Episode 27: What Does Your Mouth Have To Do With Erectile Dysfunction?

It’s easy to get on board thinking about how your diet impacts your digestive tract. It makes sense, for example, that eating fast food might leave you running to the bathroom.   

But it’s harder for most of us to make the connection that what’s happening in our mouths has a huge impact on what’s going on for us between the sheets.   

On today’s episode, Andrea is talking with Dr. Amy Killen, an anti-aging and regenerative physician specializing in sexual optimization and aesthetics, about how the oral microbiome is tied to sex.   

They discuss the importance of nitric oxide in the body, including what it is, where it comes from, and how you can increase it to boost the health of your sex life. They also talk about the impact of common vices, such as smoking, chewing tobacco and sugar -- and how all of these can wreak havoc on physiology and libido.   

To connect with Dr. Killen and to download her free e-booklet, "Sex and Skin Top Ten,"go to dramykillen.com.    

On this show, you’ll learn: 

• Why sexual health serves as the “canary in the coal mine” (1:29)
• What sexual health encompasses (2:04)
• How our oral microbiome impacts sexual health (3:17) 
• Broad recommendations for supplements (6:28)
• Effects of tobacco and potentially vaping (10:47)
• Certain probiotic strains that help (14:01)
• The impact of fake estrogens on our sexual health (15:30)
• Inflammatory diet food offenders (22:28)
• Testing for nitric oxide levels (24:16)
• The first steps to improving sexual health (26:38)
• Seeking help with bio-identical hormones (30:01)

Transcript:

Andrea Wien: Welcome to The Microbiome Report powered by drmicrobiome.com and Dr. Mahmoud Ghannoum's new book, Total Gut Balance out now for Amazon pre-order for a December 24th release date. I'm Andrea Wien and today I'm talking to Dr. Amy Killen, an MD and expert on anti-aging and regenerative medicine with a focus on aesthetics, platelet-rich plasma, stem cells, hormones, fitness, and sexual health. She's the Medical Director of BioRestoration Medical, in Draper, Utah, and teaches physician training courses on best practices for using regenerative medicine in aesthetics and sexual optimization. On this episode we dive into how the oral microbiome is intricately tied to gut health and how what's going on in our mouths impacts our sex lives. We also talk about the best foods to eat, to improve your sexual health and how an inflammatory diet like one high in sugar leads to problems like erectile dysfunction. Enjoy the show.

So we recently spoke to Dr. Keesha Ewers about how libido acts like an indicator light for wellness today. Today we're diving deep into this topic and even more detail with Dr. Amy Killen. So Dr. Killen, thank you so much for coming on the show.

Dr. Amy Killen: Thank you. I'm excited.

Andrea Wien: So to start us off, can you tell me a little bit about why sexual health often serves as almost the canary in the coal mine?

Dr. Amy Killen: Yeah. In order to be sexually healthy or at least have optimal sexual health, you actually have to have positive input coming in from all other six main components of health. So that includes, physical health, as well as mental health, and emotional health, spiritual health, social health, and environmental health. So it's like the center, at least for me, it's the center of health where it gives us a good indicator of how you're doing generally in all other aspects of health.

Andrea Wien: Now when we talk about sexual health, what does that encompass? Is it just something like ED, what are really the components of sexual health that we're looking at?

Dr. Amy Killen: Yeah. It's a lot more than just the health of the sexual organs. And that's one thing I talked to patients about. A lot of times patients will come in with some kind of sexual complaint when they come to see me they're having ED, or they're having vaginal dryness, or they're having pain with sex or something like that. But oftentimes as we dive into looking for the source of the problem, the source of the problem actually isn't in the genitalia at all. It's actually something to do with maybe it's a hormonal problem, or maybe they have inflammation because of their diet, or maybe they're post-menopausal and not on hormones. There's all these other things that are causing it that are oftentimes not actually the genitalia. So to me, sexual health includes all of it includes everything that's going on that contributes to your ability to have a healthy sexual relationship. And that includes everything that's in your brain, that's in your body that is contributing in any way to that function of bonding that you have.

Andrea Wien: Okay. Now something think that most people don't really realize is how our oral microbiome, so what's going on in our mouth is really intricately linked to the gut microbiome and how that whole picture impacts sexual health. I think people think how could what's possibly going on in my mouth impact what's going on in my sex life? Can you talk about that.

Dr. Amy Killen: Absolutely. So it's fascinating actually. So one of the key players in sexual health is nitric oxide, of course, nitric oxide anyone who is involved in health probably knows that it's important for all different types of health. But nitric oxide is the main chemical messenger that tells your blood vessels to open up and to let the blood in. So for instance, when you're having an erection, you have to have this nitric oxide signal in the pelvis that tells the blood vessels in the penis to open up, let the blood in and stay there for a while and that's how you get an erection. Of course, women also need blood flow for vaginal lubrication and clitoral engorgement and things like that. So nitric oxide is a big player. So one thing that happens as we get older is that we lose the ability to make nitric oxide ourselves.

So nitric oxide is most commonly made inside the blood vessel. So the cells that line the blood vessels called the endothelial cells. They make nitric oxide from L-arginine or L-citrulline or things like that. But as we get older, we develop inflammation and then we get atherosclerosis and plaque building up in those blood vessels, which makes those cells dysfunctional. And they're not able to make as much nitric oxide. So by the time you're 40, you're making about half as much nitric oxide as you were when you were 20. And that number keeps going down every single year. So the problem becomes that we don't have the nitric oxide that we need to have an erection or to get the blood flow into the pelvis that we want, unless we're getting that nitric oxide from food.

So that's the other pathway is you can actually take in foods that are high in nitrates. And those are things like green leafy vegetables, arugula, spinach, kale, beets are really high in nitrates, pomegranate, chocolate, all kinds of foods have a lot of nitrates in them. You take in the nitrates and then it's actually bacteria in your mouth that begin the first step of converting the nitrates into nitric oxide. So that's where the microbiome of the mouth becomes very important.

Andrea Wien: And I think it's interesting too. We've seen some studies that this nitric oxide aside from sexual health can really help promote colon motility. So how much we're pooping. And I would assume it has to do with the inflammation that's probably reduced when we're going regularly and flushing our system and getting toxins out. And then also you mentioned touched on it, but anyone with high blood pressure, this is also something that we should be looking at and all of that can really be tied to the mouth.

Dr. Amy Killen: Yeah, absolutely. There's actually been some studies done that have shown that people who use antiseptic mouthwash for just seven days in a row will see an increase in their blood pressure because of it. And so basically you're killing the bacteria in your mouth because you're using this mouthwash that's killing them. And within a shorter time of seven days, your blood pressure will start to go up. So that's really important. We also see, and nitric oxide is tied to everything from triglycerides to gym performance and how well you're doing with your workouts. But in sexual health, I have all of my male patients over the age of 40 make sure that they're eating foods high in nitrates and, or taking supplements that can be helpful for increasing nitric oxide because it's such an important thing to think about. And no one really even knows about it in this field.

Andrea Wien: I'm sure that there are individualized supplements for people based on their individual situation, but are there broad things that you can recommend in terms of supplementation?

Dr. Amy Killen: I have no relationship with this brand, but there's a supplement called Neo40, which Dr. Nathan Bryan has made and he's a PhD researcher who's really big in this field that had the most evidence behind it that I've seen as far as increasing nitric oxide levels. It's not dependent on the L-arginine pathway. So a lot of supplements out there that are at the gyms and things that are in your pre-workouts or other supplements they're based on L-arginine and L-citrulline, which can be helpful if you're younger, usually less than age 40. And if you happen to be low in L-arginine, because again, you can make it in your blood vessels from L-arginine, but that pathway becomes dysfunctional as you get older.

So it doesn't tend to be as effective in people who are over 40 or so, or people who have a lot of inflammation. So that's something to think about. Right now, as far as I know, there aren't any probiotic supplements that are directed just at the salivary microbiome. Although I've talked to people about that, something that we definitely need, but it's not something that I think is readily available right now.

Andrea Wien: And then in terms of medications or things we might be taking that could really impact this and have a negative effect on nitric oxide, something like a PPI or an acid blocker. Can you talk about why that might be the case?

Dr. Amy Killen: Yeah, absolutely. So the second step in making nitric oxide from the nitrates, the first step is in the mouth. The second step is in the stomach. When you swallow the nitrites that are made in your mouth. The second step is that your stomach acid then reduces them further to nitric oxide. So you have to have a very acidic stomach for that to happen. And millions and millions of people in the US and worldwide are taking medications that prevent their stomach from making much acidity. The biggest problem players are the proton pump inhibitors. So those are like your Protonix, omeprazole medications like that, some of which are over the counter, some of which are prescription, but so many people get put on these medications because maybe they had some heartburn or they have a stomach ulcer or something, and then they never get taken off of them.

This is not something that once you're on it, people just stay on it. Proton-pump inhibitors have been known, now we know in studies to increase your risk for everything from high blood pressure to heart attacks and strokes. And one of those mechanisms may be because they significantly reduce your body's ability to make nitric oxide. The other medications that are in that same category, but a little bit different are the H2 blockers. And those are things like Zantac or Pepcid, which are available over the counter. They're not quite as bad as the PPIs in this regard, but they do affect stomach acid and can certainly affect your ability to make nitric oxide as well.

Andrea Wien: And what about things like smoking, chewing tobacco, or even vaping. Do those have any impact I'm sure on the oral microbiome, but does that have any impact in what you're looking at with your patients?

Dr. Amy Killen: Yeah, absolutely. I don't know so much about if they affect that nitric oxide directly, but smoking is one of the biggest contributors to erectile dysfunction in men and certainly in sexual dysfunction in women as well. So anything that is going to cause that inflammation and vasoconstriction, which is the narrowing of the blood vessels is going to affect your sexual function. So that's everything from high blood pressure chronically to smoking, to high sugar diets and diabetes being overweight, not exercising. But smoking is one of the things. If I have patients that come in and they're smoking, that's one of the first things we work on because I have young men 30 year olds or young women who are smokers that have sexual dysfunction just from smoking. And they don't realize that that's the cause of it.

Andrea Wien: Yeah. I actually had a client myself come in and he had ED, which he was very reluctant to tell me about. His wife actually was in the appointment with him. And she said, "You have to tell her, you have to tell her that this is going on." And he was a tobacco chewer, he chewed tobacco all of the time. And he was coming to see me because he had started to have some heart-related incidents, not heart attacks, but just some difficulty breathing, racing heartbeat, things like that. And he was concerned because his family had a history of heart disease and he couldn't possibly see how his chewing tobacco could impact his ED.

And we got into this discussion and talked about nitric oxide, and I still don't think that he fully believed it. I think he was just on the fence that we were trying to get him to eat more vegetables, but we can see it very clearly in the literature that that's what's going on.

Dr. Amy Killen: Yeah, absolutely. It's a fairly common cause in younger people, of course, older men as well. But I have several younger patients who come in their thirties and they're pretty healthy otherwise, but that they smoke and they've noticed ED from that. And if we can get them off smoking, it's great because obviously you're going to have improvements in the ED, but then you also have cut your risk for heart disease and lung cancer and Alzheimer's and strokes, and all the other things that smoking was known to do.

Andrea Wien: Do you the same concern about vaping.

Dr. Amy Killen: I don't know as much about vaping, certainly nicotine in itself is not necessarily a bad thing. Sometimes in small doses, it can be helpful. And again, that has been shown to have some nootropic tendencies. But I worry about vaping just from a health standpoint from some of the other things that are going on with vaping in lung... this weird lung disease that's out there that's happening with vaping that are killing a lot of people. This is a big problem in Utah right now, but I don't know that it's been studied specifically for ED, but I think it's probably something to be concerned about just because it doesn't seem like it's necessarily super helpful just for general health.

Andrea Wien: I think just in terms of raising inflammation in the body is something we always want to stay away from and anything that could potentially do that, which vaping would certainly fall into. We've talked at length on the show about the gut-brain axis and how neurotransmitters like serotonin are really produced mainly in the gut. But I think people are probably less familiar about the sex hormones and how things like estrogen, testosterone, progesterone are all impacted when we have an inflamed gut. Can you talk about that connection?

Dr. Amy Killen: Yeah, absolutely. So that's definitely a gut hormone connection as well. It's just like a gut everything connection. I feel like the gut it's at the center of so many things. With testosterone, for instance, there's actually a pretty good study that was based on the GELDING theory where basically it looked at obesity and low testosterone. So we know that obesity is a risk factor for hypogonadism or low testosterone production in men. And in this study they basically said what is the reason for that? And one thing that they found is that obesity, of course, is in a lot of people associated with inflammation and this inflammation is going to cause an increased gut permeability. So you get endotoxin migrating into the body from the gut where it's not suppose to be there.

And that endotoxin actually directly affects testosterone production. So it goes into the testes, it decreases production of testosterone in the testes. And then it also affects the pituitary gland and a number of the hypothalamus and pituitary hormones, including luteinizing hormone and FSH, which are responsible for fertility. So they found that there was a direct link between this endotoxin creation or migration and low testosterone because of different mechanisms. And that things like probiotics and healthy diets and changes in food consumption can change that dramatically and increase testosterone levels just by that single mechanism, which I think is pretty cool.

Andrea Wien: Yeah. And I think we talked a little bit about probiotics on here and how so many of them are transitory. Are you finding that maybe like spore based probiotics are more effective for that conversion, or is it really just any probiotic that could be right? Are there certain strains, I guess I should say that are better for this?

Dr. Amy Killen: Yeah. I tend to use the spore based private probiotics in these patients. I also work very strongly with them on diet and obviously avoiding things like sugar, and inflammatory foods, and processed foods and GMO foods. And getting a lot of healthy vegetables is going to go a long way as well and also doing prebiotics can be helpful as well, but the testosterone piece is a big one. The estrogen piece is also very interesting as well. There's a collection of estrogen metabolizing bacteria that are in the gut as well. And depending on the number of those bacteria, you can either make more active forms of estrogen or less active forms of estrogen.

So some people, for instance, people who have like polycystic ovarian syndrome or things where maybe they have too much estrogen they may have more of these estrogen producers, these beta glucuronidase producing microbes in their gut versus others. Or some people may have less like the postmenopausal women they'd have oftentimes less of these estrogen producing microbes in their gut, which can contribute even more because they're also not making estrogen in their ovaries. So it's a very interesting little dance that these microbes are doing in terms of making estrogen and progesterone, or contributing to the way it's processed in our bodies.

Andrea Wien: And what's the impact of the xenoestrogens. So these are fake estrogens we might be taking and are things that act like estrogen in the body from things like cosmetics or environmental toxins. How are those playing into that dance?

Dr. Amy Killen: Yeah. Certainly, estrogens can be problematic. We see that in men, especially, but it wouldn't women as well. It's hard because there are some phytoestrogens, estrogens that come from plants that can be helpful, in postmenopausal women, for instance, when they're not making very much estrogen. Maybe adding in some phytoestrogen can be helpful and it can reduce some of their post menopausal symptoms. But at the same time, we don't want to be getting too many of these estrogens because then you can have overload of estrogen symptoms and that can contribute to in men you can get gynecomastia where you get breast tissue swelling, or you can gain weight and get obesity from it. So it is something that should be watched I think certainly in the things we put on our skin and the environmental toxins, all these things. Many of them are these hormone dysregulators, or they affect our hormone cycles and should be... we're very careful about looking into.

Andrea Wien: I think sometimes people get confused too, when they hear that you mentioned plant estrogens can often sometimes be helpful even. So these are things like soy things of soy based products like tofu and things like that. Are you recommending people use those in moderation, or stay away from them completely if they have certain issues?

Dr. Amy Killen: I use them sometimes there are a lot of foods that have phytoestrogens, everything from certain types of grains and legumes to even fruits and vegetables can have different types of phytoestrogens in them, soy as well can. Certainly, you have to be a little bit careful with soy and some people soy can affect them in a negative way. And you don't want to get too much of that, but for women who are post-menopausal, some of these phytoestrogens I think can be helpful in improving symptoms that are going along with that. I also do a lot of just bio-identical hormone replacement in my practice. And I like to be able to use those hormones as well. I find that it's a good way to be able to strategically personalize how much estrogen we're giving someone. And it's the exact estrogen their body's making. So it can be really helpful for some people.

Andrea Wien: That's a topic that we haven't really discussed at all on this show. So bio-identical hormones versus synthetic hormones and why one might be better than the other.

Dr. Amy Killen: Yeah. There's so many reasons. So biomedical hormones, basically just that they're the exact same molecular structure as the hormones that you make in your body. So the estrodiol for instance, is the bioidentical estrogen. It's one of the estrogens that you make. And that could be given as... We can give it to you orally or give it to you in other ways versus the other we say synthetic hormones, but really any of these can be synthetic. It's not so much about where it's made. It's what the chemical structure is. But for instance, the estrogen that was used for a long time in hormone replacement for women was actually a conjugated equine ester, which came from course urine estrogen that was created for women to help them with menopause symptoms. Those synthetic not like our own body hormones are much more inflammatory.

The progesterone, especially the progesterone that was in non bioidentical hormone for a long time, was known to be very inflammatory. And actually that was the piece that ended up causing increased risk of heart attacks, and strokes, and breast cancers, and these other things in the big study, the women's health study that was done years ago that got so many more women off of hormones was really not because the hormones themselves were bad. It was because of the way we were giving them these synthetic non bio-identical hormones were very inflammatory and we're increasing our risk for a lot of things. So in my practice, we use only bio-identical hormones. So it's basically testosterone, progesterone, and estrogen, that's exactly like what your body is making. And we're able to give you that back without causing any of the inflammation that the other versions did.

Andrea Wien: Got it. And I have to imagine too, that the microbiome interacts differently with the non bio-identical versus the bio-identical.

Dr. Amy Killen: Yeah. It definitely does. I don't know all the specifics about it, but I know that the non bio-identical, the progestins specifically just cause mass amounts of inflammation, it's everywhere. And I don't know if it's specifically in the gut, but it's certainly something that we saw big spikes in some of these other pieces like the breast cancer, and the strokes, and the heart attacks. And that's where everyone got really scared and were like, "We need to get these women off of these drugs." And all of a sudden all the women stopped taking their hormones. And we've swung the pendulum back a little bit at this point where a lot of women are taking hormones, but they're doing so in a way that's healthy for them. And it's not going to be harmful in the long run.

Andrea Wien: This episode is brought to you by drmicrobiome.com, the website of our resident scientist, Dr. Mahmoud Ghannoum and his new book, Total Gut Balance, fix your microbiome fast for complete digestive wellness. Dr. Ghannoum has spent over 40 years studying our microbial communities and has now condensed his insights into an entertaining book that dives deep into the fungal colonies in your microbiome. Why candida gets a bad rep, and his advice for a diet plan complete with recipes that's happy for your gut based on years of clinical research. He also lays out a handy test to take. So you can find out where on the health meter your microbiome is at today. And then he gives you recommendations on how to better balance your gut in 24 hours with supplements, lifestyle, and diet. Total Gut Balance: Fix Your Mycobiome Fast for Complete Digestive Wellness is now available for pre-order at Amazon and Barnes & Noble, just simply search Total Gut Balance book to find it. The book will be shipped and released on December 24th.

Do we know at all, even with the bioidentical hormones now, how I'm assuming that when you take them, you're taking more into your gut than you would, if your body was just producing them naturally, or maybe it's all at once versus more of a drip effect if your body's making them naturally. Does that have any impact on gut health? Have we seen anything with that?

Dr. Amy Killen: I haven't looked into that specifically. I will say that there are a number of different ways to take these hormones. So the oral consumption of estrogen or estrodiol is something that is done as is progesterone, but a lot of these other things are not taken orally, they're taken sublingually as troches or similar, or they're taken transdermally as creams, or even as pellets where we put them under the skin and they get slowly absorbed. Because the oral forms in some cases just don't work as well, they do get taken up... Either the gut microbiome affects how effective the absorption is, or they get absorbed, but then they have to go through the liver pathway and the liver will decrease the bioavailability of some of them. So a lot of the hormones that we use in my practice are not taken orally, they're taken other ways.

Andrea Wien: Okay. That makes a lot of sense. I want to come back around. We were talking a little bit about inflammatory diet and just foods in general. So when you say inflammatory diet, what are some of the biggest offenders that we're seeing food-wise in terms of sexual health?

Dr. Amy Killen: Sugar is a big one of course. And I talk to patients about how it's not just sugar, like table sugar, but obviously it's any food that gets made into sugar directly in your body. Any of the simple carbohydrates, the breads, the pastas, the cereal that you thought was healthy, but now you learn it's not. So it's any of those simple carbohydrates and sugar are I think the top thing that I worry about with patients. But other things as well artificial sweeteners can have a big impact on gut microbiome. And of course it can have a big impact on things like diabetes risk as well, highly processed foods that are going to have a lot of the processing agents can be harmful as well.

And then every patient is different. I have some patients that are sensitive to gluten or dairy or soy or things like that, but I have some that are not. So a lot of times we'll do an elimination diet for a couple of weeks and get rid of some of the most common offenders. And then we'll start to add those things back and see how they react to those things.

Andrea Wien: And what about something like coffee, especially for the oral microbiome? I know, obviously we know it's not great for our teeth, but is it impacting the oral microbiome that we know of?

Dr. Amy Killen: I haven't seen anything about coffee. I haven't looked into it specifically, but I haven't seen it. And I tell patients depending, again, on the genetics of their coffee metabolism. Some patients do fine with coffee, it actually can be helpful for them. And then some patients coffee is going to actually be harmful and it's going to increase their risk of cardiovascular disease. And also things like ED. So some of that is based on genetics and such, but a glass or two a day is probably fine for most people.

Andrea Wien: Let's talk about that testing piece a little bit. So how can people find that information out or even going back to the nitric oxide, are there tests that people can do? Are there blood tests where we can learn how much nitric oxide is in the blood?

Dr. Amy Killen: So the nitric oxide, the easiest way to test for it right now is a salivary test. There are salivary strip tests that you can actually just buy them on Amazon, if you look up nitric oxide test strips. That HumanN, which is the company that makes Neo40 also sell some of those test strips. But basically you just basically put some saliva on it. Because nitric oxide itself is such a... It's only around for a few seconds. It's a very fast, quickly metabolized molecule, it's hard to test for it in the blood easily, but the salivary strips are pretty good. They basically are light pink, middle pink, dark pink, depending on how much nitric oxide you have in your body at that time. And you can do tests, you can eat a bunch of beats, or arugula, or salad or things like that. And then an hour or two later test your nitric oxide with your saliva. And you can see an increase in your levels, which I think is pretty cool.

Andrea Wien: Is there a level that you're looking for generally?

Dr. Amy Killen: On those test strips, I tell patients just to try to aim for the dark pink, which I don't know what the actual levels are in the blood. But dark pink is better than light pink, especially again in the older patients, your patients who are really needing that nitric oxide. Because if you think about it as you get older and you get atherosclerosis, the blood vessels get more narrow, obviously. And so for erectile dysfunction, for instance, that you have less blood being carried already to the penis because the blood vessels are more narrow. And so those people really need the ability to vasodilator open up those blood vessels with the nitric oxide because they're already aren't carrying as much blood. So they're reliant on that vasodilatation. So it's important for everyone, but especially the older that we get.

Andrea Wien: Mm-hmm (affirmative). And I think something that some people might not know is that drugs like Viagra and some of these other things are actually working on that nitric oxide. So they're keeping that around longer in the blood so that then you can have the erection, but if you don't have any nitric oxide to begin with those drugs aren't going to work.

Dr. Amy Killen: Exactly. That's exactly right. And that's what I see... I have a lot of men who they've been on Viagra for 10 years, it's worked great for them they've never had a problem. And all of a sudden, the last couple of months, it's not working as well, or they're requiring higher and higher doses for it to be effective. And a lot of that's just nitric oxide. They don't have enough nitric oxide for the Viagra to work on. And if we can just get those levels up, then the medications will still work for them.

Andrea Wien: That's great. So if someone came to you and wanted to improve their sexual health, what's the first few things that you would tell them to do just baseline?

Dr. Amy Killen: Baseline things are just improve your general health and that's easier said than done of course. Losing a little bit of weight, getting physically active, exercise is a huge one. We know that even just 30 minutes a day of walking can reduce erectile dysfunction risk by about 40%. So just a moderate amount of exercise, certainly more is better as far as exercise goes and ED. But the value of exercise can not be overstated when it comes to sexual health. So exercise, diet, I think that the mind component is also really important. For women, especially, but also for men. But I see so many women who are generally healthy, they don't really have a lot of problems. Their blood flow is not the issue, but they're having sexual dysfunction. And a lot of that is coming from stress, and cortisol, and emotional and mental issues that are at play that are really affecting their sexual health more than the physical components.

Andrea Wien: And for those women... Like, for example, I was on a series of bioidentical hormones. Is that a place where you would go first or is it more so like, "Go try to decrease your stress levels with meditation, with a yoga, things like that." Or is it, "Let's see if we can get some of these hormones up." For example, if you have bottomed out cortisol, which is what my situation was.

Dr. Amy Killen: Yeah. It depends on the person and certainly what their preference is. A lot of people by the time they come to see me, they've already tried all kinds of other things. They're fairly well read, and they've been doing meditation, and they've been walking and exercising and they're at the end of their rope. So a lot of times those people will go ahead and just start... will try some of the hormone replacement at low doses as we continue to try to make improvements in lifestyle. And then some women or some men as well will come in and they haven't tried other things, or they really want to work on lifestyle first and try to avoid having to be on medications. And certainly in those people, I'm happy to work on those things as well.

Andrea Wien: And when you're putting someone on hormones, is that something that's typically a short term solution or there are some people that are on it forever?

Dr. Amy Killen: It depends on the case. For instance, if you have a woman who is, maybe she's just gone through a stressful situation, or maybe she's just had a baby, or things like that, where there's a transient change in hormones. It may be that we just need to be on hormones for a short period of time. If it's a cortisol problem, for instance, like you talked about with you then you probably don't need to be on either medications or even supplements like the adaptogenic herbs and things long-term. It's really about, "Let's get these levels up normal." And then hopefully whatever else has gone on in your life, stress wise has been handled or is improving and then you can get off of them.

But for some hormones, like for men with testosterone, for instance, once they start testosterone replacement, oftentimes that is a long-term medication because taking testosterone exogenously is like when I give you testosterone, then your body's not going to make as much of its own testosterone because it's already getting it from somewhere else. So that's something that you want to be aware of is that you start taking it. And then if you stop it, your body's not going to make as much afterwards, at least for a period of time. So it may be a commitment to take some of those medications.

Andrea Wien: Okay, great. And obviously this is something that you want to do with a licensed practitioner. Are there certain doctors or practitioners who are better suited to do some of this bio-identical hormone work? Is it conventional doctor, can I just go to anyone?

Dr. Amy Killen: It's becoming more and more commonplace now for conventional doctors to know about at least the basics of some of bio-identical hormone replacement. When I first got started in this about seven or eight years ago that wasn't the case, but there are more and more people doing it. I also think that functional medicine doctors could be great, some naturopathic doctors do hormone replacement. People who've gone through training in anti-aging medicine or longevity medicine, or some of these tracts will have knowledge about these hormones as well.

Andrea Wien: And you do a lot of work in terms of stem cells and some other more innovative technologies and techniques. Can you just briefly touch on those and how that might play into everything that we're talking about?

Dr. Amy Killen: Yeah, absolutely. I do quite a bit of work with regenerative medicine, regenerative medicine, basically meaning using your own body's ability to repair itself and heal itself. So I use stem cells and other biologic growth factors, PRP, platelet-rich plasma, exosomes, which are all basically things that we can use. We can inject into different parts of the body, including into the sexual organs to increase your own body's regenerative capacity, increase blood flow, increase nerve regeneration, repair cells maybe that are not as functional. So I do some of these regenerative procedures in combination with other regenerative strategies like shockwave therapy. For instance, for men GAINSWave is one of the protocols in the United States, but basically using shock waves or high intensity sound waves to help your body repair its own tissue.

So I have a lot of men with erectile dysfunction or Crohn's disease where we can actually do these a series of these treatments and we can reverse their erectile disfunction, so they don't need medications anymore. And that's, I think pretty awesome. And other things that women like vaginal lasers, or vaginal radiofrequency devices, or even some of the take home pelvic floor strip simulators, all of these things are basically just helping your own body to repair itself and improve the health of those tissues. So that maybe you don't need the help of other medications or outside assistance after that.

Andrea Wien: That's so interesting. Do if there's any work being done in terms of gut diseases? So things like celiac or Crohn's where there's been extensive damage to the gut wall?

Dr. Amy Killen: With stem cells? There's quite a bit of work. I don't know, specifically with celiac, but I know for Crohn's for sure. There's quite a bit of work being done in the stem cell regenerative medicine space, looking at auto immune disorders because the stem cell therapies they're immunomodulatory. So a lot of times when you're getting... like even IB stem cells, for instance. You could get your own stem cells taken from your fat and you can then get them put into an IV and you could see changes in the way that your immune system is that inpatients who have all different types of autoimmune disorders have seen benefit. There's still multiple ongoing studies and is still considered to be quite investigational, but lots of really positive things in the auto immune space having to do with stem cells, as well as some of the GI diseases, the IBS and the Crohn's, and, and some of those things. I know that they are definitely looking at treating those with stem cells.

Andrea Wien: That's so interesting. And I wonder if one day we'll get to the point where we can retrain our immune system for people with autoimmune disease. For example, I have celiac to not be attacking our own body and retrain through stem cells or some other means it's very interesting to think about.

Dr. Amy Killen: I think absolutely. I think that we're not quite there yet, but there's all different... the stem cell space is such a big one and right now we're at the beginning of it, but as we get better and better, we'll be able to develop actual stem cell lines for all different things. For instance, you can take your skin cells for instance, and then turn those skin cells back into essentially cells that act like embryonic stem cells that are able to do all different things. And then they can basically then turn them down different roads, turning them into maybe they're neuro stem cells, or maybe they're gut stem cells, or maybe they're a pancreatic stem cells. So essentially they're able to formulate cells for all different types of the body. So I think eventually we'll be able to use those stem cell therapies in specific ways for all different diseases.

Andrea Wien: Yeah. Well, we'll certainly have to have you back on in a couple of years when this technology has advanced and we know more, and hopefully it can point to some very interesting findings with gut health. So thank you so much for coming on the show today. If people want to find you learn more about your practice, how can they do that?

Dr. Amy Killen: So the easiest way is my website is Dr. Amy Killen, which is K-I-L-L-E-N. I'm also very active on Instagram at Dr. Amy B Killen. I post a lot of things on there and then I have several different practices, but you can find me on my website and I can direct you to the different practices as needed.

Andrea Wien: Okay, great. And we will link to all of that in the show notes at biomeblog.com. Dr. Killen, thank you so much. Have a great day.

Dr. Amy Killen: Thank you. You as well.

Andrea Wien: As always thanks so much for listening. To pre-order Dr. Mahmoud Ghannoum's new book, Total Gut Balance, head to Amazon and search Total Gut Balance book. You'll find information in the book on the best diet to feed your microbiome. Until next time I'm Andrea Wien.

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