Hi, everyone, this is Dr. Joseph Antoun and I'm your host for the Fasting and Longevity Summit. Is a big pleasure today to talk to Dr. Eric Ramos. We talk a lot about women's health.

Today we're going to talk about men's health and longevity, the other half of society. And it's a big and important topic today, so please listen carefully.

Dr. Ramos, thank you very much for your time today. Absolutely. Thank you, Dr. Antoun, for having me. Pleasure to be with you. Thank you. Can can we start by you say a few words about yourself, your background, your specialty.

And then after that, I'm going to ask you a few questions about men's health, fasting, longevity in men. For sure. For sure. Eric Ramos, I'm a clinician here in Oklahoma, predominantly focusing on men's health.

You can you can generalize men's health with three primary emphasis regarding hormone therapy, sexual health and weight loss. We can definitely get into how each one of those is related to, you know, overall discussion as well.

Yeah, that's fantastic. You categorize it. Do you want to elaborate a little bit more about men's health and the typical categories that men come to your clinic with or express them themselves with?

Absolutely. And so for I guess, the the bread and butter, so to speak, is testosterone deficiency. The the headline of it is is that with testosterone deficiency, it's probably one of the one of the most used labs that can be associated or predictive of a range of metabolic issues such as obesity, type 2 diabetes, even overall mortality.

In other words, a low testosterone is associated with a higher all cause mortality regarding men's sexual health. There's some some beautiful data. One study in particular by Esposito at all, I want to say 2014 or so demonstrated very well the association of adhering to a mediterranean diet and a decreased prevalence of erectile dysfunction.

And so very, very beautifully well laid out in that paper. Regarding weight loss goodness we could point to 30 plus different trials looking at the improvement and preservation of lean body mass, in particular in patients who were testosterone deficient, who then improved that aspect with testosterone therapy.

And so. Yes, sir, and this is a very important topic because traditionally the weight loss industry and whether that's chronic calorie restriction and or now the see, my group that we're going to be in was impact the aim of losing the weight while sacrificing the muscle.

And that's that's a very important topic in here because it's how they all fail in a long term. Right. Diets have been here for decades semaglutide than there was epic in the Rigby's.

They actually have been approved for diabetes years and years ago now they're a little bit on the hype and the on the consumer side, but they've been there for diabetes for a while and did not induce any improvement in the numbers of diabetes.

And again, the secret is slowing down muscle and metabolism. And now this is an introduction to testosterone. And you mentioned getting back, helping a little bit with the muscle and maybe talking a little bit about fasting and how you use those interventions in your planning for restoring men's health and men's muscle.

Absolutely. And it's what you just described is exactly why I thought that the introduction of the FMD, the Fasting Mimicking Diet, would be just very complementary to our goals of of maintaining the living mass, which the FMD clearly does, coupled with the improvements that testosterone can bring about as well.

And so, so one thing that can happen with testosterone deficiency is, is there tends to be a a decrease in lipid oxidation. And so with fasting and with the FMD, tons of data points to point to that show that lipid oxidation increases perhaps in particular to men's health, a number of data points showing that histological changes within the penile tissue itself basically there's there's fat deposition within the penile tissue that that definitely downstream leads to erectile dysfunction.

And with the addition of fasting and with testosterone therapy, you can ameliorate those symptoms as well. In regard to. Pectoralis, before we move, what's the protocol you use, how you used and when you mentioned FGM?

I bet you mentioned ProLon. What what is the protocol? What would you what was protocol you use with be with the patient? Absolutely. And so your general recommendation for a majority of guys who who are both higher or elevated BMI or with testosterone deficiency, is 1 to 3 prolonged cycles once a month for the three cycles consecutively.

And and that that does so many things. One in particular I'd like to touch on is, is the improvement in the psychological kind of approach to dietary choices.

And if we can improve that right off the bat and then begin to improve testosterone levels, then it's just a great synergistic combination. And so in short, you know, testosterone coupled with the FMD 1 to 3 times right off the bat, that's fantastic.

And you see metabolic improvements as well in their in their metabolic changes in their markers. Yes, sir. Yes, sir. It's always impressive to see the triglyceride HDL ratio just just plummet and we'll get into a particular case here shortly. But essentially cut his triglycerides in half.

And generally speaking, a number of other biomarkers as well. Ensign, did you have a case in mind that you wanted to add in before we started the study, when I wanted to lead with the case in mind and talk about what fasting did for that, for that, for that individual.

Absolutely. And maybe to to introduce the patient, a 40 year old gentleman, he was a BMI, roughly 40. And previous background in powerlifting as well.

Initial testosterone levels were about to 60. His initial triglyceride level was 390 and he started off on the FMD shortly after beginning treatment with us.

And I still remember him on, on day four he came in and, and he had been taught and told to eat steaks all day, every day. All right. Kind of go along with the weights and all that stuff.

But he fasting mimicking diet, putting the fasting mimicking that is plant based. So for those listening here, it's a five day out. The problem is if five day of fasting would mean that that is all plant based identity issues but but plant based diet so go ahead sorry.

Me know no that's a great emphasis because the impact of that plant based going from basically a one area from historical dietary choices he said on day four, he's like, this is pretty cool but kind of weird.

Like, I'm not hungry, but I feel energetic and so he he just did extremely well. One of my favorite patients that we've ever had. And we he did offer to to to provide us before and after pictures as well that maybe we can use also.

It's impressive. But yes, at the end of a six, seven month period, mid two hundreds, testosterone level to mid 600 testosterone level, he cut his triglyceride HDL ratio from 8.8 to 4.4, along with losing about 40lbs just under.

And so that's about about 13% total body weight loss. Within within 3 month. And so this is about 6 months into treatment. Yes. And what I'm probably most proud of in his case is not only in his situation, because he shifted, like I mentioned, the steak all day, every day to a mediterranean slash, plant based approach, not only him, but his spouse as well.

So he he essentially he's changed his trajectory healthwise completely from one road to the to the completely different path. And it's that's upon service.

That's the number one benefit when people do prolong the service are showing is where they express themselves saying, I changed my relationship with food, right?

I'm making more plant based choices. I'm eating smaller portions. I don't need to binge eat at night and that addicted anymore to sugar and then addicted to my dessert so and it's it's fascinating because if you fast just for a few hours or actually I was I just interviewed Dr.

Joel Fuhrman who specializes in that if you fast for 2 hours and then you eat at 5 p.m., you binge eat, you overeat because your system is still craving that hunger.

So prolonged is the five day so trains you to go off the bingeing and actually a lot of people when they start and they want they think, oh, I'm going to eat a lot and they think I'm going to basically carbs.

They were like, You know what? I don't want to eat or I want to eat healthy choice, so give me a salad or give me a soup. And and I always say it's long enough to induce the behavioral change and get you off your addictions.

And it's short enough that most people can complete. And that's that's the balance of of the five days. And it seems this is what you're seeing in your in your clinic as well.

Oh, absolutely. You've done very well to to make something that you could literally take off the shelf and employ and see that quick win on the weight loss that typically gets the headline right.

But what I tend to love seeing is the biomarker change, the cholesterol, inflammation, the sirup, etc. So so I thank you. To Dr. Ramos. I and when it quickly here by probably one of the most important current topic not important an absolute but current topic which is this craze about the semaglutide and it will go with and it was big thing and you know they're they're helping a lot of people because it's a short term short term, you know, that's sort of it's it's it's an easy injection.

It's an injection. And maybe soon they'll become orals and but at the same time, a lot of the weight loss is tapping into muscle. 20 or 30% of the weight loss is muscle or some side effects with no nausea, vomiting, but risk of pancreatitis and gastric paralysis.

Now we're seeing and the cancer risk. How do you but then they help you on the short term if you're really big and need to lose a lot of weight, how do you how do you use how utilize all these tools that testosterone, the prolonged fasting and then and the semaglutide?

And how how do you make choices in your clinic with with those tools? Absolutely. It can be tricky, right? Because in one patient, just one of these is the perfect answer, the next one, all three of them.

And so really, the the difference comes down to the patient's goals. The kind of long term longevity goals as well regarding the the GOP injectable medications or potentially soon to be oral options.

Definitely, definitely impactful. You know, I don't think those are going to be going away any time soon, just tremendously impactful. But I also see just some potential things to keep in mind as far as, like you mentioned, the the gastroparesis, the alias aspects low risk compared to potentially a greater benefit regarding cardiovascular benefit, uh, a significant decrease in BMI, etc., that can be achieved with those.

And like you mentioned very correctly, the, the lean mass is, is a big player. It's one of the, the combinations that we see very beneficial is with the testosterone in specific patients, testosterone combined with JLP type medications because we can help maintain and in some cases gain lean mass alongside use of the GOP medications.

So very impactful. In do you use the combination in your clinic and can you tell us a little bit how do you use it or what's the protocol? No, we do depending on the patient.

And like I mentioned, goals, it can be very, very beneficial to simultaneously address the hormone profile of kind of not to not to get too in depth, but an estrogen dominance in many cases.

There's a low testosterone coupled with an elevated astro tidal. And when when simultaneously that can be improved alongside improving the the overall dietary choices consumptions with these GOP mechanisms, uh, at the same time, basically that trend and that trajectory can start to change in as little as a few months.

Fantastic. Well, I appreciate you very much for your time today. This is a very important topic and I'm pretty sure we'll talk again soon about it. It's it's it's a fast evolving discipline within and within, within health and longevity.

Before we conclude here, do you any any any words, any conclusion, any take home points that you want to highlight? Sure. I think I think first and foremost, for a lot of patients, whether it's low testosterone or wanting to address weight, really the the I guess what I would leave you with is the steps overall, they can seem pretty mountainous, but taking those initial steps to get assessed and to get in, to have a clinician look over hormone levels and help you with initiation of FMD, it can, it can truly change your lives.

And I get to see that on a daily basis. So I'm very happy just with the outcomes. Appreciate it very much, Dr. Ramos, and we'll talk soon. Again, thank you very much.

Absolutely. Thank you, sir. Have a good day.

Eric Ramos, PA-C

Fasting’s Role In Optimizing Men’s Health