Fasting’s Role In Optimizing Men’s Health

Eric Ramos, PA-C

Absolutely. Thank you, Dr. Antoun, for having me. A pleasure to be with you.

Joseph Antoun, MD, PhD, MPP

Thank you. Can we start by, you saying a few words about yourself, your background, and your specialty? And then after that, I’m going to ask you a few questions about men’s health, fasting, and longevity in men?

Eric Ramos, PA-C

For sure. For sure. Eric Ramos, I’m a clinician here in Oklahoma, predominantly focusing on men’s health. You can generalize men’s health with three primary emphases regarding hormone therapy, sexual health, and weight loss. We can definitely get into how each one of those is related to the overall discussion as well.

Joseph Antoun, MD, PhD, MPP

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 themselves with?

Eric Ramos, PA-C

Absolutely. And so for I guess, the the bread and butter, so to speak, is testosterone deficiency. The headline of it is that with testosterone deficiency, it’s probably one of the most used labs that can be associated with or predictive of a range of metabolic issues such as obesity, type 2 diabetes, and even overall mortality. In other words, low testosterone is associated with a higher all-cause mortality. Regarding men’s sexual health. There’s some beautiful data. One study in particular by Esposito et al. 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.

Joseph Antoun, MD, PhD, MPP

This is a very important topic because traditionally the weight loss industry and whether that’s chronic calorie restriction and or now the semaglutide, wegovy, or ozempic they aims of losing the weight while sacrificing the muscle. And that’s a very important topic in here because it’s how they all fail in the long term. Right. Diets have been here for decades semaglutide, the ozempic, and the wegovy are there. They actually have been approved for diabetes years and years ago now they’re a little bit on the hype and 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.

Eric Ramos, PA-C

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 maintaining the living mass, which the FMD clearly does. Coupled with the improvements that testosterone can bring about as well. And so one thing that can happen with testosterone deficiency is there tends to be 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 fat deposition within the penile tissue that definitely downstream leads to erectile dysfunction. And with the addition of fasting and with testosterone therapy, you can ameliorate those symptoms as well.

Joseph Antoun, MD, PhD, MPP

Dr.Ramos, before we move, what’s the protocol you use? How you used, and when you mentioned FDM, I bet you mentioned ProLon. What is the protocol? What would protocol you use with the patient?

Eric Ramos, PA-C

Absolutely. And so,  general recommendation for a majority of guys who are both higher or elevated BMI or with testosterone deficiency is 1 to 3 ProLon cycles once a month for the three cycles consecutively. And that does so many things. One in particular I’d like to touch on 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 testosterone coupled with the FMD 1 to 3 times right off the bat.

Joseph Antoun, MD, PhD, MPP

That’s fantastic and do you see metabolic improvements as well in their metabolic changes in their markers?

Eric Ramos, PA-C

Yes, sir. Yes, sir. It’s always impressive to see the triglyceride HDL ratio 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.

Joseph Antoun, MD, PhD, MPP

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 individual?

Eric Ramos, PA-C

Absolutely. And maybe to introduce the patient, a 40-year-old gentleman, he was a BMI, of roughly 40. And previous background in powerlifting as well. Initial testosterone levels were about 260. 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 day four he came in and he had been taught and told to eat steaks all day, every day. All right. Kind of goes along with the weights and all that stuff.

Joseph Antoun, MD, PhD, MPP

The fasting mimicking diet. The fasting mimicking diet is plant-based so for those listening in here, it’s a five-days. The ProLon is a five days of fasting mimicking diet that is all plant-based. Highly nutritious but plant-based diet so go ahead, sorry.

Eric Ramos, PA-C

No. That’s a great emphasis because of the impact of that plant-based going from basically a 180 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 just did extremely well. One of my favorite patients that we’ve ever had. And he did offer 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 hundred testosterone level to mid 600 testosterone level, he cut his triglyceride HDL ratio from 8.8 to 4.4, along with losing about 40 pounds just under. And so that’s about 13% total body weight loss.

Joseph Antoun, MD, PhD, MPP

Within three months?

Eric Ramos, PA-C

And so this is about six months into treatment.

Joseph Antoun, MD, PhD, MPP

Yes.

Eric Ramos, PA-C

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 essentially, he’s changed his trajectory healthwise completely from one road to the completely different path.

Joseph Antoun, MD, PhD, MPP

And that’s upon survey, that’s the number one benefit when people do ProLon. The surveys 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 I’m not addicted anymore to sugar and I’m not addicted to my dessert. So, and it’s fascinating because if you fast just for a few hours or actually I just interviewed Dr. Joel Fuhrman, who specializes in that. If you fast for a few hours and then you eat at 5 p.m., you binge eat, you overeat because your system is still craving that hunger. So ProLon is the five-day so it 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 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 it. And that’s the balance of the five days. And it seems this is what you’re seeing in your clinic as well.

Eric Ramos, PA-C

Oh, absolutely. You’ve done very well 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 CRP, etc. So, I thank you.

Joseph Antoun, MD, PhD, MPP

To Dr. Ramos. I want to include here by probably one of the most important current topic. Not important, an absolute but current topic which is this craze about the semaglutide, wegovy, and ozempic and they’re helping a lot of people because it’s a short-term, it’s an easy injection. It’s an injection and maybe soon they’ll become orals 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 in the short term if you’re really big and need to lose a lot of weight. How do you utilize all these tools, the testosterone, the ProLon fasting, and then semaglutide? How do you make choices in your clinic with whose tools?

Eric Ramos, PA-C

Absolutely. It can be tricky, right? Because in one patient, just one of these is the perfect answer, in the next one all three of them. And so really, the difference comes down to the patient’s goals. The kind of long-term longevity goals as well regarding the GOP injectable medications or potentially soon-to-be oral options. 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 gastroparesis, the alias aspects, low risk compared to potentially a greater benefit regarding cardiovascular benefit, a significant decrease in BMI, etc., that can be achieved with those. And like you mentioned very correctly, the lean mass is a big player. It’s one of the combinations that we see very beneficial is with the testosterone in specific patients, testosterone combined with GOP-type medications because we can help maintain and in some cases gain lean mass alongside the use of the GOP medications. So very impactful. 

Joseph Antoun, MD, PhD, MPP

Do you use the combination in your clinic and can you tell us a little bit about how do you use it or what’s the protocol?

Eric Ramos, PA-C

We do. Depending on the patient. And like I mentioned, goals, it can be very beneficial to simultaneously address the hormone profile of kind of not to get too in-depth, but estrogen dominance in many cases. There’s low testosterone coupled with an elevated estradiol. And when simultaneously that can be improved alongside improving the overall dietary choices consumptions with these GOP mechanisms at the same time, basically that trend and that trajectory can start to change in as little as a few months.

Joseph Antoun, MD, PhD, MPP

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 a fast-evolving discipline within health and longevity. Before we conclude here, do you have any words, any conclusion, or any take-home points that you want to highlight?

Eric Ramos, PA-C

Sure. I think first and foremost, for a lot of patients, whether it’s low testosterone or wanting to address weight, really 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 truly change your life. And I get to see that on a daily basis. So I’m very happy just with the outcomes.

Joseph Antoun, MD, PhD, MPP

Appreciate you very much, Dr. Ramos, and we’ll talk soon. Again, thank you very much.

Eric Ramos, PA-C

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