The Testosterone, Weight Loss & Hormone Lies Your Doctor Never Told You | Brigham Buhler

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2:00It's great if you total the car, but if you're expecting it to rotate the tires, change the oil and maintain the vehicle, you are going to be sorely disappointed. What happened in the 90s is those entities were captured by the big five insurance companies. The reason that is a crucial puzzle piece to understand for your listeners, at that point in time, They went away from negotiating down the price of a prescription drug to negotiating up the price of a prescription drug.

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4:14It is actually plasma. It's the post-plasma exchange, all of the gunk that's in your blood right now. That's Brigham's clinic. And so today, we're going to talk about the power of natural medicine. We'll talk about the future of peptides. Brigham, welcome to the show. Thank you for having me. Well, man, hey, I'm so excited you were able to come up here. I know you're in Austin, and so we were talking about how everybody's moving to Austin or Miami or Nashville. They're the hotbeds. Yeah. It's nuts. Yeah. Great people, and super excited you're on. I remember seeing you on Joe Rogan. I think you've been on there a couple times, and him holding up those bags of yellow stuff.

4:49Let's start there just for a minute. I'd love to ask you about plasmapheresis, also known as therapeutic plasma exchange. And this is a therapy that more I mean, it's been around for quite a while, but more and more people are now doing it for, you know, essentially blood filtration and detoxification. Yeah, it's a great tool. And there's tons of tools in the tool belt. One of the things that I try to explain to the general public is oftentimes medications, treatments, or even a treatment modality in a primary care practice or traditional medicine practice, they won't get offered that. Not because it doesn't work or not because it's not efficacious, but just because it's not covered by the insurance model.

5:30So traditionally, those machines were used sometimes in hospital systems to detoxify like burn victims. They've been used for over 25 years. So it's funny because it's being touted as like new technology, but it's old technology being repurposed and utilized for new approaches to medicine. Well, it's so funny. So when I started my, I started a clinic here about six months ago in Nashville called the longevity clinic. And we do a lot of these therapies there. And the nurse I hired came over from Duke. She was in the oncology department there. She's a nurse practitioner. And I brought a plasma exchange to her and she's like, oh yeah, I've been doing that for 10 years and I told her what we would do it for and she's like well I've never done it for that I've done it but never for for have you seen good results at y 'all's practice yeah well actually so we're about to bring in something called as soon as we can we're hoping in January uh in use phoresis oh yeah yeah so you're I'm sure you're probably familiar there as well very similar so we're actually kind of waiting on that technology to probably most likely use that there too uh but this is yeah yeah it's definitely I definitely think that's the direction a lot of this stuff is headed um we added that to our clinic not even maybe seven months ago um and we just added it uh to give patients other options um we saw immense results with eboo yeah you know which is kind of like uh in my opinion like plasmapheresis light uh it has some of the same effects and benefits but not as uh deep of a dive into that uh treatment modality um and so the folks we have treated with it had immense uh results um we've used it on several individuals who had microplastics issues um one of them has actually spoken on joe as well uh a chef buddy of mine uh philip franklin lee crazy story he had uh a testosterone of in the hundreds um and was trying to conceive with his wife and they had been trying for over a year with no luck and what we uncovered was essentially he had a the highest level of microplastics that our clinicians had ever seen um in an individual and through plasmapheresis hockett and uh and then just giving him glutathione and iv therapies periodically we were able to drop those levels down without ever prescribing testosterone this this man's testosterone went to above 800 and now he and his wife are pregnant with their second child amazing and so like again these are just amazing tools that have immense possibility It's just where do we use them and, you know, what benefits can they provide to patients?

8:05Yeah, you know, you mentioned insurance a minute ago. Like, I think when I first opened my practice here, this is about 20 years ago in Nashville. I, one of the most common things I would hear, and by the way, anyone that's a practitioner will know they've heard this before as well. One of the top probably two questions I would hear from patients is when I first met them, does my insurance cover this? Yeah. And the thing is, is that it typically doesn't, right? When you look at therapeutic plasma exchange, Eboo, advanced red light therapy, nutritional IVs, all of these advanced therapies that have really incredible healing properties, insurance almost never covers them.

8:44And the reality is, is that, you know, so many people, they want the best care, but insurance doesn't cover the best care. They cover sort of like really the worst care. Yeah, absolutely. And that is crazy you're saying that because that was the genesis of why I went and started Ways to Well. I had invested in blood labs and genetic labs, and I was out educating clinicians in Texas about the importance of proactive predictive screening, right? If chronic disease is killing 1.7 million Americans a year and we can prevent the chronic disease, if we can get proactive and predictive, right? The diabetes that develops in your 30s started in your 20s.

9:22The cancer that manifests in your 40s was probably discoverable in your 30s. That's right. And can we catch these things early, screen for these chronic diseases and get proactive, predictive and prevent these chronic diseases from ever manifesting? But to do that, you got to be able to take a look under the hood. And what I saw, and it varies by state. So I don't want to say every single state. I mean, every insurance company is different. but josh in the state of texas literally the insurance company sent letters to the doctors threatening their contracts for pulling comprehensive blood work on patients that had the in-network benefits to have full blood work and so the doctors would call me go hey i don't know what i did wrong but i'm getting threatened from blue cross blue shield or united i'm not going to pull comprehensive blood work anymore wow and so i would go out and to explain to patients when your clinician in an insurance model is pulling blood work oftentimes it's a minimal panel and it's not your clinician's fault they're doing the best they can to navigate a system that's got both their hands tied behind their back and so that's what i basically spun off and this was 10 years ago and said we're going to build a cash pay blood lab and we're going to do full panels for patients we're going to do full genetic screenings on patients uh and allow patients to have a cash alternative, which now is kind of commonplace.

10:40It's pretty wild how readily adopted that's become. But 10 years ago, everyone thought, no way, patients will only work within an insurance model. And I think a lot of it's post-COVID. Patients now don't necessarily trust the insurance companies in the traditional status as much as they used to. And they're asking a lot more questions. Yeah, I mean, there's no doubt that COVID, I mean, there was a massive shift. And I kind of already saw it moving that direction slowly, but it absolutely put the foot on the gas pedal, accelerated everything forward. And yeah, same thing. We have people coming to the clinic and they want the most extensive blood work possible.

11:17And the great news is there is some incredible lab testing today. I mean, you can do, you know, on the cancer side of things, you can do a grail test. You can do an RGC Greek test and look at, hey, what nutrient, like what herbs, what natural compounds. compounds but also even the non-natural compounds what are the most effective at killing this exact type of cancer early cancer screening to your point picking things up years before you would ever have it so you don't have to go and do chemo and radiation that again the preventative markers are great and then the longevity markers like i love there's one i do a lot of oxidative stress testing like the the f2 isoprostanes is like one of my favorites looking at a lot of the advanced heart marker i mean so just just your point there are like being able to pick up things early today and then fine-tune what people should be doing in terms of like so many people are wasting money on supplements and if they got the right testing done man you can dial it into what's really going to move the needle and i notice people are like wow i'm actually noticing a big difference now with the supplements i'm taking the foods i'm eating are you using uh it's not it's old news now but the mtfhr like you see so many patients with it and then the detox methylation detox issues and they're not absorbing the supplements loads yeah and they were taking massive amounts of these supplements that they're just kind of wasting yeah most of our panels we're doing the mthfr now now one thing i didn't realize until we started doing a lot of the van screening is there's so much nuance to mthfr i mean whether you have uh you know which gene you have of there's a lot of other variants though there too like for instance i'm mthfr but if i take a methylated b complex i feel awful i feel wired but just absolutely tired and exhausted all the time and so i'm exactly the same that's funny you say that i'm exactly the same yeah uh and it's weird too i have a i know people love nad i have the for nad for me it makes me anxious it impacts my sleep for days not just not just the day up for like a week it will impact my sleep uh same so there's a difference between being a fast metabolizer and slow metabolizer with an mthfr gene so if you're if you're one or the other one you'll tolerate it fine another you'll feel terrible what i found for myself is just interestingly if i took nr i felt awful like just absolutely terrible for days if i took nmn i felt fine so a lot of it is the form you're taking And the same goes for the B12 and the methylfolate.

13:46But the great thing about these blood tests is you can really dial it in and tell. And I love the more advanced genetic panels. I mean, you know, I did a genetic panel myself and my daughter. My daughter was having swollen tonsils and some allergy issues. We went and just looked at, oh, she doesn't convert vitamin D well. She doesn't convert omega-3 fats well. Like, there are so many now genetic panels where people can learn about their own body, what nutrients are best for them. And I know these are ones you're running, too. No, no. You mentioned how you metabolize slow, fast, and moderate metabolizers.

14:16Again, to walk back in time, 10 years ago, part of what I was educating clinicians on is the cytochrome P450 testing. And it was readily available. And it was not crazy cost prohibitive. And insurance companies just quit covering it for all the patients. Sent letters to all of the doctors in Texas saying, hey, we're no longer covering any of these genetic tests. Genetic screening on expecting mothers. got pushed back by five years at a lot of the hospital systems in Houston, Texas. And lo and behold, it was all part of a negotiation with the insurance companies on, you know, what they get paid on C-sections and all these other things.

14:53And oftentimes the negotiations impact what accessibility patients have. And that's where I've become so passionate about. I'm not saying it's the only way, but a cash pay model does put the power back in the hands of clinicians and back in the hands of the patient where clinicians and patients can decide side by side if insurance isn't going to cover these things do they want to move forward and is this something that adds value to them in their lives yeah yeah no i i totally agree i agree if you are living in that medical model and you are at the mercy of our conventional medical system you're getting you know you're getting the worst care in the world for health care and not the worst care in the world but you're getting close to the i mean in industrialized nations you're very, very near the bottom.

15:36Again, just for everybody listening, if you break your arm, right, we've got a great system. It's fantastic. But if it's not a serious, true emergency, you're at the bottom. It's somewhere, and I'm trying to remember, I think overall quality of life, America's like in the 70s, I want to say in terms of healthcare, we're like 42. It changes every year, but generally that's the ballpark we're in and it's not good. And it's because we're relying on insurance. And so, you know, I want to go back to some of these therapies. So you talked a little bit about plasmapheresis or what we call plasma exchange.

16:07And what it does, it's pulling out microplastics, glyphosate toxins, pathogens out of your blood and body. You talked about someone being able to get pregnant because we know microplastics cause testosterone to drop dramatically. What conditions is plasmapheresis most beneficial for, generally speaking? um well we're using it more for preventative but i will get a real world example since we're here in nashville is uh it's been pretty public about jelly roll and us helping him with his weight loss and when somebody loses that much weight you know you're you have to detox all that weight right and his biomarkers were pretty catastrophic during that weight loss and even though his weight was coming off and he was improving and his insulin levels were improving he was chronically inflamed chronically uh swollen and bloated uh and he would he came in and did the plasma phoresis treatment and one of the things that he talked about was for two weeks he was able to sleep for the first time in years like getting above 80 on his sleep tracking wow and he was just wowed by it um so we've used it in instances like that a lot of the weight loss i mean so many patients are on glp1s now and jumping on glp1s and then they come in because they didn't do them right or they're losing muscle and they weren't guided appropriately and they thought it was like this silver bullet and they're chronically inflamed even though the glp1 is supposed to bring down inflammation too yeah and that rapid weight loss does all those toxins go somewhere right and you sweat them out and you burn them off but they also end up in the bloodstream and so we've used it a lot in those instances as well with really really good results um another one that talked about it was uh russell crow um he's down 40 pounds uh he just went viral for uh like he posted a picture of him saying the gladiator's back basically and his biceps are big again he's in shape again but so much of that is just chronic inflammation the bloating the swelling the inflammation and you're fighting an uphill battle as you get older and you've put your body through that for years and years oftentimes decades yeah yeah you know one thing you know something that This is quite a few years ago.

18:25I had a close friend of mine who was losing a lot of weight. I mean, probably lost, I don't know, 40, 50 pounds. And they did it while on a ketogenic diet. But they had a heart attack towards the end of it. And you know the reason why, but just to share with everybody, when you lose that much body fat that quickly and you have all of this fat in your body and you have all these toxins, I mean, your liver has to deal with it. And if your liver is stressed, well, now you're, again, thinking about your liver's producing cholesterol. I mean, it's a big part of what happens in your bloodstream and keeping that balance there.

18:59And so, anyways, losing a lot of weight can increase your risk of heart disease, heart attack, stroke, a number of other conditions and people don't realize. And this is why it's really smart to, if you are going to lose weight, do it in a really clean way. Keep inflammation very, very low. and do it if you're going to need to lose a lot of weight, oftentimes partnering with a practitioner to do it and doing it the right way. Because I get it surprisingly, but yeah, there's side effects of weight loss when it's done quickly. And everyone, it's so funny on the GLP ones. It's like either people love them or they hate them and they're very polarized.

19:34And it's like, it's the last two years. That's been this mega hot button topic. I don't know what. Well, my opinion is this. I think, you know, there's an ancient proverb and I really like it and it's this. You know, the dose determines the medicine or the poison. And I, listen, I'm a big fan of peptides. I think generally if they're used correctly, some of the benefits are really immense. You know, I think that the micro dosing and again, they're called micro. I think I'd call it probably the right dosing combined with higher protein resistance training. I think small amounts are fine. Again, the problem is everybody's just going on these these drugs, not changing anything, having, you know, gastroparesis and it's causing malnutrition.

20:21And one of the so one of the things that we already talked about that this brings it back full circle. This is one of the things I've talked about on Joe. One of the challenges is a PBM, which is the insurance company, is incentivized to stair step you up to the higher dosages. So we we had patients coming into our practice in a cash pay model who said I was doing great on the lower dosage of trizapatide or semeglutide. And my doctor had to bump me up because the insurance company wouldn't cover it anymore. And so I had to go to the higher dosage. But the reason being you're restricted by what was approved in those clinical trials and what dosage rates were reimbursed in the PBM negotiations.

21:01And so oftentimes patients are stair-stepped up to a dosage that may be overkill for what that patient needs. And that clinician's just trying to get that patient coverage under their insurance plan. Yeah. And when you really peel back the layer, I don't know if you've ever covered the PBMs on your show, or I don't want to get too in the weeds. But if you want, I can break it down because it's fascinating. Yeah, you could. Yeah. You're out of the insurance model, correct? Yeah. We currently aren't focused now. Again, we do, of course, like everybody does, we do HSAs. We always call them super bills.

21:32We give them, if they want to give it to their insurance company, then patients can do that. So to further elaborate on what you and I are talking about, this is what I uncovered. I owned retail pharmacies that build insurance companies for over six years, and I broke out of that. So my pharmacy now is a cash pay pharmacy mailed to your doorstep. ReviveRx in Houston, Texas. We work with cash pay clinicians, telemedicine companies. And the goal was to drive down the cost of prescription medications or any treatment modality, peptides, HCG, fertility drugs. So many of these that are way overpriced in these other models.

22:10When I ran that, it was shocking to me. So a little walk down history lane. Pharmacy benefit managers were established to negotiate down the price of prescription drugs to make drugs affordable for me and you and our grandmas and grandpas and our family members. What happened in the 90s is those entities were captured by the big five insurance companies. So this is all fact. United, Cigna, Aetna, Blue Cross Blue Shield own the pharmacy benefit managers. The reason that is a crucial puzzle piece to understand for your listeners is at that point in time, they went away from negotiating down the price of a prescription drug to negotiating up the price of a prescription drug.

22:52And you go, wait, why would the insurance company want to make the drug more expensive? That doesn't make any sense because they get rebates from the pharmaceutical companies. So products like insulin, this has all been uncovered by the Senate House Committee, Finance Committee that investigated the cost of insulin. Why did insulin triple when the cost of manufacturing insulin went down, when the patents got older? Why is it going up in price and the average American spending more on insulin than ever before? it's because there were up to 30 % of the money generated from an insulin prescription is given back to the insurance company in the form of a rebate.

23:32Wow. And in any other field, we would call that a kickback. Yeah. If I was spiffing the clinician, 30 % of every prescription they wrote, that would be a kickback. But they have safe harbors in place that are legacy safe harbors. This is all stuff that I'm helping Ken Paxton at the state level in Texas fight. I know Secretary Kennedy's trying to expose this at the federal level. But this is important because what you see is a boom in the utilization of prescription drugs. The average American is now on four or more prescription drugs. Like you said earlier, we're one of the sickest countries in the world, but we spend more on healthcare than any other developed nation.

24:11And as you follow the money trail, you'll uncover why. So the insurance companies hold that rebate at a PBM, which is a shell corporation. They then tell congress senators all these politicians we only make a six percent profit margin as an insurance company that's false most of the profits are being held at the pbm 30 of the revenue of of most of these companies is being held at those entities and then at the end of the year all those costs are passed on to an employer so a company like me ways to well i employ over 500 people between ways to well and revive at the end of the year united signa and whoever it is comes back and passes on those costs they go gee brigham they were on a glp one susie was on a glp one for 12 months at 1300 a month but they didn't pay 1300 a month because they got a huge rebate on the back end so you get what i'm saying they're cooking the books for profit margins but the problem becomes you are now incentivizing the insurance companies to pressure doctors to prescribe first.

25:18And think about this. The more drugs you push and the higher dosage, the more money they make. The bigger the reimbursements, the bigger the cost. And that's why GLP-1s were$1 ,300 a month. Everyone was getting pushed to the higher dosages. And that's the problem. I mean, there's such a big difference in taking a double or a 10 times the dosage you should. And that's what we're happening. You know, one of the principles of natural medicine is don't force the body. Nudge the body, change the environment. Let's start moving in the right direction with, you know, your diet and nerves and lifestyle.

25:49Medications literally go the way that they are at the dosages they're at. It's forcing your body to do something in a really aggressive manner. And that's what's happening. You know, there was a study that came out about three months ago on the thyroid drug levothyroxine, right? So this is found in Synthroid and most, you know, most thyroid medications today. And this is out of the Journal of American Medical Association, it said around 21 million out of the 23 million women on levothyroxine likely don't need it. It's of no, they're getting zero benefits. This is, we're talking about a major, major study.

26:26I mean, that's, that's crazy. Think about how many women are on thyroid drugs and it's doing them no good. I, one of my mentors, Larry Lipschultz, he's, he's the head of urology over at Baylor in Houston, Texas. He's been practicing urology for over 50 years. I mean, he's a legend in men's health rights for men's health magazine. I remember him telling me forever ago. This is 20 years ago. The most the optimal dosage is the minimal dosage required to elicit the desired response with the minimal side effect profile. And that was just hammered into my head. Yeah. And so like everything we try to do is start small.

27:00Don't you don't hit somebody with even within the peptide world. So many people are putting people on five peptides out of the gates. And it's like, well, now you don't know what's causing the side effect. what's causing the benefit where is that where are it's all risk reward even with peptides and i think the smart approach is to take a calculated strategic methodical slow moving approach to dialing that patient in and you start small and you start with one medication you don't add five things to a patient's you know medication protocol overnight but that's what traditional medicine is doing now and again i'm not blaming the clinicians you know my dad is on literally nine medicines as a 70 year old man and one and then it's the neurologist is blaming the cardiologist and the cardiologist is blaming the endocrinologist and they're all just pointing fingers and it's in medicine it's gotten so siloed and so compartmentalized that we're not i feel like we're not treating the body as a as a unified system as one closed circuit system well you know the other benefit of doing it the way you're talking about too, you're introducing one thing at a time is one thing I've discovered is, you know, a lot of times when we think, let's even talk about natural medicine.

28:14Let's talk about type 2 diabetes and insulin resistance. You know, there's a lot of talk about berberine and I think berberine is great. But what I've noticed is some patients respond way better to berberine than others do. You know, in Chinese medicine, when you look at berberine, I mean, this is found in, you know, some really common herbals like, you know, Goldenrod and some others. And it's great for insulin, but it's also very, very cooling to the body. So if somebody already comes in and let's say they have type 2 diabetes as well, their body temperature is already really low. We don't want to kind of force it or push it to be even more cool.

28:51And so, you know, I think there's still some nuance there of, hey, we can try berberine, but there's a lot of other herbs. There's, you know, there's vanadium, there's bitter melon, there's a gymnos, there's cinnamon, and there's all kinds of things. And this is where I'm a big fan of personalized medicine of really looking at the whole body. And I like looking at things from the Western perspective, from the functional medicine perspective of the advanced blood panels, but also looking at tongue diagnosis and what's your history. And then, Hey, let's see what works for you really dialing it. But you know what?

29:20It takes an, it takes a lot more time with a patient to really perfect their protocol versus the average doctor visit today is seven minutes so the only thing doctors have time for is just here's prescription you know see it see you later and that that's what's that is what is so important everything you're laying out is what i've been trying to scream from a mountaintop it's it's not that the these clinicians are doing the best they can to navigate a difficult system but at the end of the day the insurance companies and the pharmaceutical companies are benefiting and patients are being left high and dry yeah and i tell patients all the time you have to view insurance like car insurance your health insurance is like car insurance it's great if you total the car but if you're expecting it to rotate the tires change the oil and maintain the vehicle you are going to be sorely disappointed yeah yeah you're going to wake up one day with a chronic disease and go well why didn't my doctor catch this it's not that your clinician's not a phenomenal clinician with phenomenal training it's that your clinician is limited with what they can test what's what what they can run and like you said they've got six minutes with you they've got to pay their staff most of their days now are spent arguing for billings and collections yeah that's right i mean it's it's really really tough and i feel bad for so many of these doctors that are in that model and and i worked with all those guys and girls and that's what i saw firsthand and how it led to me starting this was more of just trying to i always say i was just trying to fix problems and then everywhere I looked I lift a rock and there was another rattlesnake and I'm like okay well here's another problem we can try to fix and I've realized clinicians want to do what's best they're the biggest advocates and passion passionate people on the planet about helping people but we're limiting their ability to do that and that's where I love models and practices like yours like ways to well that allow patients to decide alongside a clinician what pathway is best for them.

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31:57If you're ready for it to finally make sense, go to mybloodwork.com and order your kit today. That's mybloodwork.com. Well, you know, I remember through COVID, there was a couple natural doctors I would see mentioning things online and a couple, I met more conventional doctors. They came out and said they wanted to recommend things like ivermectin. They wanted to recommend more vitamins and nutrients. They want to recommend those things, but it would breach the standard of care and they didn't want to lose their license. I mean, so, so, so think about there's doctors out there saying, I know exactly what's best for the patient, but I'm not going to do it because I could literally lose my license if I do what's best for the patient.

32:35You're spot on. Even owning a pharmacy, compounding pharmacy we had clinicians prescribing ivermectin during covid and we got a letter from the texas state board saying if you dispense one prescription of ivermectin for for covid we could revoke your pharmacy license wow that's how out of control that got and that's terrifying and an obstruction of care on modalities that could potentially help patients and we were blocking that uh and and that's one of the things that i also have been like trying to ring the bell on time and time and time again what i have seen from these regulatory bodies is very unfortunate even even what happened with peptides i don't know how intimately familiar you were but i submitted 17 foyer requests to the fda after they banned peptides 17.

33:27wow they never responded to one And I just had the privilege of testifying three weeks ago at the FDA on peptides in front of a committee of clinicians, of patient care advocates that were able to decide for themselves based off the data. and what happened there was very very disheartening um we provided the fda with over 800 studies over 5 000 pages of documents including a retrospective analysis of bpc 157 where we looked at 14 million patients and there were three adverse events three and i can tell you the fda deemed all three of those as extreme as uh what was the verbiage they used not extreme it was a major adverse event.