My guest today is endocrinologist Dr. Jordan Geller. Dr. Geller approaches your hormone story like a mystery that is uniquely yours. He discusses that you may have the same diagnosis as another patient but how you get a desired outcome can be completely different. We discuss how men may have hormonal issues as well, but tend to put them on the back burner or ignore them. Dr. Geller shares what he sees in the area of infertility, weight gain, and sleeplessness and why women don’t have to suffer through menopause. He shares possible strategies for navigating and balancing your hormones. Dr. Geller sees a lot of patients who are trying to figure out if they have a thyroid issue or hormonal imbalance and introduces the best first steps to solving the issues before medication. He is not opposed to medication but practices a step-by-step approach to finding a solution that may oftentimes fix the issue before needing to go on meds. Dr. Geller walks the walk. He takes care of himself and is genuine about helping his patients. Enjoy.
Listen to the episode here:
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Key Topics:
- Dr. Geller’s Mentors [00:05:20]
- Discussing Integrative Medicine and Lifestyle [00:10:07]
- Going to the Doctor [00:14:06]
- Fixing the Lifestyle [00:18:19]
- The Thyroid Gland [00:22:24]
- Thyroid and Pregnancy [00:25:18]
- Sensitivity and Mindfulness [00:27:20]
- Setting Boundaries with Patients [00:29:21]
- A Good Time to be Proactive on Checking Health [00:31:14]
- Pre-Diabetes and Diabetes [00:34:12]
- What Dr. Geller’s Patient List Look Like [00:35:11]
- Simple Health Tips from Dr. Geller [0038:48]
- Dr. Geller’s Mindfulness Approach [00:43:10]
- Getting Personal with Dr. Geller [00:45:35]
- What to Give Attention to for Women Going Through Menopause [00:53:18]
- On Hormone Replacement [00:54:14]
- On Recommending Supplements [01:00:11]
- On Heart Diseases and Alcohols [01:01:19]
- A Brief Talk about PCOS [01:05:38]
- Looking at Different Opinions [01:08:11]
- Lessons from COVID [01:10:24]
- Getting Off Thyroid Medication [01:12:52]
- On Plastics in Beauty Products [01:15:17]
- What Dr. Geller Wishes For People to Think About or Do [01:16:46]
- Can Sex Support Hormones?? [01:17:38]
Don’t Neglect Your Hormones, Holistic Approaches to Better Hormonal Health with Endocrinologist Dr. Jordan Geller
“The earlier we look, the more likely we’ll find things that we can start to intervene about whether it’s a thyroid issue, pre-diabetes, pre-pre-diabetes, cholesterol issues, or weight issues. Most of these chronic diseases that we deal with have a long latency period. It’s only if we choose to look at it and acknowledge it.”
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“The conversation about hormones is interesting because if you think of it from an ancestral standpoint, we were born to reproduce and die. Because of modern medicine and we’re living to be 100 now, what are we going to do with these next 50 years? You want your functional age to line up with your hormones. That’s the gap that I need to fill in. We talk about hormones. I do feel that if they’re done safely and properly with good oversight, screening for cancers, and things that could be potentially an issue, it can add a lot of quality to people’s lives.”
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“There are so many things that contribute to heart disease. By focusing on, “This is a problem that can be solved with a pill,” we’re missing out on a lot of opportunities to educate people, unfortunately. Your hormones are precious and need to be tended to. A lot of times, when I see somebody who has a hormone imbalance, it’s not because they’ve got a disease that was imposed upon them. It’s because of lifestyle choices whether it’s diet, stress, poor sleep, toxins, or any of these things that we’ve talked about. The one that I would waive would be for people to be willing to take a broader look at it and not just expect that they can take a pill or put the toothpaste back in the tube. It’s not that simple.”
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My guest is Endocrinologist, Dr. Jordan Geller. I asked him before, “What’s your ratio, 20/80 men to women, that come in?” He goes, “No. It’s 95% women and 5% men.” The reality is women have more complicated hormonal systems for obvious reasons. What he shares is that oftentimes men will either put it on the back burner or ignore it. It’s important for all of us to get an understanding of what is going on under the hood from time to time.
A lot of us go to doctors because we don’t feel well or maybe someone is trying to get pregnant and they’re not having success or they’ve had weight gain. For certain women, maybe they’re at that time where they’re going through menopause and they’re suffering and not sleeping and all of these things. What I love about Dr. Geller’s approach is regardless of who you are, he said, “Even if you and I have the same diagnosis, what will work for you as a patient will be different than will help get me the end results that I’m looking for.”
He approaches each patient uniquely, imagine that, and like a story, one that you take slowly. He’s not quick to just go, “You’ve got a thyroid issue. Let’s give you these medications,” or you think you have PCOS or something like that. His whole approach is, first of all, step by step, “Let’s find out what’s going on. Things are leading to this.” What are the things that we can do slowly that we’ll see if we can get results first?
I am seeing more and more and it makes me incredibly hopeful that more and more doctors are saying, “Great, let’s look at lifestyle, let’s look at nutrition, or let’s look at even some natural remedies if they can be effective in supporting your hormonal system before we put you on a medication that maybe then you’d have to be on your whole life.” He lives it himself. If you see Dr. Geller, he has a lot of vitality, he’s healthy, and he takes care of himself. He spends time with his family and has that balance in life even though I’m sure he has to work incredible hours. He genuinely wants to help his patients.
Dr. Geller is part of what I am seeing more and more of these doctors that go, “I learned a ton at medical school. They didn’t talk to us about nutrition. I’ve made up some ground. I’ve even learned from my patients. Now I’m trying to figure out how to integrate these things into my modern practice.” I learned a lot and I’m inspired by Dr. Geller’s passion for what he does and the level of how conscientious he is about taking care of his patients. I hope you enjoy the show.
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Dr. Geller, you go to medical school and you’re good in the sciences. Was someone in your family a doctor?
My dad was.
What kind of doctor?
He was an internist, a general practitioner. If anything, he dissuaded me from going to med school. He didn’t want to be that parent whose son went and became a doctor.
Like his dad. Did you know in high school, “This something that interests me.”
I was not a science person in high school. I was more into liberal arts. In undergrad, I was a sociology major. I’m not good at checking boxes and sociology is a little bit of everything, its history, politics, and economics. I did want to go to med school at some point. I was intimidated by math and science. Finally, I said, “Screw it. I can do this.” I went back and did my pre-med and then I ended up going to med school. I had some wonderful mentors and it worked out.
Were one of these mentors part of why you decided to specialize and become an endocrinologist?
Yeah.
We were talking about it when we briefly discussed it on the phone, it is one of the hardest and most complex. It’s a symphony, it’s hormones, it’s all these different things. What happened in that relationship that you thought, “This is for me.”
When you’re doing your residency and you rotate through cardiology, GI, and everything, I went through endocrine. I had this mentor and his name is John Adams and he’s at UCLA now. He specializes in metabolic bone disease. He researched osteoporosis, vitamin D disorders, and all sorts of esoteric things. He taught me so much.
We did a lot of research in that area and it was a good template for other endocrine disorders and how we approach them. Bone disease is fascinating, it’s governed by hormones, and there are so many lifestyle effects, supplement issues, toxins, and, of course, medications when they’re appropriate. It was a good lens through which I could learn about endocrinology.
It’s funny because even being in your office, you’re a surfer. You have a gentleness to you. It seems like maybe you’re a person who approaches your practice creatively.
I do. Endocrinology is so much about art and medicine. That may be an overused expression sometimes but we’re dealing with real symptoms and real conditions. People feel crappy or have weight issues, menstrual issues, men with testosterone issues, or whatever the symptom is. The treatment is got to be personalized and finessed. It’s not just a one size fits all approach.
How long have you been practicing now?
Over twenty years.
That’s a long time. I’m curious, what have you seen in over your twenty years that surprises you that’s been changing and showing up either less or more?
There’s a greater acceptance of the role of supplements and other non-medical approaches and finally a much-delayed recognition that there’s a lot out there that helps people that were not in the medical books when I was in school.
Let’s say a real doctor like you. In the terms of Western medicine, you’re a real doctor. You’re the perfect person and the type of doctor that can be almost the liaison to discuss lifestyle and integrative medicine. I don’t think it’s harder a lot of times for people to come from the other way if that makes sense. The general population is usually going to receive this information better from what they see as a real doctor. Looking at you, you live like that, you live a healthy life. You don’t have to tell anyone, you can see it. Do you know who Paul Chek is?
No, I don’t.
Paul Chek always used to say that your trainer and your doctor should practice it as close to the nude as possible so you can see how it’s working for him. You want to have a doctor that you go, “That guy has vitality,” or, “She has a big lifeforce and they look healthy.” Have you always thought, “I can slip in this idea,” or get your patients to see the lifestyle component of it? Have you had more momentum in the last ten years of that?
[bctt tweet=”It may make someone feel better to think that something is natural but it doesn’t mean that it’s necessarily safer.”]
It’s something that’s definitely evolved. When I first went into practice, I had this book of knowledge from a real conservative Western medical training. My patients would come in sometimes with a table full of supplements they’d bring in and they would be teaching me, frankly, about some of this stuff that I’d never heard of.
Give me one example.
For example, there’s a supplement called ashwagandha, it’s popular. I remember the first time I heard it, I said, “What is this? I have no idea.” I remember a patient who brought it in and she unloaded her bag. It covered my whole desk, a pyramid of supplements. That one, I do remember. I couldn’t even pronounce it then. Now, I recommend it. I know about it and I’ve studied it. There’s good science behind it. Unlike many supplements, there are good studies showing its benefit. That’s one example.
Over time, medicine, to its detriment, closed its eyes and ears to what was previously thought of as anecdote or BS, which now come full circle. We have evidence to show that these things work. In thyroid, we talk about different thyroid hormones like T3. It’s a hot issue that was blown away for a long time. Traditional physicians would say, “There’s no need for T3. Patients don’t benefit from T3.” Now, we know that’s not the case.
Other terms like adrenal fatigue. There’s no medical textbook that has adrenal fatigue. To this day, Western-trained doctors will say, “That’s BS. That’s not a real diagnosis.” There’s plenty in the scientific literature about cortisol dysregulation and the effects that stress has. Maybe we call it something different but it’s quite evident.
In a way, you have to have a different thinking. The doctor is supposed to know. There’s this expectation, like, “I’m going to come to you. I’m going to talk to you about how I’m feeling. You’re then going to come up with some ideas and a formula for me.” How do you then simultaneously say, “I’m going to look into ashwagandha.” You’re dealing with hormones. For people who don’t know, ashwagandha is supportive. Is it both male and female? Certainly female.
Yeah, the adrenals.
The other one is Tongkat Ali. Do you know that one?
You got me there.
It’s good for testosterone and men. You should check that out, Tongkat Ali. Where do you figure out the way to learn about these things that you don’t know about?
One of the things I mentioned about having a good mentor was still not abandoning the scientific principles that I learned. Also, he got me involved. I did an NIH fellowship concurrently when I was doing my residency and that was in clinical research. The point is I can still take those same principles that we use in Western medicine and apply them to supplements or other interventions or recommendations for lifestyle. That’s the tests that I use.
I look in the medical literature, I look in PubMed, I read original research papers, and I use databases. We do the best we can. I have the oath to do no harm and I stick pretty hard to that. I do try to make informed decisions. My patients are sometimes their own experiments. We’ll have a patient who has a symptom and we’ll do an intervention and see how they feel. It’s an N of 1 so-called controlled trial.
Case study of one, I get that. That’s important, it has to start. As you said, everybody’s so different. When we were talking earlier, why would someone come to you? How do they end up here with you?
There’s one of a few different scenarios, the most common one is someone doesn’t feel well. They have symptoms and they’ve probably gone on to Google and put their symptoms online.
Self-diagnosis.
They come here and they tell me what’s wrong with them and what they want. Sometimes that’s a difficult conversation because I want to be respectful, of course, and I listen to what everybody has to say. People are so sure, in this day and age, of what they’re getting online and unfortunately, it’s not always the case, especially with medical issues. We’ll talk. I always spend a lot of time sitting in this room like you and I are doing with my patients.
We’ll sit here for about an hour and we’ll go through all of the systems in their body, their sleep, their diet, their exercise, their gut, their bladder, and their libido. We talk about everything. Ultimately, maybe they are right, maybe it was their thyroid, or maybe there’s something else that we can discover. That’s one common scenario by which somebody comes in.
Another one is the proactive, healthy person who feels great and looks great and they want to check their hormones and look under the hood so to speak, and see where everything’s at. The third scenario is a patient referred by a physician for a specific issue. They have a thyroid tumor, a parathyroid issue, diabetes, or something that they need me to manage it.
Can you manage and they can improve simultaneously those bigger ones? If somebody has diabetes, certainly with lifestyle, they can support it. Weight loss, instantly, they talk about how that right away at least makes you a little more sensitive and that helps. What if somebody has a tumor or something like that on their thyroid?
Those are more what are called black-and-white issues that we have to deal with that may not be as managed with lifestyle remedies. There are still things that someone can do to support their health in any way. Taking a supplement and managing your sleep and your stress is not going to probably help a thyroid tumor. It needs to be more definitively treated.
Diabetes, for example, is the perfect synergy between lifestyle choices and changes that someone can make and Western medicine. When I meet somebody with diabetes, I tell them, “There’s no disease I know of that, on one hand, can be so terrible and fatal yet at the same time is pretty much reversible to a large degree or at least containable.” This is a lifestyle disease by and large. We can intervene and make great changes. Yes, there is a role for medication when it’s appropriate, I’m all in favor of that. I try to empower my patients to make choices that can change that trajectory.
Does it ever blow your mind that people go, “No, that’s cool. I’d rather take the pill and deal with it.” You get that, right?
All the time.
Let’s talk about that. This is the interesting thing about some of the different biological traits that can work against us in this world that we live in with so much excess and we don’t live a life. I always laugh when I go to the gym to lift weights. Before our life, you had things that you were working and walking and doing and you didn’t have to be like, “I’m going to the gym.” Sometimes I do feel like a knucklehead. You go, “Really? You have to go lift weights?”
What is it in your experience? I’m always fascinated. For someone, it’s like the moment of truth, they’re here to see you, they’re either pre-diabetic or they have diabetes, and you go, “This is exciting. You have some opportunities.” They go, “I don’t think I can stop drinking or eating that. I’d rather just take the medication.” In your experience, what is holding us back from being able to make those changes? Is it just too uncomfortable to change?
For a lot of people in this day and age in which we live, they’re used to being able to get somebody to fix their problem, “Give me something to fix the problem. I don’t have the time or the wherewithal to do it.” A lot of people don’t want to invest in themselves in that way and it’s unfortunate. By the time someone’s diagnosed with diabetes, to use this disease as an example, 50% of the pancreas is already shot. You’re already playing with half a deck. We need to preserve that.
Medications don’t necessarily do that and they certainly don’t incentivize patients to make the lifestyle changes that they need to do so it’s difficult. I don’t want to impose my own biases on patients. I would never take all these pills. I would eat healthily and exercise. You try to lead by example and educate. My job is to educate my patients and help them make the best decisions that they can.
How do you keep recharging that system though? I feel like if I was a doctor, by the 10th year, how do I keep rebooting that system to give each patient that objective opportunity? What practice do you have in place for yourself to be like, “Okay.”
I try not to give up on people and I always think of the successes, that’s what helps motivate me forward to have the energy to help people. I think of that one patient, it’s a lot more than one, who did it and that’s what helps motivate me. I’ll share patient stories with other patients, anonymously, to help them feel like they’re part of a community and they’re not dealing with this alone.
I tell my patients, “Let’s be strict with the goal and flexible on how you achieve it. Let’s stretch out the timeline. You don’t have to fix your diabetes and lose 60 pounds in six months or a year. If it takes 2 or 3 years, who cares? We’ve got time to do this.” Once they have a more reasonable timeframe in mind, it also takes some of the pressure off and they’re more open to making changes.
Do you think it’s important that you see their house is on the same page as them or their partner? How much of that plays a part? Do you get access? Do you get the husband or the wife in and go, “We all have to do this.”
Dr. Jordan Geller – It’s a team approach, that’s how I look at it with my patients.
We don’t often all sit down together but it is part of the conversation I have. I want to know what’s going on at home. Is your spouse supportive of this? Is your spouse or partner struggling with similar issues? Do you have teenagers at home where the cupboards are full of crap? I do want to know what sort of struggles they have and what support system they’re going to have outside of my office.
Frankly, sometimes patients will use it as an excuse and they’ll say, “My husband or my wife likes to eat this or that or loves to cook.” I’m like, “You can still make your own choices. You can still sit at the table together and eat two separate meals.” It’s not always easy or practical but I don’t think everybody should be victimized by other people’s choices.
It’s an interesting thing when you’re in a partnership how you do the together road and you always have that way of having your own road too at the same time. It’s such an interesting dance. Of the three scenarios, someone’s not feeling good and they come in and see you. I know that’s weight gain and the hair and nails maybe can get brittle. If it’s a thyroid issue, maybe sleeplessness, constipation, or a few things. How would somebody think, “Maybe this is something to do with my thyroid?” Also, can you explain to people exactly what the thyroid does because it’s really important?
The thyroid is a little gland, it’s about the size and shape of a butterfly, and it’s in the center of our neck. It has an important role in almost every function of our body, our skin, our hair, our nails, our digestive system, our heartbeat, our brain function, our body temperature, and our menstrual cycles. There’s not a system that doesn’t need it for something. The problem with thyroid is the symptoms are so nonspecific. If you have fatigue or weight gain or constipation, that could be the thyroid or it can be twenty other things.
My job as an endocrinologist is when I see somebody because they come in with symptoms, the first thing I need to think about is, “Is this a disease or disorder? Is this something more Western or more Eastern so to speak?” That’s the first branch point that my mind goes to, “Let’s make sure there’s nothing serious medical going on. Let’s rule that out.” The thyroid, I jokingly call it the gland of opportunity because it’s an opportunity to survey all of the systems in our body whether or not it leads us to a diagnosis of hypothyroidism or not.
Is it blood work? Is that the first line of defense? Do you get a panel of bloodwork? What is it that you’re looking for that gives you an idea if the thyroid is in play or not?
There are a few components to a thyroid panel. The main hormone the gland makes is called T4. T4 gets converted throughout the body into something called T3, which is the more active hormone. Most of our glands have a feedback loop. If our thyroid is underactive, another hormone will kick in called TSH. A higher TSH generally indicates an underactive thyroid. It’s another indirect way of assessing thyroid function.
I’ll look at that whole panel. I’ll also look at autoimmune markers. Particularly in patients who have a family history of thyroid issues, if they’re pregnant, or trying to get pregnant, autoimmunity plays a bigger role in my assessment. Sometimes we’ll look at other minerals cofactors. We’ll look at their urine iodine levels. We may look at heavy metals. I’m not a super-specialist in toxicology but it is an area of interest. We’re trying to dig deeper a little bit to find out what’s the root cause of someone’s thyroid issue if they do have one.
Can pregnancy kick off thyroid issues? What happens there? Is there a way that after the baby comes, things can stabilize? What happens there?
When estrogen levels go up, it can put a demand on the thyroid gland that a normal and healthy gland can compensate. If a gland has some autoimmunity or inflammation in it or it’s mildly low, it suddenly accelerates the issue. It’s particularly important during pregnancy because, as I tell my patients, there are two patients in the room, there’s the mom and the baby.
The baby is dependent upon the maternal thyroid for the first trimester, for sure, and throughout pregnancy. It does put an increased demand. Sometimes, after pregnancy, it’ll certainly clear up. A lot of autoimmune conditions can improve during pregnancy. It requires close monitoring because it’s such a dynamic time for the thyroid.
Moms have a baby and then they’re nursing. If anyone’s gone through that in a normal environment, you can get back to normal pretty quickly with your weight. You’ll see certain moms that can’t get rid of the weight. You’re already sleep deprived and you have all these other components happening but a lot of it could be that the thyroid is not working properly.
It could be but it’s not always. Unfortunately, a lot of patients will come in certain that it’s their thyroid and it’s not and it’s other hormones at play or it’s the fact that their lifestyle has taken such a radical turn. They’re sleep-deprived and they’re having to eat a lot of calories to breastfeed. There are a lot of factors going on at that time. If it’s not thyroid, it doesn’t mean we can’t help them.
Take a look at it. It must be interesting. You must have to be delicate with people. These are sensitive times. If someone is vulnerable, not feeling well, and all of that, that seems like a natural trait.
It is an important trait to be sensitive and mindful of what’s going on.
You have a family, you have two daughters. Do you ever say to your girls, “Suck it up.” Are you like that across the board?
I’m pretty sensitive.
You would not last in my house. My daughters would be like, “We got a live one here.” It’s interesting, it just comes easy to you.
When you’re dealing with these issues, it’s a matter of being empathetic and sympathetic to people. It’s not a trait that can be learned or taught by a physician. Either you have it or you don’t.
Did your mom worry about you? I have one daughter who’s incredibly empathetic. I used to say to her, “Can you listen to your friends,” and not make it her problem? She was so empathetic. She’s learned how to drive that car a little bit better. She’s older. That must be interesting, especially for a male, to be that empathetic.
It can be good. It can also, frankly, be a burden at times. As a physician, you have to deal with difficult things, you have to deliver bad news or hear bad news, and you get deep into people’s lives. That does weigh on me, to be honest.
We were talking a little bit about you wanting to be there for your patients, you want to be there all the time. You do have a life and you have to have bits and pieces for yourself, creating those boundaries. A lot of people’s work and life are mushed together. What tactics have you found that are at least the most effective at getting a shot at creating appropriate boundaries? We’re close to Beverly Hills. This is the way I want it zone. What strategies have you learned over time to create those boundaries?
A lot of people want to, frankly, be friends and hang out.
I can see why.
You’re in a room with someone and they’re telling me the deepest details of their lives and I appreciate that. I’ve had a few patients whom I’ve become friends with them or my wife and I have gone out with them. Those relationships sometimes don’t last, frankly, because either the medical relationship gets impacted or the friend relationship gets impacted and the boundaries get blurred and it’s not always a good thing. I try to keep those boundaries with my patients. They don’t have my cell phone. They don’t call me at 10:00 PM. I have no problem shutting off my phone and going off the grid and being with my wife and kids or doing things for myself that I love to do. I don’t apologize for that at all.
Do you ever fire patients?
I have.
How do you do that?
I have an attorney. I have a certified letter that has to go out when that’s happened but It’s usually for, frankly, people that are abusive. If someone’s abusive to my staff or me, that’s the line that I draw. I can tolerate difficult people and I can tolerate people that have psychological issues but if someone’s abusive, that doesn’t work for me.
[bctt tweet=”It’s important to get sunshine and fresh air. Be outdoors and get off the grid.”]
You’re saying it so lightly but I’m sure you have to deal with a lot of things. In the second scenario, someone is trying to be proactive in their health. Let’s say they’re feeling pretty good overall, they’ve probably had their blood panels done, and nothing weird has shown up. Is it 40 or 30? Is it male or female? If you were going to say, “The best-case scenario would be around this age.” I know you can’t tell people what to do that way.
I would say by the 30s. The earlier we look, the more likely we’ll find things that we can start to intervene about whether it’s a thyroid issue, pre-diabetes, pre-pre-diabetes, cholesterol issues, or weight issues. Most of these chronic diseases that we deal with have a long latency period. It’s only if we choose to look at it and acknowledge it. I don’t have an exact number but that third decade is probably a good time to do a check-in. Certainly, for women, before they’re wanting to start families and if they choose to do so, it’s an important time period.
Do they have to go through their regular doctor to get to someone like you? Are they allowed to just call up and say, “I’d like to make an appointment.”
Most people are referred to me through someone or if they contact us directly, then we’ll still ask for a referral, generally speaking.
You don’t want to be sending out any certified letters.
I want to know who can I report back to if there’s something wrong with this patient. Who else is accountable? Who can I call and say, “This patient needs this or this other test. I’m concerned about their heart.” As an endocrinologist, you find cardiac things and maybe they need to have heart scans or stress tests and things that start to get out of my wheelhouse. I do like to have another person anchored to my patient when possible.
I know what that means, “I can’t help you. I’m so sorry.” I get that. In the third scenario where someone gets sent to you, what are you seeing a lot of? Are they usually coming because of the thyroid? Is there anything that gets coupled with the thyroid? A lot of times, two things live together.
A lot of times, thyroid, hormone issues, and thyroid nodules will be found together. Those thyroid nodules are common in thyroid cancer. It’s common and increasing although it’s generally a “good” cancer compared to the other ones out there. There’s a whole host. Endocrinology is so broad. People may send a patient to me.
There’s another hormone called parathyroid, which are glands that are behind the thyroid gland that controls calcium regulation and it’s important for bone health. When that gland is out of whack, people get osteoporosis. They’ll have kidney stones and high calcium levels in their blood. That’s another thing people may be sent to me. I’m not a reproductive endocrinologist, that’s a whole other specialty. A lot of times, somebody will be going through IVF and they’ll flag something wrong with them, diabetes, prediabetes, or something that needs to be tuned up.
When someone’s pre-diabetic, tuned up means what?
It means we need to intervene and protect your pancreas from failing. Diabetes, ultimately, is a vascular disease. We’re trying to protect the small vessels, the eyes, the heart, and the kidneys. That’s what I try to educate patients about. Pre-diabetes is a real opportunity to make an intervention and change the course of their lives.
When we were talking and I said, “What is your patient list look like? 80/20 female to male.” You said it’s probably somewhere between 90/95 female to male. I understand, I’m a female. I have daughters. I’ve witnessed it in a few places. I’ve played sports with other females. I understand how complex that system is. Men could equally benefit from getting in here. Is it that they ignore it? It doesn’t occur to them? What is it?
Men do ignore things. For example, pituitary disorders. Pituitary tumors in men present at a much later stage with more complications because they don’t have the cues that women have. For example, a cycle every month. They may not realize something’s happening or they’re more likely to ignore things. Guys, frankly, will assume, “I’m tired. Maybe I’m working too hard.” They don’t think a little deeper about it in my experience.
Guys are more embarrassed about things. A woman will come into my office and tell me crazy stuff, deep and dark stuff that’s revealing. They have no problem sharing with me. Guys are embarrassed to tell me that their libido is low or that they’ve been taking some supplement that someone gave them at the gym and only finally now they’re willing to disclose it and things like that. There is that issue. Men are at risk for a lot of the same issues. We have our own version of what’s called andropause, it’s like menopause. Testosterone drops about 1% a year after age 40. Some people can accelerate.
Off a cliff.
Men develop osteoporosis. I’ve seen it in young men. It’s not just grandmothers’ disease. Osteoporosis and other metabolic bone diseases can happen in men. Of course, diabetes is rampant in men. Thyroid tumor, thyroid cancer, and hypothyroidism. although it’s way more common in women, it does happen in men, especially if there’s a family history. There’s a real opportunity for men to become more aware of their hormones.
Do you know the book Count Down? It’s 1% since 1970 or something like that, maybe an average of 30 points less testosterone if you’re now a 25-year-old male versus a 25-year-old male in 1970. The environment, it’s everywhere, stuff, plastic. People ask me all the time, “What are you going to do?” It’s too overwhelming to take it all on. The best shot you have is to keep yourself strong and your immune system. See people like you, get your blood work looked at, and have a sense of what’s going on with you. I don’t think we can manage, “What air am I breathing? Is that a chemtrail? What’s in the bread? That makes you a cookie too.
It’s overwhelming.
It’s too much. You have a family. You’re a healthy person yourself. I would love to know if there are certain things that you do to fortify yourself and that maybe you encourage your daughters to do. A lot of times, and you must see this in your practice, what keeps people from starting is they either feel so far behind, or it all seems too overwhelming. I don’t even want to open the box. We were talking about toxicologists or metals. When you hear people, “I have high metals. My mercury is high.” I’m like, “Here we go.” That’s a whole thing in itself. Is there something that you do or you have your wife do or you encourage the girls to do the best that you can?
Start simple with the obvious things like plastics. Plastic is such a huge source of toxins that affect our hormones. To a large extent, we can eliminate plastic water bottles, plastic utensils, and cutting boards. Never heat things up in plastic. That’s a good starting point at home. For the products that we use in our bodies, we need to learn how to read the labels on a bottle of sunscreen like we would read a food label, hopefully. The chemicals that are makeup and sunscreen.
My kids know more about this stuff than I do. That’s important because these endocrine-disrupting chemicals go through the skin easily. They’re all lipid soluble and they store for years and years in our bodies. Those are a couple of things. Try to eat organic because the pesticides are loaded with endocrine-disrupting chemicals. We do the best we can but, you’re right, it can be overwhelming.
I remember I gave this talk about endocrine disruptors and pollution. It was all about how there are microplastics in all of our feces now, which we can detect. I had a photograph of people picking up trash at the beach, which is a great thing to do, and I do it. The tool that you use to pick up plastic is made of plastic. The gloves that the people are wearing are plastic and the bag that you put the trash in was plastic. It’s a vicious cycle of crap that can be overwhelming. My point is that the photo showed how futile this can feel at times.
As it is, people are overwhelmed with work and their own feelings. I don’t think so many people wake up each day being like, “I can’t wait to take the day on.” A lot of people don’t sleep well. I think they don’t feel well. It’s an interesting thing to try to make it achievable. Let’s say you have someone who comes in and you can tell this is a new conversation for this person. When do you say, “We’re going to take a look. We’re going to take baby steps. Expand and open the window.” Is it 1 or 2 things we’re going to take out of your life and 1 or 2 things we’re going to put into your daily practice? Do you have starting points?
I educate them about this great group, EWG, and their Dirty Dozen list of endocrine disruptors, which is a user-friendly way to identify what are the common sources of this stuff in our home and our lifestyle and how we can avoid it. That’s an example of what I do. It’s overwhelming. You can’t start listing off all these chemical names and expecting people to figure this out on their own. That’s a great resource that I give out to a lot of my patients.
They’re good.
Starting small and being aware of this stuff is the first step and realizing we’re not going to do it all. We can’t control the air that we breathe and the soil that our foods are grown in and the water that’s coming out of the sky when it does rain. We do the best we can.
Dr. Jordan Geller – The earlier we look, the more likely we’ll find things that we can start to intervene about, whether it’s a thyroid issue, prediabetes, cholesterol, or weight issues.
You must meditate or something. You seem awfully calm to me. I don’t know what’s going on. Are you crying on the inside? What is it?
I’m enjoying this. This is fun. I don’t meditate.
You have a zen-like exercise. When you see certain people, you think, “They like their life. They’re the life that they’ve created.” Do you have anything specific that you do that has boosted you and helps you keep in that homeostasis place?
I try to integrate polarities within my life. For example, I don’t go and meditate but I try to have a mindfulness approach throughout the day. I’m grateful for what I have. I take care of myself. I don’t want to be the patient that’s having to sit across from me in my office one day and that’s a real motivating factor for me. I wake up, I try to have a structure to my day to work out early in the morning because, like most people, I’m not going to want to probably do it in the afternoon.
I don’t know if you’re talking about someone like me and patients, you’d be like, “I need to go home and sit on the couch for a second.” You just get it over with in the morning, some kind of training.
Yeah. I work out at home. I do a mat Pilates and weights routine. I keep it pretty simple. I walk a lot whenever I can. I love to walk and hike. I love the outdoors. It’s important to get sunshine and fresh air and be outdoors. I’m preaching to the choir. That’s important to me. Getting off the grid and having some sense of adventure and some challenge and expanding my comfort zone are all important things that we need to do.
What about it as a dad? We’re joking about how important parenting, that job, and that title is. I always say it’s like the moving bullseye, you can’t hit it multiple days in a row. You’re lucky if you sometimes get an arrow on the fringe. I think, “That was a success.” Our kids mean so much to us and it is the most humbling job that there is. I’m curious if something for you as a dad has shown up to be true. We learned so much over time, especially after kids are teenagers if there’s unspoken philosophy that’s shown up to be true for you as a dad.
I’m hyper-aware of time, how fast time passes, and how short life is, partially because of what I do here, meeting people at different stages of their lives. When we had little kids, everybody says to you, “They grow up so fast.” That always annoyed me. Everybody says that to you. That was a real motivating factor for me.
I’ve always wanted to be involved in my daughters’ lives and spend every minute I have with them. I never miss any school event. Even to this day, I’ll go to the dentist with them. They make fun of me because I want to tag along. At some level, I felt that by doing that, I wouldn’t have that feeling that things happen so fast and yet they’re older and it does feel like it went by fast. We’ve got a lot of great memories. I try to be present.
The other important thing that has worked for me is you see so many parents who have teenagers and there’s this break-skidding sound, their relationship goes to crap, they hate their kids, and their kids hate them. We never wanted that in our home. You have to constantly reinvent your relationship with your child as they’re getting older. It’s not like I can run home and go to the park and take my kids on the swings now but we can go have a coffee or we can go play tennis or we can go walk around the block or whatever it is. You have to find active ways to keep that relationship going and I’ve been blessed to be able to do that.
It’s interesting too with kids when we have to try to keep seeing them with those new eyes, it’s hard to do. I’m always fascinated when you realize that, in certain ways, your kids are way ahead of you. You have those moments where you’re like, “I’m barely qualified to parent them in this area.” It’s interesting.
Rather than fight that, I always will tell my girls and they’ll say, “What do you think? Tell me.” I’m like, “You know maybe better than I do in certain ways.” It’s seeing them for who they are at this moment. In a partnership, when you’re in long partnerships, you have a practice, that’s a lot. You’re making it sound easy and easygoing but there’s a lot of dancing. You can only speak for your side. What is it that shows up about the way that you can be your best or that it’s worked out the best when you adhere to certain ideas?
You’re referring to my marital partnership, I assume.
Yeah.
For me and for us, what works is you have your life together and then you have your independence and that’s an important feature of a healthy relationship that you don’t see often, it’s either one extreme or the other. That’s what’s worked well. My wife is an incredible person. We have a wonderful time together. We hang out. She knows that it’s healthy for me to go off and go on a sailing trip or go to El Salvador or do any of the other stupid things I do. I respect her time to be alone and do what she wants to do. It’s healthy to be independent people at the same time.
Sometimes if Laird and I go to work let’s say and there are a lot of people. You deal with people every day. We can go in and out of it. We’ll be traveling. You’re trying to be present. You’re doing it at the highest level. People are confiding in you, they’re telling you all these things, you’re trying to help them, and they’re in a vulnerable time. How do you have gas in the tank for your family when you go home? That’s always something most of us are struggling with. You want to be your best at work and then you want to come home and try to even be better for those people. How do you have that?
I don’t work right up till the hour that I go home, that’s what’s worked for me. Many physicians are not even home for dinner. I start my day early. I’m up at 5:00. I start my day early and I end my afternoon at a reasonable enough time that I can go home and there’s some buffer time where we can decompress and reconnect. That’s important.
It’s always fascinating when we’re stressed out and then we go home and we’re our worst for those people. I always say to people, “I treat no one better than I treat Laird.” I treat Laird the best of any person that there is. He’s hoping that that’s the way it is. Also, you realize that if you can figure out those ways to do it. It doesn’t mean all the time I blow it. You created the upcycle, the up flow, that’s helpful.
It’s that reentry.
I fake it all the time. Do you fight on the way home from vacation, especially when your kids were little? You don’t fight on that flight home?
I’m just depressed when vacations end.
That’s me being like, “Do you have the bag? Did you get the bag?” I feel like our family is in a brawl on the flight home from a holiday. I’m like, “This is a great holiday.” It’s all logistics, kids, and stuff. It is pretty funny. I look at other people and I’m like, “That family looks happy. What’s wrong with us?” Your food, you, personally.
What’s my day?
Yeah. What does it look like?
I’m pretty much a creature of habit. In the mornings, I’ll have a lot of protein. My whole day, I’ll have a lot of Greek yogurt, all the eggs, nuts, butter, and things like that. Whey protein powder, that’s my morning routine, and some fruit. By 10:00, I’m starving again. I do bring food with me to work usually, lean protein, maybe some sliced turkey, cottage cheese, and nuts. I’ll graze starting at 10:00 in the morning. By 3:00, I’m starving again. I eat a lot throughout the day. It’s healthy and it’s clean. I do enjoy desserts. I’m not perfect, of course. My wife is a great cook. She would like to cook at home. We don’t eat out too much. I’m blessed in that regard as well.
[bctt tweet=”Start simple. Plastics are such a huge source of toxins that affect our hormones.”]
One of my daughters cooks well. He was picking up all the equipment and she cooks and I’m like, “Thank you.” She’s good too. She’s still okay to chop every single vegetable. After a while, I’m like, “I don’t even need that vegetable in the dish because I’m over chopping.”
It’s a great skill. I don’t know how to cook at all.
Really?
Nothing.
Keep playing that angle.
It’s a skill I wish I learned.
Let’s talk about menopause and women who come and see you. I get this all the time, menopause and pre-menopausal. Are there things that women can do? I think they think it’s a sentence. I’m in that pocket. I just said I’m not going to fight anything but I’m not going to be like, “That’s how it is.” I’m going to keep doing my best. I’m going to get my bloodwork done. I’m going to train. I’m going to do resistance training. Especially for women, you’ve got to keep lifting time under tension. Is there anything that you would say as a doctor for women who are going through menopause to pay extra attention to?
Those years before menopause is critical, that’s when you’re building up your reserve, and that’s going to help sustain you through that transition. I talk to my patients about this, women who go into menopause are unhealthy in many ways, whether that means being overweight or not eating healthier, or exercising. It’s hard enough even if you’re super fit and healthy but it’s a real uphill battle. It’s not that it can’t be helped, it’s just much harder. Those years before menopause make a difference.
If someone’s 55 or 60 and they go, “I was doing other things. Now I’m trying to pay attention.” Is it lifestyle? Is it like, “Let’s look at our food, our movement, our sleep, our stress, and our relationships, and then we’ll talk.”
Do you mean, we’ll talk about hormone replacement?
Yes.
When does that come into the conversation?
Yeah.
All those things matter. I never have a hormone consultation in a vacuum where we’re not talking about diet, sleep, stress, exercise, relationship, and gut health to the extent that I’m knowledgeable about that. All these things always matter. The conversation about hormones is interesting because if you think of it from an ancestral standpoint, we were born to reproduce and die. Because of modern medicine and we’re living to be 100 now, what are we going to do with these next 50 years?
You want your functional age to line up with your hormones. That’s the gap that I need to fill in. We talk about hormones. I do feel that if they’re done safely and properly with good oversight, screening for cancers and things that could be potentially an issue can add a lot of quality to people’s lives. I’m conservative with hormones. I’m not like some of these doctors out there. It’s always better, in my opinion, to start slow and increase it than to do the opposite.
Is it different for different scenarios? Is it shots? Is it pellets? What is it typically?
For most women, we use the skin, and we use patches or creams. I’m not a fan of the pellets, I don’t administer pellets. I don’t have any skin in the game. In my experience, I’ve seen scenarios where the pellets surge and give a high level of a hormone and people feel terrible. You can’t take them out once they’re in. I like a drug that we can monitor and adjust and that’s not the case with pellets. For me and my patients, it doesn’t work well. We do use many other forms of hormones.
I have an artificial knee. I think about what a luxury we have now. Before, on a lot of this stuff, it was like, “Sorry, you don’t feel good.” We have many incredible options in front of us. You talked a little bit about this bridge between the West and the East and integrative medicine. I know supplements are a hard, big, and wide thing to talk about. You’re always going to hear people talking about vitamin D, a shortlist, quercetin, and a few things. Are there supplements that, for the most part, if things are lined up, you think, “These are supportive.”
There are. More often in the perimenopausal or in women who are cycling in pre-menopause, those states in true menopause, there are some supplements that can help in menopause like black cohosh or other estrogenic types of herbs. At the end of the day, some of these things maybe not even safer, necessarily than using pharmaceutical estrogen.
At the end of the day, there’s an estrogen receptor. If there’s a chemical that’s hitting that, it may make someone feel better to think that it’s natural but it doesn’t mean it’s necessarily safer. I’m always researching what’s been published that can help somebody with symptoms for those patients who don’t want to take hormones. I don’t shove those down someone’s throat. A lot of patients don’t want to take that and I respect that. We try to find ways to help them.
They are allowed to have that conversation first, like, “I’d rather try it the natural way first.” Is there ever a time when someone comes in and you go, “We’re stuck here. Medicine is the only way.” There are those times.
Why suffer? Patients will come in and they’ve been trying the herbs, the acupunctures, and all this stuff. They still have night sweats and hot flashes and they’re not sleeping and they’re moody and they’re like, “Just give it to me.” I’m like, “Great, let’s do it. You’ll feel better.” One of the more gratifying things to treat as an endocrinologist is a menopause because people feel crummy and they feel so much better in a couple of weeks. It’s cool.
Does your wife listen to you?
Does she listen to this podcast?
No. Do you know how we joke about an expert or somebody who lives a mile away? Will you send her to another doctor when she’s going through different things in her medical journey?
We joke about this at home because she’ll ask me things and I don’t want to get too involved. She’ll say, “You deal with this all day. Why won’t you share with me some of your knowledge?” It’s a fine line I have to walk at home.
That’s the real secret to the marriage right there. You see that wizardry right there? I get it now. You have daughters. It must be fascinating. You must be like, “I have a lot of answers for you, girls.” You have to get someone from the outside to come in.
It’s tricky. By the way, people at home don’t always want to take your recommendations. That can create conflict too.
Pick your battles. Once you’ve done someone’s laundry, it shifts the dynamic. Let’s say someone’s interested in health and they come to see you. Even regular bye vitamins, do you like omegas? Are there certain ones that you’re like, “For the most part, these don’t seem like a waste of money. You’re throwing your money away.”
There are three scenarios in which I recommend supplements. If someone’s deficient in iron, B12, or vitamin D, our body needs these for a reason and they should be repeated. Another scenario is if they have a symptom where there’s some evidence that a supplement may help. That doesn’t have to be evidence in a medical journal. If there’s a good anecdote, I’m cool with that.
Fish oil is for mood and cognition. For example, ashwagandha like we talked about, melatonin, L-theanine for focus, magnesium, tart cherry, I could go on and on. I use supplements all the time for a targeted reason if somebody has symptoms. The third scenario is in place of a drug. If there’s somebody who has, for example, high cholesterol, maybe they don’t have heart disease and they don’t want to take a statin. There’s good evidence that red yeast rice works well so I’ll use that or krill oil.
That’s me, by the way.
Do you take that?
I have, genetically, high cholesterol. I’ve got my heart checked. It’s crazy.
There’s a lot of that out there.
What is that?
The liver makes cholesterol and it’s not just the cholesterol from your diet. As you point out, many patients are put on medication unnecessarily. Cholesterol is necessary but not sufficient for having heart disease and that’s the take-home message. You can have very high cholesterol and have perfectly clean arteries. I’ve seen patients who have low cholesterol, and LDL below 100, who have dense, bad plaque, and heart narrowing.
Dr. Jordan Geller – Cholesterol is necessary, but not sufficient for having heart disease. You can have very high cholesterol and have perfectly clean arteries.
I heard that in a lecture years ago, Robert Lustig. He was basically saying that there’s not that much of a real correlation between cholesterol and heart disease but it was some political thing from a study in the ‘60s or something, I don’t know. It’s funny how we just keep on that train though. It’s like, “I have high cholesterol.” “You get on a statin.” It’s important for people to the whole story.
It’s cholesterol, blood sugar, inflammation, stress, smoking, and environmental factors. There are so many things that contribute to heart disease. By focusing on it, “This is a problem that can be solved with a pill,” we’re missing out on a lot of opportunities to educate people, unfortunately.
I don’t drink alcohol, I haven’t in my adult life. It’s unpopular. I don’t have an opinion. If people want to drink alcohol, they should do what they want to do. It can be pretty disruptive to your health. What’s less? Tequila?
As far as glycemic index? Yeah.
Maybe not great for your life. I would probably be in brawls all the time.
Tequila and vodka are the lower glycemic alcohols. It’s a problem. It’s an epidemic. First of all, in med school, they taught us some rules of thumb. Whatever a patient tells you, you have to double or triple it.
Because they lie?
Yeah, everybody lies.
“I drink three drinks a week.”
It’s still better than most people. It’s a problem. Alcohol is sinister. What’s not been talked about a lot is that in small amounts, chronically, alcohol can have a lot of potentially damaging effects on our heart, our brain, and our gut microbiome. The conversation needs to shift from just alcoholics and binge drinking. There’s more to it than that out there.
That’s why I bring it up. I don’t want to be Debbie Downer. I support that people have to find their way. I don’t want to skirt away from something that is wildly accepted and popular like it’s okay. It is tough on you, especially if you do it consistently.
It’s the last thing that my patients will give up, honestly. I’ll see patients coming to see me for weight issues and they’ve gotten rid of the carbs, the bread, the pasta, and all the stuff, and they’re working out supposedly. It’s not till they give up that 2 or 3 glasses of wine that they’re having every night because their life is miserable.
That’s the other question. It’s that scale of it takes the edge off, more enjoyment, but then less stress, but then the booze. I often wonder, how do we get here? Do you know where it’s like, “That’s okay.”
It’s short-term. It does take the edge off that evening for somebody but then their sleep is poor, their cortisol is dysregulated, their blood sugar is out of whack, they feel crap in the morning, and they don’t want to get up and then exercise. It’s this vicious cycle. Look what we saw during the pandemic, everybody either got way healthier or way sicker. Nobody stayed the same, in my experience, from a lifestyle standpoint.
We had to make real concerted efforts to pick a line because it was unusual. I love the videos of people going into the neighborhoods and all of the garbage bins loaded with booze bottles. I’ve been asked, PCOS, if we could talk about that a little bit.
Yeah, we can talk about it. It’s said to be the most common endocrine disorder or at least amongst reproductive-age women. It’s also the most overly-diagnosed disorder. It’s got loosey-goosey diagnostic criteria. If you have high testosterone or if you have signs of high testosterone, which can be acne, hair loss in a male pattern distribution, or irregular periods.
If a woman has 2 of those 3 criteria, they can be diagnosed with PCOS. What girl doesn’t have acne ever or an irregular period? Having said all that, I’m not blowing it off, it is a legitimate thing, it’s a concern, and it’s a real risk for diabetes. It’s linked tightly with insulin resistance and diabetes risk. When I see a patient with PCOS, I’m trying to put them in one of a few categories, either it’s a cosmetic concern to them. For a lot of my patients, those are the issues that have brought them in.
It may be a fertility issue, they’re not ovulating, or it’s more of a metabolic issue, they’re on the path to diabetes. Maybe there’s a combination of all three of those. That is the area that we address. PCOS, historically, doctors put everybody on the birth control pill and it was maddening. I often say that birth control pills make the doctors’ lives easier and the patients’ lives worse. It masks the issue. It doesn’t do anything to treat it.
When I have young women in here who has PCOS, I teach them about it and they make lifestyle changes in their diet and their glycemic index that they’re eating and supplements like inositol and Berberine or sometimes we’ll use Metformin. There’s good evidence that this works and then I’ll see them back 3 or 6 months later and their cycles are better and their skin’s cleared up and they’re feeling better, that’s fantastic. It’s one of the conditions that’s amenable to lifestyle changes, for sure.
You’re not but doctors are scary. It’s hard to push back or say, “Can we check? Can we look at it a different way?” Would you say to somebody, “Maybe get another opinion before you lock and load onto some long-term treatment.”
Absolutely. There’s no harm in doing that. Patients should not be intimidated by it. It’s a different era nowadays. The way I look at it in medicine, it’s not like the old days where someone went to the doctor and the doctor said, “You have to do this.” As patients, we would accept that. It’s a team approach, at least that’s how I look at it with my patients. Patients are so much more knowledgeable. Some patients get bad information online but a lot of people come in with good information. It’s a conversation. It’s not a one-way street.
I like it when patients challenged me and ask me questions. We want to find what works best for them taking into account their values, their medical conditions, their experience, their commitment, what they’re willing to do, and what they can do realistically with their lifestyle. If somebody wants to get an opinion, either it’s going to validate what we did or it’s going to find them something better. Maybe there’s something better out there than what I’ve suggested, that’s cool. It’s about what’s best for the patient.
You have a practice now in Florida. If someone lives in Palm Beach and they have someone who knows you that can recommend them, they’re not getting certified mail. I want to say that because someone could be reading and think, “I can’t see him.” Do you do telemedicine as well?
Yeah, I do telemedicine consults all the time.
COVID, the news, and all of the world, or at least the outlets would like us to believe that we live in a combative time and it’s all or nothing. In your practice, are you feeling hopeful about the collective and how we’re approaching our health? Does it feel like we still have a long way to go to take accountability and realize how much of it is in our practice? How do you feel?
One of the lessons of COVID that I don’t think we hear a lot about is how much our lifestyle did play a role. People that were overweight and obese suffered a lot more and that’s something that you never heard on the news. All the years when we’ve been going through this, you never hear people, physicians, or medical experts so to speak, encouraging patients to adopt a healthier lifestyle. That was the biggest dividing point between who got ill and who didn’t, unfortunately. There’s some work to still be done there.
[bctt tweet=”Many patients are on medication unnecessarily.”]
When I see doctors and professionals like you who are in the position you’re in and ]you are always saying, “Yes, we can treat it and let’s look at lifestyle.” Having these conversations, I see it more and more. I’m personally more hopeful. Ultimately, you guys don’t even get time to train in nutrition in school. Maybe some of the curriculums or at least that could be a bolt-on or you’ve taken it upon yourself to do some of the work yourself. That will become more of a normal conversation besides just throwing a pill at it.
There is that statistic that we’d get an hour or two of nutrition in medical school. You and I were talking about how wildly inefficient medical school is. The bulk of material that they require us to learn, a lot of it is not relevant, frankly. Nutrition would have been something. Other education and behavior modification, helping people make better choices, empowering them to do that, and learning psychology would have been helpful as well.
We’re lifelong learners. As physicians, we’re always learning. I learn a lot from my patients. I’m constantly reading the literature and making up for those deficits that the Western medical model doesn’t focus on. It’s all about drugs, diseases, and diagnoses. There’s nothing about preventative care that we learn about or at least not to the extent that patients want that. That’s what people are yearning for.
If someone goes on thyroid medication, is it possible to get off? Is it that once you’re on, you’re on?
I’m glad you brought that up because that’s something that we could talk about with other hormones too. It depends if somebody goes on a thyroid hormone perhaps during pregnancy to support the pregnancy and the baby. In the nonpregnant state and their thyroid is okay, that’s a scenario where they can get off of it. Sometimes, Hashimoto’s, which is the autoimmune thyroid, is a condition that’s amenable to lifestyle intervention supplements. There’s good evidence for supplements like selenium, inositol, and vitamin D in dietary changes. I’ve seen those patients get off thyroid hormone.
By and large, once somebody is on a hormone, their body stops making its own. This is something that we see in men who take testosterone all the time prematurely. That shuts down their own testosterone. Taking thyroid will shut down your own thyroid to some degree. It’s the same thing with adrenal hormones or estrogens or anything. Before somebody goes on hormones, whatever the hormone is, it’s important that they are certain that they’ve had a thorough look at everything from their physician or their endocrinologist or whoever it is they’re seeing.
Do you like Brazil nuts?
Brazil nuts are great too. Brazil nuts give you the equivalent dose of selenium of about 200 micrograms.
I keep hearing that they’re great.
They’re the nut that nobody wants to eat.
What is that? It’s nature’s joke, “This one is good for you.” Have you ever had Shilajit?
No.
It’s like black tar. You should check into that. It doesn’t taste good, it’s very good for you though.
I’ve never heard of it.
I’ll send you some. You’ll be like, “Thanks,” or not. Justin, I’m giving you a crack at it. You get one. Do you have any questions?
No questions but can you talk about beauty products and plastics?
The EWG. We were talking about how it gets overwhelming all of the things that our bodies contend with, the air, the water, and the dirt. We talked about cosmetics and skincare. You do have tools and you give tools to patients and direct them to places.
The EWG, the Environmental Working Group, is my favorite resource. They have a fantastic website, they have apps, and they have this Dirty Dozen list, the Dirty Dozen endocrine disruptors, which are twelve common chemicals that are in household products, cleaning products, fire retardant chemicals, plastics, BPA, and phthalates, which are the chemicals that give flexibility to plastics. They’re a great resource because it’s information that we can act on in a pretty simple way. It’s not overwhelming. I advocate them.
Dr. Jordan Geller, thank you so much for letting us come into your space, for your time, and for your thoughts. I wonder if I’m missing anything or if you have an invitation that you feel is important and that you want to extend to people that I didn’t cover.
Thank you so much. This was fun. We’ve covered a lot of great topics. If patients have other questions, they’re welcome to try to seek me out. If I can accommodate them, I will. If I can’t, they shouldn’t take it personally.
Boundaries, my friend. That’s an important lesson.
It is.
If you had a wand for all the patients that come in and see you and you could wave your wand and say, “I wish they would do this one thing or think about this one thing,” is there anything like that?
They need to realize this concept of reserve. Your hormones are precious and need to be tended to. A lot of times, when I see somebody who has a hormone imbalance, it’s not because they’ve got a disease that was imposed upon them, it’s because of lifestyle choices whether it’s diet, stress, poor sleep, toxins, or any of these things that we’ve talked about. The one that I would waive would be for people to be willing to take a broader look at it and not just expect that they can just take a pill or put the toothpaste back in the tube. It’s not that simple.
I have one last question, it just came to me. If someone was in a relationship, of all ages, is sex important to keeping their hormones?
It’s like a use-it-or-lose-it type.
Your sex life, is it support?
It does. I can’t point to a study that would show us that but I’m sure they’re out there.
It’s done by men. Do you see that? You need to have it. I’m kidding. I just wondered about that. You wonder, is it contact in love or is there also something physiologically happening?
That’s deep.
That’s for another time. We’ll leave it at that. Dr. Geller, thank you.
Thank you, it was awesome.
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Thank you so much for reading this week’s episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guests or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button and leave a rating and a comment. It not only helps me, it helps the show grow and reach new readers.
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About Dr. Jordan Geller
Dr. Geller earned his medical degree from the University of Southern California and completed a postdoctoral fellowship at Cedars-Sinai Medical Center in Los Angeles as well as an NIH fellowship in Clinical Research. He was the past Clinical Chief of the Division of Endocrinology, Diabetes & Metabolism at Cedars-Sinai Medical Center. Dr. Geller has lectured at national symposia and authored numerous publications in the field of Endocrinology. Dr. Geller is dual board-certified in Endocrinology, Diabetes and Metabolism, and Internal Medicine and is on staff at Cedars-Sinai Medical Center in Los Angeles and Jupiter Medical Center in Palm Beach County, Florida. He manages complex hormonal disorders at his offices in Los Angeles, Palm Beach, and through telemedicine consultations.