Integrative Medicine: male obesity, testosterone, and holistic primary care

February 2014
BY VICTOR S. SIERPINA, MD, ABFP, ABIHM, Distinguished Teaching Professor,
Family and Integrative Medicine, UTMB Health

For over a decade, I have been a subscriber to Holistic Primary Care: News for Health & Healing (www. This is an easy to read, and reliable source of news in the Integrative Medicine space in a format much like the one you are holding in your hand, the Medical Journal of Houston.

Those of you who regularly read this column on Integrative Medicine know that there is always breaking news, recent research, controversies, and evolving practices that we need to keep up with to inform both our patients and ourselves. Holistic Primary Care is published quarterly, done in newspaper format, and is expertly and professionally written. It is a resource that helps us keep up with developments in the interdisciplinary field that is Integrative Medicine. I purchase annual subscriptions for myself plus another dozen or so for my residents and fellow faculty at a truly nominal cost.

The reason I am bringing this up is that when I thought about what to write about for my HMJ readers on Integrative Medicine this month, the topics in the recent winter edition of Holistic Primary Care seemed very appropriate for our audience of nearly 20,000 physicians, health care executives, and other health professionals.

For example, as a source for my weekly column in the Galveston Daily News, I used a Holistic Primary Care piece called, “The Obesity Epidemic: It’s a Guy Thing.” Written by Erik Goldman, the Editor-in- Chief, this is a well-researched, evidence based article on the male obesity problem and its relation to the role of testosterone.

Here are some key points:

  • Obesity or overweight rates for men are at 72% and rising and for women it is 64% and stable. Men also have a higher risk of cancer, diabetes, and heart disease with a life expectancy of 76 years compared to 81 for women
  • This is in part attributable to declining testosterone levels. The decrease is not just as expected with normal aging. There has been a worldwide decline in testosterone levels, sperm counts, and infertility among men of all ages
  • Avoid plastics. These act as endocrine disrupters. Don’t microwave plastic food containers, try to avoid plastic food containers and bottles, and get phthalate-free and BPA-free containers
  • Add Vitamin D. This lowers sex hormone binding globulin thus increasing availability to testosterone
  • Eat more crucifers. These vegetables help detoxify the body through improved liver activity and removal of estrogen. Crucifers include broccoli, cauliflower, Brussels sprouts, mustard greens, and kale
  • Eat more mono-unsaturated fats as these help build T levels. These fats are from avocados, olives, olive oil, nuts, and nut oils
  • Cut carbs almost completely a couple times a week, to less than 50 grams. This can help reduce insulin sensitivity, improve weight loss, and reset your body’s hormonal system to resemble that of our cavemen ancestors
  • Use the 6 inch plate and the myplate. gov for a guide to portion size
  • Squats, pushups, and jumping jacks accelerate burning visceral fat more than running

What biomarker is effective in helping men know that they may be at risk for the hazards of obesity or perhaps have a low testosterone? It is the CYCYP test (“can you see your penis?”). Look straight down and see if you can see your penis. If not, likely you are suffering from visceral or belly fat, which is correlated with lower testosterone.

An antidote to this problem is not necessarily exogenous testosterone administration, though this may be indicated if your level is below 300. My colleague, friend, and chef, Dr. John La Puma has new book out called Men Don’t Diet, Men...Refuel. Dr. LaPuma has long explored the ways health and nutrition are related. His new book offers details on excellent recipes, exercise programs, supplements, and lifestyle changes as listed above that can help main manage obesity and keep the T up. Get a copy. Mine is on the way

So all of that information came from just one article.

To give you a wider feel for the content of the most recent edition of Holistic Primary Care, please allow me to list some of the key articles and a few major points they make:

Link Between Gluten & Obesity Challenges “Classic” Picture. A bariatric surgeon found abnormal intestinal villi in many of his patients without classical celiac disease. A gluten-free diet after surgery improved biomarkers and how patients felt. Home cooking is a great way to a gluten free, healthier lifestyle.

Odd Omegas an Important Part of the Heart Health Picture. You already know about omega 3, 6, and 9. Have you heard about omega 7, palmitoleic acid? I didn’t. It has positive effects in diabetes, inflammation, cancer, and cardiovascular risk.

Root Veggies, Not Other Produce, Cut Diabetes Risk. The title is a bit misleading in that it reports that root veggies are protective but so also are leafy greens. Recommend that your patients at risk for diabetes, those with a family history, metabolic syndrome, and obesity enjoy more beets, carrots, and radishes along with spinach, chard, endive, lettuce, borage, watercress, and beet greens. Blue Momma, Big Baby. A family centered approach is warranted in childhood obesity as maternal depression is correlated with obesity in their offspring.

Are Probiotics Nature’s Antidepressants? Reports on a study underway in New Zealand. This makes sense if depression is in part related to reducing inflammation, as probiotics are known to be useful for this.

Vitamin D Deficiency Raises Obesity Risk. Obese people need more vitamin D to reach normal levels and a low level is associated with marked increased risk of developing obesity.

Beyond Balance: Tai Chi Dramatically Improves Seniors’ Overall Health. While the practice of Tai Chi has long been found to improve fall risk and balance in seniors, many other benefits accrue from this practice. Those listed include reversing disability, improving bone density, mental and emotional well being including depression and sleep, and positively impacting heart disease, heart failure, hypertension, stroke, and Parkinson’s disease.

So that is just a “Whitman’s Sampler” of one issue of Holistic Primary Care. Most of the articles provide references and if you have an interest in further learning on a topic, you can easily find the source studies or authors cited.

I must disclose that though I am a colleague and friend with Editor-in-Chief Erik Goldman and Publisher Meg Sinclair as well as most of the editorial advisory board, that I have no conflict of interest, derive no income, royalties, gratuities, etc. from this fine publication or their advertisers.

I just wanted my loyal readers in the Houston area to be aware of this excellent and enjoyable, credible resource and to encourage you to follow up your interests in Integrative Medicine, whether casual or deeply interested by subscribing to Holistic Primary Care.

2 Holistic Primary Care. Vol 14: 4. Winter 2013.