obviously the extending life using therapeutic things and doing things that make us feel better. I don't think that any of the peptides do that much, with the exception being tesamorelin. If you want to jump into that if you have any questions about Ipamorelin before I jump into the next item. I am fascinated by tesamorelin.
Ben: For people who are going to use Ipamorelin to enhance growth hormone, it has a profound impact on sleep as well like a morning dose and an evening dose, one thing that we should clarify and I'm curious if the same could be said for this tesamorelin that you're about to talk about, is that you typically want to combine it with growth hormone releasing, like CJC-1295 is very common one, because they have different mechanisms of action. They work on different receptors. One is a growth hormone releasing hormone and receptor and the other one is the ghrelin receptor which helps to stabilize your appetite. These two works on but you can literally get a five to six times effect of something like a growth hormone to create a gog like Ipamorelin, if you combine it with something like CJC-1295, for example. One thing that we should clarify for people when we throw around terms like CJC, what exactly does that mean, Jay? What would that be classified as far as a peptide is concerned?
Jay: Good question. Literally, I knew the answer at one time, what does it, I don't even remember. I know CJC-1295 with DAC or without DAC. I'm trying to remember what does CJC stand for. I don't even remember.
Ben: Okay. I can tell you something. BPC is body protecting compound and TB is thymus and beta. I actually don't know what CJC is. I forget.
Jay: I just [01:01:51] ______ that. I can tell you what GHRP mean.
Ben: Basically, one's a [1:01:59] ______. Ipamorelin would be considered a GHRP, growth hormone releasing peptide. Then, if you look at something that you'd want to stack along with that, you'd call that a GHRH, a growth hormone-releasing hormone. I think, it's what the final H stands for if I remember on the top of my head. Anyways, you usually combine something with Ipamorelin if you're going to do to clarify it to under the skin, a subcutaneous injection that you'd use for example in the morning or in the evening. You mentioned the dosage. You're correct, it's usually 200, 300 micrograms, for example, of the Ipamorelin.
Jay: By the way, what you just said is absolutely right. You'll get a much stronger effect and a much longer, more pulsatile diurnal release of growth hormone doing it with the data, the CJC. What I found, again this is my personal experience, I felt too much like I wanted to sleep. You know what I mean? It was such a strong growth hormone release that I didn't have in my natural Jay Campbell energy go through the day. It just put me in a like, “Man, I want to sleep. I want to take a nap.” If you talk to growth hormone users, that's what they feel like. There are four or five IU's a day, or whatever, that's every afternoon they're going to take a nap type stuff. For me, I didn't want to have anything do that, but you're absolutely right. It's also important. I'm sure you have a ton of women that watch this show or listen to the show. Ipamorelin is the best peptide for women, by far. I've used all of them. My wife uses Ipamorelin. I know at least 1,000 women that I've either recommended it to or just indirectly know who have used it. They all report much better skin quality. Definitely, their skin elasticity is much better and their sleep is insane. My wife uses 150 to 200, I think. A bomb could go off in her house and she won't wake up. Do you know what I mean?
Ben: For people who would hop on to you, just save your full dosage for the evening.
Jay: Exactly. That factor what you're saying too, you could do that too. I thought weird whatever I injected the CJC. I felt like a flush, like that niacin flush. I felt irritated in the area of injection. It was tapped. It was transient. It was temporary, but I just never liked the way it felt. Ipamorelin, just one dose morning, one dose night, I never ever was disturbed in any way.
Ben: Sometimes, that can be due to the presence of different growth hormone binding proteins, or in this case, a low concentration of some of these growth hormones binding proteins. I, actually, recently wrote an article on growth hormone binding proteins and whether the lack of their activity could be what's responsible for some of the deleterious or even the cancer-causing effects people associate with the use of, not Ipamorelin, but the actual growth hormone. It turns out in writing that article and doing some research on it, one of the best ways to increase the activity of your binding proteins for any of these growth hormones is the use of Quercetin, the antioxidant Quercetin.
Jay: That's awesome. I didn't know that.
Ben: In reading up on Quercetin, I just did a podcast on it a couple of days ago, actually. There are so many benefits to it. I don't currently supplement with Quercetin but after doing a lot of this research, it's one of those ones that, in the next few weeks, I'm actually planning on beginning to incorporate into a nighttime tea or something like that for this growth hormone effect that it has. That would be one thing to experiment with, would be take some Quercetin and see if you still have that same response to Ipamorelin or one of these other growth hormone releasing compounds.
Jay: As you were saying that, I just ordered it on Amazon. Good work, my friend.
Ben: There you go. Tesamorelin, what is that?
Jay: Tesamorelin is, or tesamorelin, whatever, however you pronounce it, is an FDA-approved drug. Somebody can fact-check, I'm pretty sure it was created by Merck, but I don't know. I might be off on that. Again, it's a major pharmaceutical drug. It was created for HIV-positive men suffering from lipodystrophy. The name of the drug trademark is Egrifta, E-G-R-I-F-T-A. It's a super, super expensive drug. All the guys in the compound pharmacy industry have never understood, because when they look at tesamorelin's chemical properties and then they compared it to, what's the one that they sell all the time and the name always, it's sirmorel. They said, “Oh, it's the same. It's the same. It's the same.” I've had this conversation and, actually, this debate or argument with so many compound manufacturers, because I'm like, “Okay, you think it's the same because you look at it but have you ever used both of them? If you did, you'd never say it's the same.” Everyone who's ever used them says the same thing. In fact, if you watch that roundtable last week, which I think you did, Dr. Daniel Stickler is a huge believer in tesamorelin now too. Anyway, here's my experience with it, Ben. I've used it twice now. Bro, that stuff is amazing. It was actually designed to target abdominal adiposity. Essentially, gut fat, belly fat. The one place that men probably put or predisposed to put fat on more than anywhere else is like right around the navel, that lower midsection which also tends to get a lot of visceral fat build up because, again, poor blood flow to that area. This peptide, bro, literally attacks gut fat. You could be, I wouldn't say a fat slob, but you could be one of those people that like eats a lot over the holidays, and then you're like, “Okay, I'm going to shred and I got eight weeks, 10 weeks.” That's really the impetus of “Guaranteed Shredded.” Use tesamorelin at one milligram AM and one milligram PM, same exact style of dosing parameters that I use with Ipamorelin. Dude, it is a blowtorch. It literally, incinerates belly fat. I've never seen anything like it. Quite honestly, I know people were going to probably come at me after this show runs and say, “Oh, you bullshit.” I believe that tesamorelin works better than growth hormone, in this particular way because I don't ever, in my experience using growth hormone and also talking to a lot of people who use growth hormone, it never worked in an actual geographically regional targeting of fat in that area. Again, as you know, most men, that's the one place. I actually found this out last year before I did my first round with it from Dr. Robert Kominiarek, who's one of my roundtable doctors in Dayton Ohio. He told me. He's like, “Dude, I use tesamorelin with every single one of, he calls, the metabolic emergencies. Every guy in Ohio that he comes that sees him to get optimized who's got giant belly or gut fat,” he's like, “I use it and it's like a hot knife through butter.”
Ben: Wow, interesting. A lot of people are going to hear that. They're going to want to get it. They're going to wind up at, whatever, SARMs warehouse or peptides warehouse or wherever. I'm curious to hear your thoughts about that in sourcing of peptides.
Jay: Dude, that we could go all day. We have to do another show on that. It's really sad, man. People ask me all the time like, “Why do you recommend it?” I cannot for the life of me, for who I am as a human being and what I stand for, I cannot recommend research chemical companies because if you know any of these people and you met any of these people, and again, I'm not judging them or casting anything on them, most of them are convicted felons. They have weird backgrounds. You wouldn't trust them in a normal business deal. So, why would you trust them with a chemical that you're going to be injecting into your body? The truth is that there's one compounding pharmacy that I know of right now in North America that will manufacture these things in obviously very quality control process, sterility is maintained and all that. That's Tailor Made.
Ben: Tailor Made Compounding. It was actually fascinating. You sent me the whole fact sheet, almost like the catalog of all the different peptides. This is a fantastic resource, too. Can I put that in the shownotes, by the way?
Jay: Yes, absolutely. Give credit to Ryan and stuff like that. Here's the thing, though. It's important that we say this. Again, we could talk all day on peptides. There’re only four peptides. Somebody could fact-check me. There might be six now because somebody said something the other day that two of them have recently been approved for a very specific finite medical process. I know that the four that are FDA-approved are tesamorelin. Again, because of the HIV. Ibutamoren, which is MK-677, which was also approved for men in HIV, for growth hormone increases. Then, the other two, I think, are the ones that you mentioned BP, I forget.
Ben: BPC and TB.
Jay: I don't even want you to mention it because [01:11:05] ______, I think, sermorelin is also now, in some capacities, approved. By the way, I'll say it right now. Sermorelin is absolutely worthless. Anyone who's ever used sermorelin and actually had real sermorelin, they'll tell you “I got nothing.” I'd be in a water retention. I've never seen anybody that I know use sermorelin and get results. I had guys tell me, “Oh, well I thought I lost fat.” Yes, you were dieting and doing more cardio and decreasing your insulin.
Ben: Most people will use something like CJC-1295 these days instead of sermorelin. It's so much better.
Jay: The sad part is that the doctors sell it. That's the big medical deal where that, “Oh, yes, we'll put you on sermorelin.” I'm like, “I don't want sermorelin. It's useless.”
Ben: Now, you were talking about the compounding pharmacy, like Tailor Made Compounding, but people, to clarify, can't just go there and buy peptides.
Jay: Yes, they have to get a script from a doctor.
Ben: You have to actually work with a physician and then ask that physician if they get their peptides from Tailor Made Compounding. Then, that would, at least, ensure that you've got a physician who's ordering from one doc who's associated with the company you can at least vouch for.
Jay: Exactly. They're, all, for the most part good. Again, I'm blessed that I work with or know almost all the “good doctors” in America. They're obviously in the cash pay optimization space. When they can't get from Tailor Made, for whatever reasons: back orders, they can't get whatever, again, their supplying the whole country, it seems like right now. There's one other research chemical company. Again, it's a research chemical company. I cannot, in good faith, tell anybody listening to the show right now that it's going to be legit. I do know from testing and their what is that testing, SAG, or whatever they put out. They test super high. I've never seen them fail anything below 99 or 98.5%. If you're going to buy a research chemical company, I would say that Peptide Sciences. I think they're in Scottsdale, Arizona. It's just peptidesciences.com. They test really high. I also know that a lot of doctors do go there when they can't get stuff from Tailor Made. Here's the problem, Ben. It says on the damn label, “Not for Human Use.” If you're a doctor and your patients are going there, hello, there's definitely liability. If you're a doctor and you're listening to this show, I know you have a lot of doctors listening, don't write a script for your patient to fill it at Peptide Sciences. Just go, “You go there on your own.”
Ben: I'll put a link too at Peptide Sciences in the shownotes as well. You could get berberine and take a couple of extra capsules and your blood sugars ain't go down a little bit, you can really eft up your hormonal balance if you don't use these properly. Even if you do go to Peptide Sciences, do your freaking research. I'm going to put a ton of research, exactly.
Jay: You can test them. There’re companies out there that will test them. That's what I would do. I have good friends. They're in the compounding pharmacy. Wherever we go, if anybody gives them anything. They're, “Let's test it.”
Ben: They're not expensive. A vial of tesamorelin is going to be $80, $90. However, their efficacy and I noticed the same thing walking around A4M, has influenced and pushed, especially, the field of anti-aging medicine towards a very keen interest in peptides. I agree with you that it is the next frontier of medicine and supplementation, the use of these injectable peptides. Obviously, there's still the issue that a lot of people aren't going to use them anyways because they don't like needles, and the only orally available one I'm familiar with is BPC-157, since that's found in human gastric mucosa, anyways. There's a company called Dr. Seeds sells a pretty good BPC-157 oral supplement. Ultimately, they are injectable. They are not cheap. I think, there'll be a little bit of, it'll be a little while, but I think most people listening in to this show are a little bit more on the cutting edge of what they're willing to invest in terms of their lives.
Jay: Do you think? Do you think?
Ben: The other one and I'll report on this, you introduced this to me, or at least I discovered it while viewing your peptides roundtable, is semax, which I just mentioned a little bit ago as a nootropic. I forget who on the podcast, one of the physicians, it may have been Daniel Stickler, he mentioned how profound of an improvement had on things like clear head and cognitive function.
Jay: That was actually Dr. Jim Meehan. That's actually Dr. Jim Meehan. He scripts it. He's actually the only guy. In fact, I was going to get him to write you the script before our friend volunteered. We're good. I will eventually introduce you to him because he's a good friend to have. He's an amazing guy. He listens to your show, by the way.
Ben: For those of you who [01:16:15] ______ of semax, I have a script. Let me try it and I'll let you guys know how it goes. It's spelled S-E-M-A-X, if you want to do your own research on it.
Jay: Then, there's another one. Let's just real quick for everybody's purposes, I will just run them down. I already mentioned Ibutamoren, which most people in the “bodybuilding/fitness community” know, MK-677, which is Ibutamoren. It's an oral peptide. It's encapsulated. I did use it. I got it from a compounding pharmacy, not Tailor Made, because, again, that's one that is FDA approved. Really, all the compounders will make it. Honestly, dude, it's not working for me. If you read people's reviews of it, they will say the same thing. Like, “I feel like that's one of those ones.” First off, that was an, originally, orphan pharmaceutical drug from, I think, one of the big pharmacies. They just let it go. Then, of course, the optimization space community was like, “Oh, well. It does increase growth hormone in old people.” I used it for two straight months every day. I did it every day. I’m taking same thing, cap in the morning, cap at night. All I did was I had increased hunger, and I would wake up at in the middle of the night. It was definitely doing something to my central nervous system for a while, and then it stopped working. Everyone who's used it, if you go online and you read it, you search MK-677 reviews, you'll see the same thing. I believe that it does some down-regulation of what you were talking about, the protein antibodies. You have issues where your body just says, “Okay, I don't really need this because I have my own growth hormone.” Anyway, I'm not a fan of Ibutamoren. I'm also not a fan of GHRP 2 or 6. They do create massive growth hormone release, but they also increase cortisol and prolactin. For a lot of guys, that is a no-no. Then, of course, as you know, Ben, they create increased hunger. If you're a guy that's trying to lean out, your diet's useless. You're still be so hungry, you want to eat everything.
Then, you already said, BP-157 and TB 500 are amazing, amazing peptides for healing. I've actually known people. I don't know if you this, Ben. I've known people who've used BP-157 injected locally in the scalp and it regrows hair. By the way, I don't cut you off real quick, but what's his name, Ryan. He's coming on my podcast pretty soon with one of the researchers of Tailor Made. They supposedly have created a topical men's hair regrowth cream, or it might be an injection. I don't know, specifically. He's like, “Bro, you cannot believe the research trials.” They have 10 weeks of it. They have five people. Every single one of them was near bald, and they've grown their hair back.
Ben: Wow. Ryan Smith, by the way, for those you don't know who that is, he works with Tailor Made Pharmaceuticals, or Tailor Made Compounding. He's the VP of Business Development for that company.
Jay: He's also the smartest guy that I know in the world on peptides. You should definitely have him on your show, dude. That guy is an absolute Bible on peptides.
Ben: Yes. Connect us after because, obviously, you and I have talked for 20 minutes on peptides and barely even scratched the surface.
Jay: Yes. He's the guy.
Ben: There's a lot more. Also, we're already getting long in the tooth, but I do have some other things I want to talk to you about. First of all, you mentioned when you were talking about your protocol metformin, and I asked you about that, but the other one that I said I wanted to ask you about because I'm sure a lot of people wonder, because I don't think you have hypothyroidism but you're taking Armour Thyroid.
Jay: Yes. It's a good question. When someone is hormonally optimized, you always, not always, again, everybody's different. We're all biochemically unique. You want to make sure that when there are testosterone/progesterone, if they're a woman estrogen, maybe, when that's optimized, that you're also looking at thyroid. Sometimes, they're obviously all very synergistic the way they work in the human body. When a person is hormonally optimized, they have high energy. They're obviously trying to maintain a very lean functional strong physique, like you have, like I have. A very slight uptick in basal metabolic rate, thermogenesis, and then obviously caloric burning can happen from using desiccated thyroid. Now, desiccated thyroid is a combination of 3 and 4, T3 and T4. I don't want to go too esoteric into understanding thyroid and the different pathways and metabolites and all that stuff. The reality is it's not going to disturb natural function if you just use a very, very low dose. Even if you use a huge dose, it would be debatable as to whether it would disturb thyroid function. Obviously, Synthroid and also Cytomel, which are real thyroid medications, mostly T4, not combinations. Then, the other one is T3. Those can disturb natural thyroid function, and I would never recommend those unless you'd obviously had hypothyroidism or hyperthyroidism and your doctor recommended that.
Ben: Now, are you using the same dosage when you're using something like Armour Thyroid that someone with hypothyroidism would use?
Jay: Probably not. Obviously, everybody's dosages are different based on your doctor, and your script, and your symptoms, and all that stuff. My dosage is 60 of a one grain in the morning, and usually 30 in the afternoon. I've gone as high as I've done 60 and 60. When I get my blood work done, my thyroid stimulating hormone and T3 is a little bit out of range, but nothing where it would be like, “Wow, what's going on?” Again, I've been doing it for so long. I think I started using Armour. I also rotate sometimes between Nature Thyroid and Armour. Again, they're desiccated porcine. They're from pig, because, again, pig is so close to us biochemically, which is another weird thing. I have no idea why that is.
Ben: You've had good success with dosing twice a day?
Jay: I have. That's a great question. I would not dose twice a day if I wasn't trying to be super lean. I would say I'm trying to be super lean for four to six months of the year tops. That's when I'll take a second dose. Obviously, I forget at times. We all do. You don't always remember. I always take that 60 milligrams. My script is filled by my doctor. It's I get a bottle of. I think it's a two-month script. I get one bottle of the '60s and then one bottle of the '30s. The '30s lasts a lot longer.
Ben: You're not concerned at all about that somehow down-regulating your own thyroid production?
Jay: No, because like I said, when I look at my levels of T3 and I look at my thyroid stimulating hormone, I'm just a little bit out of the range, but I'm obviously at higher. I would feel if I was going to drop off and I stopped, again I probably should test this out, I have been on it in the past, you go back into normal. Again, most doctors who are really smart about this in understanding the optimization pathways and stuff like that, they want to see when your testosterone and your other hormones are optimized. They also want to see a slight uptick in thyroid too, just to keep up with that, that whole, how would I say it, just the whole circular pathway of all of your hormones staying in balance. If you got one optimized, you want the other one at the higher end of the range too. That's why they give you a little bit of mild dose of that thyroid. Again, this thyroid medication versus Synthroid or Cytomel is totally different. Those thyroid hormones or medications can definitely affect your natural production.
Ben: The primary effect that one would expect when they do something like this would be enhanced fat loss or higher metabolism, or potentially more energy?
Jay: Both. All three, for sure. All three. Again, I'm not willy-nilly recommending this. Obviously, you should go to a physician. They need to, obviously, do an intake on you and figure out what's going on, get your blood work in labs and see your symptoms and all that stuff. For me, the real protocol when you're hormonally optimized is testosterone, metformin, and when there's a need, an Armour Thyroid or a Nature Thyroid, which again same thing, that's good.
Ben: Got it. Now, there are a ton of other things that you get into in your book, “Guaranteed Shredded,” in addition to metformin and thyroid you talk about and educate people on everything from phentermine and albuterol to nicotine gum, to a pretty hefty dose of vitamin D. It's a very interesting stack. We don't have time to get into every element of it, beyond metformin and thyroid today. Jay is indeed ripped and built. For those of you who are interested in looking his protocol and also seeing, which I appreciate, the science behind it, a lot of people like myself we're concerned about things like metformin, we're concerned about things like exogenous uses, something like thyroid, some people get concerned about Ipamorelin or tesamorelin and effects on growth hormone, or the cancer concerns he talked about earlier in the absence of proper binding proteins, the nice thing is that Jay has a lot of references in there. Go check that out, that book, “Guaranteed Shredded,” which I'll link to if you go to the shownotes at bengreenfieldfitness.com/jay. I would be remiss not to talk about testosterone, Jay. I got it. I got to give you kudos that your book, this “Testosterone Optimization Bible,” is one of the best books I've ever read on testosterone optimization, even the ins and outs of testosterone replacement therapy, which I'm becoming increasingly interested in as I age. There are a lot of questions that I could ask you about that, but what I'd like to do if you're game, is to just rapid-fire a few at you and get your reply when it comes to testosterone.
Jay: Of course. By the way, thank you for the compliment. That means a lot, coming from you. I appreciate it.
Ben: Yeah, absolutely. First of all. There are a lot of concerns out there when it comes to testosterone replacement therapy particularly its effects on the prostate, which I actually covered in my last podcast. I talked about how that's a myth unless you already have prostate cancer. It's a non-issue. Other concerns that people have are the issues with cardiovascular health. Is there a risk for cardiovascular health if one begins to supplement with testosterone injections, or creams, or lotions, or anything like that?
Jay: It's the best question you could ask about all these. As you know, in the media, I published my first book which is the TRT Manual in the very end of 2015. Then, of course, right after that was the massive media backlash with the attorneys going after the doctors, and obviously the manufacturers of AndroGel because all these guys had heart attacks. The answer to your question is if a man is what I would refer to, again, I got to give credit to Dr. Rob, a metabolic emergency, that means they have a ton of visceral body fat, they're in poor physical condition, they're untrained, and they obviously have insulin resistance probably, metabolic disorder, and then they start with a doctor who doesn't even know how to manage their endocrine system, doesn't assess all their risk factors, and maybe put some on a therapeutic injectable testosterone, their regimen, it potentially, again, I put you in all caps with stars behind it, could cause a vascular incident. It's not going to be due to testosterone's mechanism of action, but the fat person's compromised health. Does that make sense?
Jay: Remember, injectable testosterone will increase through erythrocytosis, the oxygenation of your red blood cells, which is actually a good and healthy thing. For a person who's in poor health and physical shape, they lacked conditioning, it's possible that that could cause some vascular event. The problem is, and again, this has actually already been proven in court, because the manufacturers of AndroGel have been let off on this now, is it always will come down to the individual. The only other thing I would say too, Ben, just so you understand, is that all the studies now, and there are literally hundreds of studies in the last 10 years showing this, testosterone is in fact cardioprotective. Using therapeutic testosterone when a person is otherwise normal/healthy is actually beneficial for the heart.
Ben: Unless you fall—kind of like metformin, I believe that the only studies that have shown it to be potentially dangerous if you have heart issues would be senior men older than 65 with a lot of other physical limitations.
Jay: Exactly. I'm so glad you said it. Always, when you're in a compromised patient population group, you always have to seek the wise counsel, hopefully, of your physician. The problem is, as you know, is that there are not a lot of doctors schooled in managing men's endocrine systems.
Ben: Got it. Some people will think of testosterone as something you would do for enhance libido, or erectile dysfunction, or increased energy. What I learned in your book was its effect as a nootropic. Can you explain briefly what TRT could do to cognition?
Jay: Great. Good question. That's the one thing I think most people don't understand the most. I always say this. The first side effect that is mediated through testosterone therapy, or therapeutic testosterone, is depression. It alleviates any depressive symptoms or ideology, and then, of course, brain fog is obviously one of the number one side effects, or not side effects. When you have a testosterone deficiency, people report brain fog. The testosterone will alleviate both of those because what it does is it massively stimulates dopamine signaling. Your dopaminergic pathway improved/increased. You have this feeling. Essentially, it's like a feeling of well-being. You could talk to any guys who were super low, had a deficiency. Then, two weeks to four weeks later, that's the first thing. They're like, “Holy shit. I feel like a new man.” That's due to the dopamine increases. Then, also, it definitely, definitely improves working memory. Again, there's a number of studies as you found out in my book, in the TOT Bible. I will say this. I would be remiss if I didn't say this. I just did a podcast with Dr. Mark Gordon. I know you know who he is because he's on Joe Show all the time. He's the guy that found the Warrior Angels Foundation.
Ben: Yes, I know Mark. He's a good guy. He's very smart.
Jay: Mark's awesome. We're good friends. He now has accessed to some clinical research that literally shows that testosterone is able, I'm not kidding you, he just told me this last week, stop Alzheimer's and dementia and its tracks. There's a researcher at University of Southern California. I don't know the guy’s name. I could get it. I could reach out, text him, but this guy has the insane amount of research that he has analyzed in the last two years about how powerful the effects of testosterone exerting protective effects in the synaptic and dendritic pathways in the brain, to which now they can basically say that it can, if a person gets on therapy testosterone early enough, can completely stop Alzheimer’s and dementia in a person that is predisposed to actually having it happen.
Ben: That's very good to know. I'd seen these studies already, relatively new studies that have come out displaying that it's effective and efficacious in reducing depressive symptoms, likely by acting on some of those serotonin and dopamine pathways. If it also has that effect on Alzheimer's and depression as well, and also cardiovascular health and bone density, and a lot of the other things you get into in the book, I think a lot of people, especially men, are going to be very interested in using it. Of course, you probably get this question all the time, once you start using it, don't you have to be on it for life?
Jay: You do but here's my argument to that. It's not an argument, but my counter to that. I think we're going to talk about this as we get further into this interview. The environment, Ben, you know this, right? It's an all-scale, full-out, frontal assault. From every angle in the environment now, on both male and female endocrine systems. From the EC's, from the air that we breathe, from the blue light in our screens. There’re tons of other stuff I'm not even talking about. The water supply. There are such so many chemicals laced in our environment now that you look around in the average man under the age of 25, this doesn't even count what birth control did to the younger men of today, because now there are all kinds of studies coming out on that but it's very difficult to maintain an optimized level of testosterone as you age now. Again, it's from the environment. I think you know this, and obviously, this is covered in the book. Men, sixty years ago, had three times the natural testosterone level of men walking around on the street today. That is a statistical fact.
Ben: Geez. Now, you talked about birth control. I'm mostly familiar with its effects on females. What do you mean it affects young men?
Jay: We've covered this in the roundtable. There have been some studies that have come out, and I can go back and I can find this stuff where just search the roundtable. We talked about this. There was a study that came out, I think, about three months ago, maybe four months ago, about the urogenital tract narrowing, Ben. What that means is from the testicles to the anus, it's literally narrowing for the first time that they've ever, again, in recorded modern history, which means that men are becoming more like females. There's literally now an observed–
Ben: What that has to do with the pill? Or, what would that have to do with birth control?
Jay: They say that the issue is that because birth control has been ubiquitous in the landscape for the last 30 to 35 years, that it's so prevalent in the water supply, that–
Ben: Okay. I know where you're going. I've seen some of that research too. That's talked about in the book, “Estrogeneration,” Anthony's book. I interviewed Anthony already. I'll put a link to my interview on Anthony about his book, “Estrogeneration,” so that you guys can learn more about this. To return to your point about needing to be on it for life because we're fighting in an uphill battle if you do start it. For me, cognitively, it's very similar to a glyphosate. For example, my entire family takes Zack Bush's product, RESTORE. Until Monsanto goes out of business, or I guess Bayer Pharmaceuticals goes out of business, I will take that for the rest of my life. I have a genetic deficiency for superoxide dismutase and glutathione. I will take my sublingual glutathione and do my glutathione butt injections that I do once a week for the rest of my life. Sometimes, this is better living through science and trying to optimize your body so you can better achieve your purpose in life. It is probably annoying to have to do something like an injection every week or a couple times a week for the rest of your life, but the benefits seem so profound. I've been keenly interested in testosterone replacement therapy for quite some time. Now that I'm slowly moving away from competing in a lot of these professional sports that I compete in, it's high up on my radar. That leads me into another question that I want to ask you, though. Do you have to inject? There’re pellets. There’re creams. There’re lotions. There’re gels. What's the best delivery mechanism?
Jay: Great question. No, you do not have to inject. In fact, now, for six months, actually I'm in my seventh month, I have been using cream on my testicles. Trans-scrotal application which I have to give my close friend and potential business partner, Dr. Keith Nichols, and he's not the first guy that came up with this but he's the first guy that supported it with the research. Ben, I will send you a study. The cream is eight times better absorbed on scrotal skin than anywhere else on the body. I had been on testosterone injections three times a week with a very shallow 28-gauge or 27-gauge insulin needle intramuscularly. I do my shoulders. I do my upper shoulders, triceps area. I do my quads.
Ben: Like a pin cushion.
Jay: Yes. I never injected my butt. I could if I wanted to but when you're using a little 5/16-inch needle, a little tiny insulin, I know you know what because you're injecting the glutathione. You don't have to. Exactly, I've been using injections for 17 years. There is scar tissue that comes from that. I see an ART technician once a month and she beats me up and removes all the scar tissue. It's not an issue. It's just more work. I started doing this even though I was against cream because I had tried cream in my early part of my first five years when I was testosterone. It just wasn't the same. Of course, that was a long time ago too. They've improved permeability of the VersaBase cream. They've improved the absorption. They've improved a lot of things. It actually holds stable in cream form better now too. Anyway, Keith got me to do it. Ben, holy shit, bro. It is amazing.
Ben: Totally. You have to be careful, though, when you put that on your testicles if you're with the partner, correct? You wouldn't want to do this prior to sex.
Jay: It's a good question. In the past, and obviously that's in the book, the ability to transfer the transdermal solution to a partner, a pet, any other life form, was much more preferable or possible, obviously, but that was also before I understood, or was really versed in doing it on the scrotum. Now, obviously, if you put it on your scrotum, let's say after you take a shower in the morning, which is what I do. It's a religion now for me. Then, you have sex with your wife and she goes down on your balls, then, of course. I find, legitimately, that if you, you'll have to find out and I'll give you [01:38:27] _____ at some point, but when you put it on your balls and rub the cream, dude, it absorbs really fast. It is incredible how much better this cream's absorption quality is now. Honestly, I don't ever have that issue. Now, again, I say that as a caveat. If you did have sex right after and your wife or your significant other was down there, then, yes, there's some transfer potential. But, it's not that big. I've had doctors that do this as their regular regimen, talked about all the time. They joke about, they're like, “Don't you want your wife just as turned on as you during sex?” They make jokes about it. I don't see it as a bigger risk, as if you were put it on your legs or you're putting it on your arms, which is where normally men would apply it. They say to put it inside of your forearms or the inside of your thighs. I'm telling you, dude, it's unbelievable. The other benefits too that I want to talk to you about is that it's definitely an incredible sexual function enhancer. Now, again it's not going to make you crazy porn star. But because of the increase in DHT from having the cream right on your scrotum, you have better sexual function, because dihydrotestosterone is the primary androgen signal. You're going to have better sex. You're definitely going to have, especially for men in monogamous relationships, you're going to be able to get turned on and super erect a lot faster using the cream versus injections. Again, I say that as a 17-year injection supporter. It took a lot for me, from a research standpoint and obviously anecdotally trying it, for me to start supporting the cream. I'm telling you, dude, I'm here to say to everybody in the world now, this is the better solution. I sent you my document for my speech or my lecture that I did at Swiss in October. I changed my ways. In the book, injections were number one but now I go to trans-scrotal cream, one, and one A would be injections daily [01:40:27] _____.
Ben: That's interesting. People are listening to the podcast. This must also be an update to the TOT Bible book.
Jay: Yes. 100%.
Ben: A lot of guys would be concerned about sperm count and about fertility and anything else that you should stack with testosterone to get rid of some of the potential issues in that regard, or even the potential issues with over-aromatization. What are you taking with testosterone to mitigate any of the downstream side effects?
Jay: Good question. Here's the thing. It's really hard to say this because so many people are really misinformed including myself and most doctors. The understanding in the community about suppressing estrogen, “blocking estrogen” when you're on testosterone is a total myth and a misnomer. I'll send you the lectures, not lectures, but the podcast I did. The leading testosterone doctor/researcher/lecturer is a guy by the name of Dr. Neal Rouzier. He owns a company called WorldLink Medical. His practice, which he's now retired, he just lectures and teaches, it was in Palm Springs California. He has been teaching for 10 years at all the major academies, A4M, obviously AMMG, that blocking estrogen is wrong. That all these doctors that are doing this, with an AI, which is aromatase inhibitor medication, are missing the understanding of how important estrogen is in the human body. This is where it gets really weird. I don't want to go too deep down the rabbit hole on this. You need estrogen to, excuse me, you need testosterone to aromatize into estrogen, especially as you're aging, to confer the protective effects to your biological system. When I say protective effects, men, I mean heart and vascular protection. I mean, bone mineral density protection. I mean, joint protection, brain protection. Again, vascular protection. On and on it goes. There’re 90 other pathways in the human body that estrogen exerts a protective effect. What's happened in the last 10 years as testosterone has become bigger, therapeutic testosterone has become bigger, all these doctors have been screwing up the science and blocking men's estrogen by starting them on an AI and testosterone, or whatever else. It will get to whatever else in a second because your question is a great question. I wanted to make sure that I came very clear today on this podcast because in the community where I'm in, this has been a big topic for the last four months, because more and more patients now are realizing, and of course, doctors too, that they should stop blocking estrogen. It's obviously [01:43:03] ______ to what most people believe, because they've always thought that, especially in the bodybuilding world and obviously this isn't the bodybuilding world, but the bodybuilding world has unfortunately filtered into the therapeutic world, obviously the clinical settings. They would think that, “Oh, well, if I want to have my testosterone optimized at a higher level and a ranged value that I want my estrogen lower. It's not true, even the reference ranges which I know we're going to probably talk about, where they say you should have your estradiol, which is your estrogen obviously between 30 and 45. That's wrong too, because that's not even giving you minimal protection from having a heart attack.
Ben: A lot of people don't think about that too, the protective effect of estrogen on cardiovascular function. Are you saying you would not want to take an aromatase inhibitor at all to prevent the testosterone converting an estrogen?
Jay: Never, never, never. Here's the thing. It's a great question. You're very smart, by the way. Even doctors don't catch on that fast. What ends up happening is you get tons of guys who've been on testosterone for 10 years. They're doing fine. They seem okay. They use a microdose of an AI. They say, “Well, Jay,” or whatever their doctor is, “I stop my AI. I feel a little bit better but here’s the thing…” Then, they claim that there's some symptom that they can't get away from. If they don't use the AI, the symptom comes back blah, blah, blah. The bottom line is even if you use an AI, again, I don't want to get too esoteric on AI, aromatase inhibitor medication to suppress or block estrogen when you're on therapeutic testosterone, you're causing too much harm to biological systems because you're blocking the natural by-product of testosterone aromatizing “in the estrogen” when you're on therapeutic testosterone. It's a terrible thing. Here's the thing. I don't want to scare people, but it's important that I bring this out we're talking on the show. I just did a podcast two weeks ago with the researcher. Not a named person, so it doesn't need a name who he is. His company has been doing a lot of research with cardiologists. They've been looking at men on therapeutic testosterone. They are finding that there are issues in the vascular pathways from men that are on AI's. He referred to them as microblisters in certain vascular pathways that can lead to, technically, an MI. Anyway, bottom line is if you're doing this right, you should not use or block your estrogen when you're on testosterone. The one thing, Ben, that most people get confused is they think that testosterone causes, if you don't block your estrogen, that the high estrogen effects, meaning it's high estrogen symptoms of an elevated estrogen e2 level, which, again, is estradiol, is causing the side-effects that they think are from high estrogen. It's not, Ben. It's from insulin resistance and visceral fat. If you're a dude, you got a belly, you're on testosterone, you don't block your estrogen, and then you feel like you have high estrogen in your mind because you've been told that this is high estrogen symptoms, it's not the truth. The symptoms that you're feeling are from your insulin resistance and your visceral fat deposition. That's what causes high estrogen effects. The truth is you should have your estrogen between 60 and 80 or higher when you're on testosterone to confirm minimum protective effects to your heart. Of course, all the other things we talked about.
Ben: Doesn't HCG cause a slight elevation in estrogen? Is that why you would take the HCG, or do you take the HCG along with testosterone too to maintain fertility?
Jay: Great question. I'm glad you said that, actually. I just did a video on HCG last night that I'm probably going to post later today that talks a lot about that. What it's on YouTube, I'll just email it to you. You can probably put it in the shownotes because it's going to be really, really good. HCG is definitely necessary for men that want to maintain fertility. If you went on testosterone cream hypothetically in the next year and you still wanted to have kids, which I don't know if you do or not, do you still want to have kids?
Ben: I'm not close to the idea, but not actively trying.
Jay: Let's just say that you might want to have it. What you would do is you would use HCG in a microdose fashion. Again, HCG is human chorionic gonadotropin. It is a fertility medication. Men use it when they're trying to get their wives pregnant. If you go to a fertility specialist, women also use it too. It's actually women's urine. That's what the actual base constituent of the drug is. The bottom line is that you would use a very microdose of HCG to maintain luteinizing hormone, which is LH, function so that your sperm remains motile and you still can obviously impregnate your wife. The thing is, and this is where all the confusion is, is that men who are not wanting or desiring to maintain fertility, they don't need to use HCG. Now, some guys will come to you and me or anybody and say, “Oh, that's not true, bro. I feel really good on HCG.” If that's the case, again, you're biochemically unique. You have your own interindividual. That's fine. Great. Use HCG. For me, I want to see what testosterone does in isolation, in my endocrine system. In my opinion, every man should want to do the same so that they understand what their baseline levels are one thing, one time.
Ben: That makes sense. Doesn't HCG keep your balls from shrinking too, though?
Jay: It does. That's a good point. It does. If you're a cyclist, an athlete, somebody like that, your big, sacky, hanging balls usually is a detriment from a performance standpoint.
Ben: If you're tea bagging when you take a dump.
Jay: Most guys complain. What I hear them say that you say back to him and like, “Dude, has your wife ever told you that she likes your big, haggy sacks?” They're like, “No.” I'm like, “Exactly, so who cares? It's just a thing.” You're right, that is an issue. But as far as ejaculate volume, erection quality issues, or anything like that, no. You don't need HCG for any of those things. But, yes, there is a little bit of a descendent testicle issue. Once your body is reliant on the exogenous testosterone, you will notice that if you're not using HCG. That's correct.
Ben: I know we're getting long in the tooth, not to overuse that phrase. I want to ask you at least one other important question about testosterone. That would be, for the people who go in and get blood tested for testosterone, assuming that you think a blood test is the way to go versus, say, a urine panel or a salivary hormone analysis, you can comment on that, reference ranges. What should you be looking for in reference ranges and related to the testing when you're on testosterone? What should you be monitoring to make sure that you're not venturing into any type of dangerous category as far as hormone imbalances are concerned?
Jay: You ask the best questions. To make a very, very big long narrow-minded question, go to the book, which I know you're going to provide in the links. I have that. That's actually a whole chapter on the biomarkers that you need to pay attention to over life, being on testosterone. Let's talk about the reference ranges and their accuracy.
The reference intervals for blood levels for men have actually changed in the last year. It went from 348 nanograms per deciliter on the low end to 1197 antigrams per deciliter on the high end, to now 264 to 916. What they did was, what “they” meaning LabCorp, which is again the big blood measurement company, there are others, but they're the biggest one, there's Quest Diagnostics too, they basically lowered the standard mean deviation. In their opinion or what their claim is is due to obesity and metabolic disorder, which as you know, lowers natural testosterone production by itself. They're saying that what they're doing is they're just basically applying it to the bell curve of the population. Here's what the smart doctors will tell you, Ben. It's not the truth. The real truth is they're basically now with the new normal values being lowered. Think about that. It went from 348 to 264. Then, it went from top-end 1197 to 916. It's just, essentially, they're denying treatment now because they've lowered the standards. More men who desperately, probably, need therapeutic testosterone are denied when they go to their primary care or their HMO doctor and say, “Look, dude, I want you to test my testosterone.” It comes back and the guy's 265. “Oh, you're fine.” But the guy is suffering.
Part three of your question. Therapeutic testosterone prescription is essentially a wholly symptomatic over laboratory range values. You should definitely get your labs done, of course, but, if you are still suffering from symptoms, a deficiency, which was, again, lack of cognition, lack of energy, listlessness, lifelessness, depressive, obviously brain fog, any of those things, then you should definitely go see a specialist who's not an HMO or a PPO doctor. As you know, dude, you're not going to find anybody. If you do, it's going to be pure luck. That's really qualified to manage your endocrine system. Honestly, dude, the truth is if you do go to those people and you do work with them and it's a co-pay thing and you do qualify, very rarely will you but let's say you're a 55-year-old guy and you do, they're going to screw up, Ben. They don't know what they're doing. Again, I don't blame them. There's no training, as you know. There's no training in med school for this. They don't know how to manage endocrine systems. Even endocrinologist who's supposed to know this stuff, they're not really good in prescribing hormones with men either because they look at the textbook definitions. The textbook definitions are obsolesced.
Ben: Are you talking about, or do you prefer blood testing always? Or, do you look at diurnal variation or variation over 24-hour cycle with things like a DUTCH test via urine or an adrenal stress index salivary test?
Jay: You're the man. Nobody ever talks about it. In a perfect world, I would love a DUTCH test but it's too expensive and nobody even knows what that means. Blood, which is serum, is the best way right now currently in the marketplace. Obviously, DUTCH is the best by far, but nobody's doing DUTCH, and it's very hard to get DUTCH anyway. Excuse me, salivary is completely worthless. You cannot measure testosterone, especially like you said, with the diurnal pulse. There's a doctor who's in my network. He blows up salivary test and he gives you 20 reasons why it's worthless. I just know that the only thing that salivary works for is cortisol. Everything else is too deviated. There’re too many issues that can fall into it. You just can't rely on it. Definitely, the best place is if you're a guy listening to this show right now and you have no idea, which is again 90% of society because they don't ever go to their doctor and get this measured. Doctors don't want to recommend it because it goes counter to the sick care of illness medicine model. DiscountedLabs.com. Again, I have no affiliation with these companies. I know the people that own them but I don't make money on them. DiscountedLabs.com and privatemdlabs.com, you literally just go online like you're going to Amazon. You get a testosterone, total testosterone, free testosterone, and sensitive estradiol. It's under $100. Go get that done. Then, from there, based on your lab measurement numbers, that's when you, if you have a deficiency, you should seek out really good cash pay optimization doctor.
Ben: Do you have much history with DirectLabs? That's what I've used quite a bit in the past for DIY also.
Jay: DirectLabs is amazing. I'm glad that you mentioned them. I'm very familiar with them. Never used them but they're also great too. There's a bunch of them. They come up it seems like every day now.
Ben: As the testosterone replacement therapy goes along, you're monitoring estrogens to make sure those aren't getting too high. You're obviously monitoring total and free testosterone. I would imagine monitoring sex hormone-binding globulin. Anything else that you pay particular attention to once you've already started on the therapy?
Jay: All good points. Hematocrit and hemoglobin. I'll get back to that in a second. Just like you said, this is like the advanced version. Bro, you're giving me the opportunity to update the book here online. Thank you. I really appreciate it.
Ben: You're giving me the opportunity to update my metformin chapters. Right back at you, bro.
Jay: You're the man. It's good that you brought that up because here's the truth about testosterone optimization therapy today. If you're working with a clinician that knows what they're doing and they are out there, there's not enough yet but we're working on changing that, they are looking at symptom resolution and how you feel over all of the lab reference ranges. What I mean by that is sure, when you start get the full panel, again it's in the book what you should pull, do it once a year just to feel good about yourself, to see what's changing over time, but don't preoccupy your mind with like, “Where is my total testosterone level?,” or “Where is my sensitive estradiol level,” or “Where is this or where is that?” The only caveat would be hematocrit and hemoglobin, which I'll get to in a second. Again, the only goal right now of testosterone optimization therapy is no symptoms and side-effects and feeling good. That's the two-fold goal. I want to feel great. I want to have no symptoms and side effects. All the other things, if you focus on, let's say you show up one time, they take your test and showers after you inject or after you put the cream on and you show 1,400 testosterones. That's way above the reference range. Who cares? Do you feel good? Do you have any side effects? No. The right doctor, smart doctor who gets this isn't going to look at you and say, “Oh, my God. Oh, my God. Your symptoms, you're way out of range.” Ben, what happens is the average doctor who doesn't know this, what they'll then do is they'll literally cut the dosage in half because they don't understand the mechanism of action of testosterone, they don't understand the half-life of the molecule, they don't get any of that stuff. They just see the outer range level and freak out. Then, drop the guy's dosage. Then, the guy goes on this unfortunate circle-jerk who knows how long it'll last of feeling like shit blah, blah, blah. Then, a lot of times too, I don't want to get into it, they increase their dosage of an AI, which as you know is only causing harm. That causes all downstream effects psychogenically and in the brain. Then, they just feel like they have anxiety. It's just a horrible situation.
The real truth of testosterone is if this is done right, and I've been blessed that I worked with doctors that have always done this right, there are no side effects. Now, granted, you have to do work. You do have to monitor things. You do have to take care of your life. You do have to eat clean. Train. Do all the things that you should do, which, as you know, I cover in the book. It's not a panacea. Testosterone is not some Holy Grail wonder drug. But it does help and slows your aging process. The only other thing, two things to answer that question in a long-winded way is that hematocrit and hemoglobin are the measures of red blood cell activity and levels in your body. You want to keep your hematocrit around 20. 22 would be the high end. But, between 22 and 20. Then, you want to keep your hemoglobin at about 55%. Now, one other thing about those two things is that most doctors don't understand that, because those numbers are the newer range numbers. They were based on studies of people at elevations like in Denver, also some places in the Andes Mountains in South America where they did some studies on athletes and just people living there. You aren't capable as a normal, again otherwise healthy person, of being at that range of hemoglobin and hematocrit without needing to donate or be phlebotomized. The problem is that doctors see those levels and they immediately send the guys to be phlebotomized. If you over phlebotomize a patient, you drop their iron levels too low. Then, once you drop their iron levels too low, you know what can happen. [01:58:51] ______ of that things.
Ben: Exactly. You want a sweet spot with iron because, obviously, it can act as an oxidant, which can be an issue for many men. We don't have enough time to get into that right now.
Jay: Yes, I know. I just wanted to slip just one more thing. Too many doctors think that having that elevated level is polycythemia vera, which is literally a neoplastic bone marrow disorder. When you have elevated levels, let's say you're on injectable testosterone, it's actually natural. It's called erythrocytosis, which is literally when both your hemoglobin and your hematocrit are elevated in the production of red blood cells. Basically, you're sending more oxygenated blood to your heart, which is obviously beneficial, anyway. That's all I do want to say.
Ben: To clarify for people, this is because if your hematocrit and hemoglobin go up too high while you're on testosterone replacement therapy, it could result in this erythrocytosis or blood thickening. You'd want to keep that from occurring.
Jay: Exactly. I'm going to say it. Men should always be doing cardio on testosterone. In fact, you should increase your endurance capacity because exactly what you just said, you definitely are having a thickening of the blood. The best way to replace those red blood cells and just constantly have that exchanged is to obviously do more cardio, or, at least, regular consistent cardio so that you improve your cardiovascular capacity.
Ben: It makes sense. We'll be going almost two hours, man. We're going to have to send people through the book because we didn't even scratch the surface of what you go in to in the book.
Jay: You're going to have me back.
Ben: If I can read all four of your books in six days in preparing for an interview for you, I guarantee our audience.
Jay: Dude, you’re amazing that you did.
Ben: I don't like to interview people unless I know what's up. Jay has his Aggressively Shredded Program which gets into his fasting protocol and a lot of those things that we let off with, including like how he uses metformin, the protein MCT oil drink that he uses, his other stacks that include quite a few other things that I haven't talked a lot about before on the show. I'm going to link to that. I'm also going to link to his amazing TOT Bible. That one is a must read. I would say of anything that I linked to, that's going to be one of the best. Then, I'll also link to his Aggressively Shredded Program and his website, and also, the roundtable that he did on peptides, the peptide sheet from Tailor Made Pharmaceuticals. I'll put links to his Facebook video about metformin. I'll put a link to his fat loss bundle, his men's health optimization bundle, his TRT Revolution podcast. Also, Jay is going to be sending me additional research on metformin, additional research on the reason that he switched from testosterone injections and pretty much anything that he mentioned as far as papers. He'll send all those to me. I'll weave those into the shownotes between now and when I actually release this show. Those are all going to be available for you at bengreenfieldfitness.com/jay. That's bengreenfieldfitness.com/j-a-y.
Jay, dude, we literally could talk this entire day. I have to actually go and head over to my kids' school.
Jay: It's awesome.
Ben: Thank you so much for the time.
Jay: Thank you. Honestly, this was epic. Let's definitely do it again. Like I said, I definitely want to bring you on my podcast. Again, I appreciate the opportunity. It was amazing. Let me just say one more thing. When you gave my website earlier and that thing, that is my website, but it's dead. Just have everybody who's watching this, just go to totrevolution.com, which is testosterone optimization therapy revolution. You already said it. Then, I wanted to say because you did ask me it cost on physicians. It should be anywhere $100 to $300 a month for total optimization. That's everything.
Ben: $100 to $300. It's not bad, really, considering a lot of benefits that you get.
Ben: I like it. Folks, leave your questions, leave your comments, leave your own feedback over at bengreenfieldfitness.com/jay, j-a-y. Until next time. I'm Ben Greenfield along with Jay Campbell signing out from bengreenfieldfitness.com.
Thanks for listening to today's show. You can grab all the shownotes, the resources, pretty much everything that I mentioned over at bengreenfieldfitness.com, along with plenty of other goodies from me, including the highly helpful “Ben Recommends” page, which is a list of pretty much everything that I've ever recommended for hormone, sleep, digestion, fat loss, performance, and plenty more. Please, also, know that all the links, all the promo codes, that I mentioned during this and every episode, helped to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. When you listen in, be sure to use the links in the shownotes, use the promo codes that I generate, because that helps to float this thing and keep it coming to you each and every week.
Is metformin really as dangerous as it's been cracked up to be?
What are the best peptides to use for muscle gain, fat loss, and cognition?
How can you get started with testosterone optimization therapy?
I answer all these questions and many more in this podcast with Jay Campbell, a Champion Men’s Physique Competitor and the best selling author of the Testosterone Optimization Bible and of The Definitive Testosterone Replacement Therapy Manual: How to Optimize Your Testosterone for Lifelong Health and Happiness… (along with a host of other books linked to in the resources section below).
As a 17 year TRT patient, Jay is a master at manipulating and tweaking the human endocrine system to optimize performance and health. He has experience working with thousands of men and women in optimizing their nutrition, exercise, fitness and fat loss. Jay makes it his personal mission to affect positive and rapid change in each and every client who enters the mastermind program.
During our absolutely epic discussion, you'll discover:
-Jay's daily routine and why he eats only 3 days per week…13:05
- Armour Desiccated Thyroid
- Lion's Mane
- Curcumin, Turmeric
- Protein powder, MCT oil
- Practice intermittent fasting if you're not fast-adapted or want to lose weight
- The cold-filtration whey isolate Jay recommends…
-Jay's response to my concerns about the use of Metformin…25:50
- Mitochondrial dysfunction
- 2 studies by Dr. Chandler Mars here.
- Morbidly obese diabetics using a disproportionate amount of Metformin
- “Life extension dose” varies due to body size, ancestry, etc.
- Jay has used Metformin for 17 years
- Lactic Acidosis: studies done on samples not representative of the population
- Gastric issues are a result of Metformin cleaning up microbiota
- Subsides as the biome becomes used to Metformin
- Metformin protects the brain and cleans vascular pathways
-How to go about getting Metformin…43:00
- Tell your doctor you want it because it's cardio-protective, prevents cancer and is believed to stop the progress of neuro-degenerative diseases such as Alzheimer's
- It's also very affordable
-Whether Berberine should be used, and if so, as an alternative or a supplement to Metformin…44:55
- Berberine is similar to Metformin, but isn't as regulated and is much more expensive
- Berberine doesn't have a good reputation among people in the know
- Metformin is the most studied drug in the world (because of diabetes)
-Jay's favorite peptides and what to look for when choosing a peptide for yourself…52:40
- Peptides are a great option for an aging man or woman to slow down the aging process, increase sleep, etc.
- Ipamorelin (GHRP)
- Highest efficacy if combined with a growth hormone
- Best peptide for women by far
- Neanderthal genes
- FDA approved; created by Merck
- Created for HIV positive men for lipodystrophy
- Extremely expensive
- Highly effective in eliminating body fat
- Peptide fact sheet from Tailor Made Compounding
- Sarmorelin is useless
- Semax as a nootropic
- BPC 157
- Jay doesn't like:
- GHRP 2 or 6
-Why Jay is taking Armour Thyroid…1:19:30
- Thyroid synergistic with hormones and testosterone
- Desiccated Thyroid: Combo of T3 and T4
-Rapid fire questions on testosterone…1:26:00
- Is there a risk of cardiovascular health if one supplements their testosterone?
- If a man is a “metabolic emergency,” potential for an incident; because of that person's compromised health
- Testosterone is cardioprotective; beneficial for the heart for someone in good health
- TRT as a nootropic
- Testosterone increases dopamine signaling
- Feeling of “well-being”
- Improves working memory
- Once you start using it, do you have to be on it for life?
- Yes, but the individual's environment is vital
- What's the best delivery mechanism?
- Transscrotal application (absorbed 8x better in the scrotum skin)
- What are you taking with testosterone to mitigate the downstream side effects?
- World Link Medical
- You need testosterone to aromatize into estrogen to confer the protective effects to your biological system
- You'd never want to take an aromatase inhibitor
- What should you be looking for in reference ranges, and what should you be monitoring when you're on testosterone?
-And much more!
Resources from this episode:
-Jay's TRT Revolution podcast
-Jay's book: “Guaranteed Shredded”
-Men's Health Optimization Bundle
-Ultimate Fat Loss Bundle
-T.S. Wiley's book: Lights Out – Sleep, Sex & Survival
-Amazon version of the Testosterone Optimization Bible
-Zach Bush's Restore
Other notes from Jay:
-Metformin Study: Mitochondrial Dysfunction -This was on a thoroughly compromised patient population group of Morbidly Obese Diabetics who were using anywhere from 6-9 grams of Metformin per day. If you do further searches, it’s actually the opposite. Metformin reverses Mitochondrial Dysfunction. There are many, many others.
-Metformin Study: Lactic Acidosis – The fear of this condition happening was based on a study from the 40s (still attempting to find it) also in a massively compromised patient cohort. These patients were in end-stage renal failure and also obese and diabetic. We must be mindful that correlation does not equate to causation. All of these linked studies show that Lactic Acidosis rarely happens if ever in normal patients population groups. Check them here, here and here. Elevated plasma metformin concentrations (as occur in individuals with renal impairment) and a secondary event or condition that further disrupts lactate production or clearance (e.g., cirrhosis, sepsis, or hypoperfusion), are typically necessary to cause metformin-associated lactic acidosis (MALA). As these secondary events may be unpredictable and the mortality rate for MALA approaches 50%, metformin has been contraindicated in moderate and severe renal impairment since its FDA approval in patients with normal renal function or mild renal insufficiency to minimize the potential for toxic metformin levels and MALA. However, the reported incidence of lactic acidosis in clinical practice has proved to be very low (<10 cases per 100,000 patient-years).”
-Metformin Study: Gastric Issues (Nausea, Flatulence, Gut Discomfort etc) -This happens only to people who won’t clean up their shitty diet. Because Metformin is working directly on cleansing the microbiota. All of these studies show Metformin’s action on the Microbiota. Check the studies here, here and here. “Metformin, the most frequently administered medication to treat patients with type 2 diabetes, has only recently been suggested to alter gut microbiota composition through the increase in mucin-degrading Akkermansia muciniphila, as well as several SCFA-producing (short-chain fatty acid) microbiota. The gut microbiota of participants on metformin has exerted alterations in gut metabolomics with increased ability to produce butyrate and propionate, substances involved in glucose homeostasis. Thus, metformin appears to affect the microbiome, and an individual's metformin tolerance or intolerance may be influenced by their microbiome”
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