267. Dr. Clay Moss: On Metabolic Health, Insulin Resistance, Peptides, & Sleep Hygiene

22:38Gary Brecka:which is why I'm looking at this paper. But along with a colleague of yours, you helped develop, now published actually, inpatient metabolic rehabilitation protocol. So yeah. I think this is fascinating. So I will give full credit to Dr. Joe Stanley. He's over at the James Haley VA. He's the one that's put this together. I'm really just a supporting role, backup dancer for him. Backup dancer. But yeah, no, he's very passionate about it. And part of the reason why I chose the program that I went to is because I was doing my residency interviews and I told all these program directors like, hey, I want to go into functional medicine, more lifestyle approach, kind of a root cause approach, maybe not even in the health insurance space.

23:21And I had five or 10 program directors look at me like, you're crazy. You don't want to go in academic medicine. We don't want you at this program. And that's fine. And these guys that I work with currently were like that from the get-go. And it's hard to find people like that, especially at the VA hospital. I just don't see a lot of nuance there, not saying that it's not. But he really went the extra mile and checked off so many boxes because there's so much paperwork to get anything done in the government sector. Oh, yeah. And has created this amazing program where we'll take one patient at a time who was originally in our inpatient rehab setting.

23:56Let's say they got a knee replacement. They came to us. And if they were an appropriate candidate and seemed motivated, we would talk to them like, hey, you know, we do this intensive program where you can come for like two weeks and we'll teach you how to cook. We'll teach you what supplements that you can get. We'll do a full in-depth lab analysis on you. We'll teach you how to go to sleep hygiene. I mean, we really start from a bottom-up approach. And then we track their lab values over time and they come back to us. And not only do they lose weight, their, you know, depression scores go down.

24:24they don't need enough as many medications as once we're on their total body inflammation goes down their arthritis goes away i mean yeah all of these things in real time now that i've been there long enough and get to track these patients have gone gone down and so it's now it's starting to raise the question in the government sector of like oh well if we could do this in an efficient way from the get-go you know from the very beginning then we avoid all these patients coming into the hospital later on yeah so shout out to dr stanley because he's been amazing at that you know bobby

24:57Gary Brecka:kennedy talks about that too he's like it's one thing to fix the broken system it's another thing to just keep people out of the system yeah i just want to read some of these markers because for those you know my audience that understands what these mean um this is a seven-day intensive program that produced pretty remarkable results so in 36 days um one patient example saw triglycerides dropped from 140, which isn't still extraordinarily high, but it's elevated, 140 to 55. So that's two thirds. LDL cholesterol cut in half from 130 to 66. Fasting glucose from 145 to 121. And maybe the most remarkably, homocysteine cut, almost exactly 50 % from 9.6 to 4.3.

25:40Gary Brecka:All without a single new prescription. So no additional chemicals, synthetics, or pharmacological intervention. um food movement stress management and intention i love that you use that word intention right one of the fascinating things about the research that we did in the mortality space was we knew that if you wanted to cut human beings life expectancy in half um all you had to do was put them in isolation and when we talk about the the basics to people about how impactful things like movement, stress management, intention, community connection, and how food is medicine. They almost want to refute that because it seems like it's too easy.

26:26And I would say probably the biggest thing that we did in that program is, and we've had multiple other patients since then. That was kind of the first one that we were like,

26:35Gary Brecka:oh, this works. Yeah, yeah. But the biggest thing we probably did other than sleep hygiene, which I think is amazing and we're all missing. Yeah, I want to talk about that too. Yeah, we did a full elimination diet for 30 days, and we put people back to a baseline level of inflammation. What does that look like? What is an elimination diet? So it's basically cutting out things like your gluten, your soy, highly processed foods, pretty much everything that has a high tendency to be reactive in a lot of people. And it's not like you're just eating one thing over and over again. You can still have a pretty decent diet doing that.

27:07But we cut it down for 30 days completely. Like no questions asked. We have to cut all these things out. So what was eliminated? Soy, dairy? I believe it was soy, dairy, gluten, any processed foods. Good. We kept red meat as long as it was grass-fed, grass-finished. So we made sure that everything was sourced correctly or at least tried to be. Sometimes people's wallets, they can't pay for certain up tiers or whatever, which is fine. So we kind of worked with everybody on what we could afford, what we can't, how we're going to do it. And any artificial dyes, you know, we kind of went into the weeds a little bit on that.

27:47And then after those 30 days, it was no alcohol. That's a big one. It's a massive one. And then after 30 days, we would reintroduce one thing at a time for a few days at higher doses. So like we didn't reintroduce, you know, starches. And then we'd reintroduce like gluten back into the diet. And if that person starts to, you know, and they're taking surveys this whole time of like their, you know, their mentation, how they feel, their pain. and if those levels start to drop, then we're like, okay, that's a problem. Let's cut that one back out. We'll reintroduce one more thing. And so it makes people more aware of like what they put in their body is how they're going to feel.

28:21Gary Brecka:Yeah. And then in addition to that, where they're, because you talk about stress management and then I want to talk about sleep hygiene, but what did you do for stress management? Was this meditation? Was it breath work? Was it exercise? Was it combination? Yeah. Our therapists work with the veterans and try to figure out what they want to do. Because if you don't want to do it, then there's no point in doing it, right? Yeah. A lot of them in the VA system did Tai Chi, which is amazing because not only are you moving, but you're also getting a mindfulness aspect out of it. So you're kind of killing two birds with one stone, right?

28:56It's a little bit of a biohack in its own because you're getting a little bit of a workout and movement out of it. And you're providing mindfulness, lowering stress levels. And so I think that was probably the most impactful for them. Some of them did meditation. Some did yoga. It just depends on what their baseline functionality was like, too. Some people couldn't tolerate yoga or Tai Chi. So we started with meditation.

29:18Gary Brecka:And then did you make mobility like non-negotiable in this? Like some form of exercise? Any form of exercise. Even if it was walking. I mean, we have patients that can't walk to the end of their driveway, right? So like let's make it to the first crack of the driveway on Wednesday. And then let's see Friday if we can make it two steps past that. I mean, it's about meeting patients where they are. and we don't compare to anybody else that came before them or after them. And then after this whole thing, this is like one of the best things that I think, after they go through this whole protocol, we introduce them to those patients who had gone through the protocol before and volunteered to become part of a support group so that when they get through it to the other side - Dude, I love this.

29:54They have like a wellness support group. This is awesome. It's amazing.

29:57Gary Brecka:Yeah, because then you feel like you're part of a community. You feel connected, which is one of the areas of medicine we rarely talk about. When people feel isolated, I mean, if you look at the number of these horrific crimes that are committed by, you know, very often by teenagers, but they feel completely isolated. You know, they don't have best friends and a friend circle and community and connection. They feel like a loner. Yeah. And I think, you know, this exacerbates all forms of mental illness, you know, PTSD, when people feel like I'm the only one that has this. nobody understands me um i'm unique in my suffering profile they're number one probably less likely to raise their hand to get help um and number two they just get inside of their own head and this becomes like a snowball rolling downhill it's a perfect storm with so many different things you take social isolation and then you take what's in our food nowadays you take the amount of prescriptions that we're giving people with multiple drug interactions you take the vitamin deficiencies that those prescriptions cause and those side effects.

31:03There's so many different things that you take the food that they're eating. I know you've probably seen the prison studies where they reintroduce whole food diets back into prison systems and violence goes down. Violence goes down tremendously. There's also, you know, with kids and ADHD, you know, putting them on a whole foods diet has the same effect, if not better effect than putting them on medication. So there's so many things that we're living with in this unnatural world nowadays that if we just kind of get back to our roots a little bit, we can fix things one by one.

31:32Gary Brecka:Yeah, I totally agree. You know, you often have talked about GLP-1s and I feel like GLP-1s are kind of this double-edged sword. I mean, certainly they can be life-saving for people that are morbidly obese or type two diabetics, have a lot of food noise in their, you know, just in their environment because I would put sugar addiction and food addiction right up there with nicotine, with alcohol, with some of the most difficult, you know, addictions that we suffer from. And I think because food is such a widely accepted resource, it's easy to have that addiction right in plain sight. You know, it's not like you're pulling out a handle of vodka.

32:15Gary Brecka:You know, you're just going for a Twinkie, you know? And so, you know, food noise, food addiction, morbid obesity, type 2 diabetes, I think these are areas where GLP-1s have a massive role. But now, I mean, if you're listening to this podcast and don't know one person that's on a GLP-1, I would be shocked. It's not six degrees of separation anymore. It's one degree of separation. Yeah, definitely. But you feel like they're a double-edged sword too. For sure. And for what reason? So kind of going back to what you said, I think nowadays we're being targeted with sugar in our face all the time. You go to the movie theater and before you can even watch the movie, you watch that like salivating video of a Coke being poured into a bottle and you're just sitting there like, man, I need to go get a Coke downstairs.

33:07And so it's constantly in our face. And so it's worse than it was 50 years ago for like my parents or my grandparents.

33:12Gary Brecka:Yeah. So I do think there is a little bit of targeting that goes on there. And GLP-1s, so what I'm seeing on the plus side, yes, it's taking people that maybe have passed their threshold of point of no return and giving them a tool to be able to get back to a healthier life. And that's what we need to be treating it as, is a tool, not the miracle pill, not like the fountain of youth, but just a tool to be able to use in the grand scheme of things. And I think the problem that we're all facing is that in a lot of people, we're trading obesity for sarcopenia. So we're not only – Age-related muscle wasting.

33:49Exactly. So we're not only have more fat than we need to in society, we also have less muscle. Yeah. And that's the double-edged sword right there because if – let's just say you take a GLP-1 and you lose a bunch of fat, but you also lose all your muscle and then you try to get off the GLP-1. Muscle is the biggest metabolic organ that we have. It's a huge glucose sink that's independent of insulin. So regardless of your insulin insensitivity or sensitivity, if you eat a big meal and you have a lot of muscle mass and you are using your muscle, it's a sponge. It doesn't even use insulin to do that process.

34:23So it takes it out of your blood. It gives you that buffer for maybe a poor diet every other day or whatever. And people are completely missing that. So you'll get skinny, but in a weird way, they're actually getting fatter because their overall ratio of fat to muscle has actually gotten worse.

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35:51Gary Brecka:Now let's get back to the Ultimate Human podcast. test. And I like that you think that metabolic testing and BMI testing should be a part of everyone's protocol, understand where they are with their muscle and their fat and their visceral fat. So do you think GLP-1s have a place in functional medicine if done properly with strength training and let's say the addition of peptides? 100%. I used to be anti-GLP-1. When I first came out, I was one of those people that was like, no, I think this is the bane of all existence. I'm a big fan of Red or Trutide. I think that is going to be huge whenever it becomes more available.

36:31But now we're seeing that it's cardioprotective, even though they control for weight loss. So even the people that lost less weight or more weight had the same cardioprotective effect from GLP-1s, possible cancer protective effect. So there's all this data that's coming out of the uses.

36:47Gary Brecka:Neurocognitive effects. Exactly. Neuroinflammatory effects. For sure. And so we're starting to see all of these things that it could play a good role in as being another tool in the tool belt. But, you know, you and I were talking earlier. I think one of the first steps is putting that conversation back into the clinic setting rather than kind of the back alley black market setting. Because we're not, you know, once the FDA loosens up a little bit on peptides, I'm hoping that people don't have to go and find these things on the internet. Yeah. Yeah. I think the risk is, you know, not... And I hear physicians very often attack peptides and they will say things like there's no safety data, there's no real gold standard data, gold standard science on it.

37:30Gary Brecka:That is patently false. In fact, I'll make available as a link an academic white paper with almost 800 cited research studies behind it. And some of these were gold standard studies that led to pharmaceutical approvals in other countries. I think we are going to see a certain number of peptides, probably 14 of these peptides move back onto the bulk list and be compounded by compound pharmacies so that you get stability, sterility, potency, where appropriate guarantees, you get beyond use dates so that these peptides are not expiring, you get mixing and dosing instructions, you get a protocol that doesn't help you, you know, build tachyphylaxis, this desensitization response.

38:17Gary Brecka:I think the future for peptides is very bright. I do too. And I'm an enormous fan of peptides. I'd love to hear where you fall and what are some of your favorites? How would they be used and what your clinical experience is with them? So this is the most exciting frontier of medicine in my opinion. I love hearing you say that. I love it. I'm a massive fan of peptides. And so, and one of the sad things too, we talked earlier about how the health insurance model kind of takes the art out of medicine a little bit. I have talked to physicians that work at some of the highest performance academic centers in the world and asked them about peptides and kind of get this answer like, oh, yeah, like I've heard about them.

38:54I don't really know much about them.

38:55Gary Brecka:Yeah. And it's like, okay, it's 2026. If you're a physician that's taking care of really high level athletes or just high performing people and you don't, you're just not in the system. First of all, you're probably working, you know, eight to six every single day, seeing patients six minutes a day. You don't have time to look up the studies or look up what peptides are. But also, it's just not in that setting. And so it's really sad that we've taken peptides out of the academic space because we don't have the people that really need to get the word out on them and get more data and get better data on these things to head up those conversations.

39:28And it's like we need to get that back into the real world clinical setting because it's so exciting. I'm not saying every peptide is great. There are probably multiple peptides that I wouldn't recommend people. But at least if we give it to a patient and provider interaction again instead of like going and buying it from some third-party back alley online place, then you can have the conversations about safety versus side effects. What's the risk-benefit ratio? What is this going to give you? How to mix it? I mean mixing is probably the biggest thing.

40:01Gary Brecka:Mixing and dosing is the biggest. All of these nightmare stories that you hear, a lot of them come from people that just don't mix it correctly and they're giving themselves an insane dose or no dose. Right. You know? Yeah. So, yeah, I really hope that they loosen the grip a little bit so that we as physicians can start learning about them more because many of us don't know anything about it. And then also put it back in the clinical setting so that we can talk to patients about it in a safe way. Yeah, I completely agree with you. I'd like to go through some of the peptides because, you know, peptides, first of all, insulin is a peptide.

40:34Gary Brecka:GLP-1 is a peptide. We make a lot of these peptides endogenously. It's not a voodoo sort of fringe area of science that, you know, a couple of gym bros got together and you started making cocktails like a lot of these SARMs and things like that that you see online. these are valid amino acid analogs. They're hopefully made by licensed compound pharmacies. They're done with, you know, in ISO 9001 clean rooms, positive pressure rooms with real, you know, parameters around them so that the dosage and then the strength and the potency can be guaranteed. And having been in the functional space now for about 10 years, you know, We have really seen, I don't wanna say miracles with peptides, but when people are recovering from post-surgical injuries, when they're trying to improve their performance, when they're trying to improve their recovery, especially in athleticism, most athletes are not overtrained, they're just under-recovered.

41:42Gary Brecka:So what if we dove into this category of peptides and take GLP-1s, for example, something like a redditrutide, What's the appropriate profile for someone that is interested in getting on Red at True Tide? And when should they be considering something like that? Yeah. I think it comes in the whole picture, right? Like if you get full metabolic lab testing done, you have that conversation with your practitioner, you have some sort of metabolic disease that you want to address, whether that be central obesity or non-alcoholic fatty liver disease. That's the one that they really did all the studies on.

42:20Gary Brecka:For retitrutide. For retitrutide. And it's an amazing medication for decreasing the amount of fat in your liver, which we actually didn't really have any medications for prior to that. I think at the highest dose, it had like a 100 % cure rate of – or sorry, a cure of 80-something percent of people that were in the study at the highest dose over a span of like 50 weeks or something, which is insane. I mean, that's really stubborn fat that's wedged into a vital organ that we're able to get down. So in that sense, I think it's amazing. We can target these certain things that we know cause a lot of harm down the road.

42:59But also like, you know, some people want to do it because they're obese and they just want to lose weight and like they want an extra tool in the tool belt. And I think that's okay. As long as you're getting enough protein, your strength training, and you're doing it under the guidance of a physician and you know your risks, then I think we should be able to have these conversations and not talk down on people for getting on a GLP-1 and doing these things. Right.

43:23Gary Brecka:I couldn't agree with you more. I mean, I think there'll be a lot more common as functional practitioners realize that these are more than just a weight loss tool. and when they use the full spectrum of the implication of these peptides. Let's talk a little bit about vanity because most people want to look better, they want to feel better, they want to have more muscles, they want to have less fat, they want to have clear skin. So in the world of peptides, there's the category of growth hormone peptides, GHRPs, GHRHs, where do you fall in the growth hormone peptides? i've certainly taken them with phenomenal results i think i'm in pretty good shape for 55 year old i've been hanging with these 25 year olds every morning with my with my son yeah um i don't think that and and by no means am i here to tell you how to get jacked i don't i'm not jacked and i'm not a weightlifter and i'm not a bodybuilder but i do feel amazing yeah like and and i don't have any knee hip shoulder rotator cuff low back pain and i exercise pretty intensely I really attribute that to peptides because I can tell if I'm not regularly on BPC-157 and TB-500, if I am not cycling growth hormone peptides, I notice degradation in my sleep.

44:47Gary Brecka:I notice a degradation in my recovery almost instantly. Within four or five days, it can be like, I'm off my peptide dose. And I'm pretty militant about monitoring labs. I haven't seen inflammatory markers rise. I haven't seen markers rise in any of my liver enzymes or alkaline phosphatase. I haven't seen reductions in EGFR. My kidney function increases in bond creatinine. So I'm absolutely convinced that these can be a tool in people's toolbox to reach their goals. I did 75 hard over the holidays, which was difficult when you're going home. Did you actually do it? I did. You read the books the whole day?

45:26Gary Brecka:Yeah, I did it all. The outside workouts are tough too. I love it. It is hard. But granted, when you're in Florida, it makes it a little easier. Michigan's hard to do 75 hard. That's 75 super hard. Exactly. Yeah. So it was 75 kind of hard for us, I guess. But I use peptides in order to kind of help my process along. So I was taking BPC-157, TP500. I did that for three or four weeks in the first stretch just because I had never worked out at that volume before and tracked my WHOOP data. And it was crazy because I just figured it would have more of a local response on any aches and pains. But my WHOOP data was amazing.

45:59I was getting green recoveries even though I was working out twice a day. Could be placebo. Placebo is a hell of a drug. But I was doing that. I was taking Cermorelin for a little bit of a growth hormone boost during that under the guidance. I remember you just take that at night before bed. Yep. An injection at night before bed, five days a week, two days off under the guidance of a clinician. So I took my labs before and after too, and all of my lab results actually got better, not worse. So I was doing this under good care and guidance. So you're taking the BPC and the TB500 for tissue and wound repair.

46:30Gary Brecka:Can you talk a little bit about, to the extent that you know that, the mechanism of action of these and, you know, why would somebody take BPC157 or TB500? Yeah, so I know that they're a really great anti-inflammatory. We don't really have a lot of data around whether you should inject it locally versus, you know, subcutaneous. but just the anecdotal data that I've heard from numerous people with aches and pains in certain areas that do inject it more locally they tend to get better a lot faster than they would before so I was doing it you know I had like some golfer's elbow that I was working out with and just kind of pushing through and so I was injecting it locally into that area got better within a couple of weeks then after that got better I was just injecting it you know subcutaneously and I I just felt like I wasn't getting those like next day aches and pains like I was previously.

47:24And I'm 28 years old. So it's like, what level was I really at before? I think that, you know, an older population might have a little bit better bang for your buck in some peptides because your body decreases the amount of those hormones that it makes over time. So I kind of went low and slow and it really helped me. I mean, it really did. I did not expect to have as positive of an experience with that high volume of training that I did.

47:49Gary Brecka:You know, you've also talked about, I want to go back to the muscle for a second. Gabrielle Lyon says muscle is our metabolic currency. You've talked about muscle is medicine. I've heard Mark Hyman say, if you want to live a long life, lift heavyweight. Yeah. So, you know, there are, you know, a lot of iconic figures in this space that are really trying to draw people's attention back to strength training muscle. You know, I notice in my parents that are, they're older, they're both, my mom's 80, my dad's 82. They're both very deconditioned. And, you know, my father, because he's partially handicapped, my mom, bilateral knee replacements.

48:35Gary Brecka:and cognition follows this decline in muscle function. So can you talk a little bit about the importance of strength training muscle beyond just what we see in the mirror and why you think muscle is medicine? One, I think we've just been paying attention to cardio for like the last 40 or 50 years And we've realized that we're leaving an entirely important sector of human health, especially physical health on the table, which is strength training. And I think strength training got a bad rap from like all the gym bros back in the day wanting to just get bigger. And we've just kind of disregarded that.

49:16I mean, if we look at the mortality data, I think, you know, being strong compared to being weak has somewhere in between a, you know, 200 and 400 % difference in overall mortality risk, right? Absolutely true. Which is massive. I mean, if you look at things like diabetes or hypertension or smoking, it doesn't even compare to that. And there's no pharmacological intervention that even remotely moves the needle like that. Right. So like, yeah, like if let's just say, you know, you have diabetes, you can supplement insulin for diabetes for a pancreas that's not putting enough out or for a pancreas that's putting too much out and you're not sensitive.

49:48You can't supplement for being under muscled. Right. So it's something that we don't really have a fix for on the medical side. And so it's really in the hands of the patient to be able to do that. And there's so many benefits. I mean, it increased brain-derived neurotropic factors. So you talk about the cognition. It also is that glucose sink. So maybe you become a little bit less insulin resistant, which does wonders for your mentality too. You've talked about Alzheimer's being type 3 diabetes, right? So muscle is in this grand scheme of being able to get you to a better level of metabolic health that all of these diseases stem from.

50:23So to me, muscle is the root of where all disease stems off from.

50:28Gary Brecka:Yeah. And I think that another message that is starting to resonate in our industry is that it's never too late to start strength training. And, you know, there are people listening to podcasts that are in their 60s, 70s, maybe even in their 80s, like my parents. and the benefits that they, even if they have gone their entire lifetime relatively sedentary or it's been years since they've been on a, you know, practice field for any kind of sport, there is enormous benefits from even starting today with a strength training program, resistance training program. There was a, the Lift More study, was a, I believe it came out a few years ago, was looking at, I think it was primarily women age 65 and older that either had osteoporosis or osteopenia.

51:16And they compared two groups of women. One of them was lifting heavy, like five rep max heavy for multiple compound movements, where the other was doing more like 12 to 20 repetitions, which is kind of what we originally would put people on. Because 20 years ago, we'd say, anybody that age, don't lift heavy because you'll break something, right? But what you see, if they're doing it in this controlled setting with a trainer that's making sure they have good form, not only did we stagnate bone mineral loss, we increased bone mineral density, which we never thought was possible before.

51:50Gary Brecka:That is so incredible. Yeah, so you have all these people that we've been telling like, oh yeah, we just want to like play it safe now and just try to minimize how much bone you lose. It's like, no, no, no. If you're 70 years old, you can still increase your bone mineral density if you get on a good regimen. And it doesn't mean you have to go and start powerlifting in the gym, but go in the gym, maybe get a personal trainer one or two times just to teach you how to do something and just get moving because it has so many good benefits to it. If you know me, you know I'm a huge believer in the benefits of hydrogen water.

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53:02Gary Brecka:Now, let's get back to the Ultimate Human Podcast. Yeah, I think it's hard to talk about metabolic health and longevity without bringing hormones into the picture. One of the things I really applaud the FDA for doing was removing the black box warnings from female hormone therapy. Marty McCary has talked about how 50 million women unnecessarily suffered because of these black box warnings that basically bastardized the Women's Health Initiative study and made women and practitioners think twice about hormone therapy because it increased their risk of breast cancer. Years ago, there were these correlated links between stem cells and cancer.

53:50Gary Brecka:When we basically started peeling back the layer of the onion, it wasn't coming from the stem cells, it was coming from the procedure. um and and so shedding a light on some of these you know misnomers um you know it's so astounding to me how how long sometimes it takes to turn the aircraft carrier in medicine right like how long did we sit with this food pyramid how how horrible was the war on saturated fat you know front cover of Time magazine, which literally led to this decades-long war on saturated fat. The demonization of salt over sugar. I mean, there's countless things that have - And yet the entire time, this hockey stick spike in chronic disease.

54:35So how important is it to have your hormones checked?

54:40Gary Brecka:Are you a fan of bioidentical hormone therapy? For 100%. Yeah. 100%. And do you have any experience in female hormones? So I'll tell you this right now. One of my number one regrets, and granted it's nothing that I could have done, but is not knowing how beneficial female hormones were 10 years ago because my own mother didn't get on them. And now she's 60, 61 years old. It's harder for her to tolerate after she's gone 10 plus years in menopause. And I just know all the benefits that those can cause if you're able to do it in a smooth transitional way. Now, granted, women can get on hormones later and still have good benefit, but if you're able to do it in that perfect balanced kind of ballet of going into menopause and being able to transition through that process with a good hormone clinic or physician that's well-versed in doing those things, then it's amazing for women because women have been looked down on for so many years.

55:39I mean, I remember when I was in medical school and I was talking to, you know, menopausal age women and they'd be telling me that they're having brain fog, less libido, fatigue, night sweats, all these things. And then I go and talk to the practitioner that I was working with and they're like, oh yeah, that's just what women go through. Yeah, yeah, that's just age. And by the way, we got a patient that's coming up in two minutes, so hurry it up. And then it's like, so we've just kind of brushed women aside in that way. And like you said, like Marty's book really touches on this amazingly, like that study back in 2002 or three.

56:11with the Women's Health Initiative, was a faulty study kind of to begin with. Yeah. The findings came out before the study actually came out. Yeah. And then when the study came out, you realized the findings really weren't statistically significant. They were using synthetic versions of all the hormones. And now we talk about how the healthcare space, you know, does patients wrong in certain areas. One thing that we don't talk about enough is it really did physicians wrong in this way because we learn about bleomycin and all these other cancer drugs in medical school when 95 % of us won't go into oncology, but we learn zero about hormone replacement therapy, and that's the basis of human life.

56:52Gary Brecka:Yeah, it's so astounding to me. My wife and I, Sage, we've done podcasts on this. We've been very vulnerable about it and very transparent about it. She did this Dutch test while she was going through menopause, and i'm telling you what happened to her three weeks after getting on um hormone therapy um after doctor sort of really dialed in uh her dosages was mind-numbing i mean libido brain fog uh her uh water retention her sleep i mean her cortisol and melatonin were completely inverted and her short-term recall, like the lack of brain fog, just the crushing exhaustion, the mood swings, all gone.

57:40Anxiety. I mean, it's one of the greatest antidepressants that we can give a woman. Yeah. Anybody. Someone that's really close to me came to me the other day and said that her husband had just got on testosterone replacement therapy in his late 50s, 60, and said that her husband is more patient than he's ever been in his entire life. And you think testosterone roid rage, right? Exactly, right.

57:59Gary Brecka:It's just simply not true. So where do you see, you know, what does the future hold for Dr. Moss? I mean, what is your vision of your practice, your impact? You know, how are you going to bridge this gap between allopathic medicine and functional medicine to impact the patients that you're gonna see? Yeah, so I think I wanna, so I'm pursuing formal education also in the functional medicine space through a couple of places like A4M and all these places that you go to and do online fellowships with because we don't learn that in the academic setting or at least not through that framework, right?

58:37Gary Brecka:Yeah. So thankfully I've had that my residency program is not brutal enough to where I don't have time to explore other things that I'm interested in. So I'm able to do that along with my formal residency training. And with PM &R, I get to, you know, do a lot of hands-on things like ultrasound guided injections with PRP or stem cells. And so what I want to do is take that PM &R knowledge of, you know, how do we get a patient back to being as functional as possible, take the functional medicine side of, you know, how do we avoid chronic disease and kind of morph those into a good practice that 10 years ago when I was the patient, I wish that I would have gone to.

59:14Right. Where you're recognizing things early. You're getting a sense of like what a patient's going through on a day-to-day basis. You don't just have to sit with a patient for six minutes and then push them aside. Yeah. You can actually sit down. So, you know, I have a year left of formal training. So I'm trying to build that runway out a little bit and see what's possible. I don't think I'll operate in the health insurance space as it currently stands, or at least I hope I don't have to.

59:39Gary Brecka:Yeah. I want to say this, too. You've talked about the payer system, too, like the difference between cash pay and insurance-covered events. Like just this sheer voluminous difference in cost. like the same CBC labs that they bill an insurance company$400 for a patient can get for 35 bucks. So I got last year when I had health insurance, I don't have health insurance anymore. I do crowdfunding, but I got estrogen, testosterone, free testosterone, sex hormone. I got five basic hormonal labs from my primary care doctor. And I get the bill in the mail and I paid$98. And I was like, oh God, I wonder what they billed insurance.

1:00:18I looked at it and they build insurance$1 ,500 for those five labs. And so I was like, okay, well, thank, you know, first thought is thank God I have insurance, right? Yeah. And I only paid 98 bucks. Exactly. So I go back to the same labs website and I go to order those lab tests. Like I was like, I would be doing it for a patient. And I put all five of those labs in and see what it costs. And it's$66 total cash pay. So I paid more with insurance than I did if I just went and paid cash. And I'm seeing this in a lot of different places, right? Like you see insurance bill for an MRI at like$15 ,000 when you can go pay 400 bucks for an MRI down the street some places.

1:00:57So I think the cash pay system gets demonized a little bit because people think that the physician or whoever owns the practice is selfish by going cash pay. And sometimes it is more expensive. But I also think that if you're trying to be preventative, the money that you spend on the front end could also save you a lot of money and heartache and family trouble and all of these other things on the back end.

1:01:17Gary Brecka:Yeah, no question at all. We saw the same thing when we were starting our functional medicine clinic. You know, we would have, we started with a traditional insurance model and it just became so difficult to manage. I mean, that's why like really successful medical practices have an entire division that just does billing because you could get a PhD in billing and it would drive our clinicians up a wall because they would spend so much more time trying to justify procedures and write medical necessity letters for relatively simple procedures. Prior authorizations. Yeah, if it didn't fit the algorithm, you know.

1:01:57Gary Brecka:I remember, you know, a woman walking into a clinic with an irregular node in her upper axillary region and it was nodular. It wasn't there six months earlier on palpation, you know, all the signs that you wouldn't want to see, you know, close proximity to the lymph nodes. and so she just said okay i want to um order a biopsy and some additional imaging and got rejected right and um so she wrote a medical necessity letter and it got rejected again and eventually what she realized when she spoke to the insurance company was um because the statistical incidence of cancer in that age woman was so low and this was considered a non-covered procedure and she's like i get that but the here is all of my clinical analysis everything about my training tells me this needs to be biopsied and it needs to be imaged um and here's why and then they gave her another whole framework to write another letter so in the third letter they finally covered the procedure i know somebody who has who had prostate cancer and had to get or sorry, testicular cancer and had to get his testicles taken out.

1:03:10And insurance denied his, their, you know, authorization to get testosterone replacement therapy for that the first time. So they had to go through an entire appeal process. It's like, how do you expect that person to make testosterone without testicles? Right.

1:03:24Gary Brecka:Yeah. Yeah. I mean, so I think, you know, a lot of that idiocracy, we're going to hopefully see change over time. But while we're waiting to change the system, keeping people out of the system is the best route. You know, the final thing I want to touch on, because you mentioned it in your approach to metabolic syndrome, was sleep hygiene. And I love that term, but I think a lot of people don't know what that means. You know, how do we draw attention to our sleep? What are some hygienic... I'm actually about to do a massive two-day free sleep challenge. I do them every quarter. but I'm interested in your opinion on what does good sleep hygiene look like to you?

1:04:06So I think a lot of people treat sleep in a vacuum. They're just saying I'm not sleeping well and they don't look at anything that's surrounding that event except for them lying down and actually closing their eyes. And I see this all the time and you'd be surprised. But I think if you really look at everything that leads up to sleep, not only in the first couple hours right before you get in bed, but the entire day, right? Are you getting up in the morning and getting natural sunlight? I mean, Andrew Huberman brought this kind of to the forefront, and it's been huge in that whole community lately because that cortisol spike that you get early in the morning from having natural sunlight, you can't reproduce that indoors.

1:04:43I mean, maybe with some sort of like…

1:04:44Gary Brecka:10 ,000 lumen. Exactly. Yeah. And for most purposes, you can't reproduce that. So if we're not getting that cortisol spike in the morning that's coming down throughout the afternoon, then we're staying at a baseline level of stress hormone throughout the entire day that doesn't taper off at the end. And then we have that wired and tired feeling when our head hits the pillow of like, wait, I've been tired all day. I could have just fallen asleep at my chair at work. But when I finally get to bed, I can't go to sleep because my mind is racing. Right. So I think starting in the morning with natural sunlight as quickly as you can possibly get it, like get that sun in your eyes.

1:05:18Don't stare at the sun. But then, you know, later in the day, how late are you having your meals in the afternoon, right? Are you eating at 9 p.m. and trying to go to bed at 10?

1:05:27Gary Brecka:Yeah. So I try to get, you know, two, hopefully three hours before I go to bed as my last meal because you need that time to digest. I saw traumatic improvements, yeah, doing that. Cutting down the temperature in the room to, you know, I sleep anywhere between 66 and 69 degrees. Some people even go lower than that. And I think that because it brings your core body temperature down. Taking a warm shower can help do the same exact thing. sauna before sleep is amazing for that cutting out light in your bedroom is the biggest one that i see i mean we have our whenever you see our room from the street it looks like a haunted house because there's only red lights in our bedroom upstairs i love that so like getting you know amber lights in the bedroom so that you're not having that blue light exposure that is ramping your melatonin back down um using a sleep mask whenever you travel you know we're in a hotel right now i love all of this yeah i mean there's so many things using a white noise machine if you have like a ton of road noise and stuff like that nearby there's so many magnesium magnesium glycinate is like so easy to do right before bed it's it's fairly cheap supplement um there's there's tons of things and also i think one of the most underrated things is trying to get on the same sleep schedule as whoever's in the bed with you like your spouse or girlfriend or boyfriend or whatever it is, that is huge.

1:06:44Because if you're getting, you know, if you're waking up at 10 a.m. but they're waking up at 5 a.m. and they're waking you up,

1:06:49Gary Brecka:you're not getting eight hours of sleep. And, you know, usually I find in couples, and Sage and I are this way, one is a deep sleeper, one is a light sleeper. Right. So like she can get out of bed 10 times at night. I don't, I mean, she could have a dance party on her side of the bed and I would not even know that it's going on. I'm jealous, we're the opposite. Yeah, but if I, when I wake up, if I have to use the bathroom at night, I am so intentional about how I get out of this bed. I mean, it looks like I'm trying to commit a crime. Yeah. I slide, I move my legs over onto the floor. I sort of slowly, you know, stand up because I know that she's so sensitive to, you know, me getting up, getting out of bed.

1:07:28Gary Brecka:And if I get right, you know, and then I sort of fall back into bed, throw my eye mask on and I'm like right back out. Well, she's up for another 35 minutes. Yeah. Because I've broken her out of that sleep. But I think sleep hygiene, whole food diet, mobility being non-negotiable, which you talked about strength training, so fundamentally basic but so incredibly impactful. And it makes you feel amazing. Like if you get good sleep, you work out, you look good in the mirror, so you have that confidence booster. I mean when you start to string all of these things together, it's not a chore. It makes you feel and look amazing.

1:08:02So people are happier than they've ever been when they start to implement these things. Love that you're saying that.

1:08:07Gary Brecka:So Dr. Clay Moss, how does my audience find you? How do they find out more about you? Yeah, probably mostly on Instagram is where I do most everything. Just at drclaymoss, Dr. Clay Moss. Okay, just drclaymoss, no MD, that's drclaymoss. Yep, don't even have a website yet. I'm sure we'll get there at some point. That's all right. We're cutting dry at this point, but yeah, they can find me on there. I'm pretty responsive and everything. So people have questions. That's phenomenal. You know, I wind down all of my podcasts by asking all my guests the same question. and there's no right or wrong answer to this question, but what does it mean to you to be an ultimate human?

1:08:43Doing, probably doing 80 % of the things right and leaving 20 % to actually be a human being. I think we get really caught up in all of these things a lot of times and then I don't wanna die and realize that I've been in a protocol my entire life.

1:08:57Gary Brecka:Yeah, paralysis of analysis, right? So just not letting perfect be the enemy of good, but also taking the steps to really do what you need to do. taking care of your own health is the most selfless thing that you can possibly do. I mean, if you look at patients in the hospital that have not been taking care of themselves, like sure, the end of their life is like really sad and debilitating, but also at the same time, their family is the one that's really taking the brute end of the force. If you have a patient that's really obese with diabetes, that's spending the last few weeks or months at home and needs to be changed, dressed, taken out of the bed.

1:09:32And if you take care of yourself, it gives you so much more ability to take care of others around you. And so in that instance, I think it's really selfless thing to do is to go and get checked out, start doing all of these things and try to get back on track if you're not already there. So amazing.

1:09:47Gary Brecka:Dr. Moss, thank you so much for coming on the Ultimate Human Podcast. We're going to follow your journey. I hope you'll come back on the podcast again. I feel like there's a book in the making somewhere. Maybe when you get out of residency, you got a little time on your hands. We're going to head over into the VIP. group right now. I got tons of VIPs that are so excited and have a whole list of questions for you. If you're interested in becoming a VIP, just go over to theultimatehuman.com forward slash VIP and I will see you live in one of these sessions. But until next time, that's just science.