Q&A #44: Should You Take NAC Daily—and Does Fish Oil Raise LDL?

Hi everyone, welcome to Q&A number 44. Super excited to see many of you here and a lot of you repeating over and over, and I see a lot of questions submitted. Just a reminder, those of you that are submitting questions in the chat area, that those, those questions in the chat area are for the live chat, so like right now on the Saturday that we do the Q&A. So please submit your question in the Ask a Question section because not only will the question not be answered, it also— we've— my team and I have been going through a lot of the questions that I don't get to in these Q&As and we try to email you, you know, a little bit, at least something about, you know, some sort of answer and study links to some of your questions. Those won't also get seen.

So please remember to submit your questions in the right area. I do see a lot of good questions that are submitted in the chat I just briefly looked at. So keep that in mind. We're going to do a lot of deep dives today. I choose these questions— for those of you that are new, I choose them based on top-voted questions. I choose them on— based off of my interest or interest I think that the community will have in, in, you know, in the question itself. So again, if your question's not answered, you can submit it again the following month, but also we are— my team and myself— we are going through and trying to give people some answers to questions that were not addressed in the Crowdcast.

Okay, so the first question was submitted by HC, and HC says, hi, Dr. Rhonda, I'd love to know your current opinion on using N-acetylcysteine, or NAC for short, and liposomal glutathione as daily supplements as opposed to using them intermittently. So for those of you, just as a really general background, both N-acetylcysteine and glutathione are antioxidants, generally speaking. And I know a lot of you kind of generally know that term, you know, you've You know, it's a pretty common term. But what I think is interesting, and what I think probably most people aren't realizing, so there's a balance in our body inside of our cells, and even outside of our cells, and, you know, our vascular system, for example, between oxidation and basically what's called reducing or the antioxidant effect.

So there's There's the reduction and there's the oxidation. And these things are kind of going back and forth in what's called homeostasis. And if you have too much of oxidation, for example, that can lead to a pro-oxidant sort of environment. You can damage everything from DNA to mitochondria to proteins inside of your cells to cell membranes, the lipids. Right oxidized lipids. So a lot of things can go wrong when you have an imbalance leaning towards oxidation. However, and this is where I think most people don't realize, there's also an imbalance if you have too much of the reducing effect. So the quote unquote antioxidant effect, and this is so you've probably heard the term oxidative stress. Oxidative stress again refers to Too many pro-oxidants, right?

And there's something called reductive stress, and reductive stress is also not good. And reductive stress can happen when you have too much of this, you know, of the reducing sort of equivalence in, you know, electron transfer processes going on. So this would be NADH, NADPH. Yeah. So, those are the reducing side. So, you don't want an imbalance in either sort of end of this equation, right? You don't want too much oxidation, but you don't also want reductive stress. And, I think that's important to keep in mind because in some cases, people think, oh, well, oxidation's bad, so I just need lots and lots and lots and lots of antioxidants, right? And, that's not necessarily the way to go either.

So with that said, sort of general, you know, background, a little bit on N-acetylcysteine and glutathione. So glutathione is— it's actually synthesized from 3 amino acids: glutamate, cysteine, and glycine. So N-acetylcysteine, NAC, is a cysteine precursor. And so people I mean, people often take N-acetylcysteine to give their body the cysteine precursor so their bodies can make glutathione. Glutathione itself, if you're supplementing with non-liposomal glutathione, it's basically placebo. It gets destroyed in the stomach. There's no transporters for glutathione to get into the cell, even if it were to make it past stomach acid.

So Liposomal glutathione is a little bit different because one, it's protected from destruction during digestion, but also liposomes fuse with the cell and it's a sort of, you know, alternative method for getting glutathione into the cell. So liposomal glutathione really is the only supplemental glutathione that makes it into, you know, the cells, in cells in our body, or even makes— basically can increase glutathione levels in bloodstream, which has been shown with liposomal glutathione. N-acetylcysteine. So N-acetylcysteine is— it's used as a supplement, but it's also prescribed as a drug in some instances. Most commonly in the clinical setting, it's Yeah. It's prescribed as a drug to counter acetaminophen toxicity.

So Tylenol, you know, acetaminophen, if someone takes too much of it, it can, it can be toxic to the liver. And N-acetylcysteine can help sort of prevent that hepatotoxicity, the liver toxicity. So it's mostly used in the clinical setting as a pharmacological drug in that sense. I know, you know, in the general population, people have sort of extrapolated that and go and said, oh, well, I'm drinking some alcohol, which is, you know, a little bit toxic to my liver. I'm going to take some N-acetylcysteine. I don't know that that's a bad idea because you're taking it again more intermittently. But we're going to get to the— so my thoughts on the daily taking of these compounds. Okay. So glutathione is one of our— we've talked about this many times.

Glutathione is one of our body's major antioxidant defenses, particularly in the brain. Unfortunately, especially around the age of 45, glutathione levels start to really go down. And so we don't have as high— people that are 45 and older, don't endogenously in our bodies make as much glutathione. And so that, you know, kind of help— that kind of leads to this imbalance, redox imbalance, right, where we're getting more of the oxidation. And, and of course, that's not good because that can accelerate many different aging processes as well. There's been some, you know, pilot clinical studies showing that glutathione does— supplemental liposomal glutathione Can increase glutathione levels in plasma and also in whole blood cells.

And so that's— and we're talking about, you know, a 28% increase pretty much. There was also decreases in oxidative, you know, oxidative markers. So biomarkers of oxidation, for example. Immune function markers were also enhanced as well. Again, this was a small pilot study. There's also a randomized controlled trial with N-acetylcysteine supplementation in older adults. 71 years of age was the average age. And there was also improvements. There was increases in muscle glutathione levels. There was a better balance in this you know, reduction and oxidation equation I'm talking— I was— I've been talking about. There was improvements in immune function. So there, there have been some benefits with supplementation, particularly with liposomal and N-acetylcysteine in older adults.

Again, at that point, that's where you start to see the imbalance of— because glutathione levels do go down, You start to see the imbalance in that you have more oxidation as we increase with age. Oxidation levels do go up, so there's other ways to increase glutathione. One also, one of the main reasons our glutathione levels go down when we hit about 45 and older is because our enzymes that make glutathione are not working properly, and the enzymes that are transferring glutathione to counter-oxidation, those are not working as well. Those are going down. And, uh, sulforaphane is one of the major dietary nutraceuticals that has been shown— or dietary activators, I should say, because it's present in food— to increase glutathione enzymes.

And not only increase glutathione enzymes, it's been shown to increase glutathione in the brain And also in in the blood as well. So, and and it's been shown to decrease markers of oxidation. So there's many ways to approach this decreasing glutathione levels during the aging process. And I think sulforaphane is a is a nice one because you're fixing the enzyme systems. You're not with the liposomal glutathione. It's it's kind of um. Yeah, you can raise your glutathione levels, but the enzymes that are supposed to use that glutathione, you know, to do, you know, its antioxidant effect are still down, and liposomal glutathione is not going to get around that. So I do like sulforaphane for that reason.

With respect to N-acetylcysteine, kind of an interesting one because, again, it has been shown to be important for countering liver toxicity. There's also been some, you know, small clinical trials showing it can help with pulmonary function in the lungs. It can help with— there's been some neuropathy effects as well. So there's— it's kind of mixed findings, but there's also some evidence that taking, at least in animals, N-acetylcysteine exacerbates lung cancer. And not only exacerbates, there was also a study where, like, spontaneously formed lung tumors. And these were animal studies where the dose was insanely high, not something that you would really find, you know, humans taking for a daily dose.

But I just, just out of an abundance of caution, I don't— the reductive stress, like, you don't want too much reductive stress, right? Again, if you're, like, taking N-acetylcysteine every day, you're taking liposomal glutathione every day, you kind of— it's kind of a concern that you might have that reductive stress. Whereas the sulforaphane, you're basically just boosting the enzymes in your body that naturally use it, right? So it seems like a little bit more of a better approach, in my opinion.

So I do think, you know, perhaps transiently using N-acetylcysteine may help, and especially people that have eye problems, maybe, you know, diabetic-related retinopathy, for example, or people that are, you know, if you're having some alcohol, maybe you want to take N-acetylcysteine the day and the day after, or also liposomal glutathione, maybe that's something you want to take. you know, a couple times a week versus every day. That would be, I think, my approach. Elaine is asking in the chat if cancer patients should be a bit more cautious around sulforaphane given the mechanisms in cancer that use glutathione. That's a good question. I think, you know, so I can't obviously give medical advice, particularly when it comes to cancer, because cancer is such a tricky beast.

And It's funny because the this with with the supplements, it's almost you know better to kind of strip down and not you know not take the supplements. But then you also have some animal studies where sulforaphane actually decreases tumor size and stuff. And so it's kind of it's one of those tricky things that's weird because part of also the mechanism by how sulforaphanes increase in glutathione. Is it's basically a hormetic stress that's causing your cells to increase glutathione enzymes to counter a little bit of that, kind of much like exercise does. And cancer cells are funny because they, unlike normal cells, when you give them that hormetic type of stress, they actually die because they're so wonky. They're so screwed up. That they're unable to handle it.

And that's part of the mechanisms by why exercise, for example, is really beneficial for people that have cancer because it basically sensitizes the cancer cells to death and causes normal cells to make more glutathione so that they're resilient against, for example, the toxic effects of chemo. And Lisa's asking about the optimal glutathione levels. And I actually— good question. I don't know. I don't even know if that's actually known. Um, but that'd be something interesting to look into. Hi Rhonda, I've been taking prescription Lovaza, which is— or Lovaza, which is the prescription DHA EPA omega-3 supplement, or I guess drug we should call it, and Viva Naturals fish oil separately for 3 to 4 months at a time before checking labs. Each time I've seen LDL elevate 25% or so.

Are there any genotypes associated with negative outcomes when taking fish oil, especially the DHA component? It's frustrating because you've definitely sold me on the good stuff from fish oil. Appreciate your thoughts. So I'm gonna sort of dive into lipidology a little bit here, and I guess you know at at the end of the day. We'll circle back to kind of directly answering that. But so LDL cholesterol, there's LDL-C and there's LDL particle number, LDL-P. And it's routinely calculated— basically, most of the time when you go to get your LDL measured from a primary care physician, it is— you'll get LDL-C. LDL-C is an indirect measure of LDL. It's calculated from a standard lipid panel, which is total cholesterol, high-density lipoprotein cholesterol, HDL, and triglycerides.

And there's an equation that's used, the Friedwald equation, and that's how they get LDL cholesterol. It's not directly measured. So LDL cholesterol, or LDL-C as you'll see, in many studies, and also if you're looking perhaps at your lipid panel, it's a potential marker for LDL particles, for the number of LDL particles, but it doesn't actually reflect those numbers because you actually have to get an NMR test to measure the LDL particles, and then that'll be reflected as LDL-P. The NMR test will also measure the size of the lipid particles, so it will have larger buoyant LDL particles and it'll have small dense LDL particles, for example.

And as we've talked about, you know, it's the LDL particle number and particularly the small dense LDL particle number that is reflective of atherosclerosis risk. We talked about this in many, many different Crowdcasts. You guys can go back and listen to those. There's— we have a summary document on your dashboard that you can find and you can just search small dense LDL and it'll come up. But you need an NMR test to measure that. ApoB is kind of a surrogate marker of LDL particle number. But, you know, so, so it's, it's kind of, you know, like it's a little bit more of a direct way to measure LDL definitely than the LDL-C, which is very indirect coming from an equation because ApoB is on LDL particles. So it's like it's an indirect way to measure LDL particle number.

But also, ApoB is kind of what inserts into the arterial wall. It's present on the small dense LDL particle. It gets obscured somewhat. And so, the small dense LDL particle through the ApoB being obscured, ApoB kind of inserts itself into the arterial wall. And that's sort of the beginning of the buildup of plaques in the arteries. So going back to DHA and what the literature shows with DHA affecting LDL, first and foremost, fish oil supplementation, so about 1,500 milligrams of EPA and 1,000 milligrams of DHA daily, has been shown to decrease APOB in people with dyslipidemia and also in people with normal lipids. There was a trend in a decrease in APOB in this study. So APOB again is a way of more directly measuring LDL particle number. So while APOB is So that was one study.

ApoB is mostly regulated by degradation. I'm not going to get all into that, but fish has been shown to lower ApoB synthesis as well. So another study found that fish oil supplementation— this was 1.8 grams of EPA and 1.2 grams of DHA— lowered ApoB production by around 30% in people with normal blood lipids. There was also a decrease in VLDL, which is very low-density LDL ApoB. By about 43%. So that is again ApoB, which is more of a measure of LDL particle number. Now if we're talking about LDL-C, again LDL cholesterol as most people call it, most of the time you'll see that number on a lipid panel, okay? That's the estimated LDL cholesterol based off of that equation. The Friedewald equation.

So there was a study showing that people with very high triglycerides that were supplementing with prescription EPA plus DHA have an increase in LDL-C by about anywhere between 15 to 36%. Now remember, the prescription omega-3 Levasa, Levasa, or even Vascepa is used to— is prescribed to lower triglycerides at around a dose of 4 grams per day. So EPA alone was shown to not raise LDL-C, but DHA alone did raise the large buoyant LDL. So If you're having, if you're measuring LDL-C, then, and not particle number, you might see a raise in LDL because of the large buoyant LDL going up. However, the particle number still was going down. ApoB has still been shown to go down.

And also, there was a double-blind crossover study where 2.7 grams of EPA alone or 2.7 grams of DHA alone was shown to actually slightly increase LDL-C, but the mean particle size was reduced. So, the small dense LDL went down. So, I think there's a variety of studies that are basically showing that small dense LDL cholesterol particle size goes down with DHA. ApoB, which is particle, like a, you know, particle number, also it's atherogenic, goes down. And then there's even some studies showing that LDL-C can still go down. And then there's others showing that it can go up, probably because DHA can increase the large buoyant LDL.

But at the end of the day, you know, we have meta-analyses showing, you know, intervention trials— this was over 40 different trials— showing that combined EPA and DHA actually reduces many different major cardiovascular outcomes. I think at the end of the day, if it were me, I would redo the experiment and I would definitely measure particle number. I would measure particle size. And I would talk to my primary care physician about those numbers because, again, just LDL-C cholesterol is a very crude proxy for LDL. And in fact, most cardiologists will, you know, go a step further and do the NMR to look at LDL particle number and ApoB. You know, and other and other biomarkers as well.

D. Lever is asking in the chat if there's a risk with too much vitamin E in fish oil, as which is kind of acts as an antioxidant to preserve to help prevent oxidation of the polyunsaturated fatty acids. The the level of vitamin E in the in the fish oil supplements is is so low that I personally am not concerned. With it. It's not like going— the vitamin E becomes a problem when you're megadosing. We're talking like 400 IUs a day. When you're getting up to levels like close to the RDA, which is, you know, 25 to 30 IUs, you know, and even up to 100. I mean, like, I haven't seen really any negative effects with that sort of dose. It's really— it's the megadose of alpha-tocopherol that seems to really be more of a problem.

So Dustin's asking how much to worry about cholesterol, high cholesterol numbers when your high sensitivity C-reactive protein is low. So personally, you know, I can't again give medical advice, but obviously it's better to have low inflammatory biomarkers. But I mean, there's a certain point where I mean, you just you can't ignore the evidence that like high LDL particle number increases, you know, atherosclerosis risk, cardiovascular, negative cardiovascular outcomes, you know, as well. So, and there's even studies showing that people with genetic polymorphisms that lower their cholesterol, they have a reduced risk of many different coronary heart disease problems compared to people that do not have those genetic polymorphisms.

So in other words, genetically lowering a person's cholesterol improves their chances of not dying earlier from a cardiovascular outcome. So I think there's pretty strong evidence despite what you may see in some blogospheres from people saying, I mean, I've seen a study floating around out there where it's low cholesterol is associated with a higher mortality. And you have to remember that these observational studies are riddled with problems. And low cholesterol is often a marker of frailty, malnutrition, you know, infect disease like there's. So I mean, just looking at low cholesterol and mortality is is really not a great way of going. Oh look, low cholesterol is actually going to make you. Die sooner.

When in fact, if you genetically look at someone, you know, this isn't a disease, this isn't malnutrition, this isn't, you know, all those things that could cause low cholesterol. This is they genetically have low cholesterol. They're less likely to die earlier from a cardiovascular event. I think that's a lot stronger data than looking at an epidemiological study, you know, looking at low cholesterol and saying, you know, well, what's causing their low cholesterol? Is it malnutrition? Is it an infection? What is it? So, um, I do, I do think it's a good thing to try to lower LDL particle number and ApoB. And there's a variety of, you know, we've talked about it in many different Crowdcasts, Mediterranean diet being, Mediterranean diet being one way, and olive oil, fish oil as well.

Samara said that they had just been diagnosed with rapid eye movement sleep behavior disorder. REM sleep behavior disorder. And as they understand, they have a very high probability of developing Parkinson's. They said they've started on high, you know, 4 grams EPA/DHA daily, again, which is prescribed for people with high triglycerides. But is there anything else to slow the progression of Parkinson's? So just briefly, you know, the rapid eye movement sleep behavior disorder, or REM behavioral sleep disorder. It's, it's characterized by, you know, vocalization, jerks, motor behaviors during, during the REM part of sleep. So that's like, you're not supposed to be moving around and like you're supposed to be sort of paralyzed.

So that's, that's sort of one of the characteristics of, of REM behavioral sleep disorder. Up to 82% of older men diagnosed with REM behavioral sleep disorder develop Parkinson's or dementia. Almost half of the Parkinson's disease patients, about 88% of them, you know, have REM behavioral sleep disorder. And it's also characterized by Lewy bodies. So a lot of Lewy bodies in the brain in Parkinson's patients are basically indicative of those Parkinson's patients probably going on to have dementia as well. So, so, so dementia can be a part of Parkinson's disease, and it particularly seems to be associated with REM behavioral sleep disorder due to the accumulation of Lewy bodies or alpha-synuclein in the brain.

And about 98% of individuals with a polysomnography-confirmed REM behavioral sleep disorder have this Lewy bodies in their brain. So it's a pretty strong correlation. Lifestyle factors, I would say one of the biggest lifestyle factors that has been shown to modulate the risk and progression of Parkinson's disease is moderate to vigorous physical activity. And I mean, we're talking like that. So I'm I've got Parkinson's disease in my family. I have Alzheimer's disease in my family. It's probably like neurodegenerative disease is probably one of the biggest fears I have for myself. And it is one of the biggest motivating factors for me to exercise, to do vigorous physical exercise almost daily.

And I think that's probably one of the best protective lifestyle factors that anyone afraid of neurodegenerative disease And cancer, to be honest, and cardiovascular disease basically can do. So particularly vigorous high-intensity interval training has been shown to delay the onset and also to improve the symptoms and delay progression of Parkinson's disease. So pretty strong evidence. I mean, and there's more than one study showing that. So I think that Vigorous exercise, really, really, really important for anyone worried about Parkinson's disease and Alzheimer's disease for that matter as well. Interestingly, there's a correlation between low-fat dairy consumption and Parkinson's disease, and it's specific to low-fat dairy.

I don't exactly know why that is, but there, there is a correlation there. Mediterranean diet has been shown to be more protective against Parkinson's disease. Pesticide exposure, you know, increasing pesticide exposure is also in a dose-dependent manner associated with increased Parkinson's risk. So trying to, you know, obviously people that are working in, you know, some sort of factory where they could be exposed to know, pesticides and toxins, neurotoxins and things like that is really bad. But even trying to eat organic as much as possible, you know, isn't a bad idea. Air pollutants, fine particulate matter, particulate matter is also associated with a higher risk of Parkinson's disease.

So anyone that has REM behavioral sleep disorder, in a way, it's kind of looking, it's kind of going, okay, I've got this high you know, risk of getting Parkinson's later in life, I need to do everything in my lifestyle that I can to lower that risk, right? It's almost, I would say, you know, it's very similar to someone that has APOE4 genetic risk factor and their Alzheimer's disease risk is higher, right? So people that have an APOE4 allele have to try to do everything they can in their diet and lifestyle to prevent or slow reduce their risk of getting Alzheimer's disease. So it's similar with someone that has REM behavioral sleep disorder. Omega-3 has been shown to target neuroinflammation in the disease, in the brains of Parkinson's disease.

So there's a randomized controlled trial showing omega-3 supplementation can increase antioxidant capacity in the brain in people with Parkinson's disease. So that is a good— I mean, it's one of the best, I think, supplements that someone could take to both decrease Parkinson's disease risk and also to slow the progression as well. Coenzyme Q10 is another one that's been shown to counteract neurotoxicity. It's also important for mitochondrial function. Mitochondrial dysfunction in dopaminergic neurons is one of the major causes of Parkinson's disease. I think those 2 are really some of the major, I would say, dietary nutraceuticals that I think has strong evidence to play a role.

There was a related question from Dustin about Parkinson's and how it's reduced— the risk of Parkinson's is reduced in smokers and whether or not this can be something that can be reduced by the use of nicotine. So there is, you do, you can find observational studies showing that smokers have a reduced chance of getting Parkinson's disease. But the role of nicotine in Parkinson's disease, you know, I think there's, it's a little less clear. So There has been a randomized placebo-controlled trial that was, you know, basically transdermal nicotine. So 28 milligrams a day for 60 weeks was given to people with early Parkinson's disease. So they were within 18 months of diagnosis of Parkinson's. It did not slow the progression of Parkinson's disease.

And in fact, it actually accelerated and worsened some Parkinson's disease disease effects. So, you know, again, it's just another example of how things are nuanced, things are a lot more complicated. And just because, you know, it could be smokers have a reduced risk of Parkinson's disease because they're dying of heart attacks and cancer before they can even get to Parkinson's. Like, you know, it's one of those things where, okay, this is an epidemiological study, it's observational data, we cannot establish causation. there's something going on that maybe we just can't explain. And it's not necessarily that nicotine's protecting so much as, you know, smokers are not living long enough to get Parkinson's. I don't— you know, who knows.

So in the chat, Elias is asking about dangers of plain nonfat dairy products. Is it dangerous to eat large amounts of daily, I guess, nonfat dairy as a protein source like nonfat Greek yogurt? What about whey protein powder? So I don't know. Again, taking, taking the— so protein powder is different because you're removing the fat component, right? When you're just, when you're just getting the whey protein powder, you're just getting the protein. And the observational data that I was referring to with respect to Parkinson's was comparing full-fat yogurt, or not yogurt, but full-fat dairy with nonfat dairy. And so there was something about, I mean, perhaps the full-fat dairy was more protective. Like, we don't really know what's going on with that observational data.

It's just it's a correlation, and I don't think there's anything to be concerned about with you know protein powder, whey protein powder, for example. Now eating you know nonfat Greek yogurt daily, I you know like I I can't really speak to that because yogurt also has a lot of the it's a little bit different than nonfat you know milk, for example, or nonfat. Cheese where you're, um, you're not getting as much of the probiotics as well. So, uh, I, I would definitely again take that observational data with a grain of salt. I just wanted to mention it because it was a little interesting, but, um, it's not something that I would, you know, obsess about and go, and go too far with, you know, with respect to, um, being so concerned about eating nonfat Greek yogurt.

So Eve is asking in the chat about ashwagandha in regards to sleep. We did cover ashwagandha in a previous Crowdcast. Again, go to your dashboard, foundmyfitness.com/dashboard. Check on our compilation PDF of, you know, there's like tons of Crowdcasts that we have there. And we have timelines to then to those Crowdcasts as well. And you can search ashwagandha. And then you can go ahead and go specifically to that time point where we discussed ashwagandha. There's very little evidence on ashwagandha, and most of the evidence is looking at anxiety, if I recall correctly, and it helped lower anxiety. And this was a placebo-controlled trial. It was industry-driven. In other words, it was sponsored by ashwagandha supplement company, for example, which is always something to keep in mind.

I'm not saying the data is not useful, but it's good to keep in mind. There's really not a lot of data on it. And I think the effects on sleep could be anxiety-driven. In other words, anxiety absolutely is one of the major causes of having sleep problems, right? Like waking up in the middle of the night and thinking about something stressful, you're anxious about it, and then you can't get back to sleep. So, so if you are doing other lifestyle factors that are going to lower anxiety, the likelihood that it's going to affect your sleep is, is probably quite high. And Ryan's mentioning in the chat that he's noticed the opposite effect. Ashwagandha can increase anxiety for him. People do respond differently to supplements.

This is something as I mean, people respond differently to medications, to supplements, you know, so you definitely need to listen to your body and not everyone is going to respond the same. So, so definitely, you know, if you're, if you're responding adversely to something, then, you know, certainly cut it out despite what one or two small randomized controlled trials show, right? I mean, so it's definitely good to realize that people do definitely respond differently. to different, different supplements. So the next question was submitted by Marina, and Marina was wondering about male fertility.

Marina says, hi Rhonda, could you please advise on improving sperm quality, particularly motility, morphology, and DNA fragmentation, especially when having good reactive oxygen species levels so it's not oxidative stress? I know about the general rules like being fit and active, not being overweight, but would appreciate if you could be more specific or even, even talk about some supplements. It's a bit of an under-researched area compared to female fertility. Okay. So there was one systematic review of meta-analyses of randomized controlled trials looking at the influence of oral vitamin and mineral supplementation on male infertility. So, just as a brief overview, some things that affected total sperm count were omega-3 and coenzyme Q10.

Sperm concentration were affected by selenium, zinc, omega-3, and CoQ10. Sperm motility were affected by selenium, zinc, omega-3, CoQ10, and carnitine. Sperm morphology was affected by selenium, omega-3, CoQ10, and carnitine. Interesting. The dosage, um, the dosages were for selenium, it was 200 micrograms per day. For L-carnitine, it was 2 grams per day. For CoQ10, it was 200 to 300 mgs per day. For zinc, it was 66 milligrams per day. For EPA, it was 1 gram per day. And for DHA, it was 700 milligrams— or sorry, Yes, 700 milligrams per day. And as mentioned in the question, oxidative stress is actually one of the main mediators of male infertility.

So sperm damage induced by reactive oxygen species, about 30— anywhere between 30 to 80% of male infertility cases have been attributed to oxidative stress. It causes sperm dysfunction. It's related to cellular damage triggered by reactive oxygen species. It occurs naturally in sperm cells because high levels of sperm motility induce reactive oxygen species, but too high of levels of reactive oxygen species are what's strongly correlated with sperm DNA damage and low percentages of sperm motility. Selenium is essential for spermato— spermatogenesis, and it plays a role in actually increasing glutathione peroxidase expression and activity. Selenium is important for the production of glutathione-related enzymes.

So, you know, making sure a, a, you know, getting enough selenium in the diet is important for that reason, for sperm, for sperm health. Zinc is another one that's important. So zinc is also— plays a part of this antioxidant response. It's, it's got a membrane-stabilizing activity by inhibiting membrane-bound oxidative enzymes. So an excess of antioxidants could result in significant adverse events and can promote that what we were talking about earlier, reductive stress, which can be detrimental for male fertility. So again, you know, you don't want to have too— you don't want to just sort of randomly start overdosing on too many antioxidants either, because then you might cause the reductive stress effect. But having enough of them is really important.

Omega-3 has been shown to So DHA is actually highly concentrated in sperm cells. It's actually one of the cell types, interestingly, that has a very high concentration of DHA. It has anti-inflammatory and antioxidant effects. It modifies the cell membrane composition again. So it plays a lot of important roles in sperm. CoQ10 is also important for mitochondrial function. And it inhibits peroxide formation in seminal fluid. So it basically could reduce sperm oxidative stress through that mechanism. And then L-carnitine and L-acetylcarnitine play important roles in sperm metabolism by basically providing immediate energy for use by spermatosa, which positively affects sperm motility as well.

It's also involved in the transport of fatty acids across the mitochondrial membrane so that fatty acids can get in and be used as energy as well. So L-carnitine also plays a role in that. So those are some of the supplements, at least evidence-based, that's been shown to play a— to positively affect a variety of sperm characteristics as we mentioned. Alcohol, I would say, is one that can negatively affect sperm. So there was a meta-analysis investigating the impact of alcohol intake on semen quality by looking at 18 different cross-sectional studies, say, and basically daily alcohol consumption worsened semen quality, particularly in terms of the volume and sperm morphology.

There was also a very recent study looking at in vitro fertilization, and it found that Alcohol intake in men basically prevented in vitro fertilization from working, and it had to do again with the sperm. So alcohol, probably something to avoid, if not dramatically reduce, when trying to conceive. And then also sauna use, hot tub use can affect sperm motility. Temporarily. It's very transient. But for someone who's trying to conceive, probably best to not be doing the sauna and hot tub, particularly if you're having fertility problems because of the effects on sperm motility. Those effects go away after about 6 weeks. So again, hot tub, sauna, great for a lot of, you know, health parameters. But for some— for a male trying to conceive, it can affect sperm motility in a negative way.

As mentioned in the question, obesity definitely, it reduces, you know, it's been shown to reduce testosterone, leads to fewer spermatosa. So definitely weight loss is an important strategy for any male trying to conceive as well. And then Mediterranean diet is one that's been associated with improved Uh, you know, basically sperm outcomes as well. General, general, uh, I guess things that you could just— exercise helps as well. So like things that, that you would think would be good for, you know, health are generally good for sperm with the exception of sauna, which does, you know, decrease sperm motility. Nick is asking in the chat whether it's important to or advisable to take DHA and EPA separately. One in the morning and one in the evening, as I do. I don't know that it's necessary.

I don't know that it's you know it's it's just I the omega three brand that I take happens to do it in a high EPA and high DHA sort of version. You can choose to do that if you want, but I don't know that it's bad to take them together. I don't I don't I don't think that it is, to be honest. Justin's asking if you can use the sauna as a form of contraception. No, absolutely not. It, you know, even though it affects sperm motility, many sperm can still make it. And it's probably exacerbated more in men that already are having fertility issues. I know some people that were under the impression that sauna could be used as a form of contraception, and boy were they surprised by a baby. So definitely not advised. Beck is asking about sauna for females before contraception.

There's no evidence that it has a negative effect on females before contraception. And so now, now after, like during pregnancy, I, you know, again, on the safe side, I would not do the sauna, because there's some evidence that doing hot tub can— women that do hot tub during pregnancy can sort of have— it can lead to fetal alcohol syndrome. So it can have some negative effects on brain development. Okay, so the next question I'm glad was submitted, and and boy was this a terrible study. So Susan submitted a question about vitamin D, and Susan says, "Are you familiar with the study that suggests that vitamin D supplementation may have a negative effect on the brain in some people?" It was a study that linked or in that I think the title said vitamin D increases dementia risk.

And Susan's concerned because Susan's a 78-year-old female who has the ApoE4 allele and who has osteopenia and takes vitamin D supplements. So let's look at this terrible study. First and foremost, the study was in a Taiwanese population. It was out of a Taiwan institute. And it looked at people that were prescribed calcitriol, which is the active vitamin D hormone. Okay, it was not vitamin D3. So vitamin D3, if you're supplementing with vitamin D3, vitamin D3 is the same thing that you make in your skin when you're out in the sun and UVB radiation hits your skin, right?

So vitamin D3, when you take it, is absorbed The vitamin D3 goes to the liver and it's converted into 25-hydroxy vitamin D, which is the major circulating form of vitamin D. It's what you— is used when you're doing a blood test of vitamin D to see what your vitamin D quote-unquote levels are. And then 25-hydroxy vitamin D goes to the kidneys, and the kidneys then make it into 1,25-hydroxy vitamin D. That's actually calcitriol. That is the actual steroid hormone of vitamin D. That then goes and binds to vitamin D receptors and activates a variety of genes, deactivates others. So it's the active form, okay? Calcitriol, the active hormone form, is prescribed to patients that have kidney problems because they cannot take vitamin D3.

The reason they can't take it is because You need your kidneys to convert the 25-hydroxy vitamin D into the hormone. So people with kidney disease, the kidneys aren't able to do that. So they are prescribed calcitriol. So this study looked at people that were prescribed calcitriol, okay? Again, calcitriol is used to— it's used in patients whose kidneys are not working or their parathyroid glands are not working normally. So it's used to treat secondary hyperparathyroidism. One can only assume that these patients were prescribed calcitriol because probably they're suffering from substantial kidney disease. None of this was mentioned, by the way, in the paper. It was a really terrible study. It wasn't like they— it wasn't a randomized controlled trial.

It was just looking at a population of people that were prescribed calcitriol in Taiwan. Okay, for whatever reason, likely because their kidneys weren't working properly. And the logical conclusion of this study would be people that are suffering from substantial kidney disease are going to have a higher risk of dementia. And in fact, it's been reported for many, many years that kidney disease accelerates cognitive decline. And kidney disease, and even people taking calcitriol that have kidney disease still experience cognitive decline and dementia. Okay, this is known. And so, in fact, you know, without basically even realizing it, the authors of the study just confirmed that.

But rather, they use the title vitamin D increases or vitamin D increases dementia risk when that was not shown at all. They didn't even measure blood vitamin D levels at all in this study at all. They just took the patients that were prescribed calcitriol. They didn't even tell us why they're prescribed it. Again, people are prescribed it because their kidneys are failing. So I think this was such a terrible study, so misleading to the public because You know, all the public, all people read is, oh, vitamin D is associated with dementia risk. Of course, you can find randomized controlled trials where supplementation with vitamin D3 improves cognitive function in people with Alzheimer's disease, a lot more stronger data.

So I just don't, I just like, to me, that study is so terrible and so awful that it should be retracted, in my opinion. It should be retracted and fixed. They should measure— they should tell us if the patients had kidney disease. They should measure the vitamin D levels. I mean, this whole— the whole study is just— it's a complete another— it's just— it's kind of a load of crap. Valentina is asking in the chat, during pregnancy, if I— what, you know, what sort of amount of fish oil I took, if I focused more on DHA than EPA and So yes, during pregnancy, I was focused more on DHA. I was, you know, because DHA is what's really, really important for brain development. And, and so I was taking 2 to 3 grams a day of DHA during pregnancy.

So the next question was submitted by Erica, asking about leaky gut. They were recently diagnosed with leaky gut and was wondering if there is anything on causes or treatments or anything that can help. Honestly, you know, the leaky gut really has, you know, and I've talked about it, it's intestinal permeability. There's lots and lots of reasons that can lead to an increased intestinal permeability, and certainly Crohn's and IBD You know, those those those sorts of gut diseases also increase intestinal permeability as well. So interventions that have been shown to improve intestinal permeability. So you'll see a lot in the literature, but really I would say the only one that's sort of had a randomized placebo-controlled sort of tried and true. Was glutamine supplementation.

And glutamine supplementation, basically, there's markers of intestinal permeability that are, that are often used. So this is the lactulose to mannitol ratio. And glutamine supplementation lowered that. So it basically lowered intestinal permeability. Long-term glutamine supplementation should not exceed 40 grams per day. So that— so you don't want to get too high. Glutamine, unless someone has an intestinal cancer or liver cancer, you know, because glutamine is a source, is a fuel source for cancer cells, but really I wouldn't be too concerned about that unless you actually had active liver cancer or intestinal, you know, some sort of intestinal cancer.

I think short-term for someone trying to fix intestinal permeability, glutamine is probably going to be beneficial along with bone broth, hydrolyzed collagen powder as well, and then trying to get a diet that is, you know, dial in the diet that's not going to lead to intestinal permeability. Probably cutting out a lot of fat is going to help as well because fat is really harsh on the gut. And particularly in someone in the background of intestinal permeability, it does increase intestinal permeability, particularly when you're not eating it with like a fiber source. So like a cream in your coffee, for example. So cutting, cutting down on fat during that period until the gut is able to sort of heal. Is, is probably cutting, cutting down on some of the fat is probably beneficial as well.

And then trying a very strong probiotic like VisBiome sachets. So not the pills, but the sachets. Those can be purchased in— they used to be VSL number 3. And there's a lot of literature on VSL number 3 improving intestinal per— like intestinal permeability. So people with Crohn's and IBD and colitis that also have intestinal permeability. So, um, taking, taking high doses of that, anywhere between, you know, 2 to 4 sachets a day, uh, depending on, on, on the person, um, studies have shown that it improved intestinal permeability and, um, symptoms of, you know, IBD and colitis and Crohn's, for example, as well. And so there's fermented foods and there's prebiotics, you know, there's the— there's pectins and there's the galactooligosaccharides.

And, you know, these inulin, these sorts of things also can help as well. With the fermented food, you know, when someone has active It goes either way. Some people that have active gut issues feel worse if they're eating too many fermented foods. They feel like bloated from the prebiotics. So it really like you kind of might have to test it out a little bit and try a little bit and see how you're responding. But I think the glutamine also really helps with some of that as well. So so sort of short term, the glutamine supplementation. Might actually be beneficial, at least according, you know, to clinical trials. It has been. And then fish oil as well.

Like fish oil is something that's really been shown to help with both gut issues and inflammation, negating some of the toxic effects of intestinal permeability, which would be endotoxin release, right? So fish oil has been shown to blunt some of that. Fish oil has also been shown to help with intestinal permeability, Specifically, directly. So you know, if it were me, I would of course be taking high dose fish oil. I do take high high dose fish oil. So I take you know three grams of EPA, three grams of DHA a day on most days. Sometimes I forget, and so then I up one or the other, and I take four grams. But I usually take around six grams a day. And then other things like curcumin, moriva can help lower inflammation. Time-restricted eating helps a lot.

So not eating 3 hours before bed can help with, with gut issues as well. You know, vitamin D, getting, you know, just making sure you're dialing, dialing in all that stuff as well. And then lowering the amount of food with each, with each meal also helps because like, the larger the meal, the harsher it is on the gut. And it does It does, you know, basically lead to more intestinal permeability, like larger meals, higher fat meals as well. So, so, so sort of keeping all that stuff in mind. Oh, and Ed and Twilla are mentioning the zonulin release as well. Yeah, so, so avoiding foods with, with the, with the gliadin protein, which is found in gluten.

So that also increases intestinal permeability, and so avoiding foods with gluten also is is something really important to do with people that have intestinal permeability. Sprouted sprouted grains dramatically lower the amount of gliadin, but I think when you when you're talking about someone that already has intestinal permeability, probably. Full stop cutting out gluten would be the best way to go because, because of its role of zonulin. Zonulin transiently does increase intestinal permeability, and with someone in the background of already celiac disease or intestinal permeability, that transientness isn't so transient. It kind of stays, stays you know, the tight junctions open for a longer period of time. So, so that is also something to keep in mind.

Lisa is asking about brand recommendations for glutamine. So I haven't specifically looked into which brands make glutamine, but I would not just go on Amazon and start buying bulk powder. Some of the brands you guys know that I think are pretty trusted are Pure Encapsulations, Thorne, Life Extension also. And, um, so those are, you know, those are some of the brands I, I would, I would start with when looking for a glutamine powder. So the next question was submitted by Kenny, and it has to do with 2 different models of weight gain. So Kenny is asking about the caloric restriction, sort of calories in, calories out, or the energy balance model with respect to weight loss, weight gain, and the carbohydrate insulin model.

And whether, you know, He— Kenny is saying that it seems to be— there seems to be a shift in people talking more about calories in, calories out as a major regulator of weight gain and, and also of, you know, weight loss, and how much to be concerned about spiking blood glucose levels and how much to care about eating carbohydrates. I would say, just sort of a 1,000-mile-high overview, my opinion is I think the generalization of carbohydrate and glucose spike is inaccurate. I think the real problem isn't carbohydrate intake. I think it's refined carbohydrate intake, processed food. And, you know, the processed foods and particularly processed refined carbohydrates with, you know, amount— high amounts of refined sugars in them.

I think that in combination with caloric intake, and in fact, high refined processed foods also basically inhibit some of the satiety pathways and, you know, make people more hungry. And so it's— they're kind of— they go hand in hand because they do make people eat more. Food, right? So I think I'm— some people have taken the low-carb sort of model, and they've gone just too far, in my opinion, where it's like, you got to worry about eating any carbohydrate. Like, carbohydrates are good for you. Like, vegetables are good for you. Fruits are good for you. So Going too far in that direction, going a little extreme, I think is not good.

But the refined carbohydrate—I mean, when some of these low carbohydrate, you know, and paleo diets when they first started to become popular, like the reason they—one of the big reasons they were sort of they came about and and and were designed was based off of eating whole real foods, including fruits and vegetables. Like it wasn't like don't eat any carbohydrates, don't eat anything that's gonna you know make your blood glucose levels go up like an apple. Like I mean apples are not gonna make you fat. Okay, I'm just here to tell you they're not. They're not gonna make you fat. Bananas aren't gonna make you fat. Okay, eating the packaged refined carbohydrates and eating those processed foods are what's gonna do it.

So so I think that's something to keep in mind when it's it's not just carbohydrates. It's refined carbohydrates. Like, that's really the bad guy here. When it comes to energy, you know, energy in, energy out, calorie in, calorie out, like, it's important, you know. I mean, if you eat less food, like, you're going to lose weight. Like, it's basically a true thing. But, you know, with the insulin-carbohydrate-insulin model, again, I don't like saying carbohydrate. It's more like refined carbohydrate, you know. Again, eating, eating, eating these high— and in fact, there was like a recent study by Kevin Hall showing that like the highly processed foods basically make people eat more calories. And so they go hand in hand, right?

Where it's not, you know, basically people that are eating the processed refined foods don't get full and, and they can— they keep, they keep feeling hungry. And so they eat more calories, their energy intake goes up. So I do think there's a there is also an important role for avoiding the refined carbohydrates. I don't think that means you have to avoid eating a banana or avoid eating, you know, or even avoid eating an orange. Like you know, I I think that's gotten a little bit out of control, and particularly there's all these beneficial compounds in the fruits and vegetables. I know people are more concerned about fruits, but I really don't think being concerned—I don't think people should be so concerned about eating healthy carbohydrates.

I think the concern with the carbohydrate insulin model is honestly it comes down to processed, processed refined carbohydrates. So I think that's really—it's really—it's really my. Those are my thoughts, honestly, about it. And Justin's asking about fruit smoothies, like Naked, the Naked. I generally avoid some of those like really sugary store-bought things that are, I mean, like, you know, you're just, you're not, you know, they're just sometimes they're also just chock-full a lot of sugar to some of those, some of like those Naked smoothies. I don't know that those are necessarily the best. The best way to go. So Elias is asking in the chat about flour and how flour is processed and refined, but so is like sourdough, and isn't sourdough good?

So, you know, some of the— like, I don't think like eating sourdough, lots of sourdough bread every day, like, is necessarily good. I think where some of the sourdough is good for you is coming from is a head-to-head comparison of like, you know, eating white bread, for example. Sourdough has lactic— it has lactate, lactic acid in it, and that can be beneficial for the gut. So it might help negate, you know, some negative effects of the gut. But I don't I don't know that I would go as far as saying that sourdough is good for you. Like, I don't— like, you know, it's still a pretty refined food, right?

And if you're talking about comparing sourdough to sprouted whole grain bread, I would go for the sprouted whole grain bread because you're reducing the gliadin, which is what's responsible— like dramatically reducing the gliadin, which is responsible for opening tight junctions and releasing zonulin. So basically, you're not, you're, you're, you're not really getting a zonulin release, and you're getting a lot of the whole grains and fermentable fibers and, and beneficial things as well. So, um, so I think, I think they're, they're that I would go for that over the sourdough. All right, some other rapid-fire questions. Kenny says, are you taking Are you still taking VisBiome weekly? It wasn't listed in your list of current supplements. I'm not really taking it weekly.

I mostly take it if I have alcohol. And, and that's, and that's, and that's about, that's about it. I mostly take it when I have alcohol. If I were to have to take antibiotics, I would take it as well. But I don't, I'm not really taking VisBiome weekly. Marion says, in your January Q&A, you went into detail about your current supplements, but you did not say what specific product and company you get your calcium, vitamin K2, and vitamin D combo from. So I think I did mention it, but the calcium was, it was 400 milligrams. I think I misspoke. I said 600. It's 400 milligrams. And it was vitamin D 1000 IUs and vitamin K2. And it's 2 capsules per serving. And I'm actually only taking 1 cap. So I'm only getting 300 milligrams and 500 IUs of vitamin D. I only take 1 a day.

I'm not taking 2 because I don't want too much calcium. And, and so it's pure encapsulations that I got. And I'm, again, I only take, I don't take the 2 capsule serving size. I'm actually only getting half of the dose that's on there. Joanne says, hi, Rhonda, can you address the heart rate variability as an indicator of general health? Is this a metric you pay attention to? Mine is low according to my Apple Watch. And I'm wondering how worried I should be, or if there's anything I can do to improve it. So I did address this answer. I did address a question similar to this in Q&A session number 29, Crowdcast number 29.

Some of the points I made in that Crowdcast were, I think, basically, I don't think it's a real— I think, I don't think it's a really important metric of cardiovascular health. At this moment. I think there's too many variables in measuring it and also in how it's related. And so in some cases, exercise, sauna, and cold exposure all have been shown to improve or increase heart rate variability, which is basically just the variation of time between each heartbeat. Heart rate variability does decline with age. And, you know, I There are, you know, you can find some studies that low heart rate variability is associated with increased cardiovascular mortality. But again, a lot there could be a lot of other contributing factors in that. I wouldn't be so concerned about it.

But exercise, sauna, and cold exposure have all been shown to improve heart rate variability. But it's it's sort of I don't know that it's really there yet as a. Really important metric to pay attention to. So that's sort of my, my, my quick answer on that. James asked, in last month's supplement update, you didn't mention taking magnesium. I did mention magnesium, actually. I do take magnesium glycinate, and I take 120 milligrams. I didn't, I didn't mention PQQ. And so thank you for mentioning that, because I simply just forgot to reorder it. And so I did reorder PQQ. I relooked up some of the studies on it to confirm that I wanted to take it. And I was pleasantly surprised since the last time I had done a literature review, there was an even newer study on PQQ supplementation.

It was in older adults. But again, it improved memory. So this is 20 milligrams a day, which is what the Life Extension brand has. Um, they have a 20 milligrams a day supplement. And so I did go ahead and reorder that. And as soon as I get it in, I will be taking it. I will be adding it. I will be taking it again. So yes, that was, that was just one of those little kind of mistakes that happens. Hi Rhonda, in your December podcast you mentioned Metagenics, Omagenics as a fish oil brand that you would take if you didn't have your N-Pure 3. Lisa says, however, that Omagenics is not tested by IFOS. And so what she wants to know why, why I was, I was mentioning it. So it used to be measured by IFOS, and it was actually very good.

And so, and that was like one of the main— it very recently was measured. In fact, I have like a part of the data that I have downloaded. There's a variety of batches of it that were listed as good. So that was, that was the reason. And also because it had a, you know, has both EPA and DHA in it. So that's why I mentioned it as well. There is a lot of variation even between some brands and looking even at the batch of them. And so, it is, you know, it's one of those things that I think generally speaking, finding a brand that at least consistently does have good oxidation levels and good concentrations of the EPA and DHA is important. And but yes, it is kind of annoying that there's, you know, variation even from batch to batch.

David was asking about Kirkland fish oil from Costco and that ConsumerLab says that it's the most economical. They say that the omega-3s are in triglyceride form. And it's also, it does seem to, to have a higher, have a decent concentration of EPA and DHA. You know, I think, you know, I'm not like, I think the Kirkland brand of fish oil, it's not the worst, it's not the worst option, to be honest. And for someone on a budget, honestly, you kind of have to, you know, do what you can. And so I would say, you know, if if I was, you know, on a budget, and really, it's, it's like the, the best thing that I could do at the time. I don't think it's bad. I think the fish oil brand, it does seem to at least have a lower oxidation and have a decent amount of EPA and DHA in it.

Theo asks, in response to several of your posts about the dangers of lead and cadmium in chocolate, what do you know about lead and cadmium in CocoaVia? So, Theo, you'll be happy to know it was— CocoaVia is— it was measured to be like the lowest in contaminants and the highest in polyphenols. So, if you're looking for a good high polyphenol chocolate supplement, then CocoaVia is actually the way to go. If you're looking for something to give kids that like, it doesn't have to be mostly probably what you're wanting is like no sugar. It doesn't have to be and you want no sugar and you want no like lead contamination. That's like extremely bad for brain development in children. A good brand that was shown to be very low in lead and cadmium and And also it's made with monk fruit, is ChocZero.

And something that I also, I buy it for my son. It doesn't have the highest amount of poly chocolate flavanols and stuff. But again, for kids that want chocolate and you want to get them some Valentine's chocolates or it's Halloween, Like it's really, it's kind of my brand that I go to. It's called Choc Cereal and it's made with monk fruit. It's low in lead. It's been, it was, it was tested by ConsumerLab. And also, it's not super high in polyphenols and flavonols and stuff. But again, for the kids, it's like, I think it's great. There was another rapid-fire question about infrared saunas versus regular saunas. I had done a post about on my Instagram about infrared saunas. not being as good with respect to cardiovascular effects.

And I didn't really elaborate, but if you're doing like a time comparison, like 20 minutes in a regular hot sauna versus 20 minutes in an infrared 140-degree Fahrenheit sauna, and then comparing those to 20 minutes on a stationary cycle, The hot sauna does mimic like doing 120 watts on a stationary cycle, whereas 20 minutes in an infrared sauna does not. So in other words, blood pressure improvements are not—you're not getting the blood pressure improvements that you would get from 20 minutes from a hot sauna in 20 minutes in an infrared. Now, does that mean that you get no blood pressure improvements? No, it does not. I think it just means you have to stay in there longer.

In fact, 40 minutes in an infrared sauna is something that I would predict would probably be more equivalent to 20 minutes in a hot sauna. So basically, just increasing the time spent in the infrared sauna is, is probably what I think is necessary. There have been some head-to-head— a head-to-head comparison study of hot sauna versus infrared. And again, for the same amount of time spent, the hot sauna was much better at lowering blood pressure than infrared sauna. But infrared sauna did have, you know, there were some trending effects. And again, I think just extending that time out, to a longer period of time would get you a more similar effect, in my opinion. So that's all I meant by, you know, that the infrared sauna is not as good as a hot sauna.

It's not as good when you're doing a, you know, time comparison that's similar, right? So people in the chat are asking about Hot bath and blood pressure improvements. So there there are studies showing that hot baths improve blood pressure, and again, while you are in the hot bath, while you are in this hot sauna, while you are on an exercise bike, your blood pressure actually goes up, heart rate goes up, and that's part of the physiological response to heat stress. But it's after you are finished with the heat stress, whether that is a hot bath or a hot sauna or, you know, exercise, then blood pressure actually goes down even below what baseline levels were. And someone's asking about steam rooms.

Again, I think, you know, a steam sauna could probably have similar effects if you are getting the heat stress, right? So So you want your heart rate to go up. You know, you while you're while you're in there, you want to feel that sort of that effect like you are exercising, right? You want the heart rate to go up. You want to feel hot. You want to feel uncomfortable. All those things. Okay, and then the last rapid fire question was submitted by Anika. Anika Anika says, "Hi Rhonda, based on your knowledge, are there any foods that you personally avoid or diet rules that you live?" So I, I basically would say that one of the major diet rules I live by is I, I try to focus on getting as much of my micronutrients from food and as much protein from food as I can.

And micronutrients being, of course, essential vitamins, minerals, essential fatty acids, essential amino acids, right? And so foods that are high in those are not going to be processed refined foods. They are going to be fruits, vegetables, whole foods, you know, meats, you know, fish, things like that. So really avoiding as much processed food as possible. Getting, trying to get as many, you know, micronutrients from food. So getting my green, dark leafy green veggies, getting a wide variety of colors, getting my carotenoids, getting lycopene. So eating the, eating some tomatoes and carrots and purple onions and, you know, trying to get a variety of colors and broccoli, you know, broccoli sprouts, of course.

Brussels sprouts, like all these sorts of foods, and then eating my wild Alaskan salmon and my poultry, my lean red meat. Like these are things that I really try to eat a whole foods, mostly whole foods diet. And I think that's kind of the easiest and main thing I focus on when I think about food in a sense of This is, this is supposed to provide me with, you know, vitamins and minerals and protein and omega-3. It makes it really easy to avoid processed foods because they're essentially— they don't have that stuff, right? It's just hedonic pleasure, right? You're just— it just, it tastes good. It gets you, you know, gets you full for, for a short period of time. It's giving you dopamine.

I think I think that when you start to think about food, like in that way of wow, I should be getting a dose of greens with with my meals. I should be getting you know these prebiotic fibers. I should be get like this. This is stuff my body needs. Like I need vitamins and minerals. These are these are coenzymes and cofactors. They're doing essential things in my body. It really makes it easy. And to understand why eating whole foods is so important, and it also makes it easier to understand why elimination severe eliminate elimination diets while they can work and help people sort out problems. I don't think they're necessarily best way to like have a lifestyle like because you will be cutting out a lot of important nutrients, right?

And like like like thinking about olive oil and all the polyphenols in it and. know, all these things, like they're— they all do, you know, important things in our body, and they're health-promoting. And so I think that's, that's like the, the major sort of diet rule that I say that I live by. And one last question I see here in the chat before we go. Steve is asking, at what age would you consider giving supplements like Prostafane or PQQ, etc., to my son? You know, so just as a reminder, there have been— like, my son doesn't have autism spectrum disorder, but there have been a handful of studies now showing that sulforaphane can improve autistic spectrum symptoms in both children and adolescents with autism spectrum disorder.

And I think You know, so you know I think if I were a parent of a child that had autism spectrum disorder, I would be doing the sulforaphane. I would be trying that out for sure. I don't. I think you know that's not something I'm really concerned about. Even like you know perhaps in in adolescence, I might consider starting that. But um. But that's that's a ways away, so I'm really not. I'm not worried about that at the moment. PQQ is interesting. Again, I think the main thing with children to be concerned about is because they often are picky eaters, and it's it's it's challenging to get the right micronutrients, vitamins and minerals, and fish. You know, a lot of children don't like. Fish, the most important supplements are the multivitamin, are the vitamin D, are the fish oil.

And beyond that, I'm, you know, like, it's like, first of all, like, you know, at a certain age, they're still going to be doing gummies for quite some time. And it takes a much older child to then even want to swallow a pill. So it's not really something I'm concerned about, I would say. And it's, it's going to be a while before, before I really do go there. But thank you guys for all the great, great questions. Remember, again, those of you that have submitted questions in the chat section and you want our team, my team and I, to go back, because after these Crowdcasts, we are going to go back on the unanswered questions and try to like at least email people something. Make sure you submit it in the right area because it won't get seen in the chat section.

The chat really is for our live Q&A so that you guys can chat with me, right? That's, that's really what it's for. So, um, I really enjoy these. Thank you guys so much for your support, for all the wonderful questions, for, um, the opportunity to learn more, to communicate, and, um, to kind of to, to interact with you guys and see what your interests are as well. I've got a really amazing podcast that is going to be coming out soon on Rethinking Alzheimer's disease and the way that we look at Alzheimer's disease as actually a vascular disease. It is so good. I'm so excited about it. I cannot wait to share it with you. It's really a game changer, in my opinion.

And I think 10 years from now, I think 10 years from now, we are going to be looking at dementia and Alzheimer's disease with this lens. We are going to be targeting it treatment-wise with this lens, and I think it's going to make a huge difference. So great podcast. We focused a lot on prevention. We focused on, you know, causes, on treatment. We talked a lot about ApoE4. You guys are going to love it. So have a great February month. I will talk to you all next month. Submit your questions early. Early bird gets the worm, you know, the saying as it goes. And I look forward to, to talking to you guys then. And, um, so again, thank you so much, and we'll chat soon. Bye.