May 6, 2009

Podcast #42 from https://bengreenfieldfitness.com/2009/05/podcast-episode-42-an-expert-interview-on-bio-identical-hormone-replacement-and-nutrient-therapy/

 

Introduction: In this podcast: Hormone replacement, nutrient therapy, ice baths, creatine, rapid bone healing and much much more in this episode number 42 from Bengreenfieldfitness.com.

Ben: Alright, we are back. Welcome back. I know it’s been a couple days since our last official podcast but podcast episode number 42 has finally arrived and it is jampacked. The main topic today is going to be an interview with one of the nation’s top authorities on bioidentical hormone replacement and nutrient therapies. I was very stoked to get this guy on the show – a physician from Texas, Dr. Roby Mitchell. He’s also known as Dr. Fitt and he literally is one of the world’s top authorities on this topic. So that’s going to be a fantastic interview. And in addition, we’ll have the special announcements today. Got a jampacked Listener Q and A so stay tuned for tons of great content this week from bengreenfieldfitness.com. And by the way, we’ve got a little bit of a new format in case you didn’t notice. The sound quality is going to get a little bit closer and we’re going to be featuring a new features as the podcast progresses into spring and summer. So stay tuned.

Ben: Ok, this week’s first question comes from Listener Charles.

Charles asks: I have one question, although I don’t mean to take up all of your time. (I think he’s saying that because Charles was the guy that asked about how to gain muscle while training for endurance sports, while also training for triathlon.) I was wondering if you could suggest a way to set up my workout schedule. For example, I’m usually doing some sort triathlon training 6 days a week and am additionally lifting about 4 days a week.  But I’m not sure, to make real strength gains, what exercises should I really focus on and where I would want to keep my rep ranges?   I don’t know if you care, but recently I have been getting into Crossfit workouts.  I think that creating a hybrid program that includes exercises of high weight and intensity with low reps, followed by a Crossfit style workout might be the best for me.

Ben answers: Well here’s exactly what I do Charles with the athletes that I coach for triathlon. During the offseason, during the time when it’s very important that an endurance athlete or triathlete or any athlete really prepares their body for the rigors of training, the rigors of competition – we focus on very specific strengthening of muscle groups that we know are going to take a pounding and need to be strong. The rotator cuff, part of the butt muscle that’s called the gluteus medias. We do quite a bit of adductor work. Those are the muscles on the inside of your leg. We do quite a bit of balance work, a lot of propeoception kind of mind muscle awareness type of work. But then – and one of the things that’s really important in that type of work is quite a bit of single leg exercises, single leg strengthening. When the season rolls around, we tend to move into the types of workouts that are in my book Top 12 Resistance Training Routines for Triathletes over at www.thestrongtriathlete.com and I’m going to just read you one of those workouts so you can see the types of things because then we move into a little bit higher rep exercises that are done in a circuit style very quick type of format. So for example. Here’s one that’s called extreme core. And in this workout, that’s one of those12 workouts in the book – you do one set of 12 reps for each side alternating dumbbell chest press on a stability ball. You do one set of 12 reps for each side with a single leg deadlift – that’s lifting the weight off the floor with one leg up in the air and one leg doing all the work. Then you do a single leg dumbbell row. Again, you’re standing on one leg doing 12 rows on one side and 12 rows on the other side. Single leg squat – 12 of those per side, alternating dumbbell curl to overhead press. That’s literally where you’re curling a dumbbell and then pressing it overhead. And then 12 per side of an exercise called Around the World where you’re literally taking a medicine ball or a dumbbell and bringing it in a giant circle 12 times in one direction and then 12 times in the other direction. That’s done in kind of more of a circuit style format. As you could tell, little bit higher reps. Typically 12, 15 reps. But rather than having a workout that is all high weight, low reps especially when you’re doing as much triathlon training as you’re actually doing, you may want to consider doing something especially during the race season around this time like around a 12 rep range to 15 rep range and keeping it more of a circuit style format. So for example, I typically exercise with the weights three hours a week in the offseason. Three 1 hour workouts. And nowadays I do three very short intense 20 to 30 minute workouts. So that’s the format that I utilize. So we’re going to move on to a question from Listener Karen.

Karen asks: Do you have any opinions on ice baths or cold water soaks?

Ben answers: I do. I actually after any tough workout, any real long runs, very difficult workouts – I go into my freezer, I take a bucket of ice, I dump it into my bathtub, I fill up the bathtub with cold water, I grit my teeth and I sit in there for about 5 to 10 minutes and you would not believe how much this can reduce the amount of swelling and soreness that can occur from a hard workout. Basically what happens is ice will decrease things like swelling, tissue damage, blood clot formation which is huge if you do something like a marathon or Ironman triathlon, muscle spasms, it can decrease pain. But the whole idea is when you ice an area or you subject an area, it constricts all the local blood vessels in that area. It decreases the tissue temperature in that area and that constriction decreases blood flow and essentially it decreases metabolism. So you get a lot less bleeding in that area. You get a lot less cell death, the type of thing that would occur after an acute traumatic injury where your muscles look like World War 2 after a workout. So the ice can actually assist with decreasing some of that inflammation that occurs. Some of that acute inflammation that occurs. And actually to restore blood flow to an area after your ice, you can use a warm water or a hot water soak directly after and the other thing that I’ll do if I  don’t have much time at all is just cold water in the shower followed by hot water in the shower. 30 seconds back and forth three or four times through. This would be most important if you’re a triathlete or someone preparing for a marathon or something of that nature. You’d want to do this at least once a week during your longest run day because running is really what kind of tears down the muscles. And it can also decrease pain quite a bit as well. So I am a big fan of ice baths, cold water soaks and I believe they’re mentioned by – we had Lance Armstrong’s massage therapist on here – an interview with Jeff Spencer and there’s a little search box at bengreenfieldfitness.com where you can search for any of our past episodes. But you should check that out because he talks quite a bit about a lot of other recovery protocols. And that reminds me, by the way, I do have a ‘most popular posts’ section now. If you go to bengreenfieldfitness.com and look on the right hand side of the page, you can see the top 10 most popular posts on our website. So, check that out. I think that interview with Jeff Spencer was one of the more popular ones. We’ve got another question about creatine and this is from Listener Sal.

Sal asks: I have a question I was wondering you could answer. I am a serious marathon runner, and I currently use creatine in my training. I use it for several reasons. 1) It seems to be relatively safe with no side effects 2) I’ll take anything that helps recovery 3) I currently do lower body work and core work in the gym, and I believe creatine helps me build those muscles However, creatine also causes me to carry extra water weight. I have heard that it does this, and I have noticed it myself. I carry a substantial amount of water weight around my midsection. After a long run where I sweat a lot, I can see my abs, but if I take creatine and go a day or so without sweating, there is a lot of bloating in my abs. I am worried that during a taper this will have a negative effect. (When she says taper, she probably means decrease in activity leading up to a marathon.) So when I rest for my marathon, should I stop taking creatine? Or do I need to stop a few weeks in advance to get it out of my system. I want to get the benefits of it without carrying extra weight during the race. Also, will there be any problems with stopping taking it, like withdrawal symptoms? I currently take about 5g after workouts and 3g on non workout days in the morning.

Ben answers: Great question, Sal. First of all you did mention that you’ll take anything that helps recovery. Not convinced by the research that creatine is going to help recovery. Creatine is what your muscles need to actually create a contraction. By taking supplemental creatine you can increase the amount of time that a muscle can actually produce a stronger contraction. So let’s say you’re doing a 20 yard sprint. Well you might be able to go for 25 yards or 30 yards before you started to slow down rather than 20 yards. Now the idea for endurance athletes is that the creatine can actually help stave off the amount of carbohydrate that your muscles use during a contraction. It has what’s called a glycogen sparing effect and so you essentially are able to exercise for a little bit longer period of time without using quite as much of your valuable carbohydrate stores and it can actually help you to produce a little bit stronger force or a little bit wattage during a muscular contraction so you push off the ground a little harder when you’re running or you for example are able to push the pedals a little bit harder when you’re cycling. Now most studies with creatine supplementation as you have discovered Sal, cause weight gain. They can cause some bloating. Creatine is what’s called hydrophilic. That means that it attracts water. And so when creatine is taken up into the muscle, the muscle will take water up along with it. Now there are several different forms of creatine out there and there are some that are less hydrophilic than others in terms of carrying water along with them. I take one form of creatine called CreO2. It was specifically designed for endurance athletes because it is a little less hydrophilic. It doesn’t cause the type of water bloating and related weight gain as some of the other creatine – what are called monohydrate powders that are out on the market. I will put a link to that particular creatine product in the Shownotes Sal. But the other thing is you asked about if you should stop taking it when you rest for your marathon. The whole idea is that if you start taking it after a few days, all that valuable creatine that you’ve been supplementing with is not going to be in your system anymore. And so yeah I guess if you were taking the creatine and it was helping you train harder and longer and basically making your training sessions more valuable, it’d allow you to get into better shape for your marathon but I personally would kind of like it in my body for the marathon as well. So even though it might have helped you gain valuable fitness leading up to the marathon, I would consider continuing to take it up to the marathon provided that you can get your hands on the type of marathon that’s not going to cause that extra weight. Otherwise you’d still get some benefit because you’ve been using creatine in your training. You would need about two weeks for it to get out of your system. And by the way that 5 gram that you’re taking after your workouts and that 3 grams on non-workout days, that is the correct dosage. That’s what you’d actually need to see what’s called an ergogenic effect or a beneficial effect from creatine. So I’ll put a link to that creatine product in the Shownotes and let’s go ahead and move on to a question from – this is our last question from Listener Kelsey.

Kelsey asks: I raced Ironman Canada last year and I’ve had some complications as a result.  After some terrible coaching and poor nutrition advice I had a very difficult race.  I gained more weight in the year I was training for Ironman Canada than I had in previous years sitting on the couch.  (Believe it or not, I hear that a lot.) A month before Ironman Canada I was diagnosed with a stress fracture on both of my tibias, I cut back running for the last month and pushed myself through the run on race day.  As you can imagine the run was long and cold.  (Yes, I was up there. I remember that.) Eight months later and the fracture is still far from healed.  I’ve moved to a new city and have been struggling to find medical support. I’ve been off running since the race, on my bike as often as possible but would love to heal these suckers soon.  Living in Victoria BC means I have access to some unbelievable running trails and it’s killing me not to get on them Any recommendations for stretches, supplements, etc. Note: I have a diary allergy so I take a calcium, a multi and vitamin K daily. Is there anything that may help move this injury forward.

Ben answers: First of all I would consider the fact that if you’re still experiencing symptoms from the stress fracture and let’s say you cut back running, ok so you’ve only cut back for the last month. Or I’m sorry it’s been eight months since your fracture healed. First of all I would just ask you to make sure that it is a stress fracture. It’s not something like chronic inflammation between your tibia and your fibula. There may be other things going on. Compression syndrome, things of that nature. So I’m assuming that you probably got a bone scanner x-ray and that you know it’s a fracture. But if not, make sure you do get a proper diagnosis that that actually is a stress fracture. As far as healing of stress fractures, first of all, you can reduce a lot of the stress that is placed on the tibia and the fibula and those muscles along the front of the leg by making sure you maintain quite a bit of flexibility in the back of your legs, in your gastronemius and your solius – your calf area muscles. So I would be doing quite a bit of calf stretching on a daily basis. I like some of the yoga moves like down dog. Those also do a great job at stretching what are called your dorsaflexors and that can help alleviate a lot of the issues that come along with stress fractures. I would also be focusing on strengthening the muscles in the front of the leg. One of the best ways to do this is by leaning back against the wall, standing up nice and tall and then just pointing your toes rapidly up and down and up and down. Up towards your head and down towards your floor, and you’ll start to get kind of a burn in the front of your leg as you do this. That’ll help build some of the muscles in the front of your legs that can again help keep stress off some of those areas that are being stressed on your tibias. So there are a couple of exercises you can do. As far as supplements, you have to be kind of careful by doing something like taking calcium or taking something like phosphorous to help with bone replenishment because a lot of those ingested minerals are not going to be absorbed and taking large, large amounts of those can contribute to kidney stones or to bladder stones. So you want to be careful with just taking those to actually cause new blood to be laid down. There’s one supplement that I know of that has something called lactoferrin in it which supposedly helps to target the minerals that you need into the bone to help a little bit more with what’s called osteoblast formation or the laying down of new bone. It’s a product that one of my friends told me about several months ago. He said that a lot of his people that he was working with actually were seeing an increase in bone density and an increase in how quickly bones were healing. Now I personally haven’t used this before but the stuff’s called Osteodenx. And it has that lactoferrin stuff in it. It also has vitamin D, folic acids, zinc. It’s got a glucosamine chondroitin blend as well as a turmeric root extract. There’s another one that I have used before that’s a glucosamine chondroitin. It’s called Capraflex. That one’s designed more for arthritis. It has some of those same ingredients like the glucosamine, the chondroitin, the turmeric. It doesn’t, I don’t believe, have this lactoferrin in it that the Osteodenx has but I would consider trying either of those. I’ll put a link to those after your question as something that could help versus just taking a bunch of calcium. So, that’s what I would look into. Great question. And remember if you have a question, you can email me [email protected]. If you want to ask an audio question, just call our toll free number 18772099439 or you can Skype me at the Skype name pacificfit. So let’s go ahead and move on to this week’s very, very cool interview with a guy who goes by the name of Dr. Fitt – Dr. Roby Mitchell and this interview is jampacked with very practical information on bioidentical hormone replacement therapy and nutrient therapy.

Ben: Hey podcast listeners, this is Ben Greenfield and as promised I have on the other line an expert in nutritional medicine. A guy who really practices what he preaches. This is a physician whose nutritional expertise combined with his avid enthusiasm for fitness which you’ll see if you go look at some of the pictures that I’ll put of him in the Shownotes have gained him the nickname of Dr. Fitt. He has invented exercise devices for home use. He’s trained doctors, pharmacists, health care professionals from all over the planet on successful therapies for arthritis, wrinkles, sinusitis. He’s an expert in enhancing physical performance through nutritional medicine, through alternative medicine. He graduated from Texas Tech University School of Medicine and this gentleman’s bio is too long for me to go over. We’d be here all day long but I’m very honored to have Dr. Roby Mitchell on the other line. Dr. Mitchell, how are you doing?

Dr. Roby Mitchell: Great Ben. Good to hear from you.

Ben: Fantastic. And like I said I have some pictures that I’m going to be putting up on the Shownotes and ones of you doing some extreme skiing. Another one looks like you’re involved in some pretty extreme martial arts. Tell me a little bit about yourself and your background in exercise and in medicine.

Dr. Roby Mitchell: Well I started as most people do. My first introduction to exercise was in high school sports. So I played basketball. But then I broadened my horizon a bit, just before getting out of high school I started in martial arts and went on to get my black belt and did a lot of competing in martial arts actually. Chuck Norris and I used to spar together. He used to come in and do some guest teaching for my instructor.

Ben: I got to ask you, who wins in a spar between you and Chuck Norris.

Dr. Roby Mitchell: Chuck Norris won every time. So, particularly after he went and did his movie with Bruce Lee there. But I was the only one who could even kind of keep up with him. So that’s why I always got put out in front of him. But it was a good education for me.

Ben: And from that point, where did you go in terms of exercise and learning more about the tie between medicine and performance?

Dr. Roby Mitchell: Well so from that, then I went on – while I was there at Texas Tech, I ran and played basketball all the time. So ran and played basketball, ran and played basketball. And then I came up with a knee injury and it just so happened at the time my girlfriend was a triathlete. So in order to get me rehabbed for my knee, she started me to cycling and so I started cycling and enjoyed that and got pretty good at it. She said well since you’ve already got running under your belt and you started cycling, you might as well take up swimming also. And we just started doing these triathlons. That’s how I got into doing triathlons. She kind of coached me into that.

Ben: So it was a woman that snaked you into it. That was my story as well. Same thing.

Dr. Roby Mitchell: Definitely. Definitely.

Ben: I’d never ran more than a mile before I met my girlfriend who’s now my wife who ran me into the ground. It’s funny how that happens.

Dr. Roby Mitchell: She got me into the pool. I definitely was not a swimmer. So she could definitely swim circles around us. But I thought that being in shape for running and having great aerobic capacity cycling and so forth and I could just get in the water and just swim but it didn’t turn out that way.

Ben: Somehow the water isn’t like that.

Dr. Roby Mitchell: No, you got to use a whole different set of muscles and swimming is a lot more technical. So you really got to know, in order to excel in swimming, you really have to understand the technical aspects of stroke technique and breathing and that type of thing. So you have to think a little bit more swimming than you do cycling and running. But then took courses and that kind of just made me want to explore more physical activity so while I was there at Texas Tech. They offered different classes in scuba diving and kayaking and sailing. So I just took everything and then took up skiing. The more things I took up, the more things I liked and so yeah I would recommend that for a lot of your listeners, is to not limit yourself to activities that you’re just good at or that you’re just used to doing. Broaden your horizon and get a different perspective on lots of these other activities, because not only does it enhance you mentally but when you – as I found out with swimming – when you broaden your horizon athletically and do a variety of things, it challenges your body to exercise different muscles.

Ben: That’s a good point. That reminds me of a book that I recently read called brain waves and it actually split people’s skills into auditory, visual and kinesthetic and although certain people are strong in other areas, one of the most important things you can do, for example, if you’re an auditory person is engage in sports or activities that are more visual and more kinesthetic to grow yourself from a physical and mental standpoint. So it’s a great tip. Now right now you are working as a physician. Tell me a little bit about your practice.

Dr. Roby Mitchell: So, I’ll give you a little bit of background about how I got to this point. So I went to Texas Tech medical school and it just so happened that when I was there they offered a PhD program which I took advantage of also. While I was doing that, the guy that I was working under Dr. Peter Pang, he was from Hong Kong and he had been for some time trying to establish a liaison or a student exchange program between Texas Tech  University and Jilan University which was in mainland China. And it just so happened that when I was under his tutelage that everything got into place for a student to go to mainland China and study traditional medicine, traditional Chinese medicine. Now this was back in the mid-80s when by conventional standards all that stuff was still woo woo medicine and witchcraft. And that’s how I had been trained to think about things like chiropractic and acupuncture and those types of things. But as I said I had a history of martial arts and I had been a karate instructor and had always fantasized about going over to the Orient to study martial arts. So here was this free trip to China. So even though the proviso was that I had to study this witchcraft, I took them up on it and went over there. To my surprise, once I got there and started looking at the results that they got, I was very intrigued because I saw that they were able to do some things – make a big impact in some of the maladies that we treat over here with medications. They were able to make an impact – a measurable impact, an impact that you could measure scientifically – with some of these alternative therapies, acupuncture and so forth. And before I left I was able to watch a gall bladder removal in a patient who was wide awake with his stomach wide open and they’re taking his gall bladder out and this guy’s wide awake – them using acupuncture as the only form of anesthesia. So I left with that on my mind but I came back over and finished up my conventional medical training and became an emergency room physician and as often happens you graduate from school, you start working and other things. You don’t exercise as much, you change your diet, you’re busy. You grab a donut and coffee and that type of thing. So I started putting on some extra pounds and along with the extra pounds came an elevated blood pressure and being a physician, particularly a busy physician, I did what I would have advised a patient to do which was pop blood pressure medication. I started taking blood pressure medication and it made me very sick. And that was a wakeup call for me to start thinking back to the experience that I had in China where those physicians had used this philosophy of getting the body back in balance. If you do that then the disease goes away. Well here I was with this blood pressure problem and the medication obviously wasn’t going to work for me. So I started doing some of these natural therapies, changing my diet and looking up some information back in my old biochemistry books about what makes blood pressure normal and why it goes array. And I figured out some things about the biochemistry of hypertension and did those things. I got my own blood pressure back under control and got my weight down. So that made me ethically and morally have to at least present those options to patients. Fortunately a lot of the medical literature was starting to go in that direction. We were reading a lot more in the conventional medical literature about this impact of fruits and vegetables and exercise and just the whole behavior modification implementation and how that was having such an impact on disease. So I had that to kind of back me up and started giving patients that information and to my surprise I found out that there were lots of people who wanted that information. They didn’t want to be on drugs. They wanted to get their bodies back in shape in a natural manner, so that made me pursue that a little more and I did and it finally led me to just ditch the emergency medicine career and just completely change my practice to this. It was a pivotal move. But I started doing that, and then I had to find some mentors who had been doing this because I was just completely a fish out of water as far as nutrition. I had never been taught any of that. So I went and studied with Dr. Hugh Reardon there in Wichita, Kansas who had been doing nutritional medicine for years and then I went and studied with Dr. Jonathan Wright in Washington that is kind of the father of nutritional medicine here in the United States, and studied with a couple of other folks and got that background. So I started doing that type of practice and got good enough where I’m one of the supposedly experts in it now. So that is how I got to where I am. So those are the patients that I see now. Those who want as an objective – they want to get their bodies back healthy again. So we’re not – when you come to me with high blood pressure I don’t treat high blood pressure. I teach you how to re-establish a normal biochemical environment in your body, and once that happens the blood pressure normalizes. The cholesterol normalizes. The blood sugar, the weight, the migraines, the PMS, whatever.

Ben: Now in additional to nutritional medicine, you are also recognized as an authority on bioidentical hormone replacement. Do you find that the two are linked when you’re working with someone, for example, on getting their bodies prepared for peak performance? Or on eliminating symptoms of fatigue in an athlete or even in just a regular individual?

Dr. Roby Mitchell: Oh certainly. You have to understand that hormones are kind of like the computer programmers of the body. So you have this keyboard of DNA that’s in every cell and that is the blueprint that tells that cell how to perform. Hormones, when they’re secreted from the thyroid or the testicles or the ovaries or adrenal glands – they go through the bloodstream and they dock on these cells and they go inside and they start typing on that DNA keyboard to tell that cell how to perform optimally. Around about age 27, those hormone levels start to drop. And so that’s when we start to see cell dysfunction and we start to see the advent or increase in incidence of different diseases of the symptoms that we associate with aging.

Ben: When you talk about that hormone drop at 27 years old, in your experience do you find that in both males and females or we’re talking about hormone replacement – because I know a lot of guys listen to this show – are we just talking about perimenopause in women?

Dr. Roby Mitchell: No, no, no. We’re definitely talking about drop in hormones in men also. You can see that in peak performance athletes. So you watch football players or track runners or any professional athlete in any professional sport. Around age 27 to 30, that’s when you’ll start to see them “lose their legs.” Right? So the peak performance is not there and that is because of this gradual re-esthetic drop in hormone levels.

Ben: So with bioidentical hormone replacement, or with nutrient therapy – the two topics you’re considered an expert in – how do those tie in to treating this drop in natural hormones that you’re finding in individuals who are 27 plus?

Dr. Roby Mitchell: So I really consider myself analogous to a car mechanic. So I’m a car mechanic for the body. So I get the owner’s manual and I look at the parts that are supposed to be there to make this vehicle run optimally and I just try to make sure that all of those are there. So I put them on the rack, oh this guy’s oil is low and his transmission fluid is low. So let’s bring up the level of oil, bring up the level of transmission. There’s a spark plug missing, let’s put that back. So it’s the same analogy. So we do analysis on patients to find out if there are vitamin deficiencies. If the vitamin D level is low, if other vitamin levels are low, if there are mineral deficiencies and if any of these hormone levels are low let’s bring that back up. And just as with a formula one race car, you bring those things up to their proper levels and then the person can gain optimal performance. Now of course the person has to eat correctly and they need to do a little bit of exercise but as the physician, my job is to find out if there are any nutritional or hormonal deficiencies that we need to address.

Ben: So what type of hormonal and nutritional deficiencies do you observe more frequently in the population that you work with.

Dr. Roby Mitchell: So for your listeners, one of the most important mineral deficiencies is going to be magnesium. I was a race medical director with the Ironman out there in Hawaii, and that’s what we found on these peak performance athletes – is that potassium and magnesium are two of the minerals that is critical for peak performance in athletes. When I was growing up, it was salt. So football coaches would give us these salt tablets. But we found out that the minerals for peak performance, that really affect your peak performance or the magnesium and potassium. Now there are some other nutrients that are very important. For example, iodide – we’re just starting to find out a lot more about iodide and how it not only is a substrate for thyroid hormone function but is also one of the key elements in keeping down the microbe level in your body. As these microbes, particularly fungi, start to overgrow in your body then they can zap you of strength and performance and they really start their overgrowth and then they lead into many different types of diseases.

Ben: I’m sorry to interrupt, is that a problem that people need to be concerned about? Fungi?

Dr. Roby Mitchell: Oh certainly. In the ecosystem of the world, fungi – they overtake everything, whether as props or the internal environment. So they’re the cleaner uppers. Anytime they detect that a system is starting to fail a little bit, they’re kind of those vultures of the internal ecosystem. So anytime a cell is dying or is dead, then yeast proliferates and comes in to try and clean it up. As we move past 27 and thyroid levels start to go down and oxygenation starts to decrease in the body, then that’s a signal for fungus to start overgrowing and start decomposing things. So definitely that starts to happen. That is the underlying factor, it seems to be, in most of the chronic diseases that we face today where there’s autoimmune disease or things like heart disease or Alzheimer’s, cancer – it’s the body’s response to this inflammatory response that happens when your immune system is trying to combat this yeast. It creates this chronic toxic environment that either causes disease or cells to respond in such a way that they try to survive that environment, and that’s what cancer cells are. They’re cells trying to survive in a toxic environment.

Ben: So you’ve got magnesium as one deficiency that you observe. You have this presence of fungi and the fact that iodide deficiency or therapy with iodide can help with that. What other nutritional deficiencies or hormone deficiencies do you see and how do you work with them?

Dr. Roby Mitchell: So the B vitamins are very important and some of these are a little more important in women, particularly…

Ben: Just briefly lost you there as you were saying that the B vitamins were important particularly in menstruating women.

Dr. Roby Mitchell: So I would say that nutrients across the board – can you hear me ok? Ok. Women need to pay a little more attention to, particularly if they’re menstruating because every women write a big nutritional check in the form of the blood loss that goes with their menstrual cycle. So every month the body prepares a woman as if she’s going to get pregnant so it takes all those nutrients and shunts them down to the blood around the uterus. If she doesn’t get pregnant then all of that nutrition just goes down the toilet so to speak. So women in particular have to be very cognizant that on a monthly basis, they’re writing a big nutritional check. So, these B vitamins are very important and it’s very important that the whole complex of B vitamins be added, and again for women, the iron is a little more important when they are menstruating and particularly for women athletes so they want to make sure that if they’re doing a multi-vitamin mineral, they have some iron in there. Zinc is very important for the immune system but also for thyroid function. Selenium is very important for thyroid function also. Another nutrient that athletes in particular need to be cognizant of are these essential fats. So essential fats, and this is what we find in the fish and the raw nuts and avocado and coco nut oil – these essential fats, structurally they surround the cell membrane and they allow cell membranes to speak so to speak. This allows good nutrients to come into the cell and toxic waste to move out of the cell. If you get those cell membranes saturated with this harder fat like the saturated fat, then it creates a cell wall that’s not able to breathe as well. It’s kind of like a person that has emphysema or COPD and they’re not able to exchange oxygen very well. So very important for athletes to have those essential fats saturated in all their membranes in order for them to have peak performance also.

Ben: Now to my understanding, most of these compounds would be considered nutrient therapies, but how about this bioidentical hormone replacement?

Dr. Roby Mitchell: So the hormones again, these are kind of like the fluids in your car. So the oil and the transmission fluid and the radiator fluid and those types of things – these are extremely important for cell function because again, these are the computer programmers that type on the DNA to make cells function optimally the way that they’re supposed to function. As they go down then certainly performance goes down but it also can lead to some of these chronic diseases that we have where there’s depression and heart disease or migraines, chronic fatigue or whatever. So we definitely want to keep those hormone levels at peak. Testosterone of course is a hormone that a lot of people have heard about. People think it’s a male hormone but there are no male or female hormones. Every male and every female produce exactly the same hormonal composition. It’s just we produce them in different amounts. So men will produce a lot more testosterone than women. But women produce and need and benefit from testosterone also. So as testosterone levels start to go down in women, we see a decrease in muscle mass, we see a decrease in brain function. We see a decrease in sex drive. We see changes in the lipid bile chemistry and so forth. So the testosterone is very important for both sexes. The opposite is true also. So estrogen – women produce more but men produce and need estrogen also and progesterone and DHEA and all these other hormones. Thyroid is a hormone that is a common denominator in dysfunction in men and women. Women tend to have more problems with thyroid related diseases because of their production of estrogen. Estrogen is a hormone that will inhibit thyroid function and that happens because nature wants women to have a little more fat just in case they get pregnant. But that is a very important hormone particularly for performance for both sexes.

Ben: Now Dr. Mitchell, when you’re looking at someone’s thyroid levels, most of the time when someone comes into my office and they bring in their bloodwork with them and they say their thyroid levels are just fine but they’re very fatigued, they have what’s called a TSH value. Do you look at more than that?

Dr. Roby Mitchell: Oh of course. That’s probably one of the most useless blood tests that a person can get because they are so misleading. So again, these hormone levels fall in a re-static fashion. So like turning down the knob on your radio. So it’s a very subtle decline. And you get a deficiency – you get deficiency symptoms long before that is reflected on a blood test. And if they go to my website, they can look up all the different symptoms of hypothyroidism and there’s a lot of them because thyroid affects every cell in your body and depending on your genetics you may have different symptoms from person to person. So the blood test is definitely not a way to evaluate a person for thyroid dysfunction. A doctor has to make that clinical diagnosis. So I have to sit you in front of me and look at you from head to toe because the body won’t lie to you about its lack of thyroid. Cells in the body respond very predictably to low thyroid levels. So the physician has to know how to read a person’s body in order to tell whether they’re hypothyroid or not and not depend on those blood tests.

Ben: And what type of things do you look at when you’re reading someone’s body?

Dr. Roby Mitchell: So starting with their hair, I’m looking for split ends and frizzy hair, dry hair that doesn’t have the luster to it so its collagen levels go from skin and hair, then you start to lose the luster of hair and you start to lose the elasticity of skin as thyroid levels go down. Things start to dry up so scalp may be dry. There may be dandruff there. There may be patches of psoriasis. As I go down I’m looking for bags under their eyes so there’s a pathology called mixadema where things start to swell. So this can happen. This is what causes those bags under the eyes. I have them stick out their tongue. If the indentations of the teeth are reflected on the edges of the tongue, that’s what we call scalloping. That’s a primary indicator of hypothyroidism. Even a person just coming in, when I shake their hand and if I feel like their hand is very cold. That tells me that their circulation is low and they may have thyroid disease. On the fingernails, I’m looking for ridged nails, splitting of the nails and cracking of the nails. Very soft nails. Again the thyroid is not getting in on the DNA and coding for the assimilation of these proteins that help you make good collagen and strong nails and strong skin. I’m looking for any type of fungal infections. Fungal infections on the feet. I’m looking for any history of fungal infections that they have. Jock itch in men or athletes’ feet or vaginal yeast in women. Irritable bowel syndrome and those types of things. On the feet especially – so this is because it’s so far away from the heart, this is usually where low thyroid symptoms will show up first. So I have a laser thermometer that I can point at their toes and see what the temperature down there is. A lot of people have a 20 degree difference between their sublingual – between the temperature underneath the tongue and the tip of their toe. So all these things in your body – they’re like fish swimming in the same fish tank. They need to be around the same temperature. If you’ve got a 20 degree difference between the temperature under your tongue and that in your toes, something’s wrong. So I look at that also. I look at the integrity of the skin. The thyroid hormone is very integral to making collagen so if you’re developing wrinkles, if you’re losing elasticity of skin, that says that there’s a hormone problem there. The way a person carries their weight – so if you’re building up a lot of fat around your abdomen, what we call trunkal  obesity or this android obesity, that’s a signal that you’re building up fat because your body is not metabolizing because of low thyroid. So those are just again – people can go to my website and get a more extensive list but those are some of the things that I look at as a patient is walking in the door and I sit down and start talking to them.

Ben: So it goes a lot deeper than just that blood test. Now you talked about testosterone, estrogen and thyroid as three of the hormones that you look at. Are there others?

Dr. Roby Mitchell: Certainly. DHEA is another hormone. The adrenal glands produce hormones also. Actually the adrenal gland is two glands in one so it has two different sets of hormones that it produces. So these adrenal hormones such as cortisol and these what we call glucocorticoids are very important in certainly metabolism and mineral metabolism, so keeping your sodium potassium and those types of balances in balance. But then there’s the other part of the adrenal glands that produce epinephrine and nor-epinephrine so these fight or flight hormones also. So those have to be looked at also. So hormonal therapy yes is a very comprehensive treatment program that you have to look at and make sure that the levels of all those hormones are where they need to be because these hormones – they interact with each other in a synergistic manner. Cortisol and thyroid for instance, one doesn’t work well without the other. So if you don’t address cortisol deficiency and you just give someone thyroid, you’re not – the person may still have low thyroid symptoms. Because the thyroid synergizes with cortisol in order to work as well and vice versa. If they have a thyroid deficiency, and you only correct the cortisol levels then the person is not going to do well. A lot of these women go for hormone replacement therapy and they go to  a doctor that only knows how to replace estrogen or maybe estrogen and progesterone and they get on those hormones. They may feel a little better but they don’t have their energy and their skin is still bad and they have all these other symptoms. So, it has to be a comprehensive assessment of all these hormones. Again, just like a mechanic would do in assessing an automobile.

Ben: With such a delicate balance between the hormones, do you use different types of tests for each different hormone? Or are you just doing for example a blood test or saliva test?

Dr. Roby Mitchell: So there’s blood test, there’s saliva test and there’s urine test. The most comprehensive test is what we call a 24 hour urine test. So the person takes a kit home and over a 24 hour period, they give us a sample. So this is the most complete picture that we can get of how a person is producing hormones and we can look at the biochemical pathways, which way when this person has DHEA – is it being transferred in estrogen or is it being transferred into testosterone? When they produce estrogen there are a couple of different pathways that estrogen can go also. So that gives us the most complete picture. You can get some valid information from blood testing also. But again that is more like a snapshot. So that gives us a moment in time of what the hormonal balance is, whereas the 24 hour urine test is more like a movie as compared to a snapshot. And then the saliva test, again that is a snapshot. But you can do serial saliva samples that give us a little better picture. So those are useful but in the end, again like back with the thyroid, is this clinical assessment that you have asking questions and looking at the person’s body and so forth that helps you make the critical decision. I don’t use those many tests anymore. When I first started doing this, I depended on the test a lot, but at this stage of my experience, I don’t really need the test so much.

Ben: Now, if we have a listener listening in to this show, and they’re thinking that they may have some of these symptoms that you talk about and they actually are interested in getting tested, give them an idea that if they are tested for a deficiency or for an excess – what the treatment is actually like. Do they expect to be taking bioidentical hormones for the rest of their life? How does this actually pan out for someone?

Dr. Roby Mitchell: So if there’s a deficiency, first we want to know why that deficiency is there. Do they have a deficiency because they have a substrate deficiency? So are they not giving themselves the building blocks that are needed to make that hormone? Is it because they’re 60 years old and things have just declined and are in decline? Do they have an infection of some organ that is causing that organ not to perform as it should. So first we want to assess why they have the deficiency. So if you have a deficiency just because you’re getting older, then that is probably not going to reverse itself. So you are going to need supplemental hormone in order to maintain your levels. So that organ…

Ben: Sorry, I lost you there for just a second. The problem is we’re having a little bit of a hailstorm outside. But you said that when you’re looking – you kind of cut off when you were talking about the deficiency of the organ?

Dr. Roby Mitchell: Yeah, so if it’s happening because of age, then that is not likely to reverse. So in that instance, that person is going to have to be supplementing with testosterone, estrogen, progesterone, DHEA, whatever the hormone may be. Many times we find for instance with thyroid hormone that the thyroid deficiency is because they don’t have enough selenium or they’re not taking iodide or there’s an infection in the thyroid and once that is addressed and thyroid function comes back on board, and we can reduce or even eliminate thyroid replacement. So again it’s about the core reason – the fundamental reason why that hormonal deficiency is there that dictates whether that person will need to be on it for an extended period of time.

Ben: Are there specific resources that you’d point the audience to, to learn more about these considerations?

Dr. Roby Mitchell: So there’s a very good book by a friend of mine Mark Star called Hypothyroidism Type 2. That is the book that I would get first because this is such an epidemic in the United States and it’s so critical to peak performance. So thyroid hormone controls your ability to metabolize sugar. So we’re talking the oxygen sparkplug and combustion there. So that’s particularly for us athletes. That’s key. That book is very good to read. There’s a Dr. Jonathan Wright that has a very good and readable for the layperson book on hormone replacement therapy aimed at women. It’s called Natural Hormone Replacement For Women Over 40. And I would say for women over 27. Actually these hormone deficiencies could happen at any stage in life. So some people are born with hormonal imbalances right out of the womb. So it really doesn’t matter about your age. It certainly increases with age but when we see women having these PMS problems and problems with depression and kids who are overweight and ADHD and those types of things, many times those are hormonal imbalances that can be corrected. But his book is a very good and readable – it’s only 60 pages – it gives people a good foundation of information that they can then just have a good discussion with their doctor where they go in with a little more information and this is something I would definitely recommend for everybody before ever going in to talk with a doctor. You need to arm yourself with a little information so you kind of have an idea at least about how the conversation should go and you’re not just taking information from the doctor because there are a lot of doctors out there that really don’t have a clue about the specifics of hormone replacement therapy and optimal fitness and that type of thing. That’s not how we were trained in medical school.

Ben: And of course your website, www.drfitt.com and that’s spelled with two Ts, I’ll put a link to that in the Shownotes. I’m going to put a few pictures of Dr. Fitt as well. He obviously practices what he preaches and you have a quote on your website that I’d like to finish with and here why this is your favorite quote. What is that favorite quote, Dr. Mitchell?

Dr. Roby Mitchell: Let me see, I have a couple of them.

Ben: The one that I’m looking at says “You’ll never medicate your way out of the diseases you behave yourself into.”

Dr. Roby Mitchell: Correct. And so again, it was my experience with my high blood pressure, I tried to medicate my way out of that. And this is what we’ve been trying to do for years and years here in medicine – is give people these medications. But take away these diseases like high blood pressure and high cholesterol and so forth… but what the medical literature is very clear about is that our most effective interventions are when we get people to change what they eat, start to exercise, get rid of the cigarettes, reduce their stress. So these so called behavior modification techniques. That’s really the answer. So you got to behave your way out of the diseases that you behave yourself into.

Ben: And if I could add, I see a lot of people who would appear to be healthy on the outside because I coach people like Ironman triathletes, but you sit them down and you start to talk to them and you find out that they’re actually struggling with a lot of the things you talked about today with fatigue or with poor energy levels or insomnia. So I would just tell people out there in the audience, if this describes you, then delve into some of these resources that Dr. Mitchell talked about today and educate yourself on a little bit more than just fitness and healthy eating. That’s a fantastic place to start but sometimes it goes a little bit deeper than that, right Dr. Mitchell?

Dr. Roby Mitchell: That’s correct. You got to think about your body as a machine. A Formula 1 race car and again particularly for those that are out there – athletes trying to seek optimal performance – you have to know what are the integral parts that allow you to have optimal performance and these hormones are a huge key. The nutrition is a huge implementation also. So you have to understand those basic things going in before you are able to understand the things you have to do in order to get peak performance.

Ben: Alright, well Dr. Mitchell. Chuck Norris’s ex-sparring partner and an expert on nutritional medicine and bioidentical hormone replacement, thank you for coming on the show today.

Dr. Roby Mitchell: Thank you Ben and keep up the great work. A lot of people need what you’re doing.

Ben: Alright, we’ll talk to you later.

For personal nutrition, fitness  or triathlon consulting, supplements, books or DVD’s from Ben Greenfield, please visit Pacific Elite Fitness at http://www.pacificfit.net