Dr. Eric Serrano is the ace sought out by elite athletes around the world for help with the most difficult of problems. He spends a large part of his time promoting the health of his everyday family practice patients in Pickerington, a suburb of Columbus Ohio. Amongst the thousands of patients are elite athletes from around the globe who will travel to the ends of the earth to consult with Dr. Serrano.
A wide array of athletes from the NFL, NHL, MLB in addition to countless elite amateurs make up Eric’s elite client list of athletes. His cohesive expertise comes from years of practicing medicine and his career as a record-breaking powerlifter. As an athlete and family man, Eric understands the needs of his clients and pushes himself to stay on the cutting edge of training, supplementation, nutrition, injury rehabilitation and performance enhancement.
Dr. Serrano is a graduate of Kansas State University and earned his medical degree at Kansas University. Currently, he is a professor of family practice medicine at the Ohio State University. One will never have an idea of what extreme demand exists for Dr. Serrano’s services, which is obvious by viewing a message log full of inquiries from elite athletes, strength coaches and related practitioners around the world. He is truly the expert of experts, only the elite come to for guidance and information.
JP: Let’s start with protein. How much does one need if they are training heavy to put on strength and size?
Dr. S: That’s an easy answer. If you are a male, 1 – 1.5 grams per pound. The maximum would be 2 grams per pound if you are training extremely heavy plus doing aerobic exercise. If you are a female. 0.8 grams per pound is sufficient. These recommendations are for people who are not taking anabolic steroids of course.
JP: How about for fat reduction?
Dr. S: It is more important to manipulate fat and carbohydrate levels for body fat reduction than overall caloric intake. In fact, some people do not consume enough calories for true fat loss to occur. The above-mentioned protein ratios apply here as well.
JP: You always hear the casein vs. whey debate and I know that you’ve actually separated proteins for their predominant anabolic or anti-catabolic properties. Can you briefly explain this? What are the best protein powders on the market?
Dr. S: First of all, I do not believe that whey isolates are the best. Let me explain why. When we simplify things, we tend to destroy other things along the way. For example, going from milk to whey destroys many of the growth-support proteins. Taking this a step further, processing whey alters the alpha-lactalbumin to beta-lactoglobulin ratio so that the latter is in greater concentration in the end product. Well, guess what, beta-lactoglobulin is the most allergenic protein of them all!
To answer the casein vs. whey question, it depends on the process. There’s calcium, potassium and sodium caseinate, but I prefer to use milk protein isolate that has all the proteins together or micellar casein which seems to be a superior source. For whey, I favor whey concentrate which is cheap, pure and better quite frankly. There’s a supplement called ImmunoPro which is not cheap, but has a more favorable alpha-lactalbumin to beta-lactoglobulin ratio and is one of the best products on the market.
To gain size, you want proteins with both anabolic and anti-catabolic properties. Anti-catabolic proteins are rapidly absorbed and will prevent breakdown of muscle (eg. free-form and branched-chain amino acids which get in the system quick, raise insulin which prevents the muscle from breaking down) while anabolic proteins will help build muscle (eg. red meat).
As far as I’m concerned, the best proteins on the market are Beverly International Ultra Size (which also has beef in it), Biotest Low-Carb GROW!, Champion Nutrition Met Max, ImmunoPro as I already mentioned, MD+ Myosin, and a meal replacement powder called Micellean Bioactive Superfood from VPX which tastes pretty good too.
One more thing regarding protein, you can snack on soy beans if you wish, but no time in a male’s life should they consume a soy protein isolate!
JP: Many people are looking for ways to naturally increase testosterone levels. Any suggestions?
Dr. S: Believe it or not, there are some studies (on resistance trained athletes) that show that eating too much protein can actually decrease testosterone levels especially when fat and carb levels are low. There is a direct correlation between dietary (saturated and monounsaturated) fat and testosterone – in general, the higher the fat intake, the higher the T levels. Olive oil, cheese, are red meat are excellent sources. Many athletes stick to only lean cuts of meat – it’s these guys in particular that can attain an erection but have a hard time keeping it (pardon the pun!) Also, a study just came out recently showing that tribulus specifically from Bulgaria (not Japan, China or India) and from the fruit (not the stem or the roots) elevated LH and testosterone levels.
JP: How can you naturally control dreaded cortisol levels?
Dr. S: Well, every time you eat, you lower cortisol levels – raising insulin lowers cortisol – that’s a natural response. So, the first method would be to eat frequent small meals. There are certain supplements that will lower cortisol levels naturally: rhodiola rosea (600 mg), panax ginseng (2 studies now show that it decreases cortisol levels – you need a minimum of 1 gram), PS (400-800 mg). Fats are also very important particularly monounsaturated fats, but no matter who you are and what you do, the best way to decrease cortisol levels is sleeping at least 8 hours a night! There’s a book called Lights Out: Sleep, Sugar, and Survival by T.S. Wiley & Bent Formby that illustrates this. The process involves circadian rhythms of hormones and timing of melatonin levels. There were an incredible number of studies performed on this subject, but on average 8 hours of sleep (optimal being 9) is necessary every night. The key is not watching tv late at night. One study I recall involved placing people in a dark room and shining a little light bulb behind the knee for 20 minutes to see what would happen. The subjects’ sleeping pattern changed even though they were in a dark room, and in only 2 weeks, the melatonin levels of all the subjects was completely altered so you know that the skin has some type of sensitivity to light. That’s why in the summer, we stay up longer because there is more light and in the winter, the opposite occurs. Since there’s less light, we feel more tired, stressed and depressed and we want to go to bed earlier. It makes sense!
JP: How would you go about regenerating the adrenals after say a lengthy period of stimulant abuse?
Dr. S: If you use stimulants or thermogenics for more than 12 weeks, you kill the adrenal glands. It takes about 8 weeks to recover. To regenerate them, you need to take adrenal gland supporters (eg. Standard Process Drenamin, Metagenics Adrenogen), vitamin C (at least 3 grams a day), DHEA, and fish oil. In fact, the adrenal glands are 60% fat – polyunsaturated fats are important here (they will also decrease cortisol levels). Again, sleep is crucial.
JP: Or how would you cleanse the liver after a steroid cycle which included orals?
Dr. S: Okay, make sure that you have some liver tests (i.e. blood work) done by your physician to obtain a baseline. This is one of the few times that I agree to a medium protein diet. In addition, it is important that you do not smoke, drink (alcohol), take Tylenol, birth control pills or other drugs during this time. To clean the liver, you need the right foods. Eggs are useful in this situation – the lecithin found in eggs will help. As far as supplements are concerned, liver tablets (Beverly International Ultra-40), milk thistle, glutathione, and glutamine also helps the liver. Finally, 25-50 grams of vitamin C taken intravenously has been shown to regenerate the liver. I use this approach in my office occasionally when I have a patient with hepatitis A, B or C and the results are incredible!
JP: Okay, let’s give the reader an example of how you diagnose things. We’ll take the thyroid for example. You’ve mentioned that you check TSH, T4, T3, reverse T3 and triglycerides as well as ask questions about hair loss, constipation, weakness, palpitations, and usage of carbs and caffeine. What exactly do you look for and how do you go about correcting some of these anomalies? How about boosting the thyroid gland, what would you suggest?
Dr. S: Yes, the biggest problem I’ve seen in this area is that some labs return normal and you assume everything is fine so you do nothing – you must listen to the patient! If the thyroid is borderline, meaning that TSH is between 2.5 and 3.0, you can use adrenal supplementation for 4 weeks. If after 4 weeks you do not see results, then I would recommend thyroid medication. Armour thyroid is a natural thyroid that contains both T3 and T4. If you have someone with hyperthyroidism, then putting them on a thyroid medication may actually help to lower their levels.
JP: You’re not a fan of milk, but you don’t mind other dairy products like cottage cheese or even whipping cream. Why is this? Also, what type of cottage cheese do you recommend (i.e. organic, low or high fat, does it matter?) and when?
Dr. S: Let’s clear up the first part: it’s not that I’m not a fan of milk, I’m not a fan of pasteurizing and homogenizing milk! Heating at high temperatures for a short period of time is okay, I guess, but filtering the fat through small filters completely changes the composition of milk. Raw milk is great but it is difficult to obtain (unless, of course, you get it straight from the breast!) Goat milk is a better choice than cow milk because it has more fat and less carbohydrates, and it tends to be a lot friendlier for people with milk allergies because the protein sources are different. Cottage cheese is one cheese that will actually elevate sugar and insulin levels. I would recommend organic, high fat (the highest you could find) cottage cheese.
JP: Explain why you believe this whole concept of acidity is faulty.
Dr. S: I assume that you are talking about the acidity of the blood. This being the case, the human system is so keen on controlling the pH of the blood that any change affects the body. For that reason, the body will try to fight acidity or even alkalization. I don’t believe too much on this concept. I do agree, however, that certain foods will affect the pH of the blood for a short period of time, but it’s nothing to worry about. The most common change in pH is secondary to a lack of oxygen. If this happens and you go too acidic, then you’re in deep shit!
I have a problem with those that claim that eating too much meat will make you too acidic. Let’s go back to prehistoric times when there was no agriculture so there were no grains. Basically, we had to hunt to eat. We ate lots of meat and got our fiber from eating intestines not grains. In the summer, we had plenty of fruit to feed on (like cherries, strawberries, etc.) but what happened when winter came? It’s gone! The only thing left is food that is walking around so we had to follow this food that would migrate south. Now, we would stumble across other sources, like bananas for instance, which would influence nutrient intake. Our bodies, therefore, were never deficient because we would transition between seasons – this is one of the reasons why I believe in a food rotation diet. Anyhow, to get back to my original point, if you’re going to tell me that eating meat is going to make me acidic than there were a lot of acidic people millions of years ago and we would not have survived!
JP: What are your views on food combining?
Dr. S: The body is prepared to digest food, plain and simple. It does not have a separate blueprint for each individual food. You think your body automatically recognizes that you’re eating a banana or a strawberry? No, it doesn’t work that way. It is true, though, that combining certain foods can affect you hormonally. For instance, eating carbohydrates with protein will elevate insulin levels and facilitate the transport of amino acids into the muscle cell which is beneficial post-workout. However, people are misguided if they feel that food combining will aid digestion. If you have a healthy digestive system than food combining is unnecessary. If this is not the case, then fix it!
JP: Can you clear up the whole egg issue. For one, some people don’t believe that we digest eggs all that well and that they are a common food allergy; whereas, others feel that since they are so similar to human tissue, they are easy to digest. Then there’s the issue of cooking them or not. On one side of the coin is Dr. Mercola who believes that cooking destroys some beneficial enzymes and nutrients and that the risk of salmonella poisoning is actually quite rare. Then there’s John Berardi who says that cooking the eggs will increase their absorption. And finally, the whole egg and cholesterol issue.
Dr. S: Eggs are one of the most allergenic foods you could eat. Is there a difference between boiling, scrambling, or eating raw eggs? Yes. The more you cook eggs, the greater the free form amino acids. Eating raw eggs provides intact proteins which is more allergenic. Boiling is a step in the right direction, but scramble your eggs as much as possible. Mercola is right in that cooking will destroy some enzymes, but it’s a trade-off where I prefer less allergies over more enzymes. I definitely agree with Berardi that cooking eggs will increase their absorption.
Cholesterol and eggs is not an issue at all. I can’t believe that people still suggest this to be true! Almost every hormone you have is cholesterol-based except for protein-based hormones like insulin and growth hormone. The lower your cholesterol levels after the age of 55, the higher the chance of cancer!
JP: You impressed me with your knowledge of kinesiology and your diagnostic skills. What are some of the common weight training injuries that you see in your practice?
Dr. S: The most common weight training injuries that I see are imbalances between the frontal superficial line versus the back superficial line. Visit http://www.anatomytrains.com for more information. Hamstrings are notorious for being tight. Also, I notice many people lacking the supporting muscles. For instance, it’s common to see weak lats with strong upper traps pulling the shoulder girdle closer to the clavicle which causes impingement of the rotator cuff. Also, stress-related injuries which affects posture results in weaker muscles that are more prone to injury.
JP: While we’re talking about injuries, any tips or supplements that will speed up healing?
Dr. S: There are many supplements that will speed up healing. Research has shown that digestive enzymes will help injuries. They act as anti-inflammatories and will even help reduce cancer. Another big one, albeit through a separate mechanism, is glucosamine and chondroitin. These are more applicable to the joint (as is collagen); whereas, enzymes (specifically bromelain) will act on the tendons. Fats are also important. Fish oils and GLA have been shown to have a potent anti-inflammatory effect. Other supplements include Vitamins C (2 grams) and E (800 IU’s), MSM, reishi mushroom, cat’s claw, tumeric, feverfew but the dosage used will depend on the injury.
JP: You’ve mentioned some impressive numbers with regards to your own training and I saw you perform multiple repetitions of towel chin-ups with ease. Do you have any strength tips that you would like to share?
Dr. S: Wow, I never knew you were so impressed with me, JP! First of all, the most common mistake I see is overtraining. If you’re over 35 years old and do more than 10-12 sets per body part, you are overtraining! If you do legs more than twice a week (depending on your state), you’re overtraining! In a strength phase, work your legs only once a week and your total workouts should not exceed 3 times a week especially if you are performing any aerobics. Always keep in mind the stress factors of your client, such as work, rest, nutrition, family, etc. I have research that clearly demonstrates training more than 3 days a week elevates cortisol levels for up to 4 days. This is important because elevated cortisol levels will not help you build muscle! You want to have an acute destroying effect on the muscles and then stop it – allow them to recover and build. One of the best ways to stop this so-called destruction is to use BCAA’s. BCAA’s lower cortisol levels. I’ve been saying it for years to always ingest BCAA’s pre-workout.
Another thing, you’re only as strong as your weakest link. So always work on your weak muscles. One way to figure this out is to train the body unilaterally at first to see what is lagging behind. Once you know, spend more time on that particular side. Also, remember that your grip dictates your strength – if your grip is weak, you won’t be able to bench as much. The most common weakness I’ve seen are hamstrings while the glutes get too strong. Usually, both the lower and upper back tend to be weak leading to injury.
JP: I learned from you that limited range calf raises hit the medial head of the gastrocnemius. Any other little secrets?
Dr. S: If I tell you then they won’t be secrets any more, but I’ll share one with you anyway. A common injury I see involves the origin of the biceps (long head) due to lat pulldowns. Most people tend to train their biceps solely with elbow flexion, but the biceps function as both elbow and shoulder flexors. Usually, biceps injuries occur at the shoulder. To properly train them, you should go from a stable to unstable, prestretched to shortened position. Let me explain what that means. Anytime you rehab someone, you should start from a stable position and work around the joint that is hurting. So, if the origin of the biceps is painful, you can work the distal end in a stable position by performing elbow flexion without contracting the origin at the shoulder. This way the muscle does not weaken and heals faster due to increased blood flow, although sometimes it is necessary to just rest. Sit on an incline bench and perform an incline curl as normal (involving only elbow flexion.) This is considered a prestretched position which helps the fascia heal. Performing incline curls on a Swiss ball will actually provide a more stable environment since you can rest your triceps on the ball. Move to a contracted position (i.e. preacher curl) after a few days or even a week when there is no more pain. Then, progress to more unstable positions.
JP: Can you discuss your fruit hierarchy? A little while ago, you faxed me a flowchart that showed the end metabolic pathway of fructose. Although known for their high antioxidant and fiber content, why is that fruit consumption can hamper fat loss? And can you explain why it’s important to eat fruits in season?
Dr. S: Don’t get me wrong, I don’t think fruits are bad. It’s the amount of fructose in the diet that we must be concerned of. Fructose (specifically high fructose corn syrup) is the #1 sweetener used. It’s a very metabolic, pro-oxidative pathway that is used as a glycosylated carbohydrate because the body does not like to do anything with it – you have to spend a lot of energy to change it to fat or glucose/glycogen so the body converts it instead to glycosylated proteins. Health-wise, this is not desirable. Fruits will make you fat not because they are bad for you, but primarily for the reason that people eat fruits that are “easy”, i.e. grapes – just put a bunch in your mouth, or bananas – peel one and keep walking (and they have about 3 or 4 a day!) Usually, people that eat fruit, do not eat proteins with them – another mistake. Fruits (fructose) are excellent post-workout because they are slowly metabolized, just make sure to add protein with it. Also, I do not believe in juicers because they remove the pulp/fiber from the fruit.
Why is it important to eat fruits in-season? Because God knows better! You should eat fruits that are in-season at that time. For instance, if it is cold outside, eat an apple; whereas, in the summer, strawberries, cherries, watermelon, etc. are in-season. Do not eat fruits that are not available. Bananas are not in-season during the winter, yet guess what the most commonly consumed fruit is at that time? That’s right, bananas!
JP: Can you reveal your new food pyramid? I’ve heard you discuss the inherent problems with the original model, and although the new proposed pyramid is a step in the right direction, it’s still off. Please explain.
Dr. S: Water should be at the bottom because you can die after 3 days without water. Tell me which food is more essential than that? Next would be proteins, preferably organic. Then comes vegetables, everything but white potatoes (sweet potatoes are fine) and corn (which is actually a grain). The next level involves fruits and nuts together – I consider these the same in value. Cheeses follow since most are not fermented. After this comes carbohydrates – the best sources are rice and oatmeal. My food pyramid would include a disclaimer that reads: “Carbohydrates are activity dependent!” If you are a couch potato, then you should not consume any carbohydrates – no grains or anything – and fruit only occasionally. However, if you are active, then by all means, consume those carbs.
JP: I know that you are a fan of fish oils and olive oil. Can you discuss the importance of these unsaturated fats? What makes your new Alpha Omega M3 better than most of the other EFA supplements?
Dr. S: As I discussed earlier with regards to olive oil, higher monounsaturated fat intake increases testosterone levels while decreasing cortisol. Fish oil can decrease the size and number of fat cells. The reason why my Alpha Omega M3 is one of the best EFA supplements on the market is because it is the only one with just a little bit of ALA yet contains high dosages of olive oil, fish oil, CLA and GLA in specific ratios. Another good one is MD+ EFA+, but it’s missing the olive oil (monounsaturated fat) which I feel is important.
JP: With all this talk about mercury toxicity, is it even safe to eat fish these days?
Dr. S: I had a guy who was eating 3 cans of tuna a day. He upped it to 5 and his mercury levels shot from 5.2 to 47.4 – that’s toxic! So, you have to be careful with some fish especially tuna, shark and dolphin. Salmon, herring and crab are okay.
JP: You’ve brought to light that the enzyme responsible to break down ALA into the active constituents DHA and EPA is deficient over the age of 35. Does that mean that it is relatively worthless to take flax seed oil over that age? And if below 35, how much flax seed oil should you take?
Dr. S: Flax seed oil is very high in polyunsaturated fats. These fats are unstable in the body because they can be easily oxidized. The enzyme responsible for breaking down ALA into DHA and EPA is lower (not deficient) after the age of 35. I just found out in a study conducted on pregnant women that taking as little as 3 teaspoons of flax seed oil removed all the EPA and DHA from the breast milk. Yet, when they changed to fish oil, EPA and DHA were present in the breast milk. That tells you something. The conversion rate is only 15% from ALA to EPA/DHA so it’s better to take fish oils. What are things that affect the enzyme: caffeine (people taking thermogenics have even lower activity of that enzyme), high insulin levels (from excessive carbohydrates), alcohol is the biggest factor, and low magnesium levels.
JP: This last question is a must ask. Any new hot supplements we should look out for?
Dr. S: I am conducting a study on Humanavor right now. I’m measuring insulin, lipid screen (good and bad cholesterol), DHEA and cortisol levels. I’ll let you know what happens. Some good, new ones include anti-cortisol, hyper-metabolic supplements meaning that instead of just concentrating on a thermogenic effect, you have something that lowers your cortisol so that insulin works better (or is diminished) similar to alpha-lipoic acid. Also, a combination of BCAA’s with taurine and arginine before workouts.
JP: Thank you, Dr. Serrano, for taking the time to conduct this interview. As always, talking with you is a serious learning experience. I know that you are extremely busy these days with over 8000 patients and that you are not taking on any new clients. How can the readers out there contact you if they are interested in a consultation?
Dr. S: Go to http://www.infinityfitness.com/consult/consults.html.