Dr. Eric Serrano's ideas may be considered controversial by many, but he's regarded highly by many of his peers when it comes to sports nutrition and supplementation.
Dr. Serrano is known for looking where others don't when it comes to common roadblocks in health and fitness. He's a details guy, and he'll make you think about every aspect of your nutrition and supplementation program.
We had a chance to sit down and talk to him recently. Here's what he had to say about a number of topics.
JPC: Dr. Serrano, you've written a lot about stress, overreaching, and overtraining. How do you detect overtraining?
Dr. Serrano: When you're talking about overreaching and overtraining, you've got to be careful because most people will just look at your training program and say you're fine. Well, they don't look at your sleeping habits. Are you married with kids? Are you dating someone behind your wife's back? Are you going to church? Are you working? You've got to look at all these factors.
To gauge stress, you can always measure cortisol in the blood, and now you can even measure its conversion in the urine, which gives you a better picture. Research also indicates that measuring amino acids is effective. Specifically, the glutamine to glutamic acid ratio should be a certain number.
If I measure that in the blood, I can tell right away if you're overtraining. I discovered this ratio after reviewing a number of research papers, but it's my little secret!
JPC: What's your opinion of the Adrenal Stress Index test by Diagnostechs? This is a saliva test used to measure free cortisol rhythm throughout the day.
Dr. Serrano: Saliva testing for cortisol is more accurate than blood, and urine is even more accurate than both of them, but it's also more expensive. The body gets rid of cortisol by degrading it to cortisone which you can then measure in the urine. For most purposes, though, saliva is good enough and the ASI test by Diagnostechs is pretty good.
JPC: By the way, would you check progesterone levels in a male, and would you ever prescribe it to a male?
Dr. Serrano: The only time I'd check progesterone levels in a male is when their Testosterone or DHEA levels don't return to normal, or they're depressed, or they experience joint problems. Then I'd check it. Progesterone is actually considered the mother hormone.
JPC: I thought Pregnenlone was the mother of all hormones?
Dr. Serrano: Well, what comes after pregnenlone? Progesterone, of course. I'd rather prescribe progesterone than pregnenlone to bypass an unnecessary step. Why build a house from the basement when you can start on the main floor?
I've tried this with a few males with low Testosterone and it has worked quite well. Just 100 mgs and they feel great – no more depression, no more headaches, etc. So I do think it has merit in certain cases.
Now, it can get quite complicated because progesterone can increase androgen levels (i.e. anabolic hormones) or it can increase cortisol (i.e. a catabolic hormone). I can manipulate those pathways somewhat by giving the patient just a bit of cortisone to encourage progesterone toward the androgenic route.
JPC: Hold up there, doc. If you give cortisone, aren't you adding fuel to the fire?
Dr. Serrano: Oh, good question! Think about it this way. If you have a patient who's under an extreme amount of stress and they're already producing quite a bit of cortisol, by giving them just enough exogenous cortisone, it can help lower their endogenous cortisol production significantly through feedback inhibition. It's a way of tricking the body!
JPC: Ah, much like the trick you use with hyperchlorydic patients (i.e. people who produce too much stomach acid): you give them a bit of HCL to lower their own production.
Dr. Serrano: That's right.
JPC: What about the controversy that DHEA is over-prescribed today, and that after a month of use, in most males it'll increase estrogen levels and in most females Testosterone. Is this true?
Dr. Serrano: This is very true, although it depends on the dosage as well as the size of the person. For instance, you don't want to start the average female on 50 mgs of DHEA right off the bat. Always start low and work your way up. Even a 25 mg dose is too much in most cases. Start around half that amount and work up in 5 mg doses for best effect. For males, I start them at 25 mgs.
JPC: Should you cycle off DHEA after a certain period of time?
Dr. Serrano: If you're below the age of 40 for males and 35 for females, then you should cycle DHEA. Above those ages, there's no need to since you're not producing that much anymore.
Keep in mind that it's very common for people to use DHEA and Testosterone together. This is a mistake. What happens when you use both of them simultaneously? They spill over into estrogen!
JPC: Okay, while we are on the subject, what are the best forms of DHEA (i.e. sublingual, oral, etc.) and Testosterone?
Dr. Serrano: For DHEA, sublingual is best. For Testosterone, creams and injections work best, but I do prefer the cream form.
JPC: Which cream – Androgel or Testim?
Dr. Serrano: Here's the lowdown between the two: Androgel will result in higher total Testosterone levels while Testim will give you higher free levels which is actually more desirable. The other difference is in the smell. Most females will be attracted to guys using Testim rather than Androgel.
JPC: Interesting! What are your views on Testosterone replacement and anti-aging therapies then?
Dr. Serrano: I believe in Testosterone replacement and not just for males. Testosterone is actually the most under-prescribed medication for females. I may give a female a packet of Testim or Androgel to use every four or five days depending on her situation (symptoms, menstrual cycle, etc.).
Melatonin is another anti-aging remedy. People who are depressed and have a hard time sleeping at night often have very high cortisol levels. Melatonin can help counter the ill-effects of cortisol and induce sleep if taken at bedtime. The problem is that most people take too high of a dose. Again, start low at around 1-2 mgs and work your way up from there.
JPC: How does a guy boost his girlfriend's or wife's libido through the roof without her knowing it? Just kidding... unless you have an answer.
Dr. Serrano: Well, there's a sneaky way of doing it but you didn't hear it from me. Theoretically, if a man was to apply some Testosterone cream to his body and, while it's fresh, hop into bed and give his partner a great big hug (and maybe hold onto her a few seconds longer than normal), there's a good chance that a small amount may accidentally rub off on her.
In fact, they've studied this in real life with Androgel, believe it or not, and it did significantly raise the partner's Testosterone levels in no time!
JPC: I know you've presented whole seminars on this topic, but can you briefly describe the diagnostic methods you use to evaluate hormones?
Dr. Serrano: Well, you have urine, saliva, and blood. If I have a choice, I prefer urine because it gives you the breakdown of metabolites over the past 24 hours. Blood will only give you a snapshot of that particular time and it's not always truly indicative of what's happening in your system.
If you were watching a football game, for example, and your team lost, your blood work would show elevated cortisol and depressed Testosterone values for that particular time. So how do you know if this is a normal reading or not? Urine is more accurate in this manner.
JPC: Let's discuss the thyroid gland for a second. If TSH levels are high, how do you go about improving thyroid function by natural means? And just for a review, what about if TSH levels are low?
Dr. Serrano: You know, I've played around with this quite a bit, but if someone comes along with high TSH, I don't fool around. It's just too important. I place them on Armour Thyroid which is actually a natural thyroid source. No supplement is as effective.
In fact, if it's very high, I'll use Thyrolar first, which is a synthetic version of T4/T3, and then introduce Armour Thyroid once their levels normalize. And I've had some cases in my office where I've been able to wean patients off of Armour Thyroid after six to nine months of use so they're not on it forever. They just needed a bit of nutrition (i.e. raw material) to feed the thyroid gland to get it working again!
If TSH levels are very low, you need to find out why they're hyperthyroid. Is it Graves disease? Do they have cysts, etc.? Actually, many people can present with normal TSH levels but their thyroid can still be out of whack. Many drugs/medications are culprits for this.
Here's another aspect that you may not have thought of. Why do people gain weight when they quite smoking? One of the primary reasons is that nicotine increases the conversion of T4 to T3. Well, when nicotine is no longer there, T3 levels begin to drop!
JPC: Do you feel that the morning body temperature test is valid to gauge thyroid function? It's been criticized quite a bit lately.
Dr. Serrano: In order for it to be accurate, you must test it at the exact time, place, etc. If you don't standardize the test properly, it'll affect the results. That's why it has been criticized so much.
JPC: Okay, how about the adrenals? You've mentioned in the past using a product like Standard Process Drenamin to regenerate the adrenals. What is the exact protocol that you use in this case?
Dr. Serrano: If I have someone that's highly stressed, I'll start them on hydrocortisone (60 mg for a male, 40 mg for a female) and they do great!
This works extremely well for patients with fibromyalgia as well. Remember, these individuals are working their adrenals so hard to make cortisol that the hydrocortisone will literally and figuratively ease the stress! It will help the adrenals rest. There afterward, I may prescribe a product like Drenamin.
I don't really use protocols in my office because as soon as I say I have a protocol, someone is going to come around and mess it up. My theories will go down the drain and one patient can throw everything out the window! It's always different for everyone. I may say that out of hundred people, fifty or sixty can use this protocol. That's a safer approach.
I generally check the adrenal gland function by measuring DHEAS, cortisol (urine cortisol if possible), T4, T3, TSH, estrogen, progesterone, and (total and free) Testosterone. I'd then screen for symptoms.
JPC: What about using something like licorice root to extend the half life of cortisol?
Dr. Serrano: Oh, I have some beautiful info for you. Okay, oral licorice will extend the half life of cortisol, but at the expense of what? Your androgenic hormones. That means lower Testosterone!
However, if you topically apply licorice cream to an area, guess what happens? You lose fat in that area! I'm not making this stuff up – it's been confirmed through ultrasound measurements.
JPC: Speaking of losing fat, I've heard you mention that females have higher intramuscular triglyceride levels, and because of this their training should be slightly different than that of male's for body composition. You recommend they follow their high-intensity interval work with lower intensity activity. Can you discuss this further?
Dr. Serrano: There are two types of triglycerides – one in the plasma and the other in the muscle. My theory is that you start females on a 5-10 minute warm-up, for example a jog, not only to lower blood sugar but also plasma triglycerides. Then you introduce high-intensity interval training (HIIT).
I've discovered that the optimal time for HIIT is 12 minutes of 6-12 seconds high intervals followed by 9-15 seconds of low intervals. Keep in mind that you might start a beginner at only 3 minutes total duration and then gradually ramp them up from there. Then you can end with a 5-10 minute cool-down.
You can extend this a little longer for females but maximum duration of time shouldn't exceed 42 minutes. After this point, you start eating away your muscles!
JPC: Sounds reasonable. I'm curious, what type of prescription do you use to detoxify the liver? And how often?
Dr. Serrano: In my office, I have access to IV administration, which is the route I'd take if a patient has a drastic liver condition such as hepatitis. However, for a simple detox, there are a few requirements.
First, fix the diet. Make sure they're eating properly. Second, give them enzymes because the liver, believe it or not, will make enzymes as well so that will ease the burden.
JPC: When you prescribe digestive enzymes, when the hell should you take them? Before the meal? During the meal? After? Everyone seems to have a different recommendation!
Dr. Serrano: Okay, first of all, as soon as you start chewing something, your system begins to make enzymes. Now if you have someone that has problems producing stomach acid, then give them HCL at the beginning of the meal and digestive enzymes half an hour after the meal to aid digestion. For those individuals who don't have acid-related problems, they can take a broad-spectrum enzyme during their meal.
There are generally three reasons that people would take enzymes in supplement form:
- As an anti-inflammatory agent (in which case, you'd take them on an empty stomach between meals).
- For digestive purposes (see above)
- To ease the stress on the liver and pancreas
If it's for the latter purpose, then take your enzymes half an hour before you eat to get them into your system, thereby reducing the stress on the liver and pancreas when you do eat. You see, timing of enzymes (or any supplement for that matter) really depends on the purpose!
JPC: Understood. Let's get back to the liver...
Dr. Serrano: Yes, by the way, anyone who works out will have elevated liver enzymes. The liver will work harder if you're training. There's no doubt about that. I'd prescribe enzymes as I just mentioned, as well as glutathione, alpha-lipoic acid, high doses of Vitamin C (at least 3 grams orally), and co-enzyme Q-10.
Why co-Q10? Because the liver is one of the most metabolically active organs in the body! It's always working and there are plenty of mitochondria to support.
JPC: How do you feel about cleansing diets and supplements? Some companies sell heavy metal, parasite, liver, and colon cleansing kits. Would these be good to take periodically, say one every three to four months?
Dr. Serrano: First of all, I wouldn't consider these to be cleansing products, but rather therapeutic products because you're treating a condition.
As far as cleansing is concerned, I'd never advocate a complete fast where you eat no food for several days, nor would I recommend a juice fast. These are very unhealthy practices. I would, on the other hand, encourage increased fluid intake (i.e. water, soups, etc.) and I always include enzymes for this purpose.
JPC: Now, is it possible to take too many enzymes in a day? Will they shut down your own production due to over consumption?
Dr. Serrano: No, they won't because the enzymes will start working but they'll also break each other down. In other words, the enzymes you consume will form a complex with those in the body, and this complex will slowly be broken down (i.e. digested) over time.
In 1962, there was an interesting study where they took different organs, chopped them up, and traced them in the body using a radioactive marker. Using chopped up heart, for example, they found that 71% of the tracer ended up in the heart! Chopped liver ended up in the liver, etc. Why this occurs, no one knows. Only God knows.
Take the animal kingdom for example. When a lion kills its prey, the king of the litter will come and eat the liver first. Then everyone else can have the rest. No one can touch that liver except for the king. Why? Something is going on but we don't really know the answer.
Also, North America is the only culture that doesn't routinely consume these internal organs. Where I come from, we eat everything – tongue, heart, lungs – you name it. Back in Puerto Rico, there was a time when boxers would recommend that you eat the internal organs to improve performance.
JPC: Really? In that case, is it better to use bovine or porcine (pig) concentrates in supplements?
Dr. Serrano: If it's organic, favor bovine. If not, then use porcine. You don't want to mess with mad cow disease.
JPC: Okay, what can you tell us about hydrogen peroxide IV drips?
Dr. Serrano: This is very controversial, actually. There's a big lawsuit right now where a lady in Florida died from hydrogen peroxide therapy and the family is suing the physician. The American College of Advanced Medicine is going to battle to try to protect this guy.
Now, if you asked me if this stuff will kill you, I'd say no way! It's a great way to kill bacteria in the body, but it won't kill you if administered properly. I have many colleagues who swear by it. Keep in mind that infections in the 1950s and 60s were treated with IV acid and it worked great!
Traumeel injected straight into an injured muscle is very effective. Within 24 hours, you'll notice a considerable difference. People who couldn't lift their arm, for instance, had full mobility the next day after being injected with Traumeel. It's quite impressive.
JPC: Interesting stuff. Any tips to improve restoration or recovery between workouts?
Dr. Serrano: I have research now using amino acids for various purposes such as cancer, infertility, and of course, recovery. In the latter case, we took seven subjects and gave five of them free-form amino acids (FFAA) pre and post-workout as well as between meals (Protocol A). The other two received FFAA only pre and post-workout, not between meals (Protocol B).
We measured things like strength, energy levels, soreness, and appetite which generally reflect recovery. And by the way, we also gauged these levels before they started this little experiment so we could determine if there was indeed a difference. And let me tell you, there was a difference. A big difference, actually, particularly for the group taking FFAAs between meals as well (Protocol A). All parameters improved significantly!
JPC: Which FFAAs did you use and at what dosage?
Dr. Serrano: Okay, it was a combination of high dose branch-chain amino acids and all eight essential amino acids. No non-essential aminos were used.
The dosage was the subject's bodyweight in kilograms multiplied by 0.15 in divided doses for Protocol A or half that dose pre-workout and the other half post-workout for Protocol B.
JPC: Talking about essential nutrients, without a blood test every month, how does one ascertain if they're taking in too much omega-3's from fish oil? And should we be worried about additional AA or omega-6's (even in the form of GLA), or will the natural amounts found in most people's diets suffice?
Dr. Serrano: Actually, GLA is also essential. I think many people overlook that fact. GLA, for instance, is part of the skin. Many people with severe, dry skin would do well to take some form of GLA either in the form of borage oil or evening primrose oil.
Listen, fats are beautiful! I mean, your brain is 62% fat, but what many people are lacking is balance among fats. Meridian Labs measures something called the "omega-3 index" in red blood cells which is basically the index between omega-3 and omega-6 fats. Ideally, this should be 4.7%. What they've found is that those with a higher omega-3 index had the best health scores overall.
Ultimately, we need a balance between omega-3, 6, and 9 fats. Are most people lacking omega-3's? Yes, but that doesn't mean they should disregard the others.
I used to recommend a high polyunsaturated intake, but no longer. After further research, I've discovered that this isn't ideal. Take corn oil for example. In nature, when do you see oil dripping off corn? Never. Yet we squeeze this stuff out and consume it in large amounts!
JPC: What about saturated fats?
Dr. Serrano: Don't neglect them either. They're found in nature in many of the meats we consume. The problem is that we eat the wrong type of saturated fat. Remember, we've been told over and over that fat stores toxins. Well, if you're eating toxic commercial meats, then you'll store toxins as well. You are what you eat!
Now, to go back to your original question for a second, I've found better absorption rates when fish oil (EPA and DHA) is combined with GLA. Therefore, blends tend to work better than just a straight fish oil. Again, this is to encourage balance. The body is pretty smart. If I give you two things, such as fish oil (EPA/DHA) and borage oil (GLA), it will absorb what it needs most!
If you have skin problems, that is typically an indication that you're deficient in GLA so I may recommend that alone (starting at 600 mgs to 1 g and working your way up depending on the severity of your skin). You can still take fish oil but at a separate time.
By the way, borage oil in liquid form tends to be a better source than evening primrose oil for GLA. And if your skin is really bad, combine borage oil and olive oil and apply it directly to the skin. Within 24 hours you'll notice great results, at least a 30% improvement. I guarantee it!
JPC: While we're on the subject, I read a study once that mentioned too much Vitamin E (>800 IU's) can actually inhibit tumor shrinkage and slow metabolism. Is this something to be concerned about since many people take Vitamin E to counter any pro-oxidant effects of fish oil?
Dr. Serrano: Okay, Vitamin E is a complex. It comes in the form of mixed tocopherols and tocotrienols. In that article you allude to, they only examined one form of Vitamin E. Alpha-tocopherol, if I'm not mistaken. Well, you can't do that. You're going to create an imbalance.
When you eat food, Vitamin E is present as a complex and it's actually gamma-tocopherol that's most abundant not alpha. You want to know why they use alpha-tocopherol though? Are you ready for it? Because it's cheaper! That's a faulty study. I wouldn't give it much credence.
JPC: I know you rank coconut oil very high. What about red palm oil?
Dr. Serrano: If you're asking which oil I believe is the best then I'd have no answer. I don't know. You need a combination of them.
Is one oil better than another? It depends on the situation. If you have a lot of joint pain, then coconut oil is better. It does help the joints. In a person with a lot of food allergies, olive oil and coconut oil combined. If the skin is dry, then I'd use olive oil and GLA as I mentioned previously.
The problem with red palm oil is that orally it tastes terrible, and topically it makes a huge mess so it's not practical.
JPC: Okay, next topic. How do you determine poor digestion and absorption of nutrients? What are some signs and symptoms and how do you go about correcting these issues?
Dr. Serrano: Well, a comprehensive stool analysis will do the trick but it costs $462, which many view as too expensive. In my opinion, it's worth every penny. You can also check certain bowel enzymes, blood in the stool, bloating, motility, etc.
The most important diagnose, though, is determined through one's history. How often do you go to the washroom, release gas, etc.? Are you bloated? We even listen to the bowel sounds – are they hyperactive? Do you get acid reflux?
If you want a very cost-effective method, simply gauge the smell of your stool. If your shit stinks, it can indicate poor digestion!
JPC: I've heard that one benefit of probiotics is to improve a foul-smelling stool. Is that true?
Dr. Serrano: Great question! There are a trillion cells and over 500,000 different types of bacteria in the body. How do you know that the one or two bacteria that you consume are the ones that you're missing? It's like finding a needle in a haystack. You have a better chance of winning the lottery, so good luck!
Now with that said, there are some good brands of probiotics out there. There's a company from Japan that supplies them in little green tablets, but the name escapes me right now. Jarrow is a pretty good company that most people in the U.S. have access to, and another one is Standard Process which you can obtain through a health-care practitioner.
By the way, Standard Process has an excellent product with Saccharomyces cerevisiae which is a beneficial nutritional yeast that produces lactic acid as a by-product of metabolism. This particular yeast helps establish proper pH balance vital for the promotion of nutrient absorption. It's integral in maintaining the proper environment in which normal intestinal flora thrive and it's beneficial for the overall healthy functioning of the gastrointestinal system.
Just remember, take probiotic supplements first thing in the morning and before going to bed, always on an empty stomach.
JPC: I have a client with red palms and feet, and another one with severe eczema. Any suggestions?
Dr. Serrano: That can stem from either a food allergy, low stomach acid, or a fat deficiency. You need to find out which one is the culprit. For instance, in the latter case, it's not so much the fats they consume, but which ones they absorb!
I've made this point before but it's worth reiterating: you can eat all the best foods in the world, but it means nothing if you can't absorb them. It's not what you eat, but what you absorb!
JPC: So everyone should take digestive enzymes then. Right?
Dr. Serrano: Where do you get enzymes from? Raw, uncooked, whole food. How often do we eat food in its unadulterated state? Very rarely! That's where people should start.
JPC: Thank you very much, Eric. Informative, as always. If someone wants to get a hold of you, where can they reach you?
Dr. Serrano: They can set up a consultation with me at http://www.infinityfitness.com/consult/consults.html.