Ever Onward Podcast

Why Your Annual Physical Isn’t Enough — Live Longer On Purpose with Eric Lyall, MD | Ever Onward - Ep. 107

• Ahlquist. • Season 1 • Episode 107

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What if your annual physical is giving you false confidence?

In this episode of Ever Onward, Tommy and co-host Andy Scoggin sit down with  Eric Lyall, MD —an ER-trained physician who founded Peak Personalized Healthcare in Meridian—to break down what he calls the leap from Medicine 2.0 (treat problems when they show up) to Medicine 3.0 (measure risk early, personalize the plan, and prevent disease before it becomes your “new normal”).

The conversation starts with genetic testing—APOE and Alzheimer’s risk, why “genes may load the gun,” and how lifestyle and data decide whether it ever fires. Then it gets practical: what Peak Health actually measures, what most standard checkups miss, and how a high-touch, quarterly approach creates real accountability and measurable change.

You’ll hear how Eric evaluates cardiovascular risk beyond LDL (think ApoB, LP(a), calcium scoring, and when to consider advanced imaging), why metabolic health is the foundation for everything else, and how tools like DEXA scans can track the levers that matter most: muscle, visceral fat, and bone density.

They also tackle the topics everyone’s asking about—without chasing trends:

  • Hormone replacement therapy (what’s changed, what’s still misunderstood, and why “bioidentical” matters)
  • Supplements that are actually worth your attention (omega-3s, D3/K2, magnesium, creatine, and when methylated B vitamins make sense)
  • Peptides, experimental wellness fads, and why skepticism is a feature—not a flaw

Bottom line: this episode is a roadmap for anyone who wants to stop rolling the dice on their health—and start building a longer, stronger, more capable life with intention.

Learn more: Peak Health Idaho — peakehealthidaho.com

Location: Meridian (Treasure Valley)

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Genetics And Alzheimer’s Risk

SPEAKER_02

Today on the Ever Runner Word Podcast, we have Eric Lyol MD. He is a doctor that founded Peak Personalized Healthcare and Meridian. Eric is trained as an emergency room doctor who now specializes in longevity and personalized care. With my co-host this month, Andy Scoggin, we are going to dive deep into health, wellness, hormones, cardiovascular disease, cancer prevention, and everything that Eric does at his clinic to try to help increase both health span and lifespan. So please join us today for Dr. Eric Lyle. Welcome, Dr. Eric Lyle. Thank you. Thank you. Thank you for having me. Incredible physician here with a practice that's in uh this game that we're talking about, and we're really excited to talk to you about it. Well, let's start where we were talking. We're talking about Chris Hemsworth. Uh Andy asked me, Have I done my genetic testing? And you guys blazed into a great conversation that we're going to get into. But talk a little bit about this.

Meet Dr. Eric Lyle And His Mission

SPEAKER_00

So the you know, and the doctor's gonna know a whole lot more about this than I do, but what has come out, you know, just because of the the the excellent work that's been done over the last 20 years on on the um on DNA and on genetic testing is now they can go through and look at your markers and likelihood for hundreds and hundreds of different aspects of health. And I had that done a year ago, and um like it tells me whether I'm more likely or less likely to um develop um you know new bone material, right? So I'm on the low end of that. But it also tells me if I have higher risks of certain cardiovascular events, then luckily I'm more protective from a DNA standpoint on those. Um but then it also there's one uh section they look at which has become uh a focus um in the mental health world of this APOE um gene. And there is a variant that's a two, a three, or a four, as I understand it. And if you have the and you get one from mom and one from dad. So I get an APOE from mom, APOE from dad. If they're both, if they both gave me a two, I'm actually lower uh statistically likely to have Alzheimer's um onset throughout my life with a two than uh with a three. Three is fairly neutral. So if you have two two, that's great. You're really protected. Uh two, three, you're um still fairly lower than the average person in terms of likelihood. 3-3 about neutral. Add one four in there, and so now three, four, and I'm slightly uh above uh average um for from the US population, at least, maybe rural population. And then a four-four significantly boosts your risk of um Alzheimer's. Now, having said that, you're still not destined to receive it. But what it does is it gives you this idea that, okay, I've got to be more focused on an earlier podcast, uh Tommy and I talked about insulin and all the stuff we're learning about, you know, I've got to be more thoughtful about you know my uh glycogen intake, I've got to be more thoughtful about my movement and you know all you know, brain health. So, brain health, all the things that are uh I should be focused on anyway. But if I know I've got a slightly elevated risk, I'm gonna know how to build a lifetime focus that's going to say, well, that'd be great, but you know, if if you you know reduce your alcohol consumption, reduce these other things that you know may be commonly acceptable, you know, eating a lot of junk food, whatever it is, don't do it. Yeah, do a lot less of it because the impact on you is going to have a bigger um negative result.

SPEAKER_02

The genetics might load the gun. Yeah, yeah. But then it's the rest of the stuff that pulls.

SPEAKER_01

Yeah, it makes sense, right? And that you know, there was some you know, a little bit of contention with some of these testings, like, you know, do you want to know this if there's nothing you can do about it? But with this, there's certainly something you can do about it, right?

SPEAKER_00

You know, and the B R A C, which is the likelihood of um breast cancer development. Totally. Great to know early on if you can take you know actions to to prevent so.

SPEAKER_01

Yeah, and it's one of those things like with you know, discussing with patients, you know, figuring out what their goals are too, and have that shared discussion of like, hey, do you want to know some of these things? Some people don't want to know, like, hey, am I gonna have a higher risk of dementia? But a lot of people do and want to know, hey, what can I do to help prevent that? Um, some things being simple, some things being lifestyle-oriented, some things being pharmacologic in or in origin. Um, but having that data, having that knowledge, um, I think is powerful. Um, empowers people.

SPEAKER_02

So I I think that we should, at least for me, you guys know each other, but I'd love to know a little bit about the and I just I think it was a good place to start because what we want to get in with you, and that's why I wanted to capture it, is yeah, there there's been so much advancement in in how we can learn more about us, how we metabolize, what our genetic factors are that may influence our lifestyle. So I'm glad we captured that. But yes, Andy. Eric, let's hear a little bit about you and and your practice, and then we'll we'll we'll get into the heat the meat of this.

Medicine 2.0 vs Prevention 3.0

SPEAKER_01

Absolutely. So um my background is in emergency medicine. Um, I've been in that for about nine years or so. Uh, over the past two to three years, I've really found an interest in longevity, uh, precision medicine and performance type medicine. Um, it's a new field, it's not something that was really taught about, um, at least when I was in med school. Um, but a lot of new data coming out, a lot of exciting things where we can really deep dive into what makes you you and not just say, hey, here's the protocol, here's where you fit in. Yep, you get ex pharmacotherapy for y, uh, disease process. And so um during my time in the emergency uh in the emergency room, you kind of see a lot of different things. You um come across a lot of presentations that are very similar, a lot of cardiovascular disease, a lot of metabolic syndrome, a lot of obesity that leads to downstream problems. Uh and, you know, based on my assessment of the medical community as of as it's right now, we're kind of designed, and I'm taking this term from Dr. ATA, uh, who's been a big influence of mine, uh, is medicine 2.0, where we're really good at seeing a problem and coming up with a treatment, but we're not really good at looking ahead and figuring out how to prevent diseases in the long term, uh in the long term. And so found a big interest by following Dr. Atia um and kind of jumping on the bandwagon of um how do we best optimize patients? Um and some of this was selfish, uh um selfish for myself as well. So um, you know, I was in my mid-30s, had our first kid, you start looking into your own health, um, deep diving, you know, you start to really get a sense of um that we're not infinite um and that life's gonna come to an end and want to best optimize ourselves. And so I started doing my own biomarkers, deep diving into it as I was looking into Dr. Atia and some of the longevity work he had um promoted, noticing that my uh LDL particles and LDLC was high, my Apo B was been high, my calcium score was not zero, uh, my hemoglobin A1C was 5.6, you know, bordering on pre-diabetes. And started noticing myself just being unhealthy. And part of that is coming out of residency, getting into the emergency department, uh shift work, working hard, you know, marriage kids, et cetera, life.

SPEAKER_00

Grab food as you can, grab sleep as you can, grab these things.

SPEAKER_01

They're not gonna be able to do that. Yeah, yeah, exactly. Um and so, you know, this insight of you know, looking into my own biomarkers, looking into my own health, uh, in conjunction with the recent climate of a lot more data out there from the longevity side of things, in combination also with seeing what comes into the ER and what as a common denominator for what leads people to the chronic disease, led me on this journey to developing personalized healthcare, where our goal is to deliver precision medicine and deep dive into what makes you you to help you optimize to live the longest, best, healthiest life possible. And that doesn't mean you're living to 120. You know, that means that you're living the best life possible, whether that's to 85, 95, 100, great. Um, but really helping people people optimize. And so that was a very long-winded and circuitous way of getting to my point there. But um, that's kind of my background.

SPEAKER_00

So, what do you do when I call you up and I say, Hey, I'd love to come in, become a patient. What does that mean?

SPEAKER_02

Hey, I'll tell you. You don't you don't know this. I want to he was coming on this week and I said, so I called his front office and I said, Hey, I'm gonna come do a patient intake. So I went in Wednesday and spent an hour and 15 minutes with him, and it was awesome. Yeah, yeah, it was awesome. I'm glad because because instead of like the typical thing, right, which is it's it's medicine 2.0, right? Yeah. Well, are you having a problem right now? No.

SPEAKER_01

Take your blood pressure, yeah, your pulse, your living, your what we'll message you with your labs, like thumbs up emoji at the end of the year.

SPEAKER_02

It was awesome. He went through systematically with me, and you can talk through your process, but but he went through, you know, you know, cancer screening. Yeah, we we talked about the importance of that. We talked about cardiovascular help a lot because of my problems. I've had medications test like he asked the simple question to me. I should know better, but have you had any testing done to look at these risk factors you may have, to look at about how you should be treating and optimizing your health for you, kind of this medicine for you thing. Yeah. Um, and I said, no, I haven't had any of that. So so I think the difference to Stark, I'll let you finish up, but it was it was an hour and 15 minutes. And the end of it, I just called Chad and I'm like, this was awesome. I need to do this a long time ago, and it's right here. Now, I think a lot of places around the country, you mentioned you went back. Did you go to the Mayo Clinic?

SPEAKER_00

I I didn't. I was actually up in upstate or uh just outside Manhattan. I was in just north of the city. There was a White Plains has a huge um, for whatever reason, concentration of these really advanced uh medical clinics and and uh they call them executive medicine programs, executive physicals.

SPEAKER_02

And and I've been wanting to go for a couple years to the Mayo Clinic and kind of do all this thing. Right. Uh in fact, we almost went last year, Ryan Cleverly and I. We looked it up, we said, hey, we let's schedule it together. Mike Boren had just gone and done it with Joan. Yep. He spoke very highly of it. I knew you had gone. So I was looking at this and then I'm like, this is right here, like literally right here.

SPEAKER_00

I I don't want to fly to New York or Minnesota. I want to come to somebody that I'm gonna know. On a Zoom call if I have a question later on, but I can actually go up. So I love that this is a uh, you know, finally we're big enough and and and um sophisticated enough of a city that someone like you can build a practice that really shifts from how do we, you know, just treat a problem that's been building for 10 years to how do we get 10 years ahead of a problem. Exactly.

SPEAKER_01

Yeah, that's what we've noticed as well is um, you know, LA, New York, Atlanta, big cities, Houston, Dallas. Um, there are places that, you know, focus on longevity or full concierge medicine where we're really deep diving, um, going off the standard path, if you will. But the Treasure Valley and Boise and Idaho in general, it's pretty lacking. Um, we're pretty early on. This is something that's been a growing field over maybe the past maybe 10 years, but really five. Um, and so we're in its infancy. Um, and so there's a lot of places that pop up, you know, that'll put a shingle out there and maybe, you know, del deep dive into a little bit of it, but maybe not do the full um really get into it fully. Um but you know, our goal was to really bring this to the valley so people aren't having to fly to New York to get things done like that. So we actually have a client uh um in the Sun Valley area that would fly to LA once a year to do it.

SPEAKER_00

And it's kind of like a lot of people have and have wanted this here, so it's yeah phenomenal. So from a testing standpoint, things like what are you what are the things that you can do here? Yeah. And you talked about the CAC score, which is this calcium uh score that we can get for our cardiovascular system. You know, DEXA is a is a protocol where you can look at muscle and bone density and things like that. Are you doing all of those kinds of things here?

Cardiovascular Risk: ApoB, Lp(a), CAC

SPEAKER_01

Yeah, we are. So I'll kind of give you a brief rundown and I'll go through we have like six main principles. There's more than that, but trying to consolidate it down to a couple. And so um of those six, we'll start from the top. So the biggest one will be cardiovascular disease, and we kind of already talked about that a little bit. Um, number one killer of Americans and people nationwide. Cancer starts catching up in the seventh decade or so. Um but really at this point, you know, other than testing your LDL cholesterol once a year over 35, we're not really doing too much from a preventative standpoint in medicine 2.0 model. And so our mission really is to deep dive into this, um, partly into what makes you you. So um uh some of the side some of the genetic side of things, but also just basic biomarkers. And so uh we look at APOB. ApoLibrotein B is a uh protein that lives in the basically a phospholipid layer that carries all your cholesterol around in your blood. You know, cholesterol can't just float around your blood freely, so it needs to have a um something to carry it. And so this APOB is basically a count of how many particles are floating around in your bloodstream at any given time that has the potential to cause atherosclerosis or um plaque building up in your arteries.

SPEAKER_00

So is that what some people refer to as soft plaque?

SPEAKER_01

Um yes and no. Um that does form soft plaque, which can then lead to hard plaque, depending on right.

SPEAKER_00

Because the hard plaque is generally the one, like you said, the CAC zero score that's looking at your hard plaque. Yeah. And it's really hardened around in what you know where that score is. What is harder to see, as I understand it, is that soft plaque, which can be more deadly. And so we really ought to be looking at that. And your normal annual physical is not gonna see it, but peak is gonna try to get into that side.

SPEAKER_01

Yeah, so your APOB is one of those measures that's not gonna excuse me, your level of APO B doesn't tell you what your soft plaque burden is. That's not the test for that, but that gives you a sense of what your current risk is currently, or what your risk is currently. So APOB is a modifiable uh risk factor, um, similar to your LDL cholesterol, which would be in a standard panel, but it really is a measure of how many athrogenic or how many particles uh are floating around that are at risk of causing cardiovascular disease for you. So it's better than your LDL cholesterol. So we look at that, basic blood test, comes back quick. We look at LP little A as well, another protein that lives on your LDL cholesterol that is more inflammatory, is more likely to cause vascular disease and lead to heart attacks and strokes. That's kind of what a test you can do once every couple of years. If you're integrating management, you want to test it a little bit more often. But it's kind of your genetic set point. Um so we use that along with your family history to really get a sense of what your actual risk is of cardiovascular disease. So less modifiable, very important, at least should be measured once in your life. We measure it more than that, but um and then we start integrating, you know, imaging as well. Um so calcium scoring. Um for people under, you know, people under 50, under 55, a calcium score, no cardiovascular disease history is a good place to start. You know, calcium scoring is a low-dose CT scan where we look at your heart vessels and it basically is just looking for calcium built up in your arteries, which doesn't tell you the whole story. Um, there is soft plaque that calcium score can't see, um, but it gives you a good baseline. Um if the calcium score is zero, you're relatively low risk.

SPEAKER_00

And that those are an age-adjusted score too, aren't they? Um the cat, the C A C scores. Yeah. Um so a zero for me at 64 is gonna be different than a zero for somebody at 40. So it sort of allows for a little bit more. That's my understanding.

Soft Plaque, CTA, And AI Scans

SPEAKER_01

Yeah, um, that's my understanding as well. I don't know the exact date on that, so don't quote me on it. But yeah, but but we want a zero. I guess that's the zero is the goal. We want a zero. Zero's the goal. And you know, having a positive score. I've been zero since I was like 15, I don't think. Right. That's what you know. My own mom is like 1400. So there is a huge spectrum here, and calcium doesn't mean you have a high-risk plaque that's gonna lead to rupture or lead a heart attack necessarily. But you want to know. But you want to know. Um, so we integrate, you know, basic biomarkers like LP little A, like APOB, with calcium scoring, develop a risk profile. Um, we also integrate uh more advanced testing. We do a Boston heart test um for cardiovascular disease to really deep dive into whether you're a producer or absorber of cholesterol, and that can help guide treatment if you're a candidate based on your APOB, based on your calcium score, et cetera. Um, and then there's also CT angiography of the um coronary arteries that can be really helpful as well. Look at your soft plaque. There's some really exciting uh AI-driven um analyses that are coming out. There's a clearly scan, which is just a post-processing of your CTA coronary that's really cool. Um to my knowledge, there's nowhere in the Treasure Valley that offers that yet, but I gotta imagine it's right around the corner because the technology for doing the CTA coronary is there. It's just a post-processing. Um, but we get a really good sense of what your soft plaque burden is. We can track that over time. You know, it's not a zero-risk imaging test. It requires slowing your heart rate down, it requires contrast, and so we use it diligently. We don't just give everybody a CTA coronary, we use a risk profile to stratify you and put you in a you know high, medium, low risk and decide whether or not we do that advanced imaging then. Um and then there's other genetic tests like you had uh alluded to prior that can give you a sense of whether your cardiovascular disease risk profile is high or low. Um, that's a little bit more advanced. We'll we'll do that occasionally for people. Um, different single nucleotide polymorphisms or what we call SNPs of the genetic code can put you at higher risk or lower risk. Um and similarly for atrial fibrillation, stuff like that. So a long-winded answer of saying cardiovascular disease is number one for us. That's where we really deep dive for people. Number two, and equally as important, would be metabolic health. Um you know, interrelated significantly. So having a high fasting insulin or high fasting glucose or hemoglobin A1C, which is a three-month average of your glucose, really can affect your lipid lipidology or your lipid makeup as well, your vascular health, your risk for heart attack, your risk for dementia, risk for stroke, et cetera. And so, you know, while we're looking into your cardiovascular health, we're also making sure that your metabolic health is in line because, you know, if someone comes in with a high cholesterol, high Apo B, but let's say that their LP little A is low and their overall family history is low, but their insulin is through the roof and their hemoglobin A1C is through the roof. You know, if we're there's no real point to put them on cholesterol medication at this point until we get the metabolic health in line. So they kind of interplay pretty significantly. Uh, but we look into your metabolic health uh with biomarkers. So your insulin, your hemoglobin A1C, your fasting glucose, but also your uh DEXA imaging. So we do have a DEXA scan. Uh, maybe tell people who don't know what a DEXA scan is, what that does. So DEXASCan, what it stands for is dual energy X-ray absorption. Um and classically, it's been around for a long time. Classically, it was around for osteopenia and osteoporosis evaluation, predominantly covered by insurance for postmenopausal female females. Uh with you know, better post-processing technology, we're able to really delineate your bone from your fat from your muscle based on the different weights of absorption at the plate of the x-ray plate. And so what we use it for primarily at this point is for your metabolic health and your body composition. So we can really track your muscle mass, your fat mass, your fat that we care about the most, the visceral fat around your internal organs. At the same time, we're looking at your bone health. And so we track that very often while we're managing your metabolic health to make sure, hey, if our visceral fat is high, that puts you at higher risk for inflammation, for fatty liver disease, for atherosclerosis or cardiovascular disease. And so We'll do our best to mitigate that risk by lowering that, getting our metabolic house in order before we start hammering medications for a cardiovascular disease standpoint, unless you're very high risk, um, super high calcium score, high risk plaque on your CTA coronary, et cetera. Um, but those two interplay pretty uh pretty closely.

SPEAKER_02

So not to interrupt you, but think about the difference in this, you know, medicine, you know 1.0, 2.0, and what we're talking about here for even what I have as a physician and haven't done that, yeah, it's almost embarrassing. It's like, why wouldn't you want to know all of that data so that you're optimizing treatment? Yeah, it's just so much better.

SPEAKER_01

Yeah. I mean, it's um we fully believe that what gets measured gets managed. Um, and having that data.

SPEAKER_00

And I want to get to that with you too, because now you've talked about this extensive testing that most people don't get, right, but can be valuable to every one of us. But now you've got all this data on me. Um if I'm a patient, now do you create a sort of personalized uh approach you know, program for me? Do we go back and measure it and just come back once a year and I'll see it? Or do you talk to people during the year? You know, what what what is it like to work with you?

Metabolic Health And DEXA Insights

SPEAKER_01

Yeah, so we um our goal is to be as high touch as possible. So we think that that once a year kind of touch point, hey, try some lifestyle stuff here. Here's a handout on how to lose weight or how to strengthen. I mean, you know, that's unfortunately that's just what gets lost with Medicine 2.0. I mean, I think what we've built or what we've you know started building at this point is what most doctors would want out of their practice, really high touch point, really advanced diagnostics. Unfortunately, the healthcare system is is a difficult place. So a lot of patients, very few doctors or APPs and physicians, very little time for those interactions. Insurance coverage dictates, you know, one annual screening physical a year, sick physics, et cetera. But um, our whole goal is to be as high touch point as possible. And so with what we've talked about thus far with the cardiovascular disease and metabolic health, we're getting touch points on those generally quarally. Um so from a metabolic standpoint, if we have you know high visceral fat or hemoglobin A1C, you know, average glucose is a little bit higher than we'd like. We talk about interventions, whether nutrition, strength training, zone two, which we haven't really gotten to yet, but um, and then um, and or pharmacotherapy or you know, medications if need be. And then our goal is to recheck that in three months or so, you know. Um you can do it more often than if you'd like. However, you know, a couple months isn't necessary to really make some meaningful change. So our whole point, um, our whole goal, I should say, is to really be as high touch as possible. Um, and so we do have systems in place where we can do kind of an executive physical where we do a lot of the stuff we've talked about, plus what we'll get into moving forward uh as a one-off assessment. But our main goal and where we think the most benefit comes from is that high touch point kind of month to month or at least quarterly assessments where we're really checking in on you. Integrating a personalized plan, seeing if that's working, you know, more frequently than once a year. Uh and then if it is working great, we continue the plan. If it's not, let's pivot, let's talk about alternatives, et cetera. Um but yeah, that's how we integrate it. Um Can I say one more thing?

SPEAKER_02

I think I you know, I'm just thinking um some of these things are hard, right? Because change is hard.

SPEAKER_01

Yeah.

SPEAKER_02

Depending on where you are in your life, and you know, you know, I I feel sorry sometimes for people where you say, Oh yeah, you've got a metabolic problem, you got all this risk, here's a handout, you know, go go figure out how to lose 30 pounds and work out five times a week, and here's some medicine, yeah, and we'll see uh when you need us next. Yeah. But that may be in a year when I get my physical or when I have a problem, I'm coming back. And that's kind of the way it is. Yeah. This this idea of of measuring things and then having accountability with a healthcare professional that's into your health and following you, that is 3.0.

SPEAKER_03

Yeah.

SPEAKER_02

Um totally now I'm sitting here thinking just in society with the pressures that are currently on the healthcare system, and we, you know, kind of the lie that was like, hey, if we if we if we just go to this, we're gonna start paying people for I think at this point it's it's a lie. If we start paying people for wellness, right, and and we're gonna make this big chance from fee for service to to you know population health. That's gonna be the this was the panacea, oh, it's gonna change everything. Yeah, and I think now we're into that however many decades, and we're like, uh this is really expensive, people are getting older. It's not for a lack of trying, right? The idea is good.

SPEAKER_00

It's how do you get to the execution, and nobody has has figured that out. In fact, you know, if you look at us from 50 years ago to now, metabolic health is not better. Oh no, obesity is not better. No, you know, uh you start looking down these these markers that you're looking at, yeah. And 50 years down the road, we're worse than we were sure. That's because you know, health is fighting against all the food that sits in front of us and our jobs that require us to sit at a computer and so thank goodness for people like you who say I could either be sitting in this, you know, um emergency room of all medicine is emergency medicine, unfortunately. It's all like I'll wait till it's you know exactly at the at the end of the that's a quarter.

SPEAKER_02

That's the quote of the podcast. All medicine defines healthcare, especially.

SPEAKER_00

To be able to get in ahead of it and and for doctors like you to say it's gonna be hard, but let me do that. And I know systems are working. I've been involved with the St. Luke system, I've been involved with other systems. They want to.

SPEAKER_03

Yeah, right.

SPEAKER_00

To change it, you have to change three things. You've got to change the system, yeah. Like all the doctors have been trained, thousands of doctors and and professionals and everyone that's come up. You've got to change the payers' system, which is the government and the private payer system, and you've got to change human beings. Yeah. You know, we all want the easy fix and the easy thing to figure that out. And not to have to go, you know, throw myself in a cold plunge and and then go for a long, you know, hike in the mountains when uh when you can just give me a pill. Yeah. Right. And and then I can just watch, you know, Netflix and not have to worry about it. So so for to change all those three things is brutal. And you're thinking about how to change obviously, you're thinking about the pavement system, you're thinking about the human being that you're working with, and you're thinking about your own training and how you evolved that. So you're you're hitting on all three of those.

SPEAKER_01

Yeah, we're trying to. I mean, I think it's from a system standpoint. I mean, I'm not I'm not gonna try to be the guy who's gonna change the whole system of America. But you're changing your piece of it. Yeah, yeah, that's what we're hoping to do. Like right now, I mean, you know, we're small, we're hoping to make a meaningful impact in the Treasure Valley, and I think this is um gonna be a trend line that's gonna continue. I don't think this type of medicine is gonna be niche or, you know, uh super limited. I think it's only gonna grow. It's gonna become more cost effective. I think, you know, I'm no expert on AI, but I think with the advent of AI enabling more mid-level providers to have more access to patients, I think it's gonna be able to get out there more and more. Um, you know, unfortunately, right now, you know, it is hard to make this um super broad where it can be implemented across the United States uh en masse, but we're doing our best here locally and taking our experience and hoping to grow that and uh implement it with as many patients as possible. Um, but it is exciting. Um there's a lot of challenges with the medical system. Um and I think there's a lot of frustration too from doctors, from patients, et cetera. And I think there's a lot of uh hopeful, hopefully change to be had over the next years and decades. But um, but yeah, we're doing our best here, at least locally.

High-Touch Care And Ongoing Monitoring

SPEAKER_02

I want to make sure cognizant because we uh these things go by so fast. I want to make sure we hit hormone replacement therapy. Yeah, yeah, we could. And I really with you just because I do think um, well, first of all, and you said the when you first walked in here to me, that one of the first things you said is, hey, we got to make sure that the the main things that people need to hear today are exercise, yeah, strength training, sleep. Yeah, those are the biggies. Yeah. That that's that's where you're major in the majors, right? Is DSL. Oh, yeah, exactly. And then minor in the minors. But but the minor things do matter, and I think that there's a lot of information, maybe misinformation. What I appreciate about you uh from our first interaction is you're very science-based and you're not gonna the latest trends and tricks you're not chasing. So can we talk about hormone replacement, yeah, supplements, and then peptides? Those would be kind of three I really want to hit with you.

SPEAKER_01

Yeah, let's do it. Um I'm just gonna, if you don't mind, I'll list the six things I sure that we focus on primarily just so we don't I keep I keep going off into the the weeds I need to do.

SPEAKER_02

Okay, when we were together for our first hour, 15 minutes, I don't think I got to all six because he would get to two and then I would interrupt him and I'd so yeah, I'd love to hear six for the first time.

SPEAKER_01

Yeah, let's do that so I can get that to get that out to people. Um yeah, I just keep uh rambling. Uh it's just such interesting stuff. But so we've talked about coronary disease, we've talked about metabolic health, hormones uh would be a number three, probably more evidence from longevity on the female side, but we'll get into that. Um and then uh cancer, um, early cancer detection is is really important. So um there's been some advents, you know, we've we've gotten a little bit better, but there's still some strides to be had. Um we try to implement some some new technology when we can, um, go a little bit ahead of the curve of the standard recommendations where they are at now. Um but cancer detection is really important. And then strength, like you said, strength and exercise, um, drastically important too. So that's our main six that we focus on a lot more than that, but to make it concise, those are the the big buckets that we think need to be filled before we start looking at other things.

SPEAKER_02

Great.

Building A Local Longevity Practice

SPEAKER_01

Um, but like you said, um, I think that's a great quote. And I don't know who it initially said, I know I think I've heard Peter at Diaz say it, but major in the major, minor in the minor is so true. And so if we don't have our house in order, you know, there's no point to get into like the experimental supplement that may or may not have made the elegance worm live 20% longer. Like, you know, I'm gonna be able to do that. Yeah, yeah, yeah. So I mean it's really easy to get into the weeds, and then you're like, wait a second, I'm like eating a cookie at, you know, uh, you know, at at lunchtime and then my hemoglobin before I got back. Yeah, exactly. Just the season, too. Um so but yeah, let's let's we can talk about hormone replacement for sure. So um, you know, it's an interesting topic, and I think it's gotten a lot of uh more attention over the past you know, a couple years, but really over the past year I've noticed it on on podcasts that I may listen to and stuff like that. You hear a lot more about it, specifically the uh female side of things. But um, for a long time it's been relegated into like the taboo and the you know backstreet deal kind of feels like a little sketchy, but um there's been so much data, robust data that's come out um from the male side and female side that suggests that these interventions are very safe uh and provide significant benefit. Uh so I'll start with the female side of things. So since the I think it was 1993, the Women's Health Initiative came out um that looked at hormone replacement therapy. At that time, it was equine estrogen, so from a horse estrogen and synthetic progesterone. Um there was a that study came out and said there was an increased risk of breast cancer for females that were on that. And so from the 90s up until the past couple of years, it's pretty much been off limits. Uh, unfortunately, things like that. Wasn't the black box warning just removed? Like within the last 60 years. Yeah, yeah, right. Like legitimately within the past couple months. Um so you know, in a just a couple years before that, there was the talk that, you know, more studies coming out saying, hey, like I think this, you know, or the data would suggest that this fear, this uh increased risk of breast cancer or other cancers was unfounded. Um and so fortunately that's that's changed and had a lot more access to females for for hormone replacement. Um so uh there was kind of uh new trials that looked into the WHI um uh as far as the risk for breast cancer goes. And the um relooking at the data actually showed that the estrogen only group, even though it was the not the estrogen we use estrogen we use now, so it's equine estrogen, actually had a decreased risk of breast cancer. Um and uh about a 30% decrease all-cause mortality for for females that were on estrogen. And so over the past 30 plus years we found um through more research that there's basically estrogen receptors in every cell in the body or every organ system in the body. And so when we go off that cliff in our late 40s or early 50s, uh estrogen goes to near zero. Same with progesterone. Uh, we know that affects muscle mass, that affects bone density, that affects cardiovascular health, brain health, et cetera. And so um there's a reason why cardiovascular events for females actually increase in their 50s and beyond as opposed to males, which are way out um uh outstriped females as far as risk for cardiovascular disease before that. In the 30s and 40s. Yeah, correct. Um and the same with dementia, et cetera. And so um for most females, hormone replacement therapy is a very safe intervention. Um, you know, there's still a little bit of caution about uh females that have a history of estrogen receptor breast cancer in the past. But aside from that, um using a low dose estrogen, and if you still have a uterus, a low dose progesterone uh proven very safe. And then the addition of some testosterone can be helpful for some women as well, getting that up just a you know between 20 and 50 nanograms per deciliter, so not a huge amount can be helpful with muscle mass. So that's kind of our playbook for females. Uh and now we call it instead of just hormone replacement, we call it bioidentical hormone replacement. And the reason we do that is because it actually is bioidentical. So this uh the estrogen that we're administering is not a synthetic or an equine estrogen. Um and the progesterone is not a synthetic progesterone, it's a natural progesterone. So very well tolerated. Um and generally for most females, an estrogen patch, an oral progesterone at night, and a topical testosterone, those three of those things will work work wonders for uh for energy, for mood, for muscle mass, for cardiovascular fitness, dementia risk reduction, bone ma uh bone density, etc. Um so proven safe, um decreased mortality benefit from estrogen, um, and pretty easy to implement. Um so fortunately we've seen a big uptick in in the utilization of that. Uh for males, um, testosterone replacement therapy has been a hot button topic for for many years. Um and we've seen a big push in the I guess I'll call it the industry, I wouldn't say the medical community per se, but the industry of testosterone. And so um, you know, there's been a lot of data looking into hormone replacement therapy for males as well. Um so there was the Traverse trial um 2023 that showed no uh increased risk of coronary artery disease, because there was always this black box warning or risk that testosterone was gonna increase your risk of cardiovascular disease. Um they're actually talking about taking that one off as well. Um so that traverse trial in 2023 said that there was no increased risk of cardiovascular disease. And then there's been other trials in the endocrine society actually says that there's no real increased risk of prostate cancer. So we know that it's a safe intervention. We know that testosterone levels for males have generally declined over the past several decades. We don't have a really good answer on why that is, whether that's do you have any theories on that? I I think it's probably multifactorial. I think, you know, if you look at we talked about metabolic health has gotten something worse over the past 50 years. You know, we used to be a pretty active, very slim society. We're now a very inactive, very obese society. And so I can't imagine that you know excess ob obesity or adiposity doesn't play a role into that. That's gonna increase the aromatization or the transfer from testosterone. It just means you're fat. It's a nice scientific way of saying you're a little retund.

SPEAKER_00

Um it sounds so much better than any. Yeah, but but like most things, what you're saying, doctor, is yeah, I can give you a shot or a pill or a patch. And there may be a time when that is absolutely correct. Yeah. But let's start with getting you out and and you know, walking, getting you into the into a place where you're lifting something that sits a little bit. Get get your sleep, stop eating you know junk food three times a day, etc. So all of that stuff hit on that comes first, and then we oh yeah, you know, instead of what our you know often we're sort of bombarded with, which is you know, do whatever you want. I you know, you or that adiposity, yeah, and I'll give you a pill at some point and you know, stem pick, it's a whatever it is. Yeah, and those have their place. So I don't diminish that we should, you know, great minds in medicine are thinking of how to use this for someone with a type 1 diabetes or how to use it for this. It's when we say, well, do that instead of the basics, the majoring in the majors that the majors all increase your testosterone. Yeah. Yeah. Strength training. Without even putting it without the passage. Yeah, yeah. I mean that yeah, it's it's um so start there first, then we look at once you've built that back up, then we'll look at whether we need to supplement on top of that. Exactly.

SPEAKER_01

So that's what um I kind of alluded to you know initially. There's been a huge um uptick in clinics that specify in just testosterone. That's like what they do.

SPEAKER_00

There's been some really interesting news stories. Wall Street Journal did one about two years ago, as I recall, about a bunch of um clinics down in Florida. And they weren't all ethically at the level that you'd want them to be. And there are risks when you don't have trained medical professionals that are doing this based on scientific protocols. Yeah.

The Big Six Pillars Of Care

SPEAKER_01

And yeah, and I I bring that up just because, you know, um, I think it's Charlie Munger said, show me the incentive and I'll tell you the outcome.

SPEAKER_03

Yeah, you know.

SPEAKER_01

Hey, oh, do you feel like are you feeling a little run down, like low libido? Like, you know, um, yeah, we can make that better for you. And so, you know, if the end point or the goal is to get as many people on testosterone as possible, because that's how we make our money, like, you know, they're gonna put you on testosterone.

SPEAKER_00

Yes.

SPEAKER_01

And so there's been um a huge uptick in males, predominantly younger too, which is the scary part that have been gone gone on exogenous testosterone that may not need it. So if you do a one-off testosterone on a, you know, and it doesn't matter what the age is, but you know, let's say it's 300, 400, suboptimal, you know, not technically low per se. Low would be under under 300, under 250 even. Um, you know, if you don't test their LH and FSH that come from the brain, if you don't test their other markers, their metabolic health, everything like that, if you don't put the whole picture together, you can very easily be like, yeah, you probably will feel better with testosterone. Let's try it out. But if they're, you know, from their brain, their LH and FSH is super um is super low, then we know it's probably secondary related. So, hey, tell me about your sleep. Uh, it's four hours a night. Okay, there's one lever. Tell me about your diet. Or like, I can I can look at you, I can look at your DEXA and be like, hey, okay, metabolic health's not in line here, muscle mass is low. Like, let's do some basic stuff. Let's get your vitamin D, let's get your metabolics, let's get everything in line. If we don't make strides on that, then yeah, let's kick and you're still feeling a certain way. Let's talk about you know other options for that. Um, and so I did kind of jump right into the safety profile first, which probably should have started with this, what we just talked about. But uh, but safety profile is there when done appropriately. So all the safety data is um male testosterone between 600 and 750 or so. Um, occasionally we'll shoot a little bit higher than that, 800s, 900s, but not really going to go much over that because there are risks, which we kind of alluded to.

SPEAKER_00

Right, you can go the other way.

SPEAKER_01

Yeah. So um you go, you overshoot that, you know, you can get erythrocytosis, which is basically an elevated red blood cell count. Which, you know, if you start getting over a certain level, a matter of over 54 or so, hemolone of 18, puts you in increased risk for stroke and heart attack. There's uh, you know, a potential for increased risk of blood pressure. So we want to track people's blood pressure over time. Um, so you know, we can help tailor that you know strategy to where we're not getting to elevated blood pressure, having to put you on medication for that. Um and then um uh uh prostate, we always follow your PSA. There's really no major link between prostate cancer, but we still want to track that over time. So if we're seeing a PSA velocity change, so no matter where you're starting, if we see a significant increase, we want to you want to track that. Because if there was something smoldering that we didn't know about and it does have a testosterone receptor positivity to it, there's a chance that it grows. But the overall link to prostate cancer is really mostly unfounded at this point, too. Um but we we check those. You're talking about between the PSA result and the actual cancer?

SPEAKER_00

Or what are you saying?

Female Hormone Therapy: Safety And Benefits

SPEAKER_01

The link between what testosterone supplementation and increased prostate cancer risk. Yeah. Um but in a select individual who may have already had a prostate cancer we didn't know about, even if their PSA was low. But that's why we check it beforehand. I mean, it's it's pretty unlikely that anything like that's gonna happen. But yeah. Um we want to be diligent about it. We want to make sure we're testing our levels, and so you know, we're definitely not believing a set it and forget it. Like let's say we've rolled out secondary causes, we've, you know, we've got metabolic health online, we've got a strength training program, we you know, maximize our supplements. If we're not making any headway with that, we move forward with treatment. We're checking that, you know, early on, even up to monthly, it to make sure we're in the right level, and then going out to quarterly, and then from there on you can kind of space it out for not making changes. But we want to make sure we're in a good level where we're not causing adverse harm. That's not our goal here. So um that's the hormone side of things.

SPEAKER_02

Um let me give you an intro to supplements. Yeah, yeah. So I do think for those out there who are majoring in the majors, doing all the things right, you're really tuned in now. Yeah, I think nutrition, I think the American diet, yeah, just it's hard.

SPEAKER_03

Yeah.

SPEAKER_02

Uh we know eating whole foods is the best thing to do and preparing our own meals. Yeah. But but that that that goes without saying, right? Right. Fruits, vegetables, whole meals, you know, whatever diet you pick is if you're cooking it and you know what's going into it, that's that's the way to get nutrients, especially macronutrients. But then you hear a lot about, hey, in our diet, you also need these things. We uh Andy and I talked in our first uh episode today about protein, how important that is. Oh, yeah, totally. And so I we hit that kind of heavily. That that's that's one you should be doing. But then I do think even though it's like this marginal increase and improvement, there's all this other, and that's you know, you follow the money and that's where it goes. Yeah, there's a lot of stuff out there on hor on on uh supplements. Oh, yeah, for sure. So I would like you to hit on the ones we hear, I think omegas uh for heart, I think that's good. Vitamin D3, we hear a bunch about it. Vitamin D3. Vitamin D three, I'd love to hear hear more about that. Magnesium deficiency. Yeah, I think there are some I would say that that almost everyone, especially older 50s and 60s year olds, should be taking. And I want to hit creatina. So I think I think if you could comment on on those four biggies and then in general, what you would recommend. There's a whole bunch of other stuff that's out there, but I think those are the big ones. Yeah, I agree.

SPEAKER_00

And D3, K2, K2. Yeah, yeah. Yeah, and talk about why that matters because it it I think the last couple of years, people really started to understand that. And 10 years ago, they were just taking D.

SPEAKER_01

Yeah, right. Yeah, I wholeheartedly agree with with um with that intro to supplements for sure. So our main approach is is pre-backed by data and the main ones that have data behind them, omega-3 is like ULID2, D3, K2, um, uh creatine, and then we bring in methylated B vitamins for certain people that may need them. So um Do you do a methylate?

SPEAKER_02

Do you check methylation as part of your initial screening for all your patients?

SPEAKER_01

Yeah, so indirectly. So there's a genetic way of doing it. You can test people's MTH of R gene, but you don't really have to. If you test someone's homocysteine level, yeah.

SPEAKER_00

Um two doctors talk.

SPEAKER_02

So methylation, yeah, whatever that means you're testing. So the way your body metabolizes and breaks things down. Yeah, yeah.

SPEAKER_01

Yeah, so methylation is just like a single carbon group of, you know, it adds a little tag to the vitamin, makes it an active form. The body utilizes it, you know, if I'm remembering my basic science correctly. Um some people are genetically don't do that well. Okay. And that can lead up to a buildup of a certain protein called homocysteine. Homocysteine can be hyperinflammatory, and then you're just not utilizing your B vitamins well. And so you can do an expensive genetic test and test your MTV MTH of R gene, and there's several other lists of genes in there, or you can test your homocysteine level, which is a pretty cheap$15 test or so. Uh, if that's elevated, you're pretty much guaranteed to have an MTH of R gene um mutation. And so that's a supplement that we don't recommend just universally, um, but something that we bring in based on our testing if people's homocysteine levels, let's say greater than we like it around nine or less. You know, if someone's like 10, 12, 13, 14, 15 beyond, then we'll we'll integrate that. But but yeah, to get back to our you know, the the big one. So omega threes for sure. So we most people, you know, it's I think as a blanket statement, you could say two grams of omega threes is unlikely to cause harm, very safe. Most people need it, most people aren't even.

SPEAKER_02

So I want to hit just dosing for people. So two grams of omega threes. Yeah. Um and and and does the source matter uh on that?

Male Testosterone: Risks, Testing, Targets

SPEAKER_01

Yeah. Um, so more often than not, um, we're doing fish-based, there are um vegan options, there are krill options, um, but mostly we're doing fish source. Um, I should have brought the list of the three or four we recommend because I'm, of course, I'm gonna blank on them now. But um, there are third-party verifications where they look at the tox levels of them. Um, they look at the purity and the oxidation levels. And so we've gone through that data and come up with four or so that that work out. And I'll, of course, I'm gonna blank on it. Um maybe we can put it in the show notes or something like that. Yeah, we can put it. Um but about two grams is a good place to start. Okay. We generally will test people's fatty acid index or balance. Um, a pretty simple test. We can see your saturated, unsaturated trans fats and also your fatty acid index. And so there's some good data out there that suggest that having a fatty acid index, um, so what percentage of the cell membrane is made up of DAJA and EPA, which are those unsaturated fats, uh having that above at or above 8% has about a 30% decreased mortality rate compared to being in the low category. I would say based on you know anecdotal data or limited data from our clinic, most people fall into the low category unless they're already taking two to three grams uh per day or eat a significant amount of fish in their diet. Um and so supplementing up to that point is good. So the best case scenario, we have a pre- and post-intervention test to know where we're at to guide our treatment. But in general, most people are gonna do just fine having about two grams of an EPA DHA supplement per day. Uh, and then we'll link in the show notes um those ones that have a low tox, uh, low oxidation level, and a good purity level without arsenic and all that stuff in it too.

SPEAKER_02

Fantastic.

SPEAKER_01

Umega-3s. Vitamin D, I mean, I I don't think I we're probably like 80 plus percent of people we test are low for vitamin D. Occasionally we'll have people that are high that are following maybe some bad data and taking 10,000 international units a day or something like that. Um, but most people are low. Um, and so uh a D3K2 supplement is what we recommend. Um, you know, having that combo really helps with absorption and utilization.

SPEAKER_00

And you'll dial in the amount probably based on your patient versus just saying everybody should take action.

SPEAKER_01

Yeah, so this is one of those supplements where you can't like you can't really in good faith say like everybody should be on this amount because occasionally you do. Um people that are in just fine levels don't eat it or it can get toxic. I mean, if you get your vitamin D level up too high, it's a fat-soluble vitamin. You don't pee it out, it's one of four the last I checked. Um, and so you can really easily get toxic if you're taking too much. And that's where I've had a couple people come in just taking these massive doses. Their calcium's high, they're at risk for kidney stones, et cetera. Um, so it's one of those uh supplements that we recommend most people be on, but we generally recommend people get checked prior to it instead of just blanket taking it. Uh especially uh, you know, if you're a dark-skinned individual living at northern latitudes, which you know, boise is like you're pretty much guaranteed to be deficient. Uh vitamin D is really helpful, uh, bone health is what we think about it for, but also immune function as well. It's kind of taught and labeled as a vitamin, but it's really more of a hormone, really. Um it's a you know fat-based kind of cholesterol-looking molecule that has a lot of different functions throughout the body. Um, so vitamin D is a big one. Um, creatine um is one that I feel like in high school it was just like you know, the gym bro thing to like take some creatine, and that's what you did. Got a little pre-workout with probably way too much caffeine and had some creatine in it. But um, some pretty interesting data um about creatine for not only muscle mass, but some new stuff coming out about cognition. I think it's all, you know, it's a little bit on the small side of data, uh, you know, so not robust per se, but some benefit between 10 and 20 grams of creatine for cognitive performance.

SPEAKER_02

I was gonna ask you, so I I think there's a lot of data I've been reading about, and and it it seems, I mean, it seems like and also I think the elevated creatine uh creatinine level in your blood would make you worry that you had kidney problems, but I I think that's probably been falsely Yeah, falsely put out there falsely put out there for a while.

SPEAKER_01

Yeah, it's like it's our biomarker, you know, it's a problem with the biomarker, not with the the supplement per se. So um, you know, a standard kidney function test is gonna include, you know, a couple different things, but your B UN is one blood test, and then your creatinine is another one. And so by taking uh exogenous or you know, taking a supplement of creatine, that can falsely elevate that test. Yeah.

SPEAKER_02

What dose do you because uh the one thing I haven't heard clarity on um for someone in their 50s that are thinking about taking it for the for the cognitive kind of preventative uh benefits of the brain health and muscle mass. Yeah. Do you do five? Do you do 10? Well, what's what's your number?

SPEAKER_01

If someone's not on creatine, I'll usually say start with five. Okay. Um, you know, get them used to taking it, get them uh make sure they're not having any GI side effects. One of the main side effects would be some GI distress, a little bit of bloating, occasionally diarrhea. Other than that, it's pretty well tolerated. And then if they're tolerating that, then we'll bump it up to 10. That's where we sit most people. Occasionally, if people are, you know, really um looking to optimize, they'll shoot up to even 15 or 20 occasionally. I think some of the the newer data is between 10 and 20 milligrams or sorry, grams of creatine for brain cognitive function. Um you know, generally, you know, uh the muscles are pretty greedy. They eat up most of that creatine. It's a it's a why it's important for muscle is it's a phosphate donor, and so it helps with ATP, which is the energy of the cell, if you will. Um, and so it can increase uh energy output of the muscle cell, increase the total volume of weight lifted. So that by proxy then can increase your muscle mass. Um and so that's where it first came into being, of why it got popularized, is because it did show an increase in your muscle mass, partly due to the fact that it does bring some water weight into your muscle too, so it increases that kind of pump feeling, if you will. Um, but it can increase the maximum output that you're doing in the gym, which can improve muscle mass, which can help your insulin resistance and insulin sensitivity and bone density and et cetera, et cetera. So it, you know, I think it's uh, you know, again, it's you know, we gotta have the whole house in order. Um but creatine's a good adjunct there for muscle mass and then some new interesting data about the cognitive um side of things. But but yeah, I'd say five, then I get up to 10. And then if people want to push it, I think there's really little downside to going up to 20 milligrams or 20 grams, I should say.

SPEAKER_02

And and the one question I had is kidney, kidney thing. You you you think that so if I if I've been on five for a couple years, like I have, I go to 10 and I get a little bump in my my creatinine on my blood test, yeah. That's normal. It's it's not nothing to worry about.

Supplements That Actually Help

SPEAKER_01

It's no, I I you know if there's any concern, um, you know, if creatine or creatinine, I should say, is going up with supplementing creatine, um, we'll do a systin C test. Okay. A little bit more specific testing for the for the renal function. Um, and then, you know, as long as that's in line, we don't care what the the creatine or the creatinine is. So um, yeah, and then, you know, those are the main main four, really. You know, a good there's been some evidence of a standard multivitamin for um people over 65 has been shown to improve um not really longevity, but improve some cognitive markers and functionality um uh as you age. So we'll implement that for the general public. I don't think there's a huge benefit from just a standard multivitamin, but um really low downside as well. So um pretty low-hanging fruit to consider it, um, especially as we age. Uh and then there's you know, four or five kind of interesting, I would put them in this kind of weak data, but interesting category. Um and uh, you know, those are you know, one of four here. So NAD um is interesting, it's got some good data, some meh data, mostly animal. Um yeah, so there's different ways to supplement that. So NAD is a molecule that leads into NADH, which is a basically an energy carrier in the in the cell. We know that NAD levels go down as you age. And by you know, supplementing that, there's been different companies that come out with different formulations that have been shown to increase your NAD levels. We just don't know if that really leads to any downstream outcomes. There's no data to say, like, hey, your NAD levels are that of an 18-year-old, you're gonna live you know X amount of years longer. Right. It's pretty limited. Um, so there's different ways you formulate that. So NAD, there's new formulations where it's liposomal, they put it into a fat molecule so it um can be digested and uptaken pretty quickly because it is a molecule that you know can translate. So you're basically taking the precursor and then it's well these liposomal formulations is actually the NAD, it's just um yeah, it's just contained in a way that it's better metabolized. Because otherwise, if you take just NAD, an oral supplement or sublingual, even it's gonna switch over into a oxidized form and not be really utilizable in the cell. So there are precursor molecules like NMN and NR. Um which have been around for a while. Yeah, exactly. Yeah. Um, you know, there's some interest, I think, more on the liposomal NAD, the NMN, NR, you know. Um again, if if the house is completely in order were, you know, 65 plus, and I'm throwing 65 out there just very vaguely, but you know, it's something we could consider adding. Um resveratrol, um, kind of a polyphenol type molecule found in berries and such, um, has some benefit for senescent cells or you know, cell turnover essentially. Um, it's very preliminary data. You know, who knows what the long-term outcome will look on it. Um, but something that we we look into and discuss with clients um generally again on the you know, 50s plus. Um, I'm not gonna recommend that to a 35-year-old per se. Uh urolithin A is an interesting one, um, has been shown to improve mitochondrial function. So we have some, you know, there's some data out there of mechanistically that this should improve mitochondrial function, um, uh help with senescent cells and cell turnover. We just don't have any actual data that it improves any outcome, um, but some interest out there in that one. Uh, and um uh spermidine is another one as well. Um, some mechanistic data that should improve mitochondrial health, uh, et cetera, but just no real data on uh true outcomes for for humans.

SPEAKER_02

It's so interesting to me how how often people are talking about mitochondrial health now, like everywhere. It's like it's like such a buzzword. Uh it just has become uh these things catch on. Yeah. And now all of a sudden that's all everyone's talking about. That's very helpful.

SPEAKER_01

Yeah.

SPEAKER_02

I can't believe our time went by so quickly. I've got I'm gonna I'm gonna throw one more in there. Yeah, yeah. So when I was in medical school, we were in anatomy, and someone had methylene blue, and there was a brain there. Yeah, and I remember being shocked when the brain was like literally dyed blue. Yeah. And so now that that's become uh a thing now, yeah. I can't imagine as a physician ever putting it in my body after seeing on a cadaver what it did. Yeah. But it like people are doing this. So where do you stand on it? For me, seeing it, I'm like, ah, anything that dyes my brain like that, I don't want to have anything to do with.

SPEAKER_01

Yeah, I um I was, you know, was and maybe am a little skeptical. I um my one experience with methylene blue was in the ICU um in residency, and they had used it in a refractory hypotension case because it was like sixth line that you could use for hypotension or low blood pressure. And they gave it to an individual who I think was taking another serotonin, selective serotonin reuptake inhibitor or like an SSRI antidepressant kind of medication. They developed serotonin syndrome for it from it and were like, you know, super rigid. Their blood temperature was like 104. Anyway, so that was like my one experience with it. I was like, why the heck will we give this to healthy people? Yeah, but there is some data out there that suggests that it, you know, may have some benefit. I'm kind of on that, like, I want to learn some more about it.

SPEAKER_02

I think I mean RFK Junior's like passing out like shot glasses of it in Air Force One, and I'm like, man, I don't know about that.

SPEAKER_01

I don't know. Yeah, I I mean I think it's uh it's one of those ones I have in like a short list of like kind of following. I think the wellness community has definitely jumped on it. You know, you get you know, pull up any IV clinic, they're probably gonna have methylene blue in there, it's popularized. Yeah, I don't know. There's a lot of interesting stuff in the wellness community too, like ozone, you know, uh adding ozone to your blood. Like they'll basically pull your blood out of you, run it through a machine, add ozone, put it back into you. I'm like, I don't know, man. I don't know. It seems a little bit out there, or like detoxifying your blood. I'm like, I'm pretty sure your kidneys do a pretty good job. You know, we put people on dialysis when it's at the worst case, but I don't think you know a healthy person just go get dialysis for fun.

SPEAKER_02

The one I heard the other day is like the microplastics, like they'll do it, they'll they'll basically do uh put you on dialysis and run it through this thing. And there I I just don't know. I I think we gotta be listening I think a good place to end is I think we stuck with kind of bread and butter today. Yeah, like really science proven, yeah. Again, major in the majors, the things that we know matter, and then and then once you get there, these are other things, but also be a little bit skeptical until there's data that shows that's why I like Peter Atia. There's a lot of people out there, but I think some of them clearly follow trends, and I think he seems to be, at least in my view, one of the ones that really tries to science back things.

SPEAKER_01

I agree, I agree. And and you know, with the advent of social media, you know, there's just so much out there. And I since opening a business to having a business account, and it's like all I get is healthcare-related stuff into that one. And I'll if I find myself on it, I'm like, oh my gosh, like what it you know.

SPEAKER_00

And what I love about your presentation today is there is so much well established, um, meaningful uh principle-based approach, uh, you know, just that going way out on the on the edges, yeah. Um at least for those who don't have a really unusual, unique s symptom or situation. Why? Yeah, yeah. Yeah, there's a lot that you're doing. You're testing for stuff that really has been proven to make a difference. And then you're providing a protocol for that for a patient. And then you're testing them again to see how is it doing. And then you're adjusting based on that. And you've got great a whole menu of stuff that we know works and that we're not doing already. So why not do that first? Yeah.

SPEAKER_01

There's very few people that come in with their house completely in line. They're like, dang, you're doing a great job. Like I no notes. Yeah. You're yeah, I don't have anything for you.

SPEAKER_02

He compared no notes to when I was with him. He was like, oh my gosh. Oh my gosh. Hey uh let's uh let's end with can you pull up his uh website here? Uh what's your URL? Uh it's peakehealthidaho.com. Peakehealthideho.com. Yeah. Um super easy to navigate by the way. Uh thanks. Got on and did it. You did a nice job. Appreciate it. Again, you're here in Meridian right off of the Eagle Road exit. Yep. Yep. Eagle and over I guess it's Overland. I should know that. I drive it every day. Yeah. Yeah. Well Eric, this has been uh this has been great. So Peak Peak Health Idaho. Uh thank you so much for coming on today. And I look forward to having you fine tune me.

SPEAKER_01

Yeah, absolutely.

SPEAKER_02

And I appreciate you sharing with the community. Anytime happy to be here. Thanks everybody. Absolutely.