← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
131. Dr. Elizabeth Yurth: The Science of Ketones, Hormones, and Faster Recovery
01:04:27
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- [00:03]
A
Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Today we're going to be diving into one of the most overlooked pillars of longevity, your joint health. We talk so much about brain and heart health, but if you're living with chronic pain, it really doesn't matter how long you live life. Life just won't feel good. Our guest today is one of my favorite people, Dr. Elizabeth Yurth. She's a leading expert in regenerative and cellular medicine. She's a co founder and chief medical officer of the Boulder Longevity Institute and a Stanford trained sports and spine physician. And she has spent over 30 years merging orthopedic experience with cutting edge longevity science. In this episode, Dr. Yurth is gonna break down why most arthritis isn't caused by overuse and why en says after an injury can actually slow your healing. How her protocol, the MEAT protocol, is replacing the Rice protocol and the real science behind peptides, ketones and early prevention. If you want to stay active and you want to stay pain free and mobile for decades, this conversation is completely packed with tools that can truly change the way you age. Hey everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about. Your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. Then all of these have blood Tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics, then I tell them go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our next health clinics. And if you tried to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They could even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements. They don't have pharmaceuticals they're trying to get you to take. You're just getting the data and you're getting insights from the data and you can bring this data to a clinic like ours and we then have the information that we need to tell you how, how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com drshaw and use the code DrShaw25 for a $25 credit towards your membership. Dr. Yur, thanks so much for joining me today.
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B
Darshan, thank you for having me.
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A
Yeah, all the way from Boulder.
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B
All the way from Boulder, Colorado. Well, I say I went from here to Buck Institute, Northern California, then Buck Institute to here. So I didn't have to. I only had a 55.
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A
I know. I'm just so excited that you're here because me too, I've been trying to get you here in the studio for such a long time.
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B
You and I have known each other for a while now. So it's an honor honestly to be.
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A
Here and I've learned so much from you. So for the listeners, we're on a WhatsApp group of longevity focused doctors.
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B
Right.
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A
And I could tell you without a doubt, we one of the top three smartest people in that group is Dr. Girth, who's here with us today.
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B
And so you give me too much credit, but thank you.
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A
No, definitely. And what I'll say is, you know, you have such an incredible range of topics that you can talk about. So I initially Had a hundred different questions for you and a hundred different topics. And I'm so glad I asked you. Like, I think we need to focus in on one thing today. And to me, which is something I've learned a lot from you actually about is how we're completely rethinking the model or around pain today. Right. It is so different than what I learned in medical school.
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B
Yeah.
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A
It's mind blowing to me.
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B
It's mind blowing.
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A
Yeah.
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B
And you know, one of the things that concerns me, and it was funny because it was just at this conference, it was all these researchers, right. Doing all this very cool stuff in longevity. And I was sitting at breakfast with this guy who was actually developing some orthopedic stuff, and he said, you know, why is nobody at these conferences ever talking about orthopedic stuff and joints, aside from you hear about stem cells and things like that, obviously. So that gets out there. People all know about stem cells and platelet cells for joints, but those are actually really not the answer to joint pain and chronic pain. So it's a really neglected area in our field. I mean, how many of these conferences do we go to? Right. And how many do you see people talking about joints and how joints are going to impact our longevity.
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A
Right. I mean, it's a massive piece of our health span, of our longevity and our happiness. Our happiness, Right. Being able to move.
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B
Right. No, I know. It's really, you know, honestly, until you're kind of. I tore my rotator cuff about two years ago and I had surgery. I was a full rotator cuff. I did a lifting head surgery. But, you know, it was great for a little while and then it just didn't do well.
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A
Right.
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B
I re injured it and I didn't do well. And so I've had this chronic shoulder pain and you know, you think, oh, it's just a little chronic shoulder pain. But it really is so impacted my life. I mean, everything is harder. Getting dressed is harder.
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Right? Yeah.
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B
Putting out sports bra is like impossible.
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Right.
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Just putting on coat, all these things. And so you start looking at people who are dealing with this stuff in much more severe natures lots of times, and they kind of lose the desire to want to live forever, even if they've got a great heart and a great brain and everything else, it becomes not very fun.
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A
Absolutely. My story is very similar. I was doing surgery for 20 years. 20 years. I was holding up retractors with my arms.
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B
Right, Right.
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A
And it caused little micro tears in the tendons of my rotator cuff, which over Time made my life miserable. I couldn't ski anymore. I didn't want to lift anymore in the gym.
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B
Stress to go. Yeah. Every time I'll go this, but it's really so hard.
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A
Right, right. And I think like with everything with western medicine, we just kind of wait for things to really break down before we go in and do an intervention. So I had to have surgery, you know, done and have my rotator cuff repaired.
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B
Was that did fix it.
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A
It did fix it, yeah. But it was, you know, it's not an easy surgery. It was a long recovery. Right. And I kept thinking to myself, like, why do we do this constantly? Especially like my mom has both of her knees replaced. She's going to get her hip replaced. And it's just like waiting and letting things progress to a bad place. And then we finally do an intervention. And that intervention is usually surgical. It could be stem cells, but it's just really backwards.
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B
Right, right, exactly. So for your listener's background, I came from background of orthopedics. Right. So for, you know, 30 years practicing orthopaedics and it really was, well, actually not 20 years ago, I started going, God, all I do is kind of patch people together and then they fall apart again. It was like. And you would do that over and over again. You stick a little steroid, you stick a little steroid in and finally you go, okay, well now we'll do a scope and okay, now we'll replace the joint. And that was. Everybody followed that path exactly. So I started to look at, could I do something different? Could I actually work with these people early on in the injury phase and impact their recovery much better? So I started thinking, okay, how can I use nutrition and hormones and other things that would benefit them? So I went back and started learning all this stuff, right. And I tried to incorporate that into my orthopedic practice where I, you know, in my 10 minute point, my triangle, oh, if we, you know, had you on the right hormones and the right nutrients and that didn't go so well.
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A
I bet your ortho colleagues, they did.
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B
Not like that at all. In fact, you know, at all. So I, I opened my longevity clinic 20 years ago now. So, you know, when you say I know a lot about everything, it's really simply time. I've been here so long, right? So 20 years ago, but I did both. I had my orthopedic clinic because, you know, as, you know, coming from the surgery world, it's a profitable world. I mean, you know, we had an MRI scan, I owned A surgery center. So you have all these things vested. So really I kind of wore both hats for a long time where I was like, okay, I do orthopedics by day and I do my longevity clinic by night. And it really wasn't until about six years ago that I said, okay, I've got to coincide this all to one place. And so I left the orthopedic practice and. But as you said, the biggest sort of pushing point was when one of my orthopedic colleagues came to me and he goes, you know, you can't order labs anymore on people because we don't do medicine here. We do orthopedics.
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A
Oh my gosh. You know, we follow the same journey. So, you know, 10 years ago is when I started learning about functional medicine, longevity medicine, and same thing. I was like telling my surgical patients what I'm doing to get healthy. And they were canceling their surgery. And everyone's like, what are you doing? You're getting them healthy? They're canceling their surgery. They're not making any money off of this anymore.
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B
Right. It's not very. Right. It's not. It's not profitable, Right, exactly. Joint replacements have a. They're very profitable to replace a joint. Right. Not so profitable to throw somebody on a few hormones and injury.
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A
Exactly, exactly. Yeah. So when you create a state of health, what happens is you avoid needing surgeries, prescription medications, et cetera. And it's not just for your joints, it's for every organ in your body. Right, exactly. So.
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B
But I think the joints get forgotten in this whole cascade.
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A
Right.
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B
When we look at age related diseases, they all have similar mechanisms. Right. They all are related to sort of a chronic inflammation mode, decline of immune function. So we, you know, lots of mitochondrial functions, the same things occurring in joints, but we forget that. So we're now kind of treating, you know, somebody who just has joint pain a little differently. And, you know, I think the big focus there is we need to catch people early on. Right. You know, just like you're. Once they've gotten to the point where they need surgery, yes, you can sometimes stop that. But if you could catch that person 10 years before when whatever started happening, their gallbladder started going, whatever you.
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A
Exactly.
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B
You know, and the same thing's true in, in the orthopedic world is we need to be addressing people day one of their injury. We need to be, you know, addressing people before the arthritis sets in, or as soon as they start having joint problems and sort of intervening there and not waiting till the end Game.
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A
Right, exactly. So on that topic, how does someone, when they first noticing, like, maybe they're. For me, it was like a chronic injury over time. But some people, you know, a lot of people, they, they are skiing and they fall, they hurt themselves, they. What would you recommend people do instead of just like the traditional method of how we treat these injuries differently?
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B
So the first thing is our bodies are actually designed to heal. We kind of, you know, orthopedic stuff. Injuries are always considered, you know, this kind of wear and tear. Oh, I just played too hard. I was a football player. And that actually is not, if you look at the people who really develop the worst arthritis, it's the most sedentary people, people who are not moving. It's not the football player. So even though you get these injuries now, injuries certainly compound the problem because they create this big inflammatory state. But in the best of worlds, we resolve that inflammatory state, we go on to heal. So why don't we, I mean, why can, you know, one football player go on and, you know, get an injury and then come back and play and another football player is debilitated by it forever.
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Right.
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And they have to quit their, quit playing. So there's a big difference in healing. And that has to do with what baseline levels you're at. Right?
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Right.
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It's like you for your chronic micro tears and rotator cuff, and you were this busy surgeon. You're doing all this stuff and you look at, you know, you know, what were your hormones doing? What your, what kind of nutrient levels did you have? What were your vitamin D levels? Those are all things that need to be looked at very early on. As soon as somebody has a nagging injury, because there's a reason the nagging injury is not your body's not recovering it, and it's because your body's not getting out of this inflammatory state.
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Right.
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There's a lot of reasons for that. Right. Maybe you're eating a crappy diet, maybe you're not sleeping enough, maybe you have no hormones on board or suboptimal hormones on board. Maybe you're missing vitamin D or vitamin C or, you know, so, so those are kind of the first things. But I think that, that there's sort of other simple things that when, you know, as soon as you, you notice an injury, we have to. What is our tendency to. As soon as we have an injury, our first tendency is we just pound a lot of ibuprofen. Yeah, well, remember that. That's that first time when, when we first get this injury, our Body is designed to create this inflammatory response.
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Right.
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So there's all this data now that if you take an anti inflammatory drug when you first have an injury, that you actually markedly increase the likelihood that that injury is going to be chronic. Wow. Because you shut down that inflammatory response that we want. That's what brings in all these growth factors. That's what brings in all these things that are going to say, okay, let's start healing this joint. So for at least the first three days after you have an injury, you really need to try and stay away from anti inflammatory drugs.
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A
Oh man, that's such a game changing new thought. Like everyone does that you're injured, you pop, you try to reduce the inflammation.
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B
As much as possible and your natural, you know, it hurts, so you want to do that.
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Right.
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But it's the same thing. The reason we have a fever when we get sick, it's our body's inflammatory response.
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Actually a good thing.
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Unless your fever goes super high. It's actually better to just let your fever run. It's your body's response to the illness. The same thing happens with this inflammatory state. So the goal is try and let that inflammation. So try and treat the, try and reduce the symptoms using other things, using red light, using other modalities, using peptides.
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Right. I mean, I think like, you know, people take the Advil because, I mean, some of it's to reduce pain, but also a lot of people just take it because they're being taught that the science tells us you want to reduce the inflammation.
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B
Yeah.
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And the reality is the exact opposite is what we need. Right, right. Yeah.
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B
This whole concept, in fact, even the guy who came up, that whole Rice protocol. Yeah, like Rice, ice, compression, elevation. Right. And that's what we still all follow. Everybody's like, okay, Rice, rest, ice, compression, elevation. Even the guy who first developed said, you know, I think I was wrong. And so now we actually advocate what's called the MEAT protocol.
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What's that?
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So that's motion. So you want to not stop moving. Right. So I hurt my ankle, I should keep passively moving it. Right. I need to keep motion going. That's going to get blood flow to the area. What does blood have? It has all of these healing elements to it.
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Right.
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So, and then you actually want to keep exercising. So our tendency is you hurt yourself, you lay around for a few days. Right. Really you and you, you're not going to go jump around in your sprained ankle, but you're going to get to the gym and work your upper body. You're going to get on the bike with one. Your one leg, you're going to keep moving. So that motion and exercise are actually really key factors. And the people who do that, who keep moving and who exercise, who don't stop exercising, will heal about twice to three times as fast as someone who doesn't do that, who just goes to bed and sits up with their ankle up for three days. Right, Right.
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A
That's just increasing blood flow.
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It's increasing blood flow, but it's also increasing. Think about the things when we're moving our muscles. We have these myokines. Right. We have these really important factors that come out of contracting the muscle that actually have huge healing elements in them.
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Yes. Myokines are so powerful.
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B
Myokines are so powerful. Right. You know, if we could bottle Myokines, you could hear a disease. So that's why exercise is the number one treatment for anything. Right. Is really because our muscles have so much power to create these magical forces that heal us. So we stopped doing that. Right. You know who exercises after you? Have you just sprained your ankle? You don't. I could tell you after my rotator cuff surger, I was in the gym the next day and I was using my other arm. And, you know, you're in a splint and everything else. Right. You're using your other arm, you're moving. So it's motion, it's exercise, and then it's analgesics, but not anti inflammatories. Right. And I'm not a fan of Tylenol because Tylenol actually blocks our antioxidant system. So it blocks what's called glutathione, which is one of our antioxidants. So, you know, all this debate about Tylenol truly is true. Tylenol is not a good drug.
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A
Yeah.
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B
So I'm not a big fan of Tylenol. So what do you do as analgesic?
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A
And it's important to know. Note that just real quick, because when you're inflamed, you're making a lot of oxidants, Right. And so you need.
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B
You need that antioxidant system. Powerful.
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A
Right.
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So remember what. What Tylenol does is it blocks glutathione.
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Right.
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And glutathione is one of our big antioxidant systems. I mean, it's one. So Tylenol is very potent at blocking that. That's why you can kill yourself easily with Tylenol if you take too much of it. So, you know, it's not the Best choice. So, you know, so. And it's funny, like, whenever you have a procedure done, a surgery, they always give you Tylenol to take beforehand.
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A
They do, right?
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B
You know, and going to have anesthesia, worst thing you can do is block glutathione because, you know, so, you know, I recently had to have a surgery and, you know, she's like, oh, here, take these. And I'm like, what are they? She's Tylenol. There's Tylenol. I said, no, you know, I don't need those. What if I don't even have pain afterwards? Which I didn't, you know, so why are they giving me Tylenol?
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A
You know, about 10 years ago, they came out, I think maybe more than 10 years ago with IV acetaminophen as well. They were using that before every surgery, whether people needed it or not. I mean, this cannot be a good thing, you know.
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B
No. Remember that. That detox system is the main thing. You need to detox from anesthesia.
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A
Exactly.
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B
Anesthesia. Not so benign.
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Right.
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B
So now we're blocking that. So basically, I don't recommend Tylenol. So what do I recommend? Well, there's so much you can do now with some of the modalities we have. And peptides.
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A
Right, right, exactly.
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B
You know, that's where peptides become. And, you know, peptides like BPC and thyrocin beta 4 are so hugely beneficial in this realm, you know, and especially if you can take them a little higher dose, if you can take them subcutaneously, but even the orals will have some benefit there in helping with pain. The other big one that people have no idea about is exogenous ketones.
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A
Yeah.
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B
So exogenous ketones are huge here.
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A
Wow.
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So when you look at pain reduction with exogenous ketones, they actually block what's called NLRP3 Inflammazones. They actually stop the sort of pain at its root. They also increase blood flow to the area, they increase stem cell activation, they stop catabolism, they start break, stop breakdown of the joints. So basically, simply taking a high dose of exogenous ketones, you can actually significantly reduce pain in people.
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A
That's incredible.
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B
It's incredible. And kind of on that whole realm of ketones, we just had a meeting with New York Giants about similar players and stuff, and we're talking about using exogenous ketones because they're also super protective. So if you are taking ketones exogenously and you get hit in the head or you get an injury, your Likelihood of that becoming a problem is much lower. So we're a big advocate of these players should all be doing exogenous ketones before they play, like prophylactically.
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A
Exactly. Because they're going to get, because they're going to level up, they're going to get ding.
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B
They're going to get hurt.
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A
Right.
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B
And so you can, you could actually. And plus you're going to make the quarterbacks going to perform better because they, they're going to make you more mentally acute for being able to respond faster, your reflexes are faster. You know, we even talked to, you know, they brought up, they said, well, how about the coaches? The coaches probably need them. I said, yeah, that's probably a great idea. These coaches are deconditioned and they have to think fast and they're under a lot of stress. So if they were drinking ketones during the. So what I do is in that key phase is I put people on exogenous ketones. I put them on BPC, Thymus and Beta 4. You know, you can very inexpensively now purchase a small red light, right. I mean, you can get one for $300.
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A
Right.
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B
You know, just a small panel, which is great because you hurt your knee, you put on your knee, you hurt your shoulder, you put it on your shoulder, you hurt your back, you put on your back. You don't need, you know, the massive panels that cost a lot of money.
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A
Right.
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B
You can do a lot with this small little panel. So I have people, you know, get a little red light and you know, I would tell people, just have a little red light because you're going to get hurt.
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A
Right?
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B
Right. So, so now, you know, you, you use exogenous ketos, you, BPC, Thymus and beta 4. Now we've actually accelerated the healing process. We haven't blocked it. So that's kind of our analgesic thing. And then start therapeutic approaches which are more things now like maybe muscle stim, physical therapy things to start really reactivating the joint, you know, and I love, you know, for that retraining phase using things like blood flow restriction bands, right. Where you can use a small load and still get huge benefit to the muscle. So we get people, you know, on beefy blood flow restriction bands and doing things like, you know, there's some really good, you know, just some really good muscle stimulants. You have to know the right muscle stimulus because they're to get, to get the right contraction muscles. So you can start using some muscle stimulants and things like that very early on, you do that approach, you're gonna heal so much faster than if I just sat around, took Advil and said, you know, I sprained my ankle. I would have sit up with a weekend, hold my ankle up.
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A
Yeah. Okay. So this is an incredible new paradigm in how to deal with injuries. Instead of rice, we go meat.
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B
Exactly. Which is. It's just like Dave Asprey would always say, meat over rice.
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A
Right, Meat over rice. Exactly.
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B
Stay away from the carbs.
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A
So, and this is obviously not intuitive to people because we've grown up.
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B
We've grown up with it. Doing R. That's the trainer still practicing, right?
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A
Yes, absolutely.
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B
Gyms everywhere. That's all you hear. Right.
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A
And so this is like really updating our algorithm on how we treat pain and how we treat injury based on the modern science. And so I want to do a little bit deeper, dive into each one of the things you talked about, if you don't mind. So I think it's really important for people to understand the science of some of these because beyond just injury recovery, this can be very helpful in just day to day life, even prophylactically, like you said. So let's talk about just quickly, these peptides. So you mentioned two peptides are two of my favorite. They come together in a combo called Wolverine and it's a really great combo of TB 500 and also thymosin beta.
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B
Thymus and bin 4 and BBC.
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A
BBC 1.7. Sorry. And does it have TB 500 in it or is it.
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B
Well, TB 500 and TB 4. So there's a little bit of misnomer there. TB 500 is kind of a fragmentation of TB 4. This really came out when the peptide was designed in the horse population actually for treating horses.
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A
Okay.
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B
Thyros and beta 4. Truly. And this is kind of a widely. You know, I've been unfortunately in the peptide world so long. Thymosin beta 500 really? Or TB 500 was not really the real peptide. The real peptide is Truly thymus and beta four.
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A
Thymus and beta four.
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B
But it's kind of strange. Thymus and beta four is a more complete chain.
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A
More complete chain. Okay, got it. And how does Thymus and Beta 4 work?
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B
So basically it's going to actually activate collagen actin. So it's actually going to sort of start stimulating collagen actin function.
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A
Okay.
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B
It's also going to be. So it creates angiogenesis. That's why there's some debate about maybe if you have cancer, but it creates a lot of angiogenesis. Remember, if we have an injury, we want blood flow to the area.
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A
Right. Angiogenesis and formation of new blood vessels.
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B
Right. And to heal anything. So you tore your rotator cuff. You've got to get more blood flow to area, you know, so basically, and it's one of the problems is that blood flow does get restricted when you have an injury. So basically we've got to, we've got to help that. And so that's one of the places where Thymus and Beta 4 works so well, you know, and again. And it's kind of activating this bridging of collagen actin. So basically it activates these factors. It also is a stem cell activator.
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A
Wow.
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B
So whenever we want to heal an injury, it's why we inject stem cells into a joint. You can activate some of your own stem cells. So Thymeson Beta 4 can do that very well.
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A
Interesting. And is, do you think it's also beneficial for people getting stem cells injections to also be enzymes and beta 4?
- [23:15]
B
So we do a lot of stem cell things. Everybody's followed up with BPC, Thymus and Beta 4 afterwards. So we use a combination approach of BPC, Thymus and beta 4 GHK copper.
- [23:25]
A
Right.
- [23:25]
B
Post procedure. Because you really want to accelerate the response of that.
- [23:28]
A
Right, right. It makes the stem cell injection that.
- [23:30]
B
Much more powerful, much, much better.
- [23:32]
A
And then maybe you can tell us a little bit about BPC157 works as well.
- [23:36]
B
Yeah. So BPC is probably everybody's favorite peptide.
- [23:38]
A
Right.
- [23:39]
B
Number one, it truly, you know, this question whether TB frag is can be taken orally. There's some debate in the field about that, but maybe. But bpc, definitely. One of the great things about both these peptides is they are made by our own bodies. I love things that our bodies make.
- [23:53]
A
They're natural, biological.
- [23:55]
B
So we know that they're likely safe. Right, right. So Thymosin Beta 4 is a thymic peptide. So when we're babies with this giant gland in our chest, this thymus gland, it's huge. If you look at a baby. That's right. It's got this massive mass in it. And until puberty, that thymus gland is really active and doing all this stuff. And it's producing these thymic peptides, thymus alpha 1, which is really immune modulating thymus, and beta 4, which helps us to heal and grow and recover. So those are really active until puberty. And then the thymus gland starts atrophying. By the time you're old, it's nothing. So now you're not making these thymic peptides. So what we're doing to help you heal is giving you back what your body would have done when you were 13 to heal. Right. When you could heal rapidly like you've got kids, they hurt themselves and they're better in a day. It's amazing. They break an arm into two weeks, it's healed. That's one of the reasons they're making these thymic peptides. So bpc, by the same notion, is a gastric peptide. So it's made by our gut and it's in response to kind of protecting the gut, but also to circulate to areas of injury to try and promote healing. So basically, whenever we're injured, we activate this bpc. Now the problem is, as we age, or if we have bad guts or if we have have poor health, we just don't have as much bpc. So I'm going to give back more of it.
- [25:10]
A
Right.
- [25:10]
B
And it's the same concept of we're replacing hormones because they decline. Let's replace. These things are declining.
- [25:15]
A
Right.
- [25:16]
B
So I kind of think everybody should sort of cycle these peptides periodically throughout life because I'm going to then hopefully be able to protect myself from injuries. When you work the two synergistically with BPC being, you know, and we'll call it, is modulating inflammation, it doesn't reduce or accelerate inflammation, it modulates inflammation. So it tries to keep inflammation just perfect for healing. So that's one of the things that's so beneficial about it, is we don't want to, as we talked about, completely blunt inflammation, but we'd like to modulate, have it not escalate out of control.
- [25:49]
A
Exactly. Yeah. And I think that that's what these natural biological signals do when we're young, too. It doesn't overly suppress inflammation, it doesn't overly promote inflammation. It just gets it at the right level. And our body's so smart and we'll never probably figure out exactly how these things work. We're going to need AI to help us figure this out. But we know that these are natural biological signals.
- [26:10]
B
Right. That were very active when we were younger.
- [26:12]
A
Exactly.
- [26:12]
B
And are not when we're older.
- [26:15]
A
And so.
- [26:15]
B
And I think everything kind of goes back to that. Let's try and get back the system to where it was when we were. When we were able to repair and feel good.
- [26:23]
A
You mentioned GH copper peptide as well. Can you talk a little bit about that one and the mechanism of that one?
- [26:28]
B
So GHK copper is so. So when you look at healing a wound, collagen needs copper. So it needs this combination of this GHK molecule combined to copper. And that actually is what lets collagen go from a stage of sort of disarray into nice, normal collagen. So without that on board, you get this collagen that's very dysfunctional. So that's why scar tissue forms. So if you look at an injury, you rotate a cuff or whatever you do, the biggest. The big complication that occurs with all these injuries is scar. That's why you get a frozen shoulder after you have an injury. You can't move it as a scar tissue. So if we can modulate the collagen production, GHK actually works on it again as a natural peptide. Our body makes 500 different genes. It modulates so in a positive fashion, but its main effect is in regulating collagen synthesis. So we make normal collagen, not just scarred collagen. So it becomes a really important peptide to actually add on when you're trying to heal also post surgery, right?
- [27:28]
A
Absolutely.
- [27:28]
B
So it's a really important peptide. You can use GHK copper topically. It's great for skin or if you have a topical wound, but if you're trying to heal something that's deeper, like an ACL tear or a rotator cuff or something like that, then you want to inject injected a small amount.
- [27:43]
A
Yeah.
- [27:43]
B
There are these places now that are mixing GHK Copper with BPC, with Thymus and Beta 4. And really, you don't want to do that. Copper is actually a very volatile molecule, and when you start mixing with these other peptides, it creates actually problems with these other peptides. So really, people don't want to do that. We're seeing that more in the field now where these people are mixing all these. You really want to, you know, and in a perfect world, separate all of them.
- [28:04]
A
Got it.
- [28:04]
B
I know there are people who believe you can be inject BPC and thymes and beta 4 together. I'm not a big fan of that.
- [28:08]
A
Got it.
- [28:09]
B
I like to separate them all out.
- [28:10]
A
Got it.
- [28:11]
B
I think it's just cleaner when you peptides are pretty unstable in general, and so when you start mixing them together, you can create things that, you know.
- [28:19]
A
Bonds that you don't want.
- [28:21]
B
That you don't want.
- [28:21]
A
Right. Makes complete sense. Yeah. So there's these combinations called wolverine and glow.
- [28:26]
B
And you're thinking the blow is that combination of GHK, BPC and Thymus and Beta 4. And I'm not a huge fan of it. You know, maybe it works. I'm not going to knock that maybe, you know, because anecdotally people say it works. I think the problem is when you, when you're mixing these things together, you're creating immunogenic responses over time you may create problems. And I think that that's where you know, maybe doing it acutely, you're going to be okay. I don't know. I don't think there's a lot of proof that you can mix these peptides together and not create problems.
- [28:53]
A
Got it, got it. So it's better to inject them in three separate injections.
- [28:57]
B
You want to be pristine, you know?
- [28:59]
A
Sure.
- [29:00]
B
Then yes.
- [29:01]
A
Yeah. I have to show you one of the things that we're doing for peptides here now is we're actually doing peptide injectable pens. And with the cartridges.
- [29:08]
B
So nice.
- [29:08]
A
It's so much nicer. Yeah, it's a game changer in my mind.
- [29:12]
B
It is so much easier. I know there's a company out of Europe that's doing that and you know, and you look at them like, because it is a hassle, right? It's a hassle to drop your peptide even. I love peptides. And I'll look at them something like, you know, it's just tedious, you know, you're drying up with some of them. Will take a long time to draw up and stick yourself a deal. And to have these pens are so.
- [29:32]
A
Incredibly, they're so incredibly more efficient. They're time saving, but they're just cleaner. And then we get to mix the cartridges for the patient. So there's no dosing issues.
- [29:42]
B
Right. So, you know. Yeah, that's great.
- [29:44]
A
I'll show you downstairs at Nex Health how we're doing that. But, you know, I think you're absolutely right. Like, I'm not a big fan of mixing peptides either. It's just people get fatigue with, they do get one GI muscle.
- [29:54]
B
You're right. So the question is. Yeah, you know, so is the convenience worth it? I, I don't know. Because I don't know that we, I, I, they think there's a fair amount of evidence that you might be creating problematic things.
- [30:06]
A
Right.
- [30:06]
B
Doing it for long term.
- [30:07]
A
And these peptides, I mean, like during the acute healing phase from an injury, they're extremely valuable, but they're also valuable, like you said, just cycling these in normal life, especially as you age.
- [30:16]
B
Exactly.
- [30:17]
A
Our levels are, you know, and you've.
- [30:19]
B
Heard me talk about peptides, but One of the big things I say is, well, why are we so passionate about replacing hormones? Peptides decline our bodies the same way. You know, the thymic peptides are almost nil.
- [30:29]
A
They're gone.
- [30:30]
B
I mean, they're gone. Right. You know, growth hormone, the. You know, so using growth hormone Secretagox to try and increase IGF levels, because our IGF levels are dropping. My belief is let's try and sort of cycle things through time, that we can actually keep everything at a nice level.
- [30:45]
A
Exactly.
- [30:45]
B
If we replace estrogen, progesterone, testosterone, shouldn't we also be replacing BPC and Thymosine Alpha 1 and Thymosin Beta 4 and maybe some of the thymic peptides. I mean, some of the mitochondrial peptides.
- [30:56]
A
Absolutely.
- [30:56]
B
So I think that gets kind of forgotten, you know, that these are declining, and if we can keep them higher, probably if we do get injured, we're going to recover faster just because those things are on board.
- [31:08]
A
Right, right. I think the more I think about our overall biology is that we reach this kind of peak in our 20s, probably. Right. And even in adolescence through the thymus gland, and all these peaks occur between those ages of adolescence and are mid to late 20s. And then everything's on a decline. It's not just.
- [31:25]
B
I mean, you kind of realize that your decline starts much younger than we thought.
- [31:30]
A
Exactly.
- [31:30]
B
It's like, you know, people are like, oh, I'm 30, I'm fine. You have started your decline by then. Right. You know, so when you look at these things, like, even the thymopeptides, they're starting to decline in significant amounts. Hormones are starting to decline around 30 and sometimes earlier now, in our world of toxins.
- [31:44]
A
Yeah.
- [31:44]
B
You know, and microplastics and all the things that are.
- [31:46]
A
Yeah. And like, to your point, like toxins, microplastics, all these things, they accelerate the decline even more than they used to be.
- [31:52]
B
Exactly.
- [31:53]
A
And so really, to me, like, this whole field of longevity medicine, people keep talking about living to 150, 200. To me, it's more about just how do we prevent the decline.
- [32:01]
B
The decline. Right.
- [32:02]
A
And that's what's going to add 30 useful years to our life. And that's what.
- [32:06]
B
And you feel good. Right. So if we can actually, you know, sort of. I think we will come up with. I mean, it's just. We will come up with some really good medications that do.
- [32:16]
A
It's a matter of time.
- [32:17]
B
It's a matter of time. But for now, we have a lot on hand. If people start sort of preventively Doing an earlier stage, you know, so, you know, unfortunately we didn't get into this world until, you know, later. I mean, I was older already by the time all this stuff started happening. But if you're now 30, you should be thinking about this stuff at 30.
- [32:35]
A
Exactly.
- [32:36]
B
You know, when your decline's starting.
- [32:37]
A
Well, I think the other big problem here is that the traditional medical establishment is not accepting of peptides. It's not accepting of ketones, it's not accepting of even stem cells yet. And it's, we're moving way too slow in the traditional establishment for the things that you and I know are already established. Like this is safe, effective, let's use this.
- [32:57]
B
That's what's so hard is we're fighting this paradigm of, you know, these things are not proven safe, they're not FDA approved, and yet we have these pharmaceutical compounds that have much more issues.
- [33:09]
A
Yeah, like Advil and Tylenol.
- [33:11]
B
And Tylenol.
- [33:11]
A
Right.
- [33:11]
B
I mean, Tylenol should have never been approved as a drug. And people are popping it, you know, and you know, all the time, you know, so I think that is, we have to sort of figure out how do we, you know, 17 years for the time of a drug discovery to get approval market and we have to advance that or we'll all be dead.
- [33:29]
A
Absolutely.
- [33:29]
B
But this taking the things that we know are safe because our body is already doing them. If you can take this more natural approach, it makes a lot of sense, right?
- [33:36]
A
Absolutely. Absolutely. Once again, like I always say, peptides are not drugs. Drugs are chemical compounds like Advil and Tylenol. Peptides are natural biological signals that we.
- [33:44]
B
Have amino acids that our body makes. And some of them are synthesized that our body are not natural to our body. But so many of them are, right. You know, like mitochondrial pentoplies like SS31, you know, so it is made by our mitochondria, you know, so it is a natural compound that our mitochondria make that declines.
- [34:02]
A
Right.
- [34:02]
B
So I think that my goal is always replace all these things and that's going to be your best bet.
- [34:07]
A
Exactly. And replace them prophylactively because they're declining anyway.
- [34:10]
B
So. And then if I get hurt, the hope is I heal better.
- [34:13]
A
Exactly.
- [34:13]
B
Oh my God, I just got hurt. Now I'm going to start taking all this stuff. You try to play catch up to damage tissue already.
- [34:18]
A
Right, right. This episode was also brought to you by Vitaboom. Vitaboom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood based biomarkers you could either send them your latest blood test or they will send you a finger stick test for blood analysis. Vitaboom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, Tru, Niagen, and many others for your custom daily packs. I love mine especially for travel since I don't have to bring 10 bottles of supplements with me and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to Vitaboom.com and check it out. Can we dive into ketones a little bit? Because I don't think many people have heard about ketones either, except that, you know, the ketogenic diet is where people have probably heard about ketones. Let's talk about where do you get exogenous ketones from and how do they work? And should you also be taking these prophylactively? Can you take us through a little less on that?
- [35:33]
B
Honestly, Darshan, if I were to say take one thing, if you said, you know, what is the one thing, you know, you could only take one supplement.
- [35:41]
A
Yes.
- [35:42]
B
It would be ketone. Wow, really? Yeah.
- [35:44]
A
That's mind blowing.
- [35:46]
B
That's incredibly powerful.
- [35:47]
A
Oh, my God.
- [35:47]
B
When you look at all the things that ketones can do, right? So when you look at ketones, this combination, there's, you know, there's a lot out there. There's ketone salts. Ketone salts run into the problem that you actually can change, you know, disrupt some of your electrolyte levels with those. Those can be problematic. Then we have ketone esters, which are the most common. My favorite is a company called Kinetic, which makes a ketone that they separated out the ketone ester, so they broke the ketone ester. So ketone ester is made up of beta hydroxybutyrate and 1,3 butane diol. And they both have kind of different effects. When you separate them out, you get this very nice rise in ketones from the beta hydroxybutyrate, but the 1,3 butane dial kind of kicks in later by separating them out now. So instead of just gaining, like if you took a ketone ester, you would get this big bump for about 30 minutes and then it would kind of fall back down. It can be useful, but our goal would be if we could keep ketone levels higher all the time, all the day, it would be better.
- [36:39]
A
Right?
- [36:39]
B
Which is why a ketonic diet, you're always making Ketones.
- [36:43]
A
Got it.
- [36:43]
B
The problem with staying always in ketosis from a ketotic diet is that you lose metabolic flexibility. You actually don't get very tolerant of carbohydrates anymore. And carbohydrates have some very good usefulness to our bodies overall. When you lose metabolic flexibility, you actually over time start to see disruptions in insulin, insulin resistance, things like that. So people who are constantly in ketosis are going to have problems over time.
- [37:04]
A
Right.
- [37:04]
B
It's a good thing to do, you know, acutely, if you are trying to get through something, it's fine.
- [37:08]
A
Absolutely. I just want to highlight that for our listeners. So I use the ketosis diet on my patients in brief bursts, right?
- [37:16]
B
You use it, yeah. Because to get over something like you have an autoimmune condition.
- [37:19]
A
Exactly.
- [37:19]
B
You know, you're really inflamed. It's a great way to traumatic head injury. It's a great way to jump start.
- [37:25]
A
Right. Maybe you need to do a little bit of weight loss, but for the long term, I've personally seen almost, maybe close to like a few dozen patients now that have really got dysregulated insulin sensing.
- [37:36]
B
Oh, you see it all the time.
- [37:37]
A
With ketosis for a long time.
- [37:39]
B
No.
- [37:39]
A
So it's a long term intervention. It can be a problem.
- [37:41]
B
So our goal would be to be able to eat regular diet where we're, you know, eating high protein, lower carb, but getting carbs in there and then keeping ketones high. So if I take something like this kinetic ketone, which is I'll get this nice little surge of beta hydroxybutyrate and then the 13 butane dial kicks in. And you know, it was funny, I was just at this, this conference and this guy was wearing, he had gotten not a cgm, a ketone meter, a continuous ketone meter, which I didn't even think was available, but apparently got it from Sweden. And yeah, so it was a continuous ketone meter. It was very cool. So kinetic had a booth there and so he wanted to see what happened. And so he took the ketones and it was exactly. You know, what we tell people all the time is you get this. He got this really nice rise and then it kind of dropped down a little bit and then it kind of bumped up and the 13 butane dial stayed in and he's stay ketosis with pretty high ketone levels for four or five hours. I mean, so if we can do that. So what are ketones doing? Well, it is really our brain's best fuel. So it's gonna make your brain, you think much sharper. So remember, ketones are a much cleaner way of making energy, of making ATP. So usually if you eat glucose, glucose, then it goes through oxy phosphorylation, and you go through all these steps and you finally spit out ATP. And the problem with that is each of those steps is creating some reactive oxygen so you create more oxidative stress. Ketones don't have to do that, so they can feed directly into ATP, bypassing oxidative phosphorylation. So you don't create this oxidative stress. You also, you get much more bang for your buck. So for molecule of oxygen, you make much more ATP using ketones. So it's a really efficient energy source, and you have to think that's why it exists. Right. If you were a caveman and you were starving, you needed just a really efficient energy source. Right. And so that's what ketones evolved. So it really is the best energy source, both for our brain and really in general for our muscles. There's other pieces to that because lactate's important for muscles, and so is carbohydrates. And so think about this as your cleanest, purest energy source. So this is like giving your car the best gas there is, right? You've got a sports car, you're going.
- [39:54]
A
To give the best 100 octane gas, right? Exactly.
- [39:56]
B
And all the other things we just talked about for healing, they're always gonna reduce these kind of high inflammatory states. So markedly anti inflammatory, Markedly anti inflammatory. They also, again, stem cell activation. So you're gonna see better, much more stem cell activation in people who are taking ketones regularly. You'll see much faster wound healing. So I take ketones all day long. I just sit all day long, right?
- [40:19]
A
Exactly.
- [40:20]
B
So basically, they make what's called kinetic pro, which is a very high dose in a few ounces. So I can drink my water with a little bit, just added to it, couple tablespoons to it. Right. And now I'm keeping my ketone levels high all day long.
- [40:32]
A
Got it.
- [40:32]
B
It makes me sharper, I think faster, I recover better. And then you can use higher doses. For instance, when we're working with football players, we'll take them out, have them do a quite high dose right before they're playing. Right. If they just traveled or if they're, you know, so. So you can use the higher doses acutely and then lower doses kind of throughout the day.
- [40:52]
A
Got it.
- [40:52]
B
For our neurodegenerative people, people who have, who have cognitive issues or mild cognitive decline. We're going up to 20 grams, three, four times a day of ketones. And so by doing this Connect Pro, actually they made it for doctors to use because we realized we needed much higher dose ketones and we can really. And we see significant improvements. If you look at, just looking at EEG scans on people within half an hour after taking ketones, you'll see improvement in cognitive.
- [41:20]
A
Incredible.
- [41:20]
B
So it's really, they're pretty incredible in terms of, you know, and just improvement in endurance. That's why athletes like them. Right. You know, so they're the perfect fuel. They're anti inflammatory, they're stem cell activating, they actually even have some genetic influences that are important. So if you look at kind of everything we want, this is going to be, I mean the, the by maintaining metabolic flexibility, but keeping myself in the perfect energy source, loss of ATP is sort of the link to everything, right?
- [41:48]
A
Sure, Absolutely.
- [41:49]
B
So, and now remember now if I'm giving ketones, my mitochondria get out of this oxidative stress state.
- [41:55]
A
Sure.
- [41:55]
B
They're not spinning out, having to make all this ATP, so all these free radicals. Now the mitochondria actually start to heal. So you'll see people with horrible mitochondrial dysfunction. Now the mitochondria have sort of this rest state where they're like, okay, great, I don't have to work so hard, I don't have to make more reactions. Reactive oxygen species. Because think of one of the things that mitochondria are really smart. So if they're trying to, you know, you need, you're an injured state or you, you know, you just had a virus or you just ran a marathon. The mitochondria have worked really hard to make ATP in response. They've made a lot of reactive oxygen species. They're gonna, there's a point where the reactive oxygen species start to go, okay, shut off, stop making ATP.
- [42:35]
A
Got it.
- [42:35]
B
That's why you finally get horribly.
- [42:37]
A
So there's like a feedback mechanism, right?
- [42:39]
B
Reactive oxygen species are high mitochondria. You're like, okay, I can't have any more reactive oxygen species. I'll stop making ATP. And that's why we see brain fog, shock and fatigue in people with mitochondrial dysfunction. So basically if we stop the reactive oxygen species, the mitochondrial can start rugging back up again.
- [42:53]
A
So interesting. Okay, so yeah, so basically the mitochondria are making energy from glucose, which is a really dirty way of making energy.
- [43:00]
B
It creates a lot of smoke, right? Exactly.
- [43:02]
A
Perfect. That smoke needs to be vented. And your mitochondria, which is the engine will just stop working when there's too much smoke. Ketones bypass.
- [43:10]
B
So now I can make energy stop making smoke.
- [43:12]
A
Right.
- [43:12]
B
And now my mitochondria start to heal. So they actually start processing glucose better and you know, and working better.
- [43:18]
A
So incredible. And so just practically these, these drinks, these ketone drinks, the company's called Kinetic. They make the one that has kind of a higher plasma level. There's other ketone drinks out there. Like ketone iq, I think is another one.
- [43:30]
B
Ketone IQ is so those, so those are ketone esters. And again, they're, they're fine, they work. But again, you're going to put yourself into a very rapid state ketosis and very rapid state. Our goal would be to try and maintain ketones in the blood just like your, I would argue that you can do the same thing with your, your, you know, like your brain injury patients and things like that without putting them on a ketog diet. Because I can maintain ketones the same way I can with. With keto diet.
- [43:53]
A
Yes.
- [43:53]
B
So, so, you know, I think that there, there's a place to say when you look at. Not everybody does well with ketogic diet. It's just hard.
- [44:01]
A
Yeah.
- [44:01]
B
It's hard to follow.
- [44:02]
A
It's very, it's very difficult to.
- [44:04]
B
So if I can use something now to substitute for that and get the same benefit. And you can't do that with a ketone ester.
- [44:10]
A
Right.
- [44:10]
B
Right. Now, again, I think as physicians, we're going to be going more to a higher dose product. But as if you're just kind of a general person, they have just the little cans, they're yummy. But. Or even from a cost perspective, the pro level. So the Kinetic pro. So you go to Kinetic Pro, then it actually makes a much higher dose ketone.
- [44:30]
A
Got it. Saves money too.
- [44:32]
B
Saves a lot of money. Right. Because you're using a much smaller concentration.
- [44:35]
A
Yeah. You know, I didn't know that was available.
- [44:38]
B
So I definitely should be using your patients because it's huge and it's much more cost effective for them. And you can actually just get much higher levels of ketones.
- [44:48]
A
And for the listeners, this is like spread through the longevity doctor community like wildfire. There's so many longevity doctors using this now. And to your point, it's just.
- [44:57]
B
You gave me one thing. Yeah, that's a hard question. Right. That is K2 is a great thing. Magnesium is a great thing.
- [45:02]
A
I try not to ask out of this podcast because everyone's like this is not one place.
- [45:06]
B
But let's say one thing that would give me. Because, you know, you know me, Darshan, I'm a huge mitochondria at the root of all.
- [45:12]
A
Absolutely.
- [45:13]
B
And so if I can preserve mitochondria, can I preserve everything else?
- [45:17]
A
Right, yes.
- [45:18]
B
Energy production. So, yeah, I mean, obviously it's not going to be one thing, but if you said, okay, you absolutely can. One thing. Absolutely. That's the only thing you can have that would be ketones.
- [45:27]
A
Wow. Okay. So that's another incredible new tool in the toolbox, and it lets me just briefly touch on red light therapy. So you have your patients buy red light panels. I think it's important to make sure you get a good quality.
- [45:38]
B
A good quality red light panel.
- [45:39]
A
Yeah. Because there's a very specific wavelength that you need to be at. And if you're a lot of red light panels now, they're just red lights and they're not.
- [45:46]
B
Right. You're not going to get a cheap red light. Let's put it that way. If it's cheap, it's not the red light. If you're seeing a $80 red light panel, it's probably not, you know. Exactly.
- [45:58]
A
And then you mentioned also, obviously you want to keep moving. You want to keep promoting blood flow and BFR bands. Blood flow restrictions.
- [46:05]
B
Right. And this is great. Now, like, you know, like, you know, I use. You've used BFR bands and I do. Yeah. Like, it's great because you have something hooked up to your phone, you know, so it's super easy. You look stupid in the gym, but that's okay. Mostly I do my BFR band stuff at home.
- [46:18]
A
Yes, yes.
- [46:20]
B
But, you know, but so there's much simpler to use now than the old ones. I don't know. You know, I've been in for a long time. We used to, like, just wrap.
- [46:26]
A
Was that hard to put on?
- [46:27]
B
They're hard to put on. Yeah. Yeah. So these are much simpler. They're really nice.
- [46:30]
A
What's the brand that you like?
- [46:32]
B
I like Saga. So CG is a good one. Saga is a good one. I think those are probably the two best on the market.
- [46:37]
A
Amazing. And then you also mentioned. What was the next. You mentioned one more tool that we can use for post injury recovery. Let's talk about hyperbaric oxygen therapy. I've had Scott on here.
- [46:48]
B
Love hyperbaric. Right. I mean, Scott's the pro one. I'm not gonna. I'm not gonna match anything. His knowledge about it. But I have a barrack. Post injury is.
- [46:55]
A
Is Huge.
- [46:56]
B
Right. Post traumatic brain injury, post any kind of injury recovery. Because what is it? You know, same thing. We're actually reducing oxidative stress. We're increasing oxygen flow to the muscles and the tendon and all these places that have a hard time getting oxygen. One of those big problems is why they're so hard to heal, is they really aren't, well, oxygenated tissues. They're not, well, vascularized tissues. So you can do so much with hyperbaric. I think hyperbaric is now kind of, you know, I think, rising in our longevity world. Right. As a tool that probably everybody should do, even preventatively, for longevity.
- [47:32]
A
Yeah, and that's a really good point, because all these things that we're talking about for injuries, they also work very well preventatively.
- [47:37]
B
Preventively.
- [47:38]
A
And that tells you something about them. Like, you're not going to take Tylenol every day, preventatively.
- [47:41]
B
Right.
- [47:42]
A
It's like, no one thinks that that's beneficial at all because, you know, you're going to get side effects and problems with it. But all of the stuff that we're talking about actually works preventative as well. So. And then what about, you know, you had mentioned earlier, and I want to make sure we touch on this, too. We all kind of, like, expect this future where we're going to have degenerative joint disease. Right. And the reality is that is not a future that everyone needs to head towards as though, like, that's our destiny, no matter what. Right. And so there's ways to prevent degenerative joint disease just starting in your 30s, 40s, 50s, and I would even say it's never too late to start. Right, Exactly. Can we talk about some of those? Like, what's your checklist?
- [48:21]
B
There's, well, I think, first and foremost, hormones. Right?
- [48:23]
A
Yes.
- [48:24]
B
You absolutely cannot. Your muscles are not going to do well, your tendons are not going to do well, your collagen is not going to do well without hormones on board. And that's all of them. For men and women, you need estrogen, testosterone, progesterone. Progesterone is very forgotten in men, and it's actually very critical to joint health. One of the reasons you get stiffer as you age is there's actually progesterone receptors on joints. It helps synovial fluid to be thicker and more liquid. And so basically, if you don't have progesterone on board and it doesn't get looked at in men. No, you know, I have a lot of my men who have chronic back pain or Chronic joint pain or they just wake up horribly stiff and you put them on a little low dose progesterone at night. Obviously you're using a much smaller dose than in women using like 5, 10 milligrams, but a little chokey before they go to bed at night. And it markedly helps them this, they're not waking up so stiff. It's also really prostate protective. Progesterone, it's very, very forgotten in men.
- [49:11]
A
It's actually completely forgotten.
- [49:12]
B
Completely forgotten. And so NISI really looked at like, you know, if you look at progesterone deficiencies in men, it'll look a lot like testosterone deficiency. So it really has to be looked at and checked and utilized, probably more than we do.
- [49:23]
A
And so you're saying men should even do a little troche, which, yeah, we.
- [49:27]
B
Do like a 5, 10 milligram troche. It helps us sleep. I mean, you know, if you're not sleeping well, if you have anxiety, if you have, if you wake up stiff.
- [49:34]
A
So just like in women, probably, it's.
- [49:35]
B
Like in women, you know, probably progesterone.
- [49:37]
A
So interesting. I did not know that.
- [49:38]
B
I learned something majorly protective to the problem. Prostate too.
- [49:41]
A
Huh.
- [49:42]
B
So, you know, so, you know, so we. It's hard to measure in serum because it's at a low level. So you really need more urine metabolite testing to look at it like Dutch testing, right? To really look at it in men. But you can see and you know, so in men you'll, you'll see the alpha beta pregnant alone levels. And if those are low, you need to replace it because otherwise people are not going to do well. And it's probably, I don't know, 30% of men you'll see that in. So it's not uncommon.
- [50:06]
A
You know, it's so incredible to learn this from you because I speak on stage a lot, just like you do. And one of the first things I always talk about when I talk about hormone replacement therapy is we've gone two, three generations now where people did not have the benefit of hormone replacement therapy. And now it's like you almost have to convince me, give me a reason why a person should not be on it. Because this is.
- [50:25]
B
There's none.
- [50:25]
A
There's none, right?
- [50:27]
B
I mean, not even cancer, really. You know, I mean, you know, you look at the progesterone estrogen receptor positive cancers, even those people can probably benefit. You have to, you know, to sort of buck the system a little bit and watch how you're doing other things. We know that, you know, if you've ever talked, you should have Dr. Morgan Toller on your. On your podcast. I would love to have it. But he's, you know, because listening to him talk about testosterone and prostate cancer, you're like, oh, my God, this is just asinine that we've ever thought testosterone was linked to prostate cancer.
- [50:53]
A
Right.
- [50:53]
B
So really, I don't think there's anybody who should not be on hormones. And it's so hugely beneficial to joint health. You know, it's. And estrogen for men, you know, as well as well for joint health. So I think that kind of fits into, you know, the sort of top line.
- [51:09]
A
And I don't think you can do hormone replacement therapy correctly without urine metabolites either. I think it's such a critical piece of the puzzle.
- [51:15]
B
Yeah. We have, you know, in our longevity docs group, there's always some argument right in there, people who are like, oh, you don't need urine metabolites. I'm a big believer, too. I really think urine metabolites are really useful. You need to see where the estrogen and testosterone going. Yes, right. You know, and even when you look at the testosterone metabolites into this, you know, Anderson and Dial, there's, you know, there's. There's people who even have higher levels of dht, but they're not making Anderson and Dial, so those people are not going to get the anabolic effects. So you need those metabolites, I think, to really refine treatment and to do it safely, to know that you're not making high levels of the bad estrogens that can cause cancers and things.
- [51:50]
A
Exactly. And there's different types of estrogens you can produce. And so it's not just about testosterone. Converting to estrogen is what direction is it converting, et cetera. And you get all that information with your metabolites.
- [52:00]
B
So that's why I'm a huge fan of urine metabolite testing.
- [52:03]
A
Same. I mean, there's so much precision that we can have now with our therapy.
- [52:06]
B
That, that, you know, like, why not?
- [52:08]
A
Yeah, yeah, exactly. And, you know, like, I feel that testosterone replacement therapy probably got a bad name for a while because it was done without precision. It was done, you know, people were just getting testosterone mail order and no one's even checking levels, and it led to problems.
- [52:21]
B
So, yeah, it's funny, I mean, I. When I first got into the longevity world, which is now, you know, 20 plus years ago, you learned a lot from the bodybuilders. Right. It was like they were like the people who Actually got. Were looking at the science of this replacement. It wasn't. But, you know, it wasn't the reproductive end or it wasn't just. It was the bodybuilders. Like, we know how to do this, you know, in a way. And then. And then they can do it in an unsafe way. But a lot of the really good bodybuilders have it, you know, really dialed in to, okay, how can I do this, hopefully, but still get the benefit. So you learned a lot from those people.
- [52:52]
A
Absolutely.
- [52:53]
B
But you're right, it did fall into a little bit of a, you know, bad hands, you know, and it's funny because I use in women a fair amount with osteoporosis or people with joint pain, nandrolone. So Nandrolone is an anabolic steroid. Right. And if you look at Nandolone, that's FDA approved. Yeah. History. It actually was the first treatment for osteoporosis.
- [53:15]
A
I didn't know that.
- [53:16]
B
Okay. It was like 1960s. It was, you know, and then it actually got sort of into the bodybuilder hands because it's very anabolic.
- [53:23]
A
Right.
- [53:24]
B
It's 50. If you look at testosterone, it's one to one. Anabolic to androgenic. Remember Androgenics? All the other things you think about with men, anabolics, just muscle bone building. Right, right. So Nandron's 15 to 1, anabolic to androgenic.
- [53:37]
A
15 to 15 to 1.
- [53:38]
B
So much more anabolic. But it fell into kind of the bodybuilders hands. People stopped prescribing it because now all the doctors are like, oh, okay, now I'm not doping people.
- [53:46]
A
Right, Right.
- [53:47]
B
But we use it a lot by cycling it. So if you have a female with osteoporosis, I can tell you, you. I've had women improve from like a negative three, like a really bad osteoporotic score within, you know, year. A couple of years of cycling nandrolone going into the positive states. You can't do that with any other drug.
- [54:04]
A
No.
- [54:04]
B
So nandrolones are really, actually can be really beneficial. It's great for joint pain.
- [54:09]
A
Oh, okay.
- [54:10]
B
So my joint pain. People with chronic osteoarthritis love it. It's hard to get them off of it. And you got to kind of cycle nandrolone. You don't want to do it continuously. So sometimes it's hard to get them off it because they feel so much better on it. So even things like anabolic steroids, which have kind of gotten a bad rap in our field, like a bodybuilder thing actually have some really huge benefits for us in terms of helping people to put on muscle or put on bone. So I use it a lot in helping fracture healing in my little old ladies who fracture something or my women with osteoporosis that, you know, are not doing. You know, you can stabilize things, but try and really rebuild bones. Really be anabolic.
- [54:44]
A
Sure.
- [54:45]
B
It's hard. It's a really good thing for that.
- [54:47]
A
Absolutely. So nandrolone estrogen replacement therapy for women, progesterone, testosterone for men. Don't overlook that as well.
- [54:54]
B
Yeah.
- [54:54]
A
And then obviously, stem cell injections.
- [54:57]
B
Yes. But remember, the stem cells put into so many clinics now you pop into. These people are just stem cell clinics. Right, Right. You have to get the garden all ready.
- [55:06]
A
You have to do everything else first.
- [55:08]
B
Right. So we put everybody through a protocol before we do stem cells that, you know, that really. To try and optimize them. And then, you know. So you were talking about your surgery. About half people are like, I don't think I need this anymore. We also use a drug called pentacin polysulfate.
- [55:21]
A
Say that again.
- [55:22]
B
Pentasin polysulfate, pps. So penicillin polysulfate is approved in Australia. It's a drug called. And it's in phase three trials here in the U.S. okay. It's called xylisol. And so xyosol is injectable. Pentascine polysulfate pension. Polysulfate's been around since the 80s as a drug called Elmeron.
- [55:40]
A
Okay.
- [55:40]
B
Elmaron's for bladder inflammation, the bladder cyst diet. So chronic bladder cystitis. And it came out in the 80s. It was a godsend to people who are suffering bladder inflammation. But when you look at the mechanism of drugs, there's a lot of very cool pharmaceutical drugs out there.
- [55:54]
A
Sure.
- [55:55]
B
So if you look at what penicillin polysulfate does is it blocks inflammation, but it also blocks degradative enzymes.
- [56:03]
A
Okay.
- [56:03]
B
So there's these enzymes that get accelerated in people who have osteoarthritis, something called Adam enzyme and MMP3. And now we also see acceleration of interleukin 1, beta interleukin 6. So penicillin actually works on all of those levels. It's because it's blocking this NLRP3 inflammasome, which is kind of the key to starting everything, but it's working on improving blood flow. It's blocking the bad cytokines. It's blocking. There's nothing else that blocks these degraded enzymes. There it is. But it's as easy to do. And so this is like. So they brought it out in Australia in 2019 and started working with this as an injectable. So orally as Omaron. It didn't work great for joints, but as a low dose injection it remarkably improved joint health. And within a year we not only saw stabilization arthritis, but actually improvement in cartilage. So a year after being on this drug, we saw 30% improvement in cartilage.
- [57:01]
A
Wow.
- [57:02]
B
So it's a remarkable drug that is.
- [57:04]
A
30% improvement in cartilage.
- [57:06]
B
Right. Versus the placebo group who declined it lost 6% of cartilage over that.
- [57:09]
A
Seems like we're headed towards a place where joint replacements might be a thing of the past.
- [57:13]
B
I think they will be. Well, number one, we're going to get better and better at cartilage regeneration techniques. Right. We're going to do more. But like this drug, I would say 80%. We have so many people who are headed to joint replacements. We put on this medication. It has to be the reason we can get it even though it's not approved here is that pentosin polysulfate is approved as an oral drug. So it's great. We just have a compounding pharmacist turn it into an injectable drug and we follow the guidelines. It will come to market in about two years because I've been using it for about five years now in my practice. Game changer. I will tell you, people who have bad osteoarthritis, about 80% of them see significant.
- [57:49]
A
Incredible.
- [57:49]
B
And it's incredible.
- [57:50]
A
This is all such game changing stuff for osteoarthritis. And this podcast episode I think is going to change people's lives because there's so many people out there suffering with joint aches and pains.
- [58:00]
B
Right. And there is so much you can do. You have to find a knowledgeable provider. And I think that's the problem is our field. There's not a lot of people focusing. Like even in all of our longevity docs group, if somebody came to you and tore their meniscus and their knee, you're gonna say, oh, go see your orthopedic surgeon. Really wrong thing to do. We know that surgery for a torn meniscus in the knee doesn't work. I mean, if you're a young person, you can repair the meniscus. Yes. But if you're our age and we tear our meniscus, don't go scope it. It's like the worst thing you can do. Ample studies now that show that markedly progresses the arthritis that you may get a little temporary improvement, but over the next few months you get marked worsening your arthritis. And in fact, in other countries they don't let people do surgery anymore for a torn meniscus because the results are catastrophic.
- [58:42]
A
They're horrible, unfortunately. You know, when all you have is a hammer, the whole world, you stick a scope in everything, I think. And so it's to your point like the rate of arthritis after scoping is massive and so you want to avoid it if at all possible now. Yeah, yeah.
- [58:57]
B
Well, I'm going to add one more please. When you add on your kind of preventive thing. So the other really good thing to do is, is high dose omegas which are good for everything. But here's the trick. Take a baby aspirin at night because there's this pathway people don't know about called the aspirin mediated pro resolving mediator pathway. So a lot of people have heard about pro resolving mediators. People even take them as a supplement. They take specialized proresolving mediators. But there's this pathway that if you take baby aspirin with your omegas, they don't have to take it. At the same time, you actually accelerate this pathway to make these, what are called resolvants and protectants that are these pro resolving mediators that turn off inflammation. So by doing omegas and a low dose aspirin, this is really important after you have an injury.
- [59:39]
A
Right?
- [59:39]
B
Right. So about three days after an injury, low dose aspirin and omegas, you're going to turn off the inflammation and start the healing process. But I do it ongoing. Right. And you know, I take baby aspirin every night and I take my omegas every day. And you're keeping these, these pro resolving medias at a much higher level. So you're just helping the, this process of healing and recovery. So interesting and such an easy little thing to do. Yeah, aspirin is maybe a baby aspirin. This aspirin media poor resolving media pathway is really cool. So just by taking a little bit of aspirin, you actually accelerate all these processes of making these omegas and turning them into these magical compounds.
- [60:15]
A
Another incredible tip from you that's amazing. This has been such an incredible conversation. I've learned so much from you in just an hour. And like I said at the beginning of this podcast, I'm like, like we have to have you on every, every few months because we talk about something else. Because I learn so much from you every Time. You're on the pinnacle of knowledge with longevity science. And I really appreciate you bringing all this to us.
- [60:36]
B
I appreciate you giving me the time and being here.
- [60:38]
A
All right, so no more rice protocol. We're gonna do the meat protocol.
- [60:41]
B
Meat. Meat instead of rice. You got it.
- [60:42]
A
And we're gonna work out.
- [60:43]
B
Take nothing else home. Meat instead of rice. Take some baby aspirin. Keep your hormones up, take a few peptides. You'll be good.
- [60:49]
A
Exactly. I love it. I love it. The protocol from Dr. Yurth. Where can people find you?
- [60:55]
B
So definitely our clinic, where I'm licensed in 42 states, so we can see people from all over. So if you go to www.boulderlongevity.com, that's our clinic. And you can just sign up there to get information and somebody will give you a call. Follow me on Instagram ryearth. We actually have a training academy just to kind of train. It was developed kind of just for people to help them understand their own labs and things. Now we have a lot of physicians who do it, but it's called BLI Academy. So if you go BLI Academy, it's a training academy. We do monthly Q and A's that are really fun. So you can, you can go there. Follow my YouTube. I try and do a lot of educational stuff, so I try and try and throw up new stuff in the YouTube of. Of stuff. But the. Our academy is kind of fun because we get these questions from people that are just phenomenal.
- [61:38]
A
Yeah.
- [61:39]
B
You know, so it's kind of fun.
- [61:40]
A
I love it. I love it. And you've been such an incredible, monumental force with the longevity doctor community educating all of us. So I thank you for that.
- [61:47]
B
I appreciate that.
- [61:47]
A
Thank you.
- [61:48]
B
Thanks, Darshan.
- [61:53]
A
Wow, that was. That was such an information filled episode with Dr. Elizabeth Yurth. Here were my five top takeaways from that episode. Number one, joint pain is one of the biggest barriers to healthy aging, and it's largely preventable. Longevity isn't just about organs and biomarkers. If you want to enjoy a long life, protecting your joints early, ideally in your 30s, is going to be essential. Number two, most arthritis is not caused by overuse. Sedentary people often get the worst arthritis. The real driver is chronic whole body inflammation fueled by poor nutrition, hormonal imbalances, and metabolic dysfunction. Number three, stop taking Tylenol after an injury. It will actually slow down your healing. Inflammation is the start of the healing process. Blocking it too early increases the risk of chronic pain and degeneration. Instead, follow the meat protocol. You heard about with this motion exercise, targeted anti inflammatories like peptides and ketones and appropriate therapies. Number four peptides like BPC157, TB4 and GH copper and hormones can actually dramatically improve your healing. BPC157 modulates inflammation, TB4 boosts blood flow and stem cell activity and GH copper helps collagen repair correctly to prevent scar tissue driven chronic pain. And finally, number five if you take only one supplement, it should be ketones. According to Dr. Yurth, ketones are the cleanest fuel for brain and muscles. It reduces inflammation, improves your endurance, enhances your healing and helps regulate your metabolism without the downsides of the long term keto diet thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with the your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.