Season 7, Episode 8: Men’s Health, Antiaging and Regenerative Medicine with Dr. Adam Silberman

Evelyne Lambrecht: That’s amazing. Yeah, it’s actually funny. I think you were the president of one of the student clubs. Is that right?

Dr. Adam Silberman: I helped to start a number of the clubs at best year. I wasn’t ever president, but definitely involved.

Evelyne Lambrecht: Okay, well, I remember reading something about you and I thought, okay, this is someone I should know. So I reached out to you and we had fish tacos. And then we’ve been friends and colleagues ever since.

Dr. Adam Silberman: It’s been awesome to follow your career and have you in every practice location that I’ve been involved in, as well as having you involved in business conversations has also been extremely valuable. The insight that you just offer, both clinically to providers, but also from a sort of pragmatic business standpoint is, I think, pretty unique for someone in your position to do. And we all really appreciate it. At least I do.

Evelyne Lambrecht: Well, thank you so much, Adam. That means a lot to me coming from you, especially someone who also has an MBA. So thank you.

Dr. Adam Silberman: It’s got to work for you to work. It’s all got to work, you know.

Evelyne Lambrecht: So my first question for you is what is lighting you up this week?

Dr. Adam Silberman: My kids 100%. I’ve been taking them to school early. We’ve been playing soccer in the mornings so that like 7:45, 8 a.m. early morning temperature here in San Diego is just perfect right now. And we get after it. My kids are seven and nine, and we’ve got this little 30 minute soccer game go in almost every morning before school. I love dropping my kids off, sweaty and it just puts me in a good place in the morning to start with getting clinical.

Evelyne Lambrecht: I love that. And how great everybody gets physical activity. Morning sun. Get it all out of the system. That’s awesome. All the naturopathic things. Dr. Silberman brings over a decade of training and clinical experience to his patients and their families, specializing in the use of advanced lab work, diagnostic analysis, bioidentical hormone replacement therapy, antiaging peptide therapy, natural medicine, and ultrasound guided joint injections to address disease and optimize health span. He earned his bachelor’s in psychology from UCLA, his doctorate in natural medicine from Western University and an MBA from Murdoch University in Perth, Australia.

So, Adam, I’m curious, what made you want to become a doctor and pursue naturopathic medicine specifically?

Dr. Adam Silberman: There’s a rose and a thorn in this story, for sure. We could start with the rose. The rose is that my wife actually introduced me to naturopathy medicine. Her name is Serena. She also sees clients in our concierge practice, and I met her in Perth, Australia. She was a practicing naturopath at the time, and I really had no exposure to it. Obviously, her lifestyle is every any, any naturopathy doctor is right. We live the medicine first and foremost. And so being her boyfriend and then living together, I basically received a crash course in everything from making herbal teas and tinctures, poultices to nutrition, lifestyle, movement, and even some of the more hot, cold therapies, contrast hydro. The whole deal. So it was, an experiential learning opportunity from the beginning.

And I was very performance oriented at the time. I was surfing pretty aggressive waves in Australia, and I was also playing tennis out there at a competitive level. And so having that type of support really elevated my performance. And I noticed that in my 20s. So that was the rose. And while I was out there, my, dad passed away at 52 years old. It was tragic. It was, complications of obesity. And since this is a medical audience, right. We think he had, you know, an embolism and, and passed away very rapidly. But at 24 years old, I had come back to San Diego to see my dad and found him almost 300 pounds, bloodshot eyes. So happy to see me. Obviously unwell. And my dad was just a bundle of joy. The guy was a model of how to live in a show up, tell the truth, be kind, relationships matter most way. I mean, that was his litmus test for everything. Everyone loved my dad.

And he saw a lot of doctors. And all of his doctors told him he was well, when I came home, I was shocked. You know how it is when you don’t see someone every day. When you see them every 3 or 4 months, it’s easy to notice changes. And I told them I was like, dad, I’m really concerned about your health. I don’t want my next trip back to be for your funeral. And it was. I’m an only child. It was for his funeral, and I delivered his eulogy at 24 years old. It completely changed my life.

At that moment I was like, okay, I’ve found my purpose and my passion, which is to provide a better way for people, in their health journey for themselves and their family so that they never have to unnecessarily go through an experience like that because my children are nine years old. This thing that impacted me is having a ripple effect in my entire life, and it does so in every family. My dad’s state of affairs was completely, completely reversible. It could have been completely managed. I mean, this is a guy who ran, I think, at least 14 marathons. He was an extremely fit person and had a transition in his life and his health slipped, and none of his doctors talked to him about it.

His cardiologist, his primary care physician, even his alternative medicine providers, his acupuncturist, his therapist. Nobody was having the hard conversations with him. And, I’m lucky that I had a really great relationship with him. We talked all the time. We had a great conversation a week before he passed away, but, this definitely didn’t need to be the case.

Like, right now, I’m looking after his dad. His dad is 96 years old. My grandpa, while living here in San Diego, still able to walk, still able to see my grandkids. He comes over on Wednesdays and we all play music together. Grandpa Dick. So that was just a huge wake-up call for me. It never gets easier to tell the story because it just breaks my heart. And it is a driving factor in every decision I make as a clinician. In terms of working directly with clients and also any, consulting or business relationship I get into, the outcome has to be kind of associated with are we putting in place tools and tactics and strategies for people to engage in what we do so that that type of thing doesn’t happen unnecessarily ever again?

Evelyne Lambrecht: Yeah. Wow. That’s beautiful. Thank you so much for sharing that. So I want to hear a little bit more about your practice today, what that looks like. So tell me about your typical patient. And I also know, since we have known each other since you graduated from school, you’ve worked at different practices. You’ve worked in primary care, more of the regenerative medicine side. Who’s your patient now? Who do you like working with? Dr. Adam Silberman My patient now is, there are basically three types of patients that I’m seeing primarily. As any provider knows, we see all sorts of people, because we get referred friends, we get referred colleagues, and they have different conditions. But, I’m seeing primarily men who are in their 30s and above that are interested in cardiovascular disease prevention, cognitive decline prevention, and performance optimization.

So they are interested in getting advanced blood chemistries done. Functional medicine testing when indicated, advanced imaging and screenings, and then having programming put in place that includes nutrition, movement, mindfulness, purpose, supplementation, drug therapies, compounded therapies. And Regen, as well as opportunities for international travel to do procedures that may not be available in the United States.

So those are those typically are high achieving entrepreneurial individuals. Many of them own their own businesses or are part of executive teams for large companies, that’s like a big percentage of my patient population. Now, most of the time we’re seeing their wives as well, or partners. And because I have my wife in the practice, we make a really good mix of being able to provide medical interventions in a similar manner to the men that we work with. And we have this opportunity for the women in our practice to connect in, right, with another woman to have that relationship that is unique female to female, which as I go deeper and deeper into practice, I think that it is valuable to have that as well. I think that it can live together.

So we offer great concierge annual packages for individuals. So a man themselves or a female themselves, but we offer a discounted rate if we work with a family, and then we can add on either like parents or siblings at preferred rates, because, to my point, I want to work with the whole fam, because of my own experience with my dad. And I know if I can keep Nana and Papa around a lot longer, getting up and down from the ground and being more engaging, that has an exponential impact on my clients as well. So we do have families that we see that are like three generational, where we see grandparents, parents and then grandchildren as well. And that’s just, that’s just awesome. Does that kind of answer your question?

Evelyne Lambrecht: Yes. Well, so you work with the CEO types, executive types, but you also see a lot of athletes correct in your practice?

Dr. Adam Silberman: Yeah we do. And we glean from each area of our specialties to improve how we work with the other cohorts. So we have a track where we work with high school, collegiate, semipro and professional athletes. Obviously the biggest difference in those is classification. And what types of drug therapies or interventions we can use. However, we use advanced biometric tracking. We do pretty high level testing and we integrate in with usually a full care team in and around these athletes.

Right now we have, we just had a couple athletes in the Stanley Cup. We have you know, we see Major League Baseball athletes when they come off season here to San Diego to rest, right, and recover. We do a lot of testing on them at that point in time, and down in and then they have us on access during season, to support it. Really. It’s a lot of work, honestly. It’s a lot of recovery programing, a lot of support in that piece. That’s kind of where, I think the real benefit of, of what we do can, can shine. And then when they retire, we then have like this, this transition sort of bridge that we do with them, where we do a full assessment of kind of where they’re at physiologically. And then we can transition them into a life after athletics that still feels fulfilling and gratifying. Right. So they don’t they don’t kind of slide.

We also have, Evelyne, we work with Task Force Dagger, which is a nonprofit that helps support special operations forces to see naturopathy and functional medicine doctors. So I’m one I think I’m one of one on the West Coast that works with these docs. I mean, that works with these individuals, whether they’re inactive duty, and we also get referrals from the Seals Futures Foundation, and other nonprofits that work with Special Forces. So that’s been a part of my practice since 2017. And it’s a really great group to be involved in.

We have a service arm, because we work with local fire departments to work with our with Rancho Santa Fe Fire, with Vista Fire and, L.A. County fire, some people up in North County, northern California, and we create protocols and programing for those guys to help mitigate the risks associated with their profession there. So they’re a unique cohort. So we obviously do that at a very discounted rate for them. And we also like I give a good amount of time to supporting them in lobbying for different types of testing and treatment options from the cities that they serve. So, yeah, that’s a really fun thing to be a part of and extremely rewarding And we kind of laugh every time like a dude comes on the telemedicine with like a big old mustache, you’re like, oh, right, here we go. Like this fun.

Evelyne Lambrecht: I want to go back to something you said about the athletes and working on their recovery during the offseason. And I’m curious, how do you work with them? Like what trends do you notice that are common among athletes in different sports? And what do you do for the recovery aspect? And does that also kind of translate to the work that you do with quote unquote, like the regular population, or is that totally different?

Dr. Adam Silberman: Yeah, it’s connected. The biggest difference between I think an athlete and a non athlete is that athletes have an off-season.

Evelyne Lambrecht: And we don’t.

Dr. Adam Silberman: And yeah, we don’t have an off-season. We have an on season. Yeah. So when we yeah. So it’s actually really nice. Like to work with an athlete in the off season is cool because we can bring on a chef or a nutritionist. And we can program a much more diverse food offering that than what they get in season.

And we can make sure they’re getting every color of the rainbow every day. We can really max out these really high quality sourced, organic protein and vegetables. We can really hit them with nutrient rich food. They’re also, we also get them on training programs that are a little bit more restorative versus, what they’re doing in-season. Unless they need to do something specific. Right? Like sometimes the NBA guys need to gain weight prior to getting back into the season. So then we have to tailor things a little bit specifically to what we’re trying to achieve.

We use biometric, testing on every athlete we work with. So we use an Oura ring is my preferred tool for that, for looking at heart rate variability. But certainly we use chest strap or we use a WHOOP. They’re they provide good data as well. And it’s sort of optimize the HRV we can talk about that in more detail to you a little bit later. But we’re doing coherence breath work. That’s what we’re supporting these athletes in learning. You know, one thing I learned from working with the Special Forces is that they use breath to center themselves when they’re in positions of uncertainty. Or they needed to shift their physiologic state quickly. We can demonstrate those tools to athletes and the general population. And that plays a role in how we can augment our lived experience to optimize in the moment. That’s a really powerful tool. And HRV testing and training can help improve that. And in doing so, it also improves, like your nighttime heart rate variability and other metrics.

Evelyne Lambrecht: You just brought up a couple more questions for me that I’m thinking about. I want to go back to the heart rate variability, but first, so you have all of these metrics, right, that are coming in from say, Oura or whatever else you’re using. You have all of this data. And it makes me think that a lot of times, physicians don’t actually have access to all of our data. And, I just went to a lecture at Scripps Research Institute by Eric Topol yesterday, and he wrote that book, gosh, probably over ten years ago, The Patient Will See You Now. And, I think the premise was I read it so long ago, but it was like, we have all of this data and we’re showing up to the doctor with it, but there’s no integration of all of that information. And it’s also in silos. Like, I know that you work with people’s care teams, especially when it’s for athletes, but how do you take all of that data and what do you do with it? How do you organize it?

Dr. Adam Silberman: We get data on everyone, all of our clients. I have a pet peeve about showing up to appointments and a provider not having done their due diligence to meet me with the same level of understanding that I have about where I’m at, with them and everyone’s been frustrated with that, right?

Like the nurse calls you, they ask you a bunch of questions. You filled out a bunch of paperwork, and the doc shows up like, hey, what’s up, Evelyne? And, oh, you’re here. Awesome. Good to see you. Like, how can I help you? Like, what’s up? And you’re like, oh, blah, blah, blah. I want to read my labs. Like, okay, well, let’s pull them up and see what they say. Like it’s like, no, like that doesn’t work.

So we have it built into our business model, to allow for the time that it takes to get the data that we need, from either the client or their doctors, get it synced up. Right. If we’re using a WHOOP we get synced up to their portal. If it’s a Freestyle Libre, we make sure that we’re linked up over Libre review. All of that happens before I see somebody, and then I have time to review it before the appointment. Alongside any notes that I’ve had, if they’re established or if they’re new, our intake paperwork, which is not very long, by the way, but I think it’s very focused and extremely effective.

I get all of that. Clients love that. Patients love that. If you have to charge an extra 50 bucks or 75 bucks to offer that service, right, so that your staff can collect all that data and you have like a good ten, 15 minutes to look at it ahead of time. Like it doesn’t take like once you’re once you’re efficient, it doesn’t take that long.

As a newer doc, you should give yourself plenty of time, right? Because each client is a huge opportunity for you to learn, however, when you get into the rhythm. When you seen thousands of people, you get into this rhythm. And that’s probably one thing that maybe sets us apart as a practice is like, I’m never going into an appointment, ever like, oh, what are we doing today? Like, ever. My staff knows to ask, have you seen people, like, give us stuff like, tell us, get us, get this to us?

And I know that the two things that what working with executives. Because it’s how they manage their team, right? They want to show up and their time is the most important thing. They want to show up and I’ve literally had clients come to me from some of the like THE people that are doing concierge medicine in the United States. Right? The ones that everyone knows about, and were unhappy because the doctor that they were working with in that practice would just show up and be like, well, what are we doing today? Like, you look pretty healthy, like, what’s up? And it’s like, no, no, no, we’re not paying $40,000, $60,000, $100,000. We’re not anywhere near that price. But these are what people are paying for concierge medicine from some of these very highly high profile individuals. And they’re not getting that. And so like that’s probably the exception that we’re seeing. Right. We all see the exceptions of each other and we give grace for that.

But it reminds me all the time that our clients time is precious, right? We should be spending time ahead of time getting things lined up that we can come in there and knock it out of the park. We integrate the experience. And then the other thing that we do really well is afterward we summarize because usually in functional medicine and natural medicine, we’re doing a wide array of things at once. And they don’t have to get done right away. But what has to be done is they need people need to be kept informed of like where things are at. That’s what CEOs get. They CEOs get updates. These quick little five word updates right? Whatever it is. Supplement unavailable. We’re finding a new one for you. Just little things. That’s how we manage our clients. And it creates a really strong therapeutic alliance. But there’s definitely more texting and messaging going on in our practice now than I’ve ever done in any other practice before. But because we’ve evolved into a higher touch experience.

Evelyne Lambrecht: Right. Yeah. Great tips in there. I’m curious, how are you aggregating all of that data? Because it’s all coming from different sources. What are you using to look at it holistically?

Dr. Adam Silberman: It’s depends on the client. We like Heads Up Health. Heads Up Health is great for our CEOs and athletes because they create it. We can create a dashboard, they can upload their own stuff if they want. They can play around with it and make it look how they want it to look. They can either pay directly to Heads Up for that service or they can pay us. And then we have an account. So we like Heads Up Health for a strong patient dashboard. It works well for us. Interestingly, I have a number of clients now using Function Health, which is a cash pay lab service that provides functional medicine lab testing and we can then log in together into the client’s function health dashboard, and we can go through it, go through it together. It provides trends. We have clients that use Life Force. It’s another sort of lab testing they offer. They offer provider care too, but it’s not as advanced as our as what we do is functional medicine by the doctors. It’s good. It’s really good. Life Force is good. But what we do is a little more personalized, right?

Evelyne Lambrecht: Yeah.

Dr. Adam Silberman: But they have a great dashboard and then yeah, like nothing’s perfect, but also, if you don’t want to pay for those kinds of integration tools or deal with them, it’s pretty easy these days to like pull up three different tabs on your screen right. Maybe it’s got their Whoop data. It’s got their glucose monitor. And it’s got their most recent lab test that you can trend out right. All the lab companies trend it out for you. And if you’re prepared you can have a very fluid conversation about those things, ticking back and forth between each one with people, Dexa scan or whatever. You can just have them up and just tick around. But I know that we’ve talked about Biocanic, they also have a dashboard in a platform EMR integrated. We just don’t, we’re just embedded in our, our EMR in terms of scheduling process, you know, just like everybody else. And so which is a pretty big deal.

Evelyne Lambrecht: Yeah. Thank you for sharing that resource. So I’m curious like what are some of the top things you look at aside from like HRV, what are the top things no matter who is in front of you, whether it’s a CEO or an athlete?

Dr. Adam Silberman: I mean, there’s probably a lot of the same stuff that everybody does. Right? But our general workflow, is we run an integrative blood panel, we use Quest because we have a pretty good cash rate. And since we just use Quest, they have progressively like continued to lower our cash pricing. Every three, four months, they’re like let’s go back and ask for a little bit more off, a little bit more off. So, we run a pretty comprehensive blood panel through Quest. Cardio IQ, so advanced cardio metabolic head to toe. We do sex hormones, thyroid. We run key nutrients like iron, B12, vitamin D, key inflammatory markers, homocysteine. We run LPL-2 now, interestingly, more than we did previously just because there’s been some data on it alongside homocysteine and CRP is really being a predictor of cardiovascular progression.

And we try to keep it tight. We don’t run everything at once. But we do a good blood panel. We try to do that three times a year on clients if we can. Most comply with twice a year. But as any provider knows, trends are so valuable for our clients. And, it’s honestly something that I think should be in every client’s mind as to your value and why it’s important to stay with you for a long time. The amount of trends I pick up within physiologic range that then have come to a diagnosis of disease, it’s not functional. Just disease is a lot. It’s a lot. And so it’s so useful to have these regular tools. If you can get blood work on people three times a year, I feel like that’s a reasonable. And it does yield trends with proper workup and you’ll catch stuff.

So we run blood panel on everybody right away. We are running personalized genetic testing. We’re using 3×4 right now on everybody. And it’s cool. It sets the context, a little bit of how to have a conversation about their family history and does provide some insight. I think that without current testing, it’s tough to really define what genetics mean for an action item for a client. However, I just time and time again, I notice that people connect into their story. They connect into their timeline a lot more intimately with that piece as well. And a lot of our clients are searching for explanations and it does help the conversation. Definitely. So we run personalized genetics run blood panel on everybody. If they’re willing, I’ll run an adrenal stress index. So either we’ll do a Dutch right, so we get those hormone metabolites, and we get another look at the estrogen and progesterone kind of through the urine. I like blood for testosterone. Period. Even though it comes up in the Dutch. We could have a conversation about that another time. But then the adrenal, the adrenal piece of the Dutch is great.

Or we run an adrenal stress index, through Access or, ZRT. Whatever makes sense from a price standpoint. The data sets are pretty similar. And that’s usually kind of where we that’s usually sort of where we start with people. That gives us like a good understanding of their health history, hormones, adrenal health, cardiovascular disease risk markers, rate, a window into their nutrient status.

And it’s really, we kind of we’re not a run everything practice right away. If we’re seeing in that basic blood chemistry that they’re B12 and folate are kind of suboptimal, then maybe we’ll reflex to a micronutrient, but I won’t do it before we make the nutritional changes that are obviously impacting those things or implementing a strategy. Now, the exception is sometimes with the athletes, they want a real time supplement strategy from the beginning. So with the athletes, sometimes we’ll move that that micronutrient up. Because it does help us in formulating like an NSF certified stack for them. Or if we’re formulating personalized supplements for them that are getting tested and validated externally, like they’re getting their own stuff. We’re doing that for them. Then the micronutrients are really useful because we can just dial in exactly the milligram quantities we want, everything and all the deal.

So that’s where we kind of start. And then we’ll set forth, a series of imaging recommendations for them. Most of our male and female clients, since they’re especially if they’re in their 40s or above, we’re getting a CT coronary angiogram on them, so not your calcium score, but CT coronary angiogram. We are lucky in San Diego because we have a facility here that is one of the best in the country at the image. The AI interpretation is only as good as the image you get. So it’s awesome. We use either Clearly or HeartFlow to lay in an AI interpretation.

And, I’ll tell you right now, that the person that pushed me into it was Brauner Onworker, who, as you know, has been, you know, he was the first physician to, take me in under his wing and train me, and I see him as my primary mentor in how I practice. He pulled me aside one day. I was like, Adam, like, you’ve got to start running these scans on people because a lot of the metabolic rate risk factors that we are tolerating, right. Like you got a totally passable bloodwork. He’s like, I’m finding moderate pathology in these CTCs and we’re needing to accelerate care in advance, and you need to focus really intentionally on the heart. And I’ve noticed the same thing. Right. And I’m confident that we’re saving lives, running it. So CTCA in my mind is like, above any other image. That’s like the one. It really is.

The other thing where we’re doing more is full body MRI. The reason I’m moving forward with more full body MRI is not actually for the tumor screening. It’s because now with new groups, like there’s a group called CoreViva, they have a center in Newport Beach. But what they are doing is, they are giving visceral adipose readings, looking not only in the abdomen, but also in the heart. So they’re taking like, the viscera, they’re evaluating the viscera, and they are providing insight into that. They’re also providing insight into the quality of the muscle tissue. And they’re providing insight into the joints and quality of the joints. So, arthritic, derangements otherwise, and a much more detailed brain analysis.

So what I’m seeing out of the full body MRI is really like a very nice, head to toe on musculoskeletal quality and concerns, visceral adipose, readings that are going to be extremely accurate. And then the neuro. The head and the brain piece, we’re getting more insight than a neural point on its own would give us. So that probably was an area that I wasn’t really pushing full body MRs that much on my clients. If they had really strong family history, then I wasn’t denying them. But I was certainly prioritizing the other testing that we do as functional medicine doctors and naturopaths, and also treatment, putting that money towards other things. But I’m now moving more towards a full body MR.

We also do DEXA, we rely a lot on DEXA scans for our clients to do body comp analysis as well.

Evelyne Lambrecht: Very important.

Dr. Adam Silberman: So that’s pretty much what everybody’s getting that in our practice. Male, female because they’re super useful tools not just to assess but, to my previous point, like to test and track, right? I want to know that that my therapies are making a difference.

Evelyne Lambrecht: You brought up so many things there. So I’m going to pause for a second and go back to some notes that I took and go back to a few things. So thank you for sharing about the full body MRI, because I know they can be kind of controversial and sometimes lead to false positives, or cause people to worry about things that are benign. And so are you saying the CoreVIVA that you described, like the other ones like PreNuvo, and I forget the name of the other one right now, that they don’t do that? Is that what you’re saying?

Dr. Adam Silberman: Correct.

Evelyne Lambrecht: Okay. Interesting.

Dr. Adam Silberman: Your SimonMed scan, your PreNuvo scan. There’s a couple of differences, which is why I’m really excited about the CoreViva. One, their radiologists that review the images are all on staff physicians. They’re employed. They’re not contracted to. They’re employed, they’re available. The radiologist is available, free of charge as part of the cost of the test, to review your results with you or with your physician.

It is also categorized as diagnostic testing. This is this is different to other groups that have this, well, we’re not diagnosing anything with this imaging. We’re just giving you kind of like a scan or something. The quality of the machine they’re using. It’s kind of like this the next level. And these are diagnostic scans, like this is diagnostic now which is important. So you’ve got more radiologist involvement. You’ve got committed radiologists because they’re not contracted. They’re employed. You’ve got availability of radiology. You’ve got improved machinery. And you’re getting these additional insights that you don’t typically get on the comprehensive body scan from for PreNuvo, for example. You don’t you don’t get the level of visceral out of adipose scoring. You don’t get looking at cardiac fat. Right. Because a stat that can line the Cod the heart tissue, it’s also has a viscera and or muscle quality. You don’t get a really detailed dive into your knee joints and the arthritis that potentially could be there. They do spine with PreNuvo but it’s kind of like a little bit more of, it’s looking at a few things that we’ve always wanted to see for a while.

And it’s a little bit more expensive. I think it’s going to be a little more expensive maybe than the PreNuvo, though. But like I said, you’re getting a better screening. You’re getting a better machine. And the radiologist involvement is really great.

Evelyne Lambrecht: Thank you for sharing that resource. And of course, then, for the physicians listening, it’s like we have to know what to do with all of that information, right? If you’re recommending that test.

I’m glad you brought up Cleerly as well, we’ve mentioned it a couple times on the podcast during cardiovascular episodes. I did an event with them here in San Diego a couple years ago and had a physician speak, and I think it’s just such an amazing tool, and I think AI in general can be so helpful for aggregating all this data and making sense of it to help us make better clinical decisions. It’s just kind of like medicine is sort of like lagging behind, like we have all these tools, but it’s just then what do we actually do about it? So thank you for mentioning that. That’s Cleerly.

And then you mentioned the imaging facility. Is that Image One?

Dr. Adam Silberman: Image One. Yeah. And in addition to Cleerly there’s also a scan AI group called Heart Flow that’s also excellent. They look at some different things. And so, honestly, in our complex cases, we’ll do an image at Image One and we’ll actually run it through both. We’ll run it through internally. To get a really good idea of like the plaque accumulation and characteristics of these excellent in that arena.

And then we’ll run it through the Heart Flow to get an understanding of flow rate in these vessels and having both data sets helps us to make a really strong decision alongside cardiology of how to approach someone’s heart health and then we can track it but yeah Image One is the group.

Evelyne Lambrecht: And we can get into that more a little if we have time to address the cardiovascular piece. I also wanted to go back to that we talked about a while ago. What are some of your top ways to increase HRV? And I’m also curious because you’re looking at so many patterns, do you see a connection or certain patterns in the adrenal stress index related to low HRV?

Dr. Adam Silberman: Absolutely, 100%. The tool that we use most commonly to improve HRV is coherence, breath work and visualization. In and around that, there’s a, there’s tool by Heart Math called inner balance. Put it on your ear. It can help using breath and visualization to strengthen that variability that, above anything else, has been the mainstay of our work in that arena.

Obviously, recovery to activity ratios, sleep hygiene, mineral status, mental health and fortitude. These all play a role. Hormone health. The whole thing kind of revolves and shifts HRV as anyone who’s studied it would know. I find that those two strategies though, that coherence breath work as well as visualization play the biggest role.

Interestingly, maybe not everybody’s doing this. We work with both stabilizing breath strategies with people, but we also do fire you up breath strategies with people to like to get people psyched in the zone. We want control. So we want sympathetic and parasympathetic control. So we train. We train both which is super fun. And whenever we will see improvements with those strategies, on supporting people’s sleep and also their ASIs. Breath work and visualization, targeted supplementation and then training strategies, exercise programming and timing are probably the three biggest things that I’ve seen shift the needle for adrenal index indices.

Evelyne Lambrecht: And about how quickly do you notice a difference in the HRV?

Dr. Adam Silberman: Oh, six weeks.

Evelyne Lambrecht: Okay. Easy. That’s great.

Dr. Adam Silberman: Yeah. Quick. When we have a guy in the off season, for example, or a woman in the off season, we’ll see significant changes in their heart rate variability within that window.

Evelyne Lambrecht: That’s great. You also mentioned supplements in there. So I’m curious like what are some of your favorites in this area.

Dr. Adam Silberman: Adaptogens are where we shine in herbal medicine and natural medicine. I think, you know, this year, some of our most impactful tools that we see big shifts for folks, safe and effective. So, you know, that could be ashwagandha. That could be, rhodiola. We use, we use ginseng in male clients particularly, but also female clients.

Those are, those are some really lovely herbs. Holy basil. For a long time. Right. Especially used with providers. Providers seem to connect them with holy basil. Passionflower. So the I think the adaptogens are a great tool here. I also really enjoy using mineral formulations and electrolyte formulations for clients just given the food and water quality concerns that we’re all navigating.

We do hair tissue mineral analysis. And I find in hair tissue mineral analysis a really useful tool to help adjust and correct mineral imbalances.

Evelyne Lambrecht: Yeah. I think that’s an often overlooked part of it, right?

Dr. Adam Silberman: Yeah. The mineral mean the minerals specifically. Do you see that when you talk to or like when you see what providers are doing?

Evelyne Lambrecht: Well, sometimes I just forget because it’s so basic. And we know that they have like the inverse connection with metals. And we know that people are deficient. And obviously we have to figure out like why are people deficient. Right. Is it just a diet thing? Is there a gut issue? But I started taking minerals myself recently because I was deficient in some of them, and I was sort of surprised or a lot surprised. So I think it’s just like a foundational thing that we forget about.

Dr. Adam Silberman: And it’s easy to it’s kind of easy to integrate into your program. It’s not a big lift. It’s not a heavy lift. And most people that we start working with, mineral, it’s almost like putting salt on food. Like you add minerals to your protocol and everything works better.

Evelyne Lambrecht: I love it, so true.

Dr. Adam Silberman: It really is like, don’t you act like you probably didn’t shift too much of your other program. You just pop these minerals in it, like, oh I’ll just give it a little more.

Evelyne Lambrecht: I want to talk about a few more things, and I can’t believe we’re almost out of time, but something that you mentioned to me when you and I were chatting is like men in their 40s and 50s. They often represent these lost decades, where they’re relatively healthy on the surface. But then, underneath, things are brewing, right? Because we know a lot of these neurodegenerative conditions, cardiovascular disease, all these things are brewing for decades prior. Can you talk a little bit more about that?

Dr. Adam Silberman: Men’s health is, in general, what’s interesting is, in my career, more and more, I’m getting clients who are searching for someone who focuses in men’s health. It’s very interesting that, like that is an expert in men’s health. And I love the trend because, yes, the, the 40s and the 50s for men is typically their lost decades to their own health, wellbeing and longevity. Typically, we’re working. We’ve got young kids, we have families, we have parents that we are supporting.

And, it’s a whole thing. And what it results in is inconsistent doctor visits, if at best a treading water approach to nutrition, supplementation, training and lifestyle.

And these are the windows, these are the decades where we can really be laying the foundation for muscle mass, joint health, cognitive function and bolstering these guys to the point where when they hit their 60s, we can maintain and when we hit the 70s or early 80s, when it becomes really hard to keep muscle mass on and the things you want in place humming. Right. We have a really robust reservoir, starting in the late 50s or early 60s is totally doable. And it doesn’t take a ton of time. I just feel like if guys would be willing to get into the clinic and hop on these protocols before they start feeling really, really bad. It would just make a huge difference.

And I’m starting to see it. I’m starting to see that change. But I hope that we get these, you know, to all the other doctors that listen this podcast, please start doing PSA on like public service announcements, not the blood test but the like. This is important too. But tell your female clients or tell your social media community that like dude, gotta get guys in even though they’re like well there’s nothing wrong. Like every time I see somebody are they’re always like, well, my wife sent me like, well, what? What’s going on? Nothing. Okay, well how’s this? How’s that? How’s this? How’s that though? It could be better doc. Or tell me a time when you were working with a coach and you felt your best or whatever. Like what happened to that? Well, I think I’m doing okay. It’s like, well, do you want to be okay or do you want to be great? And so you know the answer. That’s always, I want to be great because they’re great at other things, right? They’re great with their family. They’re great with their kids. They’re great looking after their folks. They’re great in business, and they’re just whatever with their health. And that’s just inconsistent. It’s a pattern.

And I think that I think that it’s a key thing to shifting, not only men’s quality of life as we age, but also this thing that’s happening in younger men where the men are going through an identity crisis period. The particularly younger men are going through this identity crisis where it’s like, who am I now? There’s a shift in the roles and responsibilities in our society, which is phenomenal and amazing and men are looking now for their intention and their purpose, and I’m confident that if these adults, these dads are setting an example of proactive work on their health and wellness, that that’s going to lead to more engaging experiences with their children, right? Doing adventures, just that alone, that will then translate to a shift in what we’re seeing in this young male population.

Evelyne Lambrecht: Yeah. Excellent point. I want to talk about testosterone a little bit because we hear that testosterone is going down in all men. I know a lot of men come to you specifically, like, doctor, give me testosterone. But I’m curious, what are some of the underlying reasons? But then also, what are you doing to address this? And I’m kind of curious, aside from or maybe even before TRT, are there other things that you’re doing or doing concurrently with that? Because in my opinion, like it’s not without some level of risk like doing that. So I’m curious what your thoughts are on that.

Dr. Adam Silberman: We’ll talk about kind of like the general male like maybe the exact right. Because when we work with the Special Forces guys or the firefighter, they have obviously unique histories and exposures that are extenuating circumstances. So they’re addressed in a different way, but usually, there are significant nutrition and lifestyle adjustments that can be put in place to understand and I kind of talk to the guys about it like this. Typically, they’ll have a number, they’ll come to you with a number. They’re like, dude, my testosterone is this. And I’m feeling these things. So I’m convinced it’s this, right?

And you’re like, look, it’s probably part of it. But we don’t know what your true physiologic potential is because we’ve got all this static in and around the test. We’ve got poor eating habits. We’ve got under training or overtraining or improperly training. We’ve got suboptimal sleep. We’ve got low HRV and irregular stress management. We’ve got challenges with your relationships. And, we need to first like acknowledge that, that these things are contributing to that number. And whatever we do, we’re going to be working on optimizing those things. And the way that we do that, right Evelyne is we use herbal medicine, we use specialists, right? Coaches, nutritionists, we use, you know, my body therapists, whatever we need to do to really start to play this out, red light therapies, other types of modalities so that no matter where we go with the testosterone, we’re really optimizing the sort of foundations of health piece as we move, not only going to give us an idea of what their real physiologic potential is, it’s also going to allow for the appropriate elimination of anything we do, keeping them safer.

And we’re going to get a really clear understanding of other potential comorbidities right through testing. Like hypothyroidism in men is a thing. And so you should always screen for it. And there are some other pieces that can be sort of directly impacting why they’re feeling, like they think they feel because of their testosterone.

So, that’s sort of where we start. And our integrative panel will rule out significant pathology that would be, one, give us an understanding of how we can treat them. If there’s primary versus secondary and hypo the whole deal. And also sort of help us understand kind of the other factors that are at play there alongside the stress adrenal stress index and a good nutrition and lifestyle journal. If we have sleep data, we kind of have everything we need right there because it’s like, look, give a guy as much hormone as you want. But if they’re apneic, you’re not going to get where you need to get with them. I’ve got anemic guys, I have hypothyroid guys, and you fix that stuff and they’re like, whoa, I feel great. And their numbers go up and it’s like, oh, cool. Like, good thing you didn’t just go to the clinic across the street and just get a shot, right?

So, we’ve got to look at all those pieces. We have to put in play minerals, electrolytes, protein, creatine. Hydration. These are foundations. We’ve got to make sure that their nutrients are supported and nourished right through food and supplementation. Have to. There are herbs that we can use to support the way men feel. We talked about some of the adaptogens before, but ashwagandha is a great tool. Mark. Strong ginseng, those are probably three that I see that really move the needle. There are others, you know, that tonga ali and tribulus and there are other herbs that can be helpful. Minerals like boron can be supportive of the testosterone to free testosterone, relationship. They certainly are not harmful. However, I think that focusing on maybe just a couple of herbal interventions alongside sort of the core mineral electrolyte protein sort of dynamic, making sure they’re getting enough healthy fat. Those are great places to start with every guy.

Now, you’re going to have a test that comes back and you’re most likely going to have everything you need when you see them the first time. If you wanted to get going on something higher level, right, because you’re going to have your hematocrit and hemoglobin, you’re going to have private PSA, your private total and free testosterone. You have a sex hormone binding globulin. You’ll have, maybe you’ll have a DHEA as well which can be helpful. You’re going to have kind of like everything you need. And I think that the world of men’s health, there are conversations about how to actively target a man’s testosterone levels. Certainly, the majority of the literature lies in using testosterone itself in different dosing frequencies and strains. However, there is a robust set of literature for using endogenous agonists to support a man’s testosterone production itself. Most commonly Clozapine and hCG, are used, Adderall is also used.

There is definitely, in the people that come and see me, they have a desire to, maybe desire to try to maintain their own production for as long as possible.

Evelyne Lambrecht: Yeah. What’s the range that you like to see? I’m sure it depends on different ages.

Dr. Adam Silberman: I’m a big proponent of kind of like the Venn diagram of decision-making in that we have labs, and we have a patient perceived symptom picture and improvement rate. I really do lean on both, very equally when I work with men, I think it’s important to do so. That being said, I definitely want guy’s numbers to be above a total of 650. Definitely. And if their free testosterone can be in the upper quartile of normal or higher, that’s great.

Where I historically see men are like, whoa, doc, I’m on right now. This is awesome. Usually they’re in the 800s or above. Usually they’re somewhere between 800 and 1,000. That’s usually where they’re starting to feel like the lights are turned on. They’re not experiencing hair loss or acne, significant testicular shrinkage or some of the other things that can happen when we can get there with foundations of health and supplementation, for sure.

We can get there in cases with, hCG or clomephene on its own. We can get there with cases of that. HCG or clomephene alongside testosterone. And we can get there with testosterone on its own. We’ve seen an evolution in how we do this over time. You know, since I started practice in 2016, we were doing things differently than we are now. So to me, that’s very reassuring because we are all communicating with each other. And there are data points being created on this particular topic. So I feel confident that when I start a guy on a protocol that I’m kind of doing minimal effective dose, tracking lab work and perceived improvement every 8 to 10 weeks in the beginning and then, ideally 16 weeks thereafter. And that keeps guys safe.

One thing I do with every man, I don’t know if everybody does it, but I make sure that they go and give blood. They go and donate blood regardless of what strategy they’re on. If they can donate blood three times a year. Not only is it good for humanity, and it also helps and keeps their hematocrit hemoglobin down and not everybody’s levels shoot up like that. So it’s necessary. But I’ve kind of just you like because like you mentioned before, I was in such a high volume clinic, I was seeing lots and I just kind of made it like a blanket, like, all right, if you want to work with me, you know the blood bank’s going to be your buddy. And this is what we’re doing? Yeah. This is your, we call it your mitzvah. This is your mitzvah. You go, you give blood. It’s good for you. It’s good for the community, do it. So is that was that kind of helpful?

Evelyne Lambrecht: Yes, definitely. Yeah. You shared so many amazing clinical pearls and I feel like, throughout this conversation you’ve shared such great information and such thorough information. And we could have gone into so many different directions. And we do have to wrap up. Unfortunately, we didn’t even get to talk about like mental health in men, which is such a such an important piece too.

But, I want to wrap up with some rapid fire questions. So my first one is what are your three favorite supplements for yourself?

Dr. Adam Silberman: The supplements that I’m using consistently now are minerals. I take a mineral blend, I take electrolytes, and honestly, like creatine rehydrate has been in my stack for a decade along with some and I love it.

Evelyne Lambrecht: Great. What are your favorite health practices that keep you resilient and balanced?

Dr. Adam Silberman: It’s just been really lifestyle focus now, even with my own clinical practice. So focused time with my kids twice a day is a nonnegotiable for me. Connection with Serena, my wife, on a daily basis where we can just take a moment, even if it’s a hug, or a short walk. We live right near the beach and so that connection to the people in my life that I love really feels good to me because the rest of the day, I’m, I’m having connection with other people. So I make sure that I give that to them.

I love the breath work that I’m doing. I really think that the breathing strategies just help put me breathing and visualization. I don’t know if everybody does this, but when I do, our Regent procedures, when I start working on someone, like when I’m about to inject into a joint or something I like mentally go to a place of like, this is very hippie dippy, but I go to a place of love and compassion in my heart. I think about sometimes I think about when I used to play music with my dad, and I go to that feeling and then I inject, I think that there’s something there that helps us stay centered and intentional. So I’ve been trying to do those things.

Lisa Portera Perry, if you ever had her on the show or I’m sure people know Dr. Perry, she’s a legend. But she used to talk about every time, touching a door handle, every time you touch a door handle. Because usually you’re then exiting or entering with a client. To take that moment to do the breath and setting yourself. So it’s an interesting little strategy that could be brought into everyday life. Because if you think about it, like anytime you’re opening a door to go someplace, it’s an opportunity to be present for that, that specific thing. So using the breathwork is something that I like to do, connecting with my family uniform.

And then like I told you, the third thing is playing music. I’ve been getting into playing with the band, we’ve got band practice tonight. I’m frothing so, so, so doing those things and really supportive for me. I’m pretty active. So training is something that I just have on point.

Evelyne Lambrecht: That’s great. And last question we’ll try to keep this one brief. What is something you’ve changed your mind about through your years in the field, which could also be not a brief answer.

Dr. Adam Silberman: This is like real talk. The use of the use of appropriate pharmaceutical intervention in cardiovascular disease prevention for high risk patients.

Evelyne Lambrecht: Tell me, can you expand on that just a little bit more?

Dr. Adam Silberman: I see that there are we now have a variety of therapeutic interventions that are pharmaceutical from more specific blood pressure medications all the way through to really advanced cardiac modifiers. It’s not just the statin world anymore or whatsoever. And running more cardiac imaging, having followed patients for longer in my career, I’ve become more comfortable with the blending of our foundations of health, our supplements and herbal medicine, and the use of targeted multimodal drug therapy in curbing the inevitable in a number of these clients, which is premature death from cardiovascular disease.

These strategies are not just for the individuals that are not compliant with all the other stuff. It’s not like, oh, well, I guess I couldn’t get you to do this because of all these things and now we’re going to give you these drugs. I would encourage people to especially those that are I’m always reticent of any drug intervention. I would just encourage people to continue to look at it, and assess it.

Evelyne Lambrecht: So it’s not an either/or. It’s a both/and.

Dr. Adam Silberman: Right. Yeah, exactly. And there is working with a preventative cardiologist who has helped me, significantly in balancing that with the other things that we do for these people. The bioidentical hormone replacement and all the other beautiful techniques that we have, that blend of the coronary and scram those tools and then using these higher level interventions earlier is something that I’ve been, I’ve been doing more in, in my practice. And that’s, you can hear it in my voice. I’m just like, oh my gosh, you know, am I going to get put on the flame here?

Evelyne Lambrecht: No, no, I appreciate you sharing that.

Dr. Adam Silberman: That’s probably the most the thing that is has changed the most from when I started practice to now.

Evelyne Lambrecht: Thank you so much for sharing that. And Adam, thank you so much for being here today, for sharing so generously with me, with our audience. I really appreciate you.

Dr. Adam Silberman: Appreciate you. Evelyne. Any opportunity I can to support you because you’re awesome, and our community is a blessing. So thank you for the time.

Evelyne Lambrecht: And thank you for tuning in to Conversations for Health today. Check out the show notes for resources from today’s episode. Please share this podcast with your colleagues. Follow, rate, or leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations For Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence based, cutting edge research and practical tips.