The Future of Wellness: Innovative Diagnostics and Treatments Unveiled

Our first guest of 2024 is Dr. Darshan Shah, a surgeon, longevity expert, and founder of Next Health. In their conversion, David and Dr. Shah take a snapshot of today’s ever-changing health optimization and longevity landscape.The two discuss new diagnostic tools like executive physicals and AI-enabled heart scans, highlighting the power of early detection in combating conditions like Alzheimer’s, heart disease, and cancer. David also takes the opportunity to learn all about up-and-coming treatments like gene therapy from an expert. Dr. Shah also shares his personal journey from surgery to functional medicine, emphasizing the importance of looking beyond traditional Western healthcare to prevent chronic diseases.

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Key Moments
“I think there's a lot going on in the world of longevity that unfortunately the FDA is trying to block. But you know, the research continues to go on in other countries and it will continue to flourish and we will be able to do a lot of these things here at some point, whether it be in the United States or outside.”

“I always tell people that we have a few different goals in mind. Our first goal is to optimize along the most common things we need to make sure your nutrition, your exercise and your sleep is perfect, right? And so as close to perfect as we can get it.”

“If Steve Jobs were alive today, and he had an executive physical, he would have been saved from pancreatic cancer."

“I always tell my patients, you need to know what your hemoglobin A1C level is. I should ask you, and you should be able to tell me what it is.”

Connect with Dr. Shah
Website
Next Health
Making the Cut: 10 Things You Should Consider Before Having Plastic Surgery
Instagram

Transcript

Speaker 1: 0:15

What kind of super-ager are you? Go to agistcom slash quiz, take the super-ager quiz and we'll send you directed, personalized information to help you super-age the best that you can. Welcome to super-age. My name is David Stewart. I am the founder of Agist and your host on the super-age show. We talk about how to live healthier, how to live longer and how to be happier, and who doesn't want that?

Speaker 1: 0:41

Today's show is brought to you by InsideTracker, the dashboard to your inner health. Go to insidetrackercom. Slash agist Save 20% on all their products. Today's show is also brought to you by SRW. Aging is inevitable, but how we age is chiefly a matter of our choices. If you go to SRWco, you can save 20% on all their products by using the code AGIST20 at checkout. This show is also brought to you by Element LMNT, my favorite electrolyte mix. It's what I put in my water in the morning and it's what I put in my water at the gym. Go to drinkelementcom slash agist and receive a free eight-serving sample pack with any purchase. Welcome to episode 166 of the Super-Age Podcast. This will be dropping on January the 10th, 2024.

Speaker 1: 1:31

We are back in the very snowy mountains of Utah today, where it's like snowing, it's like 10 degrees outside and normally this would be like a great day to go up on the hill. But I've been training fairly hard the last couple of days and yesterday, total brain fail in a slalom course. I just forgot how to ski and I said you know, I think I'm getting tired and he says you need to take a break. Contrary to our all-American work ethic, training poorly actually ingrains like stuff that you don't want, so it's better to just stop. Come back when you're better. And as much as I like to act like I'm 22, I'm 65 and my body's a little sore today, so hopefully back up there tomorrow and be it January we think about like, what are we doing? What are our goals? Where are we thinking about for the next year and maybe, if we're really forward-looking, the next three to five years? And it sort of brings to mind this ridiculous thing that us who are a little older, always we just can't help ourselves. We want to ask younger people what are you gonna do when you grow up? Oh, so you're going to college for whatever. What are your plans for that? I mean, I do it. I kind of sort of can't resist doing it, but I think we should try. I should make a better effort not to say that and just be like hey, how you doing, you know how's that working out for you. Awesome. This week on the show we've got Dr Darshan Shah and we're gonna talk to him about what exactly does medicine look like if you have the resources and the desire to pay for it? What is an executive physical? What are the things that, if you decide you want to allocate resources to, what would those things look like? I think this is really a fascinating question.

Speaker 1: 3:20

I remember growing up in the 60s and the 70s that the difference between technologies available to someone of, you know, middle-class income, to someone who was, like crazy rich, there really wasn't that much of a spectrum, because there really wasn't that much out there beyond you know. There's, you know, maybe you get a nicer hospital room or you get fancy doctors, but the outcomes weren't really that different. That was my recollection, anyway, but now that's different. You have the resources and you want to allocate them. You have access to advanced testing. You have access to a lot of very interesting modalities that weren't out there, and this brings up a lot of interesting questions. But also my recollection of reading history is that you know, for the last few thousand years, people who were quite wealthy, or you know heads of government, things like that. They always seem to have this idea that they can live forever just because of they are who they are, and, you know, I think that we're seeing some of that today, with Mr Bezos and some of the people in Silicon Valley. The difference now, though, is, at least in my view, there are technologies out there that really will extend people's health span, lifespan. All of that, I mean this, remains to be seen. We haven't seen a lot of people living to 110 or 120 or 50 or whatever yet, but I think that may be the case. And you know, I just want to point out one of my personal bugbears, which is the New York Times organization. There was a piece on the front of the Times last week where they spoke to eight gerontologists, which I'm sure they cherry picked, and these gerontologists confirmed that, really, there was nothing you could do to extend your health and lifespan outside of Eat Well, move around and have some nice friends. They weren't speaking to longevity docs. They were speaking to people who wanted to confirm the existing opinions of the writer, and I can say this because I used to work there, so I sort of know how that organization works, and what they really don't like to do is to rattle the cages of their readers. They really like to confirm where they're at. So you know, I remember a few years ago, it was like mall walking yeah, that's gonna be great. Okay, let's go. New York Times, rah rah.

Speaker 1: 5:42

I think, though, that, going back to this idea of advanced medical care. There are a few questions out there that I keep asking myself, and I don't want to come off as a moralist or some kind of like crackpot conspiracy person, but I think there's sort of a lot of things that come together in at least I live in America so here where sort of foods that are available to eat and people are encouraged to eat, and then the sort of medical tests that are, you know, sort of standard physical, and then the sort of care that's out there to deal with all the illnesses that people have. And I've heard what we have is a sick care economy. And again, even saying that I sound like a nut, I don't believe there's any sort of conspiracy out there, but I do believe there is very much a profit motive to care for disease versus prevention of disease. And just to point out I mean, we're gonna be talking to Darshan about this who who's an expert? Then you know, the number one killer in, I think, the Western world by quite a bit is cardiovascular disease. And if you go in for you know a regular physical, they're not even covering a CT. Calcium scan, which I get every year, costs 100 bucks but you got to ask for that. Darshan is going to probably talk to us for more advanced screening and things that can actually be done out there to prevent cardiovascular disease, but none of this is sort of on the menu with a standard physical.

Speaker 1: 7:05

Same thing with cancer screening. Most stage one cancers are quite treatable, or I should say more treatable than a stage three or four where things get extremely expensive and the outcomes tend to be not nearly as good. So why aren't we doing more advanced cancer screening? Well, because it costs money. I don't know. I think these things are all quite complex and dealing with extremely entrenched vested interests out there. This is not my lane. I don't play out there to you know, to change public policy or change corporate behavior. I just think it's interesting and I think that you know, as I mentioned earlier, the access to these things, the differential between what sort of a normal your insurance covered physical, what those sort of tests and investigations cost versus what's really complete and the treatments to advance one's health span and lifespan that differential is going to accelerate. It's already accelerating. I think what we may be looking at here is sort of a two or three track health care lifespan outcome and you already see this playing out when you compare income levels or education levels and health span lifespan. I think it's rather disturbing, but not something I personally can have any impact. Anyway, that's enough of that heavy stuff. We're going to get with Dr Darshan Shah, who's a wonderful man. I really enjoyed this conversation with him and he's going to talk to us about some of these technologies that are available to people, what they're all about, why we should have a look at them. We're going to get with him in just a moment after a word from the people who make this podcast possible, and those are our sponsors. Stay tuned.

Speaker 1: 8:49

Today's show is brought to you by SRW laboratories out of New Zealand. Their vision is to extend human health span. Srw labs curates the very latest in science and research to formulate premium nutraceuticals that support your cellular health, especially as you age. Working with their scientific advisory board, they seek to understand and address the causes of aging at a cellular level, providing support across 12 bodily systems with an approach that is unique to SRW. They know that doing one thing well, such as eating healthily, won't have the desired effect on your health. This is why SRW seeks to educate people on the factors that influence aging and, more importantly, biological age. Use the code AGIST20 at checkout and save 20% off any order. Go to SRWCOCODE notcom. Use the code AGIST20 at checkout. Save 20% on all their products.

Speaker 1: 9:49

Today's show is also brought to you by Inside Tracker, the dashboard to your inner health. I've been using Inside Tracker for over three years now. I've been able to reduce my inner age from my chronological age of 65 to an inner age now of 56. I did this gradually over time, following their recommendations, because not only with Inside Tracker do I have a dashboard to my inner health. Knowing what's going on inside me, I also have a roadmap on how to improve that. Their food first, supplements, second recommendations have helped me tremendously. I recommend everyone get a dashboard to their inner health. Go to insidetrackercomagist. Save 20% on all their products. After my conversation with Dr Darshan Shah, we're gonna do just try this, that little tidbit to help you live a little healthier, a little happier, a little longer. Let's give Darshan a call right now. Hey Darshan, how you doing today.

Speaker 2: 10:50

I'm doing great, David. Thanks so much for having me.

Speaker 1: 10:53

It was wonderful to have you on. Tell us a little bit about your background.

Speaker 2: 10:58

Yeah, so, david, I am a physician. I've been a physician now for almost 30 years. I can't believe it when I say that myself, but I went to medical school in University of Missouri, kansas City, graduated when I was 21 years old and decided to become a surgeon at that point in time. I was a surgeon for 20 years or so before I started having my own personal kind of health issues. David and I decided at that point to do a lot of research to try to figure out how to get myself healthy. So at that moment, when I found the miracle of kind of the longevity science world, of the functional medicine world, I realized that that's where medicine should be headed and I changed my career completely into longevity and functional medicine. And so now I'm a longevity doctor, functional medicine practitioner, and we have a set of clinics throughout the United States called Next Health.

Speaker 2: 11:51

What we do at Next Health is we help people who aren't necessarily sick. They go to their doctor and their doctor tells them you're fine, or they put them on a couple of pills for high cholesterol or blood pressure and they're just kind of left to their own devices to just get sicker right. Western medicine is so focused on treating us with pills and surgery, and what we try to do instead is to really dive deep, look under the hood of what's going on in someone's biology and give them a plan to optimize their health so they never need to use medicines or surgery in the future and they stay away from all forms of chronic disease. So that's what we do at Next Health. We call ourselves Health Optimization and Longevity Centers, and we have a pretty good process around that now.

Speaker 1: 12:35

I think it's. I think this is so interesting because I find so many physicians are in such terrible health. Right, it's appalling to me. Like you guys know all about take care of yourself, it doesn't happen.

Speaker 2: 12:48

Well, here's the thing, david we don't know all about health, we know all about disease.

Speaker 2: 12:52

That's what we've spent years and years learning about is disease. In fact, our knowledge starts when you have the diagnosis of disease. That's when your typical Western medicine doctor's knowledge starts Right. Everything before that nutrition, exercise, physiology, sleep all of that is kind of like forgotten about because that is a domain of your dietitians, your nutritionists, your trainers, etc. So I actually, when I learned to get myself healthy, I actually became a certified trainer, I actually got my nutrition license so I could learn about these things for the first time in my life, because we literally got three, four hours of nutrition in medical school and zero in exercise.

Speaker 1: 13:35

I will say in defense of Western medicine when bad stuff happens, I'm really happy for the really highly skilled people you know who can take care of it.

Speaker 2: 13:46

Western medicine is fantastic. For once you have a disease and you're diagnosed, or you have a trauma or you're sick with an infection Western medicine, thank God for the advances in Western medicine. But you know, I always say next health is for the 95% of us that aren't sick, that don't need to be in the hospital, that don't need to be in the emergency room. Where do we go? Where do we go to get optimal health? And what's incredible, david, is, as you know, there's so much of that science that's coming out of Western medicine that we're applying to health now, and it's just supercharging people's health. And so that's what we do at Next Health as well, because we bring some of that technology to people that aren't sick.

Speaker 1: 14:26

One of the things I wanted to I was really interested in having you on Darshan was to talk about this thing. It gets bandied around a lot called an executive physical. So what is this?

Speaker 2: 14:39

So the executive physical is basically the physical that everyone should have, but they can't because insurance doesn't pay for it. Okay, so, unfortunately, because people have to pay for it out of their own pocket, a lot of the people that are getting this physical are executives, ceos, people that own their own companies, that have the disposable income to do this kind of a thing. However, I will say that the prices of some of these testing modalities is getting lower exponentially year by year, and my hope is that insurance will cover it one of these days and or it'll become extremely affordable for people. So right now, for somewhere between 10 to $15,000, we've collected a group of tests that is super comprehensive and that we can use to literally detect all forms of chronic disease. So cancer, alzheimer's disease, any kind of dementia, heart disease, heart attacks, strokes all forms of chronic disease we can detect at 20 to 30 years, before it even starts. And what we empower people to do, david, is to become I call it, I call it become the CEO of your own health. Understand what these biomarkers are, where you stand currently and how you keep them optimized. So you know all disease David develops over a course of time, right, it doesn't happen like immediately and what you see in these blood biomarkers and scanning biomarkers, this thing slowly start headed in the wrong direction.

Speaker 2: 16:06

Unfortunately, most people don't know it's been heading in the wrong direction for a couple of decades when they start getting symptoms. Our bodies are so resilient to symptoms that we don't feel symptoms until it's too late A lot of times. The first indication that you have that humans have for having heart disease is their first heart attack. 50% of all heart disease is diagnosed with the first heart attack and 50% of those are fatal. So the first symptoms we have of Alzheimer's disease is severe dementia. We let it get severe before we diagnose it. Same thing with metabolic syndrome that now we have continuous glucose monitors and a few people are using them and people understand biomarkers like hemoglobin A1c and insulin levels. But for years no one knew that they were headed down the path of diabetes, until they started having vision abnormalities, until their toes started becoming purple from advanced, advanced diabetes.

Speaker 2: 17:00

And so we have the technology now, david, to head off all forms of chronic disease. If you look at the CDC top 10 causes of death, like you know, the heart disease is number one right. Number two is going to be Alzheimer's and dementia. Number three is going to be cancer, and sometimes two and three are reversed and then you have other forms of all forms of chronic disease and all of these things can become orphan disease if people have more access to these testing modalities earlier in life. So we start people to get an executive physical when they're somewhere between mid 30 to 40. Some people want to do it earlier, which is fine, as you can never be too early with this kind of stuff. But that's where we start and if you want to give you kind of a quick rundown of the tests that are included in the executive that was going to be my next question.

Speaker 1: 17:47

So cardiovascular disease, number one killer. Talk me through that. What are the tests you're looking at?

Speaker 2: 17:52

Okay, so we're looking at blood biomarkers, right, your typical ones of cholesterol. We use ApoB as the kind of the best marker of cardiovascular disease as far as cholesterol is concerned. But cardiovascular disease is not just cholesterol levels. I think there's so much controversy around cholesterol because people just tend to hone in on one thing Cardiovascular disease has three factors associated with it. One is your cholesterol levels, but that's only after you look at inflammation levels and you look at damage to your vessel wall which is due to high blood pressure. So those are three things that combine to cause cardiovascular disease. So we're looking at people's inflammatory markers as well. Inflammation is root cause of almost all diseases and definitely cardiovascular disease is high up there in the list. Now, the test that we use to assess someone is we look directly at the blood vessels of the heart using an advanced cat scan of the heart called the clearly scan. Have you heard of the clearly scan, david?

Speaker 1: 18:53

No, I've heard calcium CT scan and I've heard what's the one I had done like a sonogram on my arteries, yeah, but I don't know about this. Tell me, what is this?

Speaker 2: 19:04

Okay. So the clearly scan is an AI enabled cat scan of your heart that goes way beyond the calcium score. The calcium score is just adding up the amount of calcium that it detects around your heart and saying that you might have some calcified plaque. Here's the chance of you having it. What a clearly scan does is it shows you every blood vessel in exquisite detail and how much plaque is along that blood vessel, both soft and non-calcified. So this is a scan that takes about 20 to 30 minutes. There is some radiation involved, so we don't do it very often. We do it as our initial testing modality for people with risk factors, but we can tell in exquisite detail exactly how much plaque you have and exactly where it is, and so I was just looking at a few clearly scans a few minutes ago on some of our patients, and you know we have a couple of patients that had no idea that it heart disease, and they have massive lesions in critical arteries.

Speaker 2: 20:04

Some of these arteries are called widow makers, because these are arteries that you know first. First time you know that you have a blockage, you're having a heart attack, and so you know. It's a life-changing technology and it gives you better and more information than even a coronary angiogram. So that's where you know you go into someone's groin, you shoot dye in their blood vessels like that's too much. You don't need to do that anymore. You can now do that with AI enabled scans of your heart. So it's super state-of-the-art. They're about a thousand bucks right now to do this test, but you know, I think I think if you can afford it, it's a great to have a baseline of a clearly test.

Speaker 1: 20:41

And what are the biomarkers you're looking at for inflammation?

Speaker 2: 20:43

So we're looking at a bunch of different biomarkers. I mean, the basics are, of course, hs, crp, highly sensitive CRP, but we also look at them homocysteine levels. We're also looking at amyloid protein levels. We're a fibridogen. We have cytokines or inoleucine levels. These are all levels that we're measuring to assess someone's true state of inflammation. You know, a CRP and homocysteine tend to rise later in the game when you have more moderate to severe inflammation, but those are both markers that every person you know, we empower our patients to know, like this is what CRP means, this is what homocysteine means. You need to know where your levels are. You need to be comfortable that you're less than one you know, and so we, we watch those levels pretty carefully.

Speaker 1: 21:28

You brought something up with a clearly scan you're able to see hard plaque, so calcified plaque and soft plaque and is there. Is it possible to remove soft plaque at this point? I know I don't think you can remove hard plaque once that's there, but can you remove the soft plaque?

Speaker 2: 21:44

Yes. So now with the new PCSK9 inhibitors, there's studies showing that you are actually able to reverse plaque with using intensive therapy, especially soft plaque, of course. And then, believe it or not, there's some studies showing even reversal of hard plaque, which is incredible with intensive therapy. So I never promise that the patient. The goal is to stabilize a plaque. You want as the least amount of soft plaque as possible. So whether that's hard plaque or it's plaque and reversal, that's what you want.

Speaker 2: 22:16

And what's great about the clearly scanned too is it tells you how much of that soft plaque is highly unstable. So unstable plaque is the one that gets a blood clot in it and blocks your blood vessel and gives you a heart attack. That's what you really want to know and that's kind of like more of an emergency. That's when maybe you do need a stent put into one of those arteries. So you know, these are all concerns that people have when you're over 40 years old, but definitely over 50 or 60. But the sooner you know the better, because the sooner you can change your lifestyle and get on intervention, the sooner you can stabilize that plaque so it doesn't go in the wrong direction.

Speaker 1: 22:52

Let's go to cancer. You're doing blood biopsy and also scans.

Speaker 2: 22:58

Yes, Okay. So the state of the art for cancer. For years, for like 50 years, ever since I went to medical school 30 years ago, all we had was colonoscopy, mammograms and you know, like women would get an OB-GYN exam, men would have a rectal exam to field their prostate for a hard lump and then we have PSA, which is a marker of prostate cancer. That's all we could detect, really right. Most other cancer you didn't even know until it became symptomatic Brain cancer, always diagnosed stage three or stage four.

Speaker 2: 23:26

Steve Jobs, pancreatic cancer stage four when he started having symptoms. If Steve Jobs was alive today and he had executive physical, he would have been saved from pancreatic cancer. And so what people need to know is that, even though you have to keep your colonoscopies up to date, you have to keep your PSA levels and your OBGYN exams up to date, mammograms up to date you're only picking two cancers there, two or three cancers. All of the other cancers is about 50 of them that are very relevant, that are not detected until you have symptoms. And so now the state of the art is combining a full body MRI scan with what's called a liquid biopsy. So we do both of those as well. So a full body MRI is going to detect earlier stages of brain cancer, pancreatic cancer, liver cancer, et cetera, that you would have never known about until they became symptomatic. And then the liquid biopsy detects cell-free DNA. So this is DNA being shed from active cancer cells that has migrated into your blood and now we can detect those with advanced DNA sequencers.

Speaker 2: 24:31

So now we know, at stage one or two, a lot of these cancers if they're developing and you are not. So that's kind of what we make part of our executive physical. And look, I mean, there's for people who know about this kind of stuff, there's always a controversy of, well, what if you get a false positive? What if something shows up and you don't know what it is? And so I always have the conversation with my patients beforehand is like, look, we have to be able to be in the mindset that we can tolerate the potential negatives of a false positive, which is mainly just stress and additional diagnostic testing, versus the potential positive of detecting a potentially fatal tumor or anatomical abnormality at stage one. Right, and so that's kind of what we, what we talk about with our patients to make sure they understand both the value and some of their psychological risks that occur with advanced testing.

Speaker 1: 25:20

Are you able to remove some of the false negatives, or false positives Because you're the synergistic interaction of the blood based biopsy with the scan.

Speaker 2: 25:31

Absolutely, and we also use our blood tests. I mean, we have a lot of testing modalities that we do. We do a thousand different blood biomarkers as well, genetic testing as well, and so we can. You know, we paint an overall picture, both with symptoms testing. Traditional testing and advanced testing paints an overall picture for us.

Speaker 1: 25:50

I'm just curious what size of mass is able to be detected with the scans.

Speaker 2: 25:56

I mean as small as less than a centimeter in diameter, you can go, you know, even five millimeters in diameter. You can find cancer masses as well. A lot of it has to do with how the MRI uses a special technique called diffusion waiting, so it can actually provide a visual representation of how tissue feels, believe it or not, and so if something feels hard, it'll light up on these scans, even if it's a tiny tumor. So that's. It's really interesting how this technology works. But yeah, we can detect pretty small tumors.

Speaker 1: 26:30

Well, let's talk about the other biggie, alzheimer's Functional testing. What sort of test are you looking at there?

Speaker 2: 26:36

Right, so we do some functional testing. We do a cognitive brain test online for our patients that are experiencing potential symptoms of cognitive impairment, right? So it all starts with mild cognitive impairment and we take them through a questionnaire. If they're unsure then we'll put them on a computer that does some testing for them. But in reality, you know, there's not great testing for Alzheimer's until just now, so just in the last one year.

Speaker 2: 27:06

We now have blood tests that can detect tau protein and amyloid protein in your blood. If you know, these are the proteins that are involved with Alzheimer's disease. We can now detect these in the blood and the initial studies are showing a high correlation with the PET scans, which are a specific kind of high radiation scan that we use to actually diagnose Alzheimer's. So there's a great correlation between a positive blood test and these PET scans. So even though you know they don't say the testing companies don't say and there's needs to be a lot more research done on preventative testing of blood biomarkers for Alzheimer's, we're still doing them to give us an indication and then we'll go down a diagnostic pathway if something is comes up positive.

Speaker 1: 27:49

So let's move on from the scary stuff. We really don't want to find optimization. Before we started, you were telling me that you're doing therapeutic plasma exchange, which you're actually the first clinician I've spoken to who does that.

Speaker 2: 28:04

Yeah, so just think I step back, david, if you don't mind. When we talk to our patients, I always tell people that we have a few different goals in mind. Our first goal is to optimize along the most common things. We need to make sure your nutrition, your exercise and your sleep is perfect, right and so as close to perfect as we can get it. Most people have not even had a great education around those type of around nutrition, sleep and exercise. Most of your audience is pretty advanced, but we empower people by using things like continuous glucose monitors, sleep monitoring technology whether it be an aura ring or a pad and we put into place VO2 testing, grip testing, et cetera, to really understand where they are on those basic aspects of health. Then the second part is the scary stuff that we talked about is ruling out anything that could potentially kill you. And the third part is where I love to be with patients is the functional medicine treating disease and its root cause. So this is functional medicine. That means improving gut health, improving your hormonal health, improving your emotional and brain health as well, and detoxifying your life. So around those four different aspects of functional medicine is where we do a deep dive with blood testing and we see where their markers are and we put into place habits and therapies to really optimize along those core aspects and then, once we have all that right, we can talk about some of this advanced longevity technology that we use on site. We want to get all that right first. Right, like you don't want to start doing plasma exchange and stem cells if you're not, you know, if you're going to McDonald's every day and you're sleeping four hours a night, it doesn't make sense, right? So we want to make sure we're really getting you the maximal results and you're not basically wasting your time or your money on this. Therapeutic plasma exchange is a new procedure that we just started doing as well, about eight months ago, for longevity and health optimization purposes. But, to be clear, this has been FDA approved for two decades and we've been using in the hospital for disease states such as an autoimmune crisis, for example, is one disease state that we use it for.

Speaker 2: 30:17

And what therapeutic plasma exchange does is we put an IV in one arm, we remove your blood in your plasma, we put it in a giant machine that looks like a dialysis machine and it separates the plasma from the blood. So then in another IV, the blood goes back into your arm and then that plasma is totally removed. And I always say the bad stuff lives in the plasma, right? So you have your immune complexes, you have your inflammatory mediators, you have your cytokines, inflammatory cytokines all this stuff lives in the plasma and your body is working so hard, your liver, your kidneys is working so hard to eliminate these toxins. What this machine does is just physically separates it completely and we remove it and we throw it away and we replace that plasma with fresh albumin and IV fluids so your body can regenerate the positive things that need to be in plasma, like clotting, flacters, hormones, etc. All that regenerates within 24 to 48 hours, but all the bad stuff takes months or potentially years to eliminate. We're removing it with therapeutic plasma exchange.

Speaker 1: 31:22

So with something like therapeutic plasma exchange, I'm guessing their markers that you're comparing is to judge success. So before and after, what would you be looking at?

Speaker 2: 31:32

Yeah, same, we're looking it depends on what we're doing it for.

Speaker 2: 31:35

So if we're doing it for longevity, we're actually testing a methylation age before the treatment protocol begins and we test one at the end of the treatment protocol. We're measuring inflammatory cytokines as well. So a lot of people are suffering with inflammation and we're measuring those as well. Some people are suffering from like heavy metal toxicity, so we're measuring heavy metal levels as well. Just depends on what we see in the blood. That's abnormal that we want to affect a positive change.

Speaker 2: 32:02

Now some people they're like you, david, they're like this model of perfect health and they come in and they still want to have it done. They're like I want the latest technology. If it's not going to cause any harm, why not? And so really the only thing we can monitor in someone like that is their methylation age, and we've seen tremendous changes in people's biological age even just with one treatment. So it's really. I'm really excited about some studies coming out this year on massive biomarker changes and especially biological age changes with therapeutic plasmics change. We're going to be seeing a lot of research being published this year on that.

Speaker 1: 32:42

All the people that I've spoken to about it. I find it absolutely fascinating that you're just like strip out not even all the plasma but a section of the plasma and then you have these amazing results. And it sort of brought me like well, maybe the poor man's version of this is just donate a lot of blood all the time.

Speaker 2: 33:02

I don't know. Yeah Well, unfortunately you can't donate this much blood because you're getting pregnant. It's really anemic, but a lot of people do have positive health effects from blood donation. As you know, it raises your ethropoietin levels as well. So I think plasma exchange right now it is slightly expensive, but it's not going to be forever and I think the more research we see coming out for it, the more mainstream it'll get. The more mainstream things get, the lower the price gets. So I'm excited to see what this kind of leads us, and it's so funny to think that maybe the solution to aging one of the solutions to aging and inflammation has been under our noses for decades in the hospital and we just weren't using it.

Speaker 1: 33:47

With me the first time.

Speaker 2: 33:48

Yeah, exactly.

Speaker 1: 33:51

So you mentioned hormone optimization, which I'm not a doctor and I'm not a scientist, but I find the whole hormone thing incredibly complicated. You know, therapeutic plasma exchange okay, that's pretty straight ahead, but this stuff is like wow. So if I came into you, I'm 65, say I'm feeling like, and I don't want you to be my doctor here, but like I'm just going to make this up, so I think like well, you know, maybe I'm not, I don't have as much mental acuity, or my recovery in the gym takes a little longer.

Speaker 1: 34:23

What's interesting to me is there's sort of like various ways people do this. They'll just like give somebody like okay, here, try this gel, we'll see how you feel. And there are other places where there's like a lot of testing going on with a male. What are you looking at in terms of hormone markers?

Speaker 2: 34:40

Yeah. So, first of all, if you go to someone that gives you in gel and says, take this and see how you feel, definitely that's a red flag. That means that you know it's another one of those. Like you know, I hate to keep bagging on Western medicine and most Western medicine doctors are much more advanced now than this, but it used to be. When you had 10 minutes to see a patient and they told you this and the testosterone level was low, you just give them a bottle of gel and see you later. You know, and absolutely does not, the way to do it.

Speaker 2: 35:10

We do an in-depth hormone panel on men and women. It includes things like testosterone, free testosterone, sex hormone, binding globulin and also, you know, you have to measure everyone's PSA level. When you're doing hormone therapy, you're measuring estradiol levels, you're measuring thyroid levels, everything. So we had a complete hormonal picture. Now, David, for someone like yourself, since you gave me the example, I will tell you that if your testosterone level was low and I saved low in quotes, you know, because a lot of it has to do with your symptoms then we would talk about testosterone replacement therapy. Now there's ways to increase or boost your testosterone. Naturally, as we all know of lifting heavy weights, ashwagandha, dhea. There's other things you can do to do that, but it probably wouldn't get your testosterone level up too much, and we like to see men have a testosterone level that mimics kind of like where you were in your 20s or your early 30s. Okay, so for most men that somewhere above 400, for sure, but somewhere around five to 900, somewhere in there. So we go very much based by symptoms, david, and we're following your hormone levels on almost a quarterly basis for a couple of years until we get things exactly right.

Speaker 2: 36:33

Now we have different modalities of treating testosterone, low testosterone. One is by taking a pill that encourages your normal natural production of testosterone. That's called plumid. That can probably get you up about 100 to 300 points. Another method is by using testosterone injection therapy, and with that it's very important to do at least twice a week. We prefer three times a week dosing so you don't have these massive ebbs and flows of testosterone.

Speaker 2: 36:59

And then the last way that I like that I'd use personally and I like for a lot of patients is testosterone pellet therapy. That's where we put a small pellet of dissolvable testosterone under the skin of the buttock and it takes a little procedure once every four to six months, but it basically lets me forget about having to inject myself with testosterone. This is letting me have small doses of testosterone every day without having to inject myself. So those are three modalities. We never almost never used testosterone creams on anybody. I can't remember the last time I prescribed that, just because the absorption is so variable and it's, you know, can get on your loved ones, it can get on your pets and people forget all the time to put it on all of that good stuff.

Speaker 1: 37:47

I'm curious with the pellet, did you get a surge in the beginning, or is it even?

Speaker 2: 37:51

Yeah. So the first time that you do a pellet therapy, and maybe even the second time, you'll have an immense feeling of a surge, and that's because your testosterone has been low for so long that now it's finally normalized. Your body feels it, but after the first or second time you put the pellet in, no, it's very controlled release and it keeps you out of really you know increases over six weeks and then it's pretty steady over the next. You know three, four months and I don't feel a surge and I think most people feel pretty good after doing the pellets, after they've had a couple of you know rounds.

Speaker 1: 38:29

I've been hearing much lower doses of testosterone replacement therapy for women.

Speaker 2: 38:34

Yeah, yeah, a lot of women use testosterone replacement therapy and in fact, for a lot of women, that's all we use is testosterone replacement therapy if they're premenopausal. So women are a little bit more complex because it depends on what stage they're in of their cycle when you evaluate them, and also what stage of life they're in as far as pre-during or postmenopausal. So we really try to tailor the hormone replacement therapy towards where they are.

Speaker 1: 39:07

Tell me what are you excited about bringing in to your clinical practice that you can't right now.

Speaker 2: 39:15

I'm excited about so many things and unfortunately, our FDA makes it really, really hard to do things that they should be approving, just so that the United States can stay ahead of the game on patient care and medical technology. However, they are not approving and they're putting roadblocks in place because of the intervention by pharmaceutical companies that they can't make money off of these things. You know what I mean. So things such as stem cell therapy, exosome therapy, peptides the peptides is such an exciting field. There's so much we can do with peptide therapy. We see that right now with the peptides ozempic and margirno, like what is game changers for the world. Right, there are risks, of course, but I've been using peptides for years now things like BPC-157, cjc, et cetera and now the FDA is putting more restrictions in place on these peptides. So I think there's a lot going on in the world of longevity that, unfortunately, fda is trying to block. But the research continues to go on in other countries and it will continue to flourish and we will be able to do a lot of these things here at some point, whether it be in the United States or outside.

Speaker 2: 40:36

Now there is a lot of talk right now about gene therapy, and you might have heard of phallostatin gene therapy and I think there's definitely an incredibly new frontier. Phallostatin is just one gene. Of course, we can do thousands of different genes, if you theorize along gene therapy, what can potentially be done. But I think phallostatin is a good place to start because it's a reversible type of a thing and also the effects are simply just muscle growth and we have the biohackers trying this out right now. There still needs to be a lot of research done, but I feel like it's going to go in the right direction where we'll see more gene therapies coming out and also it becoming more standardized and more available to people.

Speaker 1: 41:20

I'm really big on testing and monitoring. You know I do some of the things that you've mentioned. I'm hearing what you've just told me. I'll probably do more Basically. I don't want to die Right.

Speaker 2: 41:35

Exactly.

Speaker 1: 41:38

But it's sort of a shame that people go and they'll get a physical once a year and they're not even checking people's vitamin D levels. It's just like it's puzzling to me. I wish that more of this was covered by insurance and there was more oversight on people's health because, as you said, especially with the two biggies, cancer and heart disease, it's really about what are you seeing early on. Once a cancer mass gets to a certain level, you're looking at 10,000, 20,000 different forms of this and that becomes really difficult. And it's the same thing with cardiovascular disease.

Speaker 2: 42:22

Yeah, I mean it's just mind-blowing to me that treating cancer costs upwards of $250,000 to $400,000 a patient, whereas giving everyone in the country a genetic test that you can get. If you really do this on scale, you could do it for $50, $100, on a yearly basis. You'd avoid so much healthcare costs and also so much pain and suffering. The same is true for heart disease, and calcium scores are not approved by insurance. To me, that's the most underutilized test in all of medicine. You could find so much advanced heart disease with calcium scores and they're only like $100.

Speaker 1: 43:07

Why not approve that?

Speaker 2: 43:10

These blood tests for Alzheimer's same thing. They're going to come out, and they're going to probably be a few hundred dollars to start, but doing those at scale and detecting Alzheimer's at an early stage is so valuable. And then I do think, though, that we do have some good testing now for metabolic disease, and metabolic disease is the base of a lot of these other diseases. So if you can keep your insulin levels under control, then you will be way ahead of the game. You have much less risk of Alzheimer's, cancer and heart disease, and the best way to do that is to know what your hemoglobin A1C level is. So that's a blood test that every doctor should be able to do for you, and it costs basically a dollar or two. And if you're hemoglobin A1C, I always tell my patients every patient you need to know what your hemoglobin A1C level is. I should be able to ask you. You should be able to tell me what it is, and I know you probably can. The most people can 4.7.

Speaker 2: 44:06

Right, there you go. 4.7 is an incredible goal to have, so I don't want to be 5.2 or less, but if you start edging up 5.4, 5.5, 5.6, you're going in the wrong direction, and we got to do something about your diet, your exercise, your sleep to get you back into where you need to be. So and that's just an easy, cheap test that almost everyone has access to, and if your doctor's not doing it, I would insist on it. Same with HSCRP. Inflammation is another root cause of all disease. Everyone should know what their HSCRP is.

Speaker 1: 44:39

I don't actually know what the number is off. I have it in my phone. It's pretty low. Yeah, one of the things you said early on was sort of the basics, what I tell people. You got to get the big rocks right, so that's sleep. If you're not sleeping, you're sabotaging anything else you do. You got to sleep, figure it out, go see somebody Get that figured out. And what are you eating? What are you bringing into your body? And then how are you moving? If you sort of get that more or less figured out, okay, now we can talk about the exotic stuff. You got to get that done or the rest of it not going to work so well.

Speaker 2: 45:21

Yeah, and David, you know, what I always find when I have that talk with my patients and just even my friends and family, is that people get so hung up on the little details, like you know, they read tomatoes are bad for you, or they read, you know, and they get so hung up and then they get like paralysis by over analysis, you know, and I say let's look at the 20% of the information and the routines and habits is going to make 80% of the difference and that's the principle, right, and it's so simple with sleep, exercise and diet, what that 20% is like. Just get that right, you know, and it's a bonus on top of that, right? So avoid ultra process food, right, like that's to me is like step one, two and three of getting your diet right. You can be pretty much eat anything else, and ultra process food is step one.

Speaker 2: 46:09

And step two on diet is maintaining a flat glucose curve. And the way you do that is reduce your carb, your refined carbohydrates, your refined grain intake. Eat your carbohydrates last in your meal, don't snack. Done you do that? You're automatically going to be healthier than most of your. You know, friends, I hate to say, and yeah, I mean we could say the same things about exercise and sleep. Keep moving, you know, don't be sedentary, and that's, that's a massive problem that we have in our society nowadays.

Speaker 1: 46:38

Yeah, I could go on and on about that.

Speaker 2: 46:40

I don't have a walking desk right now. David, I turned it off for you, oh, good for you. I give her the 20,000 steps in a day. It's amazing.

Speaker 1: 46:51

Walking is just the best, Darshan. This has been wonderful, Thank you. I'm I've always sort of wondered for myself. I mean, personally, this podcast is really just about informing me about stuff, and other people listen to it. So I was really curious about you know what exactly happens in something like if somebody goes to see you at Next Health, like with an executive physical, what are we looking for and what are the solutions there? Like if we find something, okay, that was good, yeah.

Speaker 2: 47:21

Yeah, so that's what we do. I mean, you know you come in the executive physical takes about three hours to do and then we take some. Takes a couple of weeks for us to get the results, but then we sit down with you over two or three sessions and really make sure you understand what we're looking at. You know, and like I told you, we have this kind of paradigm that we use of the wellness wheel, which goes over the 12 aspects of health, and then we develop a plan for you and a lot of the technology that you need to keep yourself healthy. We have it on site and people come in on a regular basis, weekly basis, to use it, and then we just rinse and repeat on a yearly basis.

Speaker 1: 47:54

Wonderful Darshan. Thank you so much for your time today. I know you're a really busy guy and we were trying to book this for a long time and it's been really nice to see you and have you on.

Speaker 2: 48:03

Well, thank you so much for everything that you're doing, David informing the public and doing the podcast, and asking the best questions and ensure people learn so much from your conversations. So thank you for what you do.

Speaker 1: 48:14

Thank you so much. Great to see you today.

Speaker 1: 48:17

Take care I know. Big thanks to Dr Darshan Shah. If you're interested in checking him out and what his group is all about, we'll leave the links in the show notes. It's called Next Health, you know. Based on my conversation with him, I actually just ordered a Grail blood test, so I'll let you know how that goes. I put this off for a while because I wasn't quite sure of the technology, but I feel now, especially based on that last conversation I had, that the risk benefit is worth it and so I'm going to take one. We'll see what happens we're going to get with. Just try this. After a quick word from my sponsors Did you know that just pounding water all day is not going to keep you hydrated?

Speaker 1: 48:58

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Speaker 1: 49:57

I want you all to think about one of your dreams that you would like to have manifest and you haven't done anything about it, and do something about it this year. The time is going. We can't control it. There's a lot of other things we can control in our life, but we cannot control that Absolutely. How many summers you got left? How many winters you got left? How many opportunities you have to do the thing that you want to do that, for some reason, you have been putting off? I do the same thing. There are a thousand reasons to not do something, and there's only one reason to do it because you've decided to do it in spite of other people's advice or thinking you may fail or it may not work out, or whatever. I think this is the moment, this is the time, because ask yourself, if not now, when let's take that action? Let's get it done, and I know there is some talk out there about how bucket lists are bad things and they make us feel bad. I think that's who we. Ambitions, dreams, things that we want to get done. These are reasons to get out of bed in the morning and to look forward to our lives in the future. So let's make a plan to manifest one of those dreams this summer. Take an action, in spite of what people around you may say or what your doubts are. Just do it, because if you don't, you might regret it.

Speaker 1: 51:12

Thank you all for listening. It's been great to have you with us. This is the moment in the show where I ask you a favor Please leave us a review, hopefully a good one. Leave us a comment if you'd like to do that. If you want to contact me or contact Darshan, hit me up, david, at SuperHcom. I answer all of my emails directly, personally and promptly. Until next week. Everyone, have an awesome week. Take care now. See you at SuperHcom. You, you, you, you, you.