From DNA to Daily Habits: Choosing a Longer Health Span

Speaking of Women's Health Podcast host Holly Thacker, MD sat down with Cleveland Clinic internist and executive health physician Richard Cartabuke, MD to map out how a single, coordinated visit can compress a month of care—advanced labs, imaging and expert consults—into a focused plan you can actually use. From there, they go deeper: why direct genetic testing beats ancestry kits for medical decisions, how proteomics and multiomics translate your biology into priorities and where whole genome sequencing is headed as targeted therapies arrive.

Data is only useful if it drives daily choices, in the interview learn how to turn complex readouts into simple steps: strength training, protein-forward meals, sleep regularity, blood pressure control and stress habits that lower cortisol. On the therapeutic front, they explore GLP‑1 and GIP agonists beyond weight loss—microdosing schedules, inflammation reduction and organ benefits—plus practical ways to access legitimate medication through manufacturer programs and avoid risky compounding. 

They wrap up the interview with a clear takeaway: start earlier than you think, build a baseline you can track and use precision tools to focus effort where it matters most.

Transcript

Meet Dr. Cardibuk And The Mission

Holly Thacker, MD 0:11

Welcome to the speaking of women's health podcast. I'm your host, Dr. Holly Packer, and I am back in our Sunflower House for a new edition and a very special guest, Dr. Richard Cardibuk, who is a Cleveland clinic physician, who I had the pleasure of getting to know recently at a health network uh honoring event of physicians. So he and I were being honored for our work in patients. And we're going to dive today into a fascinating and rapidly evolving area of medicine, personalized medicine, executive health, including the role of genetics, proteomics, and whole genome sequencing in optimizing health and longevity. Now, as many of you long-term listeners know, we've had uh several anti-aging podcasts, uh, a lot of uh information on personalized medicine and genetics. Um, but there's just so much into this field, and it's so exciting for Dr. Richard Cardibuk, a physician whose work spans primary, uh, internal medicine care, hospital-based medicine, and executive health. Dr. Cardibuk was born in Syracuse, New York, and he received his Bachelor of Arts in History and a Bachelor's of Science in Biology, and a Master of Arts in History from Case Western Reserve University in Cleveland, Ohio. He is definitely a renaissance man. He obtained his medical degree at State University of New York, Upstate Medical University in Syracuse, New York. He then did his residency and chief residency training at Cleveland Clinic. So he and I share that. We also share we both had acute appendicitis. We bonded over that. He completed an advanced fellowship in medical education at Cleveland Clinic. And he has a general internal medicine practice that involves primary care and hospital-based medicine and executive health. So in addition to his general medical practice, he serves as a medical director for the nonprofit health network foundation, another link between the two of us. And he's on the regional board for Make a Wish Foundation, and my good friend Lisa Margolos, who has been on this podcast, uh, is a big fundraiser and very dedicated uh to Make A Wish Foundation. So welcome, Dr. Cardi Book.

Speaker 2:50

Yes, thank you so much for having me. I really appreciate it.

What An Executive Health Exam Includes

Dr. \ 2:53

Well, you are, like I said, a renaissance man and very, very busy. Uh why don't we start with some of your work um at the Cleveland Clinic's executive health team? Tell us what an executive health exam looks like and how it's different than a traditional annual physical exam.

Richard Cartabuke, MD 3:11

Yeah, so an executive health examination is often a comprehensive full-day or half-day evaluation, and the design is really to provide an in-depth picture of a person's health in a single streamlined visit. And the programs typically will include advanced diagnostic testing, extended laboratory work, imaging studies, and then consultations with multiple subspecialists. So you may get a nutritionist, a fitness expert, a psychologist, a cardiologist, an orthopedist, a dermatologist. And then as well, we try to include some of the personalized medicine aspects that I think you're interested in in this podcast and certainly are no stranger to in your own practice. And the goal of this is early detection of disease, risk stratification, and personalized health optimization and tailoring it to the needs of the demanding schedules of these busy individuals who come in, where it may take weeks or several months to get some of this testing done, and we try to do that as streamlined as possible. In contrast, right, a traditional annual physical with your primary care physician is more focused on preventative care, and that's usually evidence-based, based on screening recommendations that are presented by our society guidelines. And that involves a health history, a physical exam, basic lab tests, and referrals to specialists that may be made but only on an as-needed basis. And the visit may be shorter, more standardized, and there's really an emphasis on addressing acute concerns, monitoring chronic conditions, and unlike an executive health exam, these are typically covered by insurance and designed for continuity of care over time rather than a single intensive evaluation. And so that's really how we try to structure the executive health program differently from your traditional primary care practice.

Dr. \ 5:07

And can anyone just call your office and get scheduled for an executive physical? Do you have to do it through your company or do you have to just be willing to pay the money and make the time?

Who Uses Executive Health And Why

Speaker 5:19

Yeah, that's a great question. So I think the interestingly, the executive health name of the program, I would say, is a misnomer. Because anyone can make an appointment with Cleveland Clinic and it's typically self-pay or concierge style. But I would say the nice piece about this is we bundle the services in a way where we create a significant discount comparative to if you're getting this pricing for these tests done commercially or kind of a la carte. So if you do it through the program, right, you're getting this all done in a way where you're usually saving money that way and you're getting a more comprehensive look at things. And anyone can call up to do that. So I have patients who come to see me from all over the country and internationally as well, who are just looking for a different approach to their health care and may say, look, I've been doing traditional primary care exams for a long time, but I really want something more intensive this time around, or I'm really looking for a different approach because I haven't gotten answers to some of the questions that I've had for some of the conditions that or symptoms that I've been experiencing for a long time.

Dr. \ 6:29

Well, that is just uh yeah, very interesting. Over a decade ago, I started with uh custom fit physicals for women, which is concierge, meaning they get a block of an hour's time and a full exam and blood work and everything arranged on that day. But it's certainly different and it's kind of focused on midlife women and menopause and hormone therapy. Um but we just thought that there were a lot of women who were um not thinking of themselves as executives. Um and so certainly you don't have to be an executive, and you know, you can be a homemaker but still be the chief executive officer of your family, right? So you of course see men and women, where of course in our Center for Specialized Women's Health, we just see women. Uh what types of patients do you see typically seek out your services?

Speaker 7:27

Yeah, I can say it's wide-ranging. So, for example, I can tell you yesterday I saw a 26-year-old and I saw an 88-year-old in the same day. So it's quite a wide range of patient ages who seek this out. And they've had much different goals, right, in terms of what they were looking for. So one was looking for a baseline and saying, this is my first time doing this program. I'm looking to do something comprehensively that then I can track over time and have really a nice comprehensive database that I can go back to and say, let's look at this over time and see if there are small changes that occur with some of the lifestyle things that we advocate for in terms of my overall health. Whereas the 88-year-old was saying, okay, I'm I'm looking for longevity for the next several years. How do we position myself well from a cognitive standpoint and from a functional standpoint? Because I have much different goals, right? I'm not looking for the next necessarily the next 30 years. And so it was interesting, right, the juxtaposition in terms of those conversations. But I think ultimately the right the approach is similar. And you've been a pioneer about uh you know women's health hormonal therapy, uh, being a champion of this, and I think there's so much benefit to having that discussion earlier, and we've known that from a cardiovascular disease perspective, right? And some of the things that you've talked about even on the podcast and some of the columns that you do for uh this service as well. I think that what people are looking for is an approach that one incorporates them into the conversation and is more focused on shared decision making, but really I think takes a deeper dive and allows you to really listen to their concerns. And to your point, right, you get an hour with the custom fit physical. We also structure it so you get an hour with the physician, and I think that that's where you really find the value. Because then I can get into things like sleep, what you're doing from a dietary perspective, what your exercise habits are like, how does stress right impact your cortisol levels? I mean, we're talking about, you know, families, we're talking about how that integrates into your business, into the structure of your household, right? For example, those things matter. And I think often in primary care, right, we just don't have enough time to structure a visit that way. And those are the drivers, right, of health and disease. And I think often we just don't necessarily put that as the primary focus.

Health Span, Priorities, And Lifestyle

Dr. \ 9:58

Yes, it is a different health care landscape than it was even 10, 15 years ago, and certainly 50 years ago. And I always encourage my patients to be so proactive. Our mission is be strong, be healthy, and be in charge. And you really have to come focused and prepared and um really approach your health, especially in your second half of your life, um, and dedicate that time to it personally. I I think a lot of patients just want us to make them go back to age 30, and we can't necessarily do that. But this whole concept of health span as opposed to just lifespan, people don't necessarily want a long life where they're disabled and not functioning very well. They want to extend their health span. And I think that's you know one of the things that you focus on. Um and you have been listening to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, and we're in the Sunflower House with uh internist, executive medicine expert, anti-aging expert, Dr. Richard uh Cardibook at the Cleveland Clinic Executive Health. And Dr. Cardibuc, you're doing really incredible work in terms of integrating genetics and proteomics within the executive health program. Can you just, for our listeners, define like what is different about genetics versus proteomics and how you're doing whole genome sequencing in your practice?

Genetics vs Proteomics Explained

Speaker 11:35

Yeah, so these are really interesting and cutting-edge types of offerings that we have, and I'm really excited that we have these available now for patients in a way that I think is effective, and now we can kind of integrate that into the overall thought process in terms of making health decisions for them and with them. So if you're thinking largely about genetics, what we often think about, and particularly I think for women's health, right, we think of bracket testing. Most people have heard about that because I think there's a lot of information out there about that. There are so many other markers and drivers of disease when it comes to genetics. And so, what I often talk about with folks is if you have a family history, if you're thinking about kids, if you're thinking about grandkids and their risk, right, getting a comprehensive screen and then having that information available can be so powerful, and we're learning so much more about how to integrate that information into your own personal health plan. So direct genetic testing becomes so helpful in order to do that. And so we offer that through a company called Invite, and that's something that individuals can actually get two different types of testing. They can do direct genetic testing to look at carrier states if they're thinking about family planning, and they can also do it to look for drivers of things like cancer risk, cardiovascular disease, and other types of metabolic disturbances that may influence their health. Separately from that, we're now going to start offering whole genome sequencing, which is hopefully going to be really instructive for patients in terms of thinking about their future. Because now we're starting to develop targeted therapies to cure diseases that we once right thought were incurable. And so that's really more cutting edge when it comes to genetics. When we think about multiomics, and maybe defining that would probably be helpful for you know some of the users, uh, you know, and individuals who who are listeners to the podcast. So multiomics is a catch-all term. So that refers to genetics, right? So genomics, your DNA, your transcription, so your RNA, and then your proteins, right, and then your metabolites that are generated from this. It also looks at things like your gut microbiome, which is getting a lot of press lately in terms of how we think about this. And so what Multiomics attempts to do is to look at a more comprehensive and systems-level view of your biology. So instead of just looking at one specific gene, we say, okay, how does that gene then express itself and cause all these downstream effects that potentially could impact your health? And so then we can actually help you make decisions based on changes in your lifestyle, changes in your diet, changes in medications that you may decide to make, changes in your sleeping habits, and then over time, hopefully, we can actually see improvements in those areas that we actually have more intense discussions about. And ways in which I think we're really seeing benefit is it allows for a much more personalized discussion. Because then we can say, okay, based on your risk factors, maybe we actually focus on these specific areas of health. So to give you an example, maybe we say, you know, looking at some of the protein metabolites that we're seeing from this drop of blood that we get, we actually see that you have a much higher risk for heart disease. So maybe our discussion actually then translates to how are we actually assessing your risk for heart disease and managing some of the things that are related to that rather than thinking about things like your kidney disease or thinking of things like your risk for gut disease, you know, things like colon cancer or prostate cancer, because maybe those actually are not in your genetic plan or as readily apparent as a problem. And so I think that's really how that can be used moving forward for folks.

Dr. \ 15:47

So we're airing in 2026. This is our um fourth season. So are you currently ordering right now and having that available in 2026, whole genome sequencing?

Whole Genome Plans For 2026

Speaker 16:01

So both whole genome sequencing and proteomics will be hopefully available first uh quarter of 2026. That is the hope.

Dr. \ 16:11

Excellent, excellent. And um I think there's so much confusion with patients, like uh in the women's health realm, of course, we're concerned about familial breast and ovarian cancer syndromes and familial cancer syndromes. And a lot of patients will reassure me, oh, I had my genetics done, I don't have BRACA, but they're getting recreational commercial like 23andMe testing, which does not test for all of it, and that's not medical testing. Um I don't know if you want to speak to that. Um and how it's different and how that informs things for the patient and for you as the physician.

Medical-Grade Testing vs 23andMe

Speaker 16:52

We are so aligned in that messaging. Um so the the challenge with 23andMe is it's great from an ancestry perspective. So I think about it as almost thinking about genealogy and almost like a project that you would do for like middle school or high school, right? Where look, we are curious to know where we come from, and that's a fun fact, right? And it's interesting to know, but that doesn't necessarily inform decisions and shouldn't inform decisions about your health. Because the problem with those types of tests is they're really only looking at snippets of these genes, so it's not direct genetic testing, and that's the difference. That's the difference, and unfortunately, and I think that it is nuanced, it's being marketed that way. And there are a number of different companies out there, and we could go through a huge list of them, and I have patients actually who come in and say, Look, I've had all of these things done, I've already had genetic testing. And I say, Well, actually, you haven't. Because unfortunately, right, the type of testing that they've done isn't direct genetic testing, so it really doesn't necessarily help us formulate a plan. So that's where I think the trust, right, and building that relationship with the physician is so powerful and so important, and having those discussions right really lay the foundation for you to then create a plan that makes sense moving forward. Because otherwise, if you're just going to some of these companies, they're trying to sell you a product that doesn't necessarily actually move the needle in terms of your overall health.

Dr. \ 18:29

And I have some concerns about the testing that they do, looking for snippets of potential cancer, you know, without symptoms in patients. And I do worry about overdiagnosis as well as underdiagnosis. What kind of insights uh can patients gain from understanding their particular specific genetic blueprint?

Actionable Insights From Your Genes

Speaker 18:53

Yeah, I think the this is ever evolving. So I think that the hope is, right, that as we get more sophisticated as a medical community and understand how to use this information better, you'll be able to select many different pathways that I think will improve their health. So an example of that is in the geriatrics community, for example. We actually do pharmacogenetics, which help choose, right, better medications for medication, right? Or maybe it chooses a statin that you specifically are going to metabolize better than this other medication. So those types of things actually are already being done and being done at a high level and are very helpful to understand about your health. As we kind of move forward now, there are already biomarkers that are already being processed for things like Alzheimer's disease, for example, that are going in the next six months to be commercially available that are going to show you what your risk for developing dementia or cognitive changes are that are going to be better than any of the MRI or imaging testing that we have of the brain that's available, which used to be right the standard of care for these individuals. So this is this is rapidly evolving. I mean, what we're talking about now in this uh you know podcast is likely going to change even in the next several months. So the nice thing is this is going to be something that I think everyone is going to start to have. So what I tell patients is do it, because doing the whole genome sequencing once in your life, having that information available at a reputable place, and then being able to go back to the well and say, great, now right we've made breakthroughs in these different disease areas, let's look at my own right genetics and my own proteomics and see how we can use that information differently is such a great place to be.

Dr. \ 20:48

Absolutely. Um so, in terms of the genetic testing, like are you um routinely offering like ApoE phenotypes for for patients in terms of Alzheimer's risk and cardiovascular risk?

Speaker 21:03

We have been, and unfortunately, I think soon we're not going to need to because we're going to have even better testing available shortly that will will give you a better risk profile in terms of what uh we think your risk of dementia will be in the future.

Dr. \ 21:19

Because I know there's a panel at the clinic that just neurologists order because I actually uh tried to order it and a lab called me and said, well, we just have neurology order this, which makes sense if it's the neurologist that's going to have to be explaining, you know, treatment options and prognosis. But I know for um general practitioners there's a Tau protein. Have you have you ordered that at all in patients to look for that?

Speaker 21:46

Yep. So, and and actually now there's a uh PET scan that you can order as well that assesses for um proteins in the brain, right, that can actually suggest that you may have a higher risk for Alzheimer's. Alzheimer's. As well, we're launching a, I think actually it's underway now, but there is a study that is being conducted at Cleveland Clinic currently that are looking at two biomarkers that actually may have better predictive value than Apo E testing and the Tau protein combined for looking at Alzheimer's risk. And the hope is that those will actually be commercially available within the next six months for anyone. So it will actually be something that a primary care physician or even our executive health practice would be able to then order routinely to look at risk. So this is going to change completely how we think about brain health.

Dr. \ 22:38

And I know for some people, if that would convince them to clean up their lifestyle or stop drinking alcohol or pay more attention to their cardiovascular risk, which I think all of us, regardless of genetics, you know, should be doing that. There's some evidence that some women may do better with menopausal hormone therapy in terms of dementia risk, depending on their baseline genetics. So I just wondered if you had any comments about that.

Brain Health Biomarkers And Hormones

Speaker 23:08

Yeah, I've actually been a big proponent of that. So some of the anti-aging uh literature that's out there, right, already suggests that I know perimenopausals, women specifically, right, benefit from hormonal therapy from a cognitive perspective. And there actually is significant data out there that shows, right, um hormonal therapy can actually benefit prevention of progression, right, of cognitive changes in those women. What I am less familiar with is what those changes look like once you're postmenopausal. Although there is some emerging data that suggests that hormonal therapy is still beneficial for that population. And I think for a long time, as you know, the women's health study was so damaging because we we went away from offering hormonal therapy to women for so long and just said, oh, just manage the symptoms or you know, there's there's too much risk. And I think we overstated that risk so significantly that instead of actually treating these women and giving them one uh improved cardiovascular outcomes, because we knew that that already was one of the benefits, we actually really harmed them in a number of other ways as well. And so it's nice that this data is kind of going back in the other direction, right? And we're starting to get more aggressive with that, although you've been banging the drum for that for a number of years, so I don't have to tell you that.

Dr. \ 24:34

I know. Well, you call me a pioneer, which is probably reflective of my age. I I prefer trailblazer, is what I've said. But yeah, true. I have been banging drums quite a bit. And I think it's important, I mean, there are risks. You can't say that there's no risk with hormone therapy, particularly oral hormone therapy and risk of clot, and some people that are perhaps genetically predisposed. Uh, and certainly oral hormones over a decade after hormonal menopause and chronologic age and when your periods stop and when you're actually in menopause. I mean, these are very different things that I don't think is are very well appreciated, not just amongst women themselves, but also uh people in health care and even in women's health. But there can be a slight increased risk of stroke in older women with established cardiovascular disease taking oral hormones, and that's why the memory, the women's memory study, you know, suggested an increased risk of dementia. Certainly the sweet spot appears to be within 10 years of estrogen deficiency, and after that, there is methylation of the estrogen receptors. And so if there's established brain disease and established heart disease, then you're not going to use menopausal hormones and say you're getting a preventive benefit. You still may prescribe it therapeutically for hot flashes or the bone or local treatment for the vagina. And I do think it's important to let women know if they can't or won't take hormones or they're past that sweet spot time, all is not lost. I mean, there are so many options that we have in the anti-um-aging realm and the health promotional realm that I don't think anyone should feel left out. And and it's never just one simple answer. Um and it's not just taking one simple pill either. I think that's what people want. They want that supplement. Oh, should I take creatine for my brain? You know, I we did uh a creatine podcast in season three. People just want that simple, quick fix, and um really anything that's worth doing is worth doing right, and it usually is not just simple and easy. So, how do you help your patients interpret complex genetic data in a way that's actionable?

From Data To Daily Decisions

Speaker 26:49

Yeah, so that I think is the the million-dollar question, I would say. So the the challenge, I think, with all of this is we don't have all the answers, right? Medicine is not black and white. And so some of it is a give and take, and I often tell folks, because we have patients, and you just you know described an aspect of this. They come in, they're taking a number of different supplements, and they say, What should I continue, what should I stop? And I say, Well, you're not even necessarily doing the basics, right? So you're not, you don't have a healthy diet, you don't have healthy exercise habits, so you know you're you're taking you know that Lamborghini out for a ride, but you're not doing any of the maintenance on it. So eventually, right, it's gonna break down. Um so you can wash it right and and make it shiny on the outside, but right, we need the nuts and bolts and all those things that are inside the car to be working appropriately before we get to some of these advanced type of things. So the way that I like to approach the conversation is really saying, let's start from the beginning. What are you doing in terms of your exercise habits, your sleep habits, how are you managing your stress, how are you thinking about your diet, how are you integrating those things into your busy schedule, and then build from there? How are then we talking about how your genetics influence each of those aspects of your life? And then let's start talking about medications, what supplements you should be taking, what should we change about these things, and then let's look at that and see what that looks like over time. And then when we see each other in six months or a year, how can we build on that? And as you know, I like anything. Some people are resistant to change, and some people have their thoughts and predilections on what they want to do, and that's fine. It's about how do we integrate and make a shared decision together, because what I want is the same thing, that health span that you described earlier.

Dr. \ 28:43

And so for any of our listeners who want more information on healthy nutrition and exercise and improving your sweet sleep quality, we have several of our, you know, couple hundred podcasts on those um topics. And listeners can go on speaking at women's health.com and under podcast search for the topic you're interested in and then the exact dates of what you're interested in and the specific podcast that I've already posted. Then you can go to your podcast app and scroll down under Speaking of Women's Health to the exact podcast that you want to listen to. Uh Dr. Cartabuk, are there emerging therapies? Well, no, before I get to emerging therapies, are there certain tests and biomarkers that you use to specifically track aging and resilience?

Biomarkers And The Aging Puzzle

Speaker 29:31

So uh there's there's a number of them, so I wouldn't say there's just one in particular that I am you know looking at. If you look at some of the data that's come out of either Hopkins or Duke or, you know, the Dundan trial, some of these other things that they're using proteomics for right now, the the data overwhelmingly suggests, right, chronologic and biologic age are kind of a fun novelty, but they don't necessarily inform how we should treat you. I think really what the benefit is, is looking at some of the breakdowns for how we should think about cardiovascular risk, and that comes in many different forms, right? And for me, that's almost a surrogate as to how well you're planning your life from a healthy living perspective, right? So are we doing the right things in terms of some of the pillars, right, that we touched on earlier? And then have you created a lifestyle that makes sense, you know, in terms of managing some of those risks? And so I wouldn't say that there's one or two biomarkers that we're following more specifically. I would say there's an array of those, and that's really what we're trying to get at when we talk about proteomics, because using AI technology now, we can follow almost a million of these biomarkers when we actually get a breakdown of some of the data. And so everybody's different, and I would say there's not one specific one that I think that I'm following regularly. Um, some of the newer ones, right, that that have gone kind of in and out of favor, right? We've been talking about things like TMAO for a long time, for example. Right. So it was one of the things that all of us were really interested in, then it fell away for a little while, now it's coming back because now there's a link between that, the gut microbiome and atrial fibrillation, for example. So you you're seeing some of the kind of older um players come back, you know, in into favor. Um, and I think that's why we're repurposing old medications, right, for newer uh types of indications. So metformin, for example, right? I mean, metformin has been around for a long time, and how many individuals now are taking it from an anti-aging perspective? Tons.

Dr. \ 31:43

Are you using any um rapamycin in your practice for anti-aging?

Speaker 31:49

So we're starting to get into that. The challenge, the side effect profile, right, for rapamycin is so challenging to navigate. Um, the mice models for rapamycin are very promising when it comes to anti-aging. Exactly. But the human kind of equivalents for that, um, I have not seen convincing data to suggest that it actually is beneficial because the uh side effects typically outweigh those.

Dr. \ 32:18

And um are I I see a lot of ads for people just to pay several hundred dollars and have like a full panel of blood work done. Um other companies that are pushing, checking your telomer age. Uh and so I know there's a lot of commercial things that people can actually go on their own and just order these labs. I wonder if you have any comments about that.

GLP‑1 Microdosing And Longevity

Speaker 32:41

Yep. Uh like anything, do your homework. There are some that are quite reputable and actually do have some science behind them. And if you look, some will actually publish their data and you can actually go to the website, look at some of the things that they have published, and see, you know, what that looks like in terms of you know how valuable it is. But I would say before you're interested in going to any of those things, bring that back to your physician and say, you know, is this something that you know I should invest in? Is this something that makes sense for me? Because all of them offer something a little bit different.

Dr. \ 33:16

Are there any specific new emerging therapies that you're excited about or you think that we should keep an eye out for and maybe have future podcasts on?

Speaker 33:26

So I don't know if this is necessarily new, but microdosing GLP1 medications, right? So Ozempic, trzepatide, manjaro, right, Zeppound, all those medications, we're just seeing so many benefits of those medications in general. And I think that that's where uh the future is. And so I can tell you that a number of individuals in the anti-aging and longevity space are now using those medications at a low dose and are using them, I would say, less frequently but uh more ubiquitously in that community. So instead of doing it every week thinking about weight management or thinking about diabetes management, they're seeing that impact on reduction in inflammation, reducing their risk for Alzheimer's disease, benefits for the heart, the kidney, and the liver. And so as a result, they're actually taking the medication and dosing it once every four weeks. So that's a really interesting piece that I'm seeing now more and more of.

Dr. \ 34:31

And I certainly see uh women in the clinic that I refer, you know, for our endocrine weight management or our bariatric services who have Syndrome X and high weight, lots of inflammation, central adiposity, elevated blood sugar, high blood pressure, lipids, high triglycerides, you know, all that deadly inflammatory um stew that's so bad for everything from head to toe. And the cost of some of these GLP uh and GIP um agonists is quite a lot. And I know a lot of people have been going to compounding, which I've always discouraged because there's no regulation, certainly in the sex hormone realm for sure. And we have so many cheap, available, tailored options that I just don't see a a role for that except in very unusual circumstances. But I know the cost is a big issue, but apparently uh I was hearing some physician, and I I don't prescribe these because I dealing with the hormones and osteoporosis and midlife women's health is like enough. It's already takes so much time uh to do to do well. But I was listening to a physician uh boarded in obesity who said now there's some programs maybe that the physician can order directly from the companies where it's a lesser price. Are you aware about any of that?

Cost, Access, And Avoiding Compounds

Speaker 35:53

I am, so I'm actually doing that currently. So Eli Lilly actually now allows you to order Manjaro or Zeppbound, right? So trzepitide, which is the generic name for that medication, directly from the company for a discounted price. Um it's nice because it actually then is shipped to you directly to your door from the manufacturer, so you know to your point that you're getting the medication and that it's not compounded, it's not mixed with anything else. So it's for lack of a better term, legitimate, right? Because you know that you're getting active ingredient that is going to work for you. And so that's how I've been circumventing issues with either cost, insurance, right, or just it not being covered, and that's how we're getting around for folks where sometimes that can be an issue.

Dr. \ 36:44

So about approximately, what would you guesstimate the savings is is it 50% or 25%?

Speaker 36:51

More than that. So the commercial cost typically for the medication is around twelve hundred dollars a month, and I've been seeing patients get this for like four hundred dollars a month. Um, so a pretty considerable savings if you think about it. And then if you're already at a place where you're then microdosing it, because that would be for a month's supply, right? You're talking about getting essentially four months worth of the medication at a time. So you can make it, I think, more cost effective. The hope for all of us, right, is to see um more generics come out and the price really reduce, you know, as a result of that. I don't know if we'll ever get to a point uh politically or otherwise where uh the pharmaceutical companies don't want to make money.

Finding Reputable Precision Care

Dr. \ 37:33

Uh but uh Yeah, and it's not just pharma, it's it's these pharmacy benefit managers, these middlemen that are allowed to control the market and set formularies and really disrupt things and make cheap old drugs like insulin and estrogen sky high. It's really frustrating because so much of my day is spent trying to educate patients on how to get their medicines at less cost. And like in the past, it used to be illegal to order medications online, like through Canada Drug. And I only found out about it because my patients said, Doctor, I either buy food or my medicine, I can't afford both. And that's just really shocking to hear. And so I really got into that field in terms of advocacy at the state and the federal level. But both sides of the aisle really benefit from all the lobbying of all of this extra money. Um, and you know, the most favored nation cost and us funding the cost for other countries and so on and so forth, and research and development, you know, isn't very important for advances, and that does also cost money. But we have a lot of information on speaking of women's health.com. If you just put the word money in on our website, um, we have lots of different tips about ways to save money. So this direct to the manufacturer and microdosing, um, you know, there's lots of tips. Sometimes we give people a higher strength of the medicine and they cut it in half or cut the pill or the patch in half can certainly, you know, make make a big uh difference. So um for some of our listeners who are just new to this whole field and are just maybe starting to take some baby steps about precision health and personalized health and proteomics, um, how what do you recommend? Because we have people from 100 different countries listening, how can people find credible clinics, uh physicians, or specific places for genetic and proteomic testing?

Speaker 39:31

Yeah, so I would say the first thing to do is to ask if it's direct genetic testing, as we've talked about, and understanding that really can help uh set you up for success. And then if you're looking for anything reputable, I would say come see me. Like happy to see anybody, right, and and make these and have these conversations because I think it really is about developing that relationship, and and you know, you've had such wonderful relationships with patients that I've sent you, and they've always spoken very highly of you, and I appreciate all the counsel and care you've given them over the years.

Dr. \ 40:04

And likewise to you too, Dr. Cardibuk.

Speaker 40:07

But I think for me, you know, it there's there's so much noise, and I think all of us feel that way, right? There's just so much information out there, and it is really difficult, I think, to know what to trust and how to trust it. So that's where I think you really do have to come back to somebody and say, look, I I have done some homework and I've investigated these things on my own, and that's okay to do, and I think you and I would encourage that, but then have that conversation right with somebody who is in that space. And if that's just I just want to try this because I'm interested and I wanted to get something done for a baseline, or I'm a seasoned expert, right? And I've done this, you know, a lot and in a lot of different uh ways, and and now I'm just looking to update and and upgrade, I think all of those things, right, we we can accommodate.

Start Early And Track Over Time

Dr. \ 40:56

And I think uh planning for the future and trying to improve your health span um and longevity are certainly laudable. You know, my my husband is not medical, he's in the financial field, and he's always telling me about these because he's always saying, Oh, you have to keep working, keep working, you can never you can never have enough money to retire because he gives the last distribution checks to some of his very healthy, very advanced age people. So people have to plan, plan for that to have have enough money for a very long and healthy life for planning. What's the one thing that you wish that every one of your patients, you know, executive, woman, uh, and anyone of various ages knew about their health?

Speaker 41:39

Yeah, I I wish that um everyone would have started earlier having these conversations, you know, before we got to the place where sometimes right there then are unpreventable things that have already occurred or already accumulated that right now we can't fix. Now we're just managing chronically. So I think the the biggest thing that I tell folks is it's never too early to start having a conversation about preserving your health. And and I think to your point, and you've seen it right in your practice, I'm sure, there are sacrifices that all of us make for our families, for our jobs, and and it and it impacts your health. And so all of that then accumulates, and so you know, no it's hard for me to say, okay, did all of that have such an impact where then it impacts your chronologic age or biologic age, you know, in the past five years, or was that 20 years ago where that had the impact? I don't know. But what I can tell you is if you start that conversation early, we can then track it better. And we know then if there are small disturbances and then we can adjust as we need to.

Dr. \ 42:47

Well, Dr. Carterbook, thank you so much for joining us today and sharing your expertise and your work is really truly shaping the future of personalized medicine. For our listeners in the Northeast Ohio area, or for anyone who wants to come and visit you, um, how can they make an appointment with you or one of uh your executive health team members?

How To Book And Final Takeaways

Speaker 43:09

Yep. So if they call the executive health appointment line, then they can just ask for me directly. Um, and so that's always an option. Um you can always find me on Twitter as well. Uh I'm at Rich Cardibuke, so there's a uh Twitter handle as well. Um and and I would say, you know, the the best thing about this, and I think you probably agree with me as well, the number of individuals that you get to meet and just hear their stories and share that information with them about their health and just see the gains that they make over time is the most rewarding part of this. Um looking forward to it.

Dr. \ 43:47

Absolutely. Well, thank you so much for uh joining us, Dr. Cardibook. Thank you to our listeners for joining us. Remember, give us a five star rating. You can share this podcast if you want to donate to our nonprofit speaking of women's health dot com yeah there's a donate button uh remember it's never too late be strong be healthy and be in charge