131. Dr. Elizabeth Yurth: The Science of Ketones, Hormones, and Faster Recovery

Welcome to Extend 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 in board certified to 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 a interview-world-renowned expert, 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 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 Long Jeviti Institute and a Stanford-Train Sports and Spine Physician, and she has spent over 30 years burging orthopedic experience with cutting-edge longevity science. In this episode, Dr. Yurth is going to break down why most arthritis isn't caused by over use, and why N 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. 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. 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. 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 self 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 self clinics. If you try 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 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 are 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 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 slash doctor shop, and use the code doctor shop 25 for $25 credit towards your membership. Dr. Yurth, thanks so much for joining me today. Thank you for having me. Yeah, all the way from here, I'm always from Portugal. Well, I say I went from here to Buck Institute in Northern California and Buck Institute to here, so I didn't have to, I don't have 55. I know. I'm just so excited that you're here because I've been trying to get you here in the studio for such a long time. You and I have known each other for a while now, so it's an honor to be here. And I've learned so much from you. So for the listeners, we're on WhatsApp group of longevity focus doctors. Right. And I could tell you without a doubt, one of the top three smartest people in that group is Dr. Yurth, who's here with us today. And so you give me too much credit. Thank you. You 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 that I'm so glad I asked you like, I think we need to focus it 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 around pain today, right? It is so different than what I learned in medical school. Yeah. It's mind blowing, it's mind blowing. Yeah. And you know, just to know, one of the things that concerns me, it was funny because it was just at this is, it's, it's 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, 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? Right. I mean, it's a massive piece of our health span of our longevity. And our happiness. It's like, you have to be able to move. Right. No, I know it's really, you know, honestly, until you're kind of, I tore my rotator cuff about two years ago. Head 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 just didn't do well. Right. And I re-angered it and I didn't do well and so I've had this chronic shoulder pain. And you know, you think, ah, it's just a little chronic shoulder pain. But it really is so impacted part of life. It does. I mean, everything is harder. Getting interested is harder. Yeah. But you have sports bras like impossible. Right. Right. Exactly. Just putting down all these things and so you start looking at people who are dealing with this stuff, you know, in much more severe nations, lots of times and that 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. Absolutely. You know, my story is very similar. Like I was doing surgery for 20 years. Yeah. 20 years I was holding up retractors with my arms, right? Right. 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. Yeah. Exactly. I got stressed about work. But it's really so hard. 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 dev surgery, you know, I didn't have my rotator cuff repaired. Did fix it. It did fix it. Yeah. But it was, you know, it was not an easy surgery. Right. And I kept thinking to myself, like, why do we do this cause? Like, especially like my mom has boast of her knees replaced, right? 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. Right. And that intervention is usually surgical. It can be stem cells, but it's just really backwards, right? Right. Exactly. So for your listeners background, I came from background with orthopedics, right? So for, you know, 30 years practicing orthopedics and it really was, 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 sickle, you sickle, you sickle, you're right in and finally you'd go, okay, well, now we'll do a scope and now we'll replace the joint. And that was everybody fall that past. Exactly. So I started to look at, could I do something different? Could I actually work with these people early on in the interview phase and impact their recovery much better? So I started thinking, okay, I'm not going to use nutrition and hormones. And other things that would benefit them. So I went back and started learning all the stuff, right? And I tried to incorporate that into my orthopedic practice where I, you know, in my tentative point, I tried to go, hopefully, you know, I had you on the right hormones and the right nutrients and that didn't go so well. I bet you're ortho colleagues. Yeah, they didn't look like that at all. In fact, you know, at all. So so 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 think you're so long, right? So 20 years ago, but I did both. I had my orthopedic clinic because, you know, as you know, I've come into surgery world. It's a profitable world. I mean, you know, I weared and had an MRI scan. I owned a surgery center, see all these things vested. So really 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. Right. And really it was only until about six years ago that I said, okay, I got a coincide this all to one place. It's my left orthopedic practice. And but as you said, my, the big sort of pushing point was one of my orthopedic colleagues came to me because you know, you can't order labs anymore on people. We don't do medicine here. We do orthopedics. Oh my gosh. You know, we follow the same journey. So you know, 10 years ago, 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 counseling their surgery. Yeah. Everyone's like, what are you doing? You're getting them healthy. They're counseling their, they're not making any money off of this anymore. Right. It's not very, it's not, it's not, it's not profitable for my executives. Joy and replacement are well, they're very profitable to replace the joy, right? Not so profitable to throw somebody out a few hormones in the future. Exactly. Exactly. Yeah. So when you create a state of health, what happens is you avoid meeting surgeries, prescription medications, et cetera. And it's not just for your joints, it's for every organ in your body, right? Exactly. So I think the joy is forgotten in this whole case. Right. When we look at age-to-aid diseases, they all, they all have similar mechanisms, right? They all are related to sort of a chronic inflammation. They're a decline of immune function. So we lost the mitochondrial function. So the same things occurring in joints, but we forget that. So we're now kind of treating you know, someone who just says, 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 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, the ball ball started going, whatever, you know, and the same things true in, in the orthopedic world is we need to be addressing people day one of their injury. We need to be oppressed, you know, addressing people before the arthritis sets in. Yeah. As soon as they start having joint problems and sort of intervening there and not waiting till the end game. 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. What would you recommend people do instead of just like the traditional method of how we treat these injuries differently? So the first thing is our buys are actually designed to heal. We kind of, you know, orthopedic stuff injuries have always concerned, you know, this kind of wear it here. Oh, I just played too hard. I was a football player and that actually is not, if you look at the people who really developed the worst arthritis, the most sedentary people, who are not moving. It's not just a football player. So when you get these injuries, now injuries certainly compound the palm 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 I mean, why can you know, one football player go on and, you know, get an injury and then come back and play another, another football player is debilitated by it forever. Right. 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? So like you for your chronic micro tears and rotator, you're this busy surgeon, you're doing all this stuff and you look at you know, you know, what were your hormones? What you were 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 a system. He has a nagging injury because there's a reason the nagging injury is not, your body's not recovering it. It's because your body's not getting out of this inflammatory state. Right. 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 sub optimal hormones on board. Maybe you're missing vitamin D or vitamin C. You know, so those are the kind of the first things. But I think 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 we first get this injury, our body is designed to create this inflammatory response. Right. So it's all this data now that if you take an anti-inflammatory drug, when you first have an injury, that you actually marketly increase the likelihood that that injury is going to be chronic. Wow. That's crazy. Down that inflammatory spots that we want. That's what brings in all these growth factors. That's what brings in all these things. They're 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. Oh, man. That's such a big, new thought. Like everyone does that. They're made up of your injured. You pop, you try to reduce the inflammation as much as possible. As your natural, you know, it hurts. So you want to do that. Right. Please, it's the same thing. The reason we have a fever when we get sick is our body's inflammatory response. It's actually good. Unless your fever goes super high, it's actually better to treat your feet for runs. Your body's response to the illness. This isn't happens with this inflammatory state. Yeah. So the goal is try and let that inflammation. So try and treat the, the, try and reduce the symptoms using other things, using red light, using other modalities, using peptide. Right. I mean, I think like, you know, people take the ad will 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. Yeah. And the reality is the exact opposite is what we need. Right. Yeah, this whole concept, in fact, even the guy who came up that whole rice pro, like rice, rice, rice, compression elevation, right. And that's what we still all follow. Everybody's like, okay, rice, rice, rice, compression elevation. Even the guy first of all said, you know, I think I was wrong. And so now we actually advocate what's called the meat protocol. Well, what's that? So that's motion. 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 is blood? Have it has all these healing elements to it. Right. 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 know, you're not going to jump around in your spray knuckle, 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 we got motion and exercise or actually really key factors in the people who do that, who keep moving and who exercise, who don't stop exercising. Well, he all 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. So that's just increasing blood flow. It's increasing blood flow, but it's also increasing. Think about the things when we're moving our muscles. We have these myocons, right? We have these really important factors that come out of contracting the muscle. They actually have huge healing elements in them. Yes. Right. Myocons are so powerful. Myocons are so powerful, right? You know, if we could bottle myocons, you could hear a Z. So that's why exercises the number one treatment for anything, right? It's really because our muscles have so much power to create these magical forces that kill us. So we stopped doing that, right? So who exercises after you have you just spray knuckle? You don't. I could tell you I'd have to have my rotaire cuss surgery. I was in the gym the next day and I was in somewhere. There are. And you know, you know, you're in a splint and everything else, right? You're using your other army movie. 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 blocks was called glutathione, which is one of our antioxidants. So we all this debate about Tylenol, which we is true. Tylenol is not a bit drug. So I'm not a big fan of Tylenol. So what do you do is analgesic. And it's important to note that just real quick, because when you're inflamed, you're making a lot of oxidants, right? And so you need, you need your oxygen. Yeah. Any oxygen is powerful. So remember what what Tylenol does is it blocks glutathione, right? And glutathione is one of our big antioxidants systems. I mean, it's one of the time I was very potent at blocking that. That's why you can kill yourself easily with Tylenol if you take much of it. So you know, it's not the best choice. So, you know, so it's funny. Like whenever you have a procedure that a surgery, they always give you Tylenol to take before. They do. Right. And you know, and even like you're going to have an anesthesia, worst thing you can do is block glutathione. Because you know, so I recently had a deaf surgery and you know, she's like, Oh, here, take the yeast. And I'm like, what are the issues Tylenol? You know, there's Tylenol. I said, no, you know, I don't need those. Yeah. What if I don't even have pain afterwards? Well, so I didn't, you know, so why are they giving me Tylenol? You know, about 10 years ago, they came out, I think maybe more than 10 years ago, with the IV, acetaminophen as well. They were using that before every surgery, whether people needed it or not. I mean, this could not be a good thing, you know? No, remember that that detox system is amazing. You need detox from anesthesia. Exactly. And I think it's not so benign. Right. 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. Right. Right. Exactly. Yeah, that's where peptides become. And you know, peptides like DPC and thibes and beta four are so hugely beneficial. And especially you can take a little higher dose, you can take them subcutaneously, but even the oral will have some benefit there in helping with pain. The other big one that people have no idea about is exogenous ketones. Yeah. So exogenous ketones are huge here. Wow. So when you look at pain reduction with exogenous ketones, that you block was called NRP3 in flammazone, so actually stop the sort of pain as 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 high dose of exogenous ketones, you can actually significantly reduce pain in people. That's incredible. It's incredible. And it kind of on that whole realm of ketones, we just had a meeting with with New York Giants about some of our players and stuff and we're talking about us exogenous ketones because they're also super protective. So if you are taking ketones exogenous and you get hit in the head, you get injury, you likely heard of that because we had a problem as much lower. So we're a big advocate of these players should all be doing exogenous ketones before they play. Like prophylaxis. Exactly. Because they're going to get, they're going to get, they're going to get hurt. And so you can, you can actually, and plus you're going to make the core back is going to perform better because they're going to make you more mentally acute for being able to respond faster, reflexes are faster. We even talked to you and they brought, they said, well, how about the coaches? The coaches probably need them. I said, yeah, that's probably a great idea. These coaches are deep conditioned and they have to think fast and they're in a lot of stress. So they were drinking ketones during that. So what I do is in that key phase is I put people on exogenous ketones, I put them on BPC, pharmacy and data for, you know, you can very inexpensively now purchase a small red light, right? I mean, you get one for $300. Right. You know, just a small panel. Sure. Great. Because you heard your knee, you put on your shoulder, you put on your shoulder, you got to go back, you put on your back. You don't need to, you know, the massive panels that cost a lot of money. Right. You can do a lot with this small little panel. So I have people, you know, get a little red light and I would tell people just have a little red light because you're going to get hurt. Yeah. Exactly. I'm going to get a little red light. Right. So now, you know, you use exogenous ketones, you BPC times and data for it. 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, physical therapy, things to start really reactivating the joint. You know, I love, you know, for that retraining phase, you think like blood for 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 beefier blood for restriction bands and doing things like, you know, there's some really good, you know, just some really good muscle stimulus. You have to know the right muscle stimulus because they're used to get to get the right contraction muscle. So I started using some muscle stimulus and things like that very early on. Okay. Do that approach. You can heal so much faster than if I just sat around, took Advil and said, you know, I sprayed my ankle. I'm going to sit up with the weekend and then my ankle up. Yeah. Okay. So this is an incredible new paradigm in how to deal with injuries. Instead of rice, we go meat. Meat. Exactly. Which is just like a day of aspirin without, I say, meat over rice, right? Meat over rice, exactly. They're away from the carbs. So, and this is obviously not intuitive to people because we've grown up. We've grown up with it. Yeah. Right. That's a trainer still practices. Yeah. Right. Absolutely. You know, every gym's everywhere. That's all you hear. And so this is like really updating our algorithm on how we treat pain and how we treat injury based on the modern science. Yeah. So I want to do a little bit deeper dive in each one of the things you talked about if you don't mind. Yeah. 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 prophylaxis like you said. Right. So let's talk about just quickly these peptides. So you mentioned two peptides, two of my favorites. They come together in a combo called Wolverine. And it's a really great combo of TB 500 and also thymusin beta, thymusin beta 4 and 4 and BPC 1.5, sorry. And does it have TB 500 in it? Or is it does? It's 100 and TB 4. So there's a little bit of misnomer there. It's 500 is kind of a fragmentation of TB 4. It was really came out when the peptide was designed in the horse population actually for treating horses. Okay. That is in beta 4 truly. And this is kind of a widely, you know, I've been unfortunately in the peptide world so long. Thymusin beta 500 really or TB 500 was not really the real peptide. The real peptide is truly thymusin beta 4. Thymusin beta 4. But it's kind of a short issue. So it's a short issue. Thymusin beta 4 is a more complete chain. More complete chain. And how does thymusin beta 4 work? So basically it's going to actually activate collagen actin. So it's actually going to sort of start stimulating collagen actin function. Okay. It's also going to be, so it creates angiogenesis. It's why there's something to bait about it. 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. Right. Angiogenesis is a formation of blood vessels. And to heal anything. So you tore your work to your cuff. Got to get more blood flow to your area. So basically, and this 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 thymusin beta 4 works so well. You know, and again, it's kind of activated. This bridging of collagen actin. So basically it activates these factors. It's also a stem cell activator. 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 thymusin beta 4 can do that very well. Interesting. I think it's also beneficial for people getting stem cells injections to also be at thymusin beta 4 the same time. We put everybody so we do a lot of stem cell things. Everybody's followed up with BPC. That was made of 4 afterwards. So we use a combination approach at BPC. Thymusin beta 4 GHK copper post procedure because you really want to accelerate the response of that. Right. It makes the stem cell injection that much more powerful and much better. And then maybe you can tell us a little bit about BPC 157 works as well. Yes. BPC is probably everybody's favorite peptide. The 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. They're natural bodies. They're natural bodies. Exactly. Exactly. So we know that they're like we say it for, right? So thymusin beta 4 is a thymus peptide. So when we're babies with this giant gland in our shell, this thymus gland, it's huge. If you look at a baby's face, it's got this massive mass in it. And until puberty, that thymus gland is really active in doing all this stuff and it's producing these thymus peptides. Thymus alpha 1, which is really immunomodulating thymusin beta 4, which helps us to heal and grow and recover. So those are really active until puberty. And then that thymus gland starts atrophy. By the time you're old, it's nothing. So now you're not making these thymus peptides. Well, I'm doing to help you heal. It's giving you back what your body would have done when you were 13 to heal, right? When you could heal rapid, like, you've got kids, they hurt themselves in their better nowadays, right? It's amazing. They break an arm into two weeks as he healed. That's one of the reasons it's making these thymus peptides. So BPC by the same, say, most notion is a gastric peptide. Yes. 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 bed guts or if we have poor health, we just don't have as much BPC. So I'm going to give back more of it. Right. And it's the same concept of we're replacing hormones because they decline. Let's replace these things or decline. Right. 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 some injuries. Exactly. So we're going to consider justically with BPC being being, you know, and what we'll call it is, is modulating inflammation. It doesn't reduce or accelerate inflammation and modulates inflammation. So it tries to keep inflammation just perfect. For example, that's one of the things that's so beneficial about it is we don't want it as we talked about completely blunt inflammation. Right. But we'd like to modulate and not escalate out of control. Exactly. Yeah. And I think that that's what these natural biological signals do when we're young do. It doesn't overly suppress inflammation. It doesn't overly promote inflammation. It just gets it at the right level and everybody's so smart that 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. That's right. That were very active when we were younger. Exactly. And are not when we're older. Right. 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. You mentioned GH got copper peptide as well. Can you talk a little bit about that one and the mechanism of that one? 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 what at let's collagen go to 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 big, the big complication that occurs with all these injuries is scar. Yeah. That's why you get a frozen shoulder after you have an injury. You can't move it as a scar tissue. Yeah. So if we can modulate the collagen production, GHK actually works on it again as a natural peptide. Our body makes 500 different genes that modulates. So in a positive fashion, but it's main effect is in regulating collagen synthesis. So we make normal collagen, not this scarred collagen. Yes. So it becomes a really important peptide to actually add on when you're trying to heal the also post surgery, right? Absolutely. 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 acyltere or rotator cuff or something like that, then you might inject a small amount. There are all these places now that are mixing GHK copper with BPC with some made of copper. Yes. Really, you don't want to do that. Copper is actually a very volatile molecule when you start mixing with these other peptides and create some 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 with these cells. You really want to, you know, and in a perfect world, separate all of them. Got it. I know there are people who believe you can be in GHBPC and sometimes in beta-forward together. I'm not a big fan of that. Got it. I like to separate them all out. Got it. 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, bonds that you don't want. Don't want that you don't want. Right. It makes a complete sense. Yes. Well, there's these combinations go Wolverine and Glow. Right. And Glow is that combination of GHK BPC and times in beta-forward. 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. And I think the problem is, when you're mixing these things together, you create immunogenic responses. And at the same time, you make create problems. And I think that that's where, you know, maybe you're doing it a QV. 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, not create problems. Oh, God. I got it. So it's better to inject them in three separate injections. I mean, that makes you want to be pristine. You know, sure. Yes. 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 car to show. It's so nice. It's so much nicer. I know. Yeah. It's a game changer in my mind. It's easier. I know. There's a company out of Europe that's doing that. And you look at them like, it's a hassle. It's a hassle to drop your peptide. Even I like love peptides. And I'll look at them. I'm like, oh, God. It's just tedious. Yeah. You're drying up with some of them. Well, we'll take a long time to drop up and see you so that you know, they have these pens are so 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. Right. So that's great. I'll show you downstairs the next health I'm doing that. But I think you're absolutely right. I'm not a big fan of mixing peptides either. It's just people get fatigued with the logical undoubtable strategies. So the question is, is the convenience worth it? I don't know. Because I don't know that we, they think there's a fair amount of evidence that you might be creating problematic things. Right. And doing it for a long term. 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 are normal life. Especially as you age, exactly. Our levels are decreasing. And me for me talk about peptides, but one of the big things I say is, well, why are we so passionate about replacing hormones? Right. Peptides decline our bodies the same way. You know, the time that peptides are almost nil. They're gone. They're gone, right? You know, growth hormone. So using growth hormone is a credo-gocs to try and increase IGF levels because their 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. Exactly. So if we're going to replace estrogen and progesterone testosterone, shouldn't we also be replacing BPC and times enough and one and times in beta four, maybe some of the time it peptides, I mean, some of the mitochondrial peptides. Absolutely. So I think that that gets kind of forgotten. I don't know. You know, that we, 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. Right. And the more I think about our overall biology is that we reach this kind of peak in our 20s, probably, right? And even in adolescents, for the thymus gland and all these peaks occur between those ages of adolescents and are mid to late 20s. Right. And then everything's going to decline. And it's not just going to be like, I mean, you kind of realize that your decline starts much younger than we thought. Exactly. Like, people are like, oh, I'm 30 and fine. You have started your decline by then, right? Yeah. And look at these things like even the peptides, their storage of decline is significant now. Hormones are starting to climb around 30 and sometimes earlier now in our world of toxins. Yeah. You know, in microplastics and all the things that are, yeah. And so to your point, like toxins, microplastics, all these things, they accelerate the decline even more than they used to be. Exactly. 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? It's a client, right? And that's what's going to add 30 useful years to our lives. And you feel good, right? So 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, it's matter time. But for now, we have a lot on hand that 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, it was older already by the time all this stuff started happening. And if you're now 30, you should be thinking about this stuff at 30, exactly, you know, when you're quite starting. Well, I think the other big problem here is that the traditional medical establishment is not accepting of peptide, just not accepting of ketose, is not accepting of even stem cells yet. And it's, we're moving way too slow in the traditional medical establishment for the things that you and I know are already established. Like this is safe, effective. Let's use this. That's what's so hard is we're fighting this paradigm of, you know, these, these are not proven safe. We've proved, and yeah, like we have these pharmaceutical compounds that have much more issues. Yeah, like I don't know. Like I don't know. I mean, I don't know. I mean, I don't know. Should have never been approved as a drug and people are popping it, you know, and, you know, all the time. Mm-hmm. You know, so I think that that is, we have to sort of figure out how do we, you know, 17 years of the time of a drug discovery to get approval market. And we have to advance that or we'll all be dead. Absolutely. And 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. Absolutely. Absolutely. Once again, like I always say peptides are not drugs. Drugs are chemical compounds like advellantide. But peptides are natural biological signals that are in the body. You know, it makes sense. Exactly. And the size that our body are not natural to our body, but so many of them are. Yeah. Right? You know, like mitochondrial pesticides like SS31. Right. You know, so it is made by our mitochondria. Yeah. So it is a natural compound that our mitochondria make that declines. Right. So I think that my goal is always replace all these things and that's going to be your best bet. Exactly. And replace them prophylactically because they're declining anyway. And then if I get hurt, the hope is I heal better. Exactly. 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 to you already. Right. Right. This episode was also brought to you by Vita Boom. Vita Boom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood-based biomarkers. You can either send them your latest blood test or they will send you a finger stick test for blood analysis. Vita Boom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. And it's great is that they also provide all the best brands like timeline, true niogen 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 Vita Boom.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 prophylaxively? Can you take us through a little? So I'm not. Honestly, I was going to say take one thing. If you said you know was the one thing you know you could only take one sample. Yes. It would be ketones. Wow. It would be really. That's my blowing. Incredibly powerful. But all the things that ketones can do. So when you look at ketones, there's a lot out there. The ketones salts run into the problem that you actually can change. This wraps them up. Electrolite levels. Those can be problematic. Then we have ketone esters which are the most common. My favorite is called kinetic which makes a ketone that they separate it out the ketone esters. So they broke the ketone ester. So ketone esters made up of beta hydroxybutyrate and one three butane dial. And they both have kind of different effects. When you separate them out, you get this very nice rising ketones from beta hydroxybutyrate. But the one three butane dial kind of kicks in later. Oh, right. By separating them out now. So instead of just gaining like if you took a ketone ester, you would get this big bump from about 30 minutes and then we'll kind of fall back down. Okay. It would be useful. But our goal would be if we could keep ketone levels higher all the time. All the day right. Which is why a ketotic diet you're always having. Yes. Get making ketones. Got it. Always in ketosis from a ketotic diet is that you lose metabolic flexibility. Right. You actually don't get very tolerant of carbohydrates anymore. And carbohydrates have some very good usefulness to our bodies overall. Right. When you lose metabolic flexibility, you actually over time start to see disruptions in insulin, insulin resistance, and things like that. So people who are constantly in ketosis are going to have problems over time. Right. It's a good thing to do. You know, acutely if you are trying to get through something, it's fine. Absolutely. I just want to highlight that for our listeners. I use the ketosis diet on my patients in brief births. Right. You use it because to get over something like you have an autoimmune condition. Exactly. You know, you're really inflamed. It's a great way to get a ketocardia. Yeah. It's a great way to get a ketocardia. Right. Maybe you need to do a little bit of weight loss. But for the long term, I've personally seen almost, you know, maybe close to like a few dozen patients now that have really got dysregulated insulin, insulin, insulin, insulin, with ketosis for a long time. No, it's a long, tremendous adventure. It could be a problem. So our goal would be to be able to eat regular diet, where we eat high protein, lower carbs, 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 once we'd be tying dial kicks in and you know, it was, it was funny. I was just at this conference and this guy was wearing it. He had got a Nazi GM a ketone meter. Oh. A ketone meter, which I didn't even think was available, but he got it from Sweden. And yes, 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 he gets 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 then once we'd be tying dial state in and he stayed in ketosis with pretty high ketone levels for four or five hours. I mean, so if we can do that, so where are ketones doing? Well, it is really our brain's best fuel. So it's going to make your brain, you know, 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 oxyphosphorylation and you go through all these steps and you finally fit out ATP. And the problem with that is each of those steps is creating some reactive oxygen. Exactly. So you create oxygen stress. Right. So you can feed directly into ATP bypassing oxyphosphorylation. So you don't create this oxidative stress. You also, it's a, you get much more bang for your buck. So for, for molecule of oxygen, you make much more ATP using ketones. So it's a really efficient energy source. Yes. We have to think that's why it exists, right? Right. If you were a caveman and you were starving, you needed just a really efficient energy source, right? And so that's what, right, way ketones involved. So it's, it's, it's really is the best energy source both for our brain and really in general for our muscles. There's other pieces to that because lactates important for muscles and so is carbohydrates and so on between. But so think about this as your cleanest, purest energy source. So this is like giving your car the best gas. Yes. So you've got to sports car getting the best. 100 out of 10 gas. Exactly. And all the other things we just talked about for healing, they're always going to reduce this, these kind of high inflammatory states. They're markedly anti inflammatory, markedly anti inflammatory. They also again stem cell activations. So you're going to see better, much more stem cell activations and people are taking ketones regularly. You're going to see, you'll see much faster wound healing. So I take ketones all day long. Yep. I just sit down and drink. And I'm afraid. Right. Exactly. So basically, you know, they make what's called kinetic pro, which is very high dose in a few ounces. So I can drink my water with a little bit. Okay. Add it to it. So you add a couple of tablespoons to it, right? And now I'm keeping my ketone levels high all day long. 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 and do a quite high dose right before they're playing, right? If they just traveled or if they're, you know, so you can use the higher doses acutely and then lower doses kind of throughout the day. Got it. For our neurodegenerative people 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 these, this, this connect pro, actually, they made it for doctors to use because we realized we need a much higher dose ketones. Right. And we can really, you know, 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. Oh, incredible. So it's really, they're pretty incredible in terms of, you know, and just improvement 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, the, by maintaining that block flexibility, but keeping myself in the perfect energy source. And last, last, last, last of ATP is sort of the link to everything, right? Sure. So, so, and now remember now, if I'm giving ketones, my mitochondria get out of this oxidist drug state. Sure. They're not spinning out. Right. So, all these free radicals, now that mitochondria actually start to heal. So, you'll see people with horrible mitochondrial dysfunction, now that 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 reaction to reaction to oxygen species. Just think of one of the things that mitochondria are really smart. So if they're, 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 it. Sure. In response, they've made a lot of reactive oxygen. Right. They're going to, there's a point where the reactive oxygen species start to go, okay, shut off, stop making ATP. Got it. That's why you finally get horrible. So there's like a feedback back in the summary. So there's like a feedback back in the summary. Right. Rectivoxid species are high. I might have cut your, like, okay, I can't have any more reactive oxygen species. All stop making ATP. Uh-huh. And that's why we see brain fog and fatigue in people with mitochondrial dysfunction. Yeah. So basically, if we stop the reactive oxygen species, the mitochondrial can start running back up here. Ah, so interesting. Okay. So I think the mitochondria making energy from glucose, which is a really dirty way of making energy creates a lot of smoke. Right. And that smoke needs to be vented and your mitochondria, which is the engine, will just stop working when they're showing that smoke. Next ketones, bypass. So now I can make energy, stop making smoke. Right. And now my mitochondria will start to heal. So they actually start processing glucose better and, you know, and working better. So incredible. And so just practically these drinks, these ketone drinks, the company's called kinetic. And 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. Yeah. So those are ketone esters. And again, they're fine. They work. But again, you're going to put yourself into a very rapistic ketosis and very rapistic. And I'm hoping to try and maintain ketones in the blood just like you're, I would argue that you can do the same thing with your, you know, your brain injury patients and things like that without putting them on a ketotic diet. Mm-hmm. Because I can maintain ketones the same way I can with ketone diet. Yes. So, you know, I think that there, there's a place to say, you know, when you look at, not everybody does what with ketotic diet, it's just hard. Yeah. It's hard to fall. It's very, it's just very difficult to. So if I can use something now to substitute for that and get the same benefits and you can't do that with a ketone ester. Right. Right. Yeah. And now again, I think like 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 the, you know, just the little cans, they're yummy. And the, the, 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. Got it. And you was wanting to use money too. There's a lot of money. Right. You're using a much smaller concentration. Yep. I, you know, I didn't know that was available. So I'm a little scared of these in 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. 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, it's one of those stuff. You gave me one thing. Yeah. That's a hard question, right? Like, I've got a G2. It's a great thing. I'm using the great thing. I'm trying to ask out of this podcast because everyone's like, there's not one. Yeah. I was like, one thing that would give me, because you know, me, Darshan, I'm a huge mitochondria. It's a root of all. Absolutely. And so if I can preserve mitochondria, can I preserve everything else? Yes. And it's so, so, so yeah, I mean, obviously it's not going to be one thing, but if you, if you said, okay, you absolutely can one thing. Absolutely. Absolutely. That's all you can have. That would be key to us. Wow. Okay. So that's another incredible new tool in the toolbox. And let's just briefly touch on red light therapy. So you have your patients by red light panels. I think it's important to make sure you get a good quality red light panel. Yeah. Because there's a very specific wavelength that you can be at. And if you're a lot of red light panels now, they're just red lights and they're not to point right. And they're, you're not going to get a cheap red light. Right. Exactly. Exactly. If you're seeing a $80 red light panel, it's probably not, you know, probably. And then you mentioned also, obviously you want to keep moving. You want to keep promoting blood flow and BFR bands, blood flow restrictions bands. Right. And that's great. Now, like, you know, I use, you know, you've, if you use BFR bands, I do. Yeah. Like it's great because you have some of the hooked up to your phone, you know, so super easy. You look stupid in the gym, but that's okay. And mostly I do might be a far band stuff at home. Yeah. Yeah. But, you know, but so there's much simpler to use now than the old ones. I don't know. I've been in this for a long time. We used to like just rap. Was it hard to put on? And hard to put on. Yeah. So these are much simpler. They're really nice. What's the brand that you like? And I like saga. So SIGG is a good one. SIGG is a good one. I think those are probably the two best on the market. 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 hyperbare coxient therapy. I've had Scott on here. Love hyperbare. Right. I mean, Scott's the pro and I'm not going to I'm not going to match anything he has knowledge about it. But I have a barric post injury is huge. Right. No. Post dramatic brain injury post any kind of injury recovery because what is it, you know, the same thing we're actually reducing oxidative stress. We're increasing oxygen flow to the muscles and the tendon and all the places that have a hard time getting oxygen. I mean, tendon. Yeah. But there's big problems is that why they're so hard. People are hard to heal as they really aren't well oxygenate tissues and not well vascularized tissues. So you can do so much with hyperbare. Right. And the hyperbarex now kind of, you know, I think rising in our longevity world right as a tool that probably everybody should do. Yeah. Even even preventively for longevity. Yeah. And that's a really good point because all these things that we're talking about for injuries, they also work very well, preventively, preventively. And that tells you something about them. Like you're not going to take Tylenol every day preventatively. Right. And 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 preventive as well. Yeah. And then what about you, you know, you'd 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 is 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 there? Well, I think first and foremost hormones, right? Yeah. You absolutely cannot. Your muscles are not going to do well. Your tendons are not going to do all your collagen. They're not going to do well without hormones. And that's all of them for men and women. You need estrogen testosterone, progesterone. Exactly. You're just think it's very forgotten in men. And it's actually very critical to joint health. Oh, okay. When you get stiffer as you age, there's actually progesterone septus on joints. It helps to know if you'll 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 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 lotus progesterone at night. Obviously, you're using much smarter dose than a woman. Yes. You're like 5, 10 milligrams, but a little choking before they go to bed at night and it markedly helps them this. They're not waking up so stiff. That's also really prostate protective. Progesterone, it's very, very forgotten in men. Completely forgotten. Completely forgotten. And these really look 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. And so you're saying men should even do a little choking, which is a mountain. Yeah. We do like a 5, 10 milligrams choking. It helps to sleep. I mean, if you're not sleeping well, if you have anxiety, if you wake up stiff, so just probably it's like a woman, you know, probably progesterone. That's the interesting. I did not know that. It's a majorly protective to the prostate too. So, you know, so we, it's hard to measure in serum because at a level, we'll see really need more urine, metabolite testing to look at it. Like gut testing, like gut testing, like to really look at it. Men, but you can see and, you know, so in men, you'll see the alpha and beta pregnant alone levels. And those are low. You need to replace it because otherwise, people are not going to do it. And it's probably, I don't know, 30 percent of men, you'll see that in. It's not uncommon. 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 gotten two, three generations now where people do 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, there's not, there's not, right? I mean, not even cancer really. You know, I mean, you know, you look at the progesterone, estrogen receptor, positive cancers. And those people can probably benefit you after you, you know, after sort of buck the system a little bit now and watch how you're doing them. We know that, you know, and if you've ever talked, you should have Dr. Morgan Taller on your podcast. I would love to. But he's, you know, because listening to him talk about testosterone and prostate cancer, you're like, oh my god, this is just ass and I. And then we've ever thought testosterone was linked to prostate cancer. Right. So really, I don't think there's anybody who should not be on hormones. And this is so hugely beneficial to joint health. Yeah. And estrogen from men, you know, as well, as well for, for, for joint health. So I think that that kind of fits into, you know, the, sort of the top line. And I don't think you can do hormone replacement therapy correctly without your metabolites either. I think it's such a critical piece of the question. Yeah. You know, you know, long time ago, there's always some argument right in there. People were like, oh, you don't need your metabolites. I'm a big believer too. I really think your metabolites are really useful. You need to see where the estrogen is just as someone going. Yes. Right. And when you look at the testosterone metabolites into this, you know, Anderson and Dial, there's, you know, there's people who even have high levels of DHT, but they're not making Anderson and Dial. So those people are not going to get the antibiotic effects. So you need those metabolites, I think, to really refine treatment. You know, you have to do it safely to know that you're not making high levels of the bad estrogen, so can cause, you know, cancer or something. Exactly. And there's different types of estrogen that you can produce. And so, you know, 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. Yeah. So as a line, a huge fan of your metabolite testing, same. I mean, there's so much precision that we can have now without therapy that, you know, like why not? Yeah. Yeah. 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 male order and no one's even checking levels. And it's like, right, right. What's the problem? Yeah. And then I first got into the longevity world, which is now, you know, 20 plus years out. You learn a lot from the bodybuilders. It was like, you do. You learn a lot from the bodybuilders, right? That's right. They were like the people who actually got worse looking at the science of this replacement. It wasn't like, you know, it wasn't the reproductive end of the noncruid or it wasn't at all. Just it was the bodybuilders like, like, we know how to do this, you know, in a way. Yeah. 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 the case, how can I do this, hopefully, but still get the benefit. Very strong from those people. Absolutely. But you're right. It did fall into a little bit of a bad hand. And it's funny because I use in women a fair amount with osteoporosis or people with joint pain. Natural. Natural is an anabolic steroid. Mm okay. Right. If you look at nanospecies and Phantomospecies. Natural is an Phantomospecies. Natural is an Phantomospecies. The history it actually was the first treatment for osteoporosis. Wow. I didn't know that. Okay. It was 1960s. Then it actually got sort of into the bodybuilder hands because it's very animal. Right. It's 50s. You look at testosterone's one to one, animal to androgen. Like we're anrogen exal the other thing you should think about with men. Animal just muscle, muscle building. Right. So, Nandron's 15 to one, animal to androgenic. 15 to one. 15 to one. So much more animals. But it fell into kind of the bodybuilder's hands. People stopped prescribing it because now all the doctors are like, oh, okay, now I'm not doping people, right? Right. But we use a lot by cycling it. So if you have a female with osteoporosis, I can tell you I've had women improved from like a negative three. I could really bad osteoporotic score within a couple of years of cycling, Nandron alone, went to the positive states. You can't do that with any other drug. So Nandron's really actually can be really beneficial. It's great for joint pain. Oh, okay. So some of my joint pain people with chronic osteoarthritis love it. It's hard to get them off of it. And you've got to kind of cycle Nandron alone. You don't want to do it continuously. So some of it's hard to get them off 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 it's just 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 a lot in helping fracture. He's going to my little ladies who fracture something or my women with osteoporosis that are not doing, you can stabilize things, but trying really to rebuild bones, really be anabolic. Sure. It's hard. That's a really good thing for that. Absolutely. So Nandron alone, estrogen replacement therapy for women, progesterone, testosterone for men, don't overlook that as well. And then obviously stem cell injections. Yes, but remember the stem cells put into it. So many clinics now, you pop in these people or just stem cell clinics, right? You have to get the garden all ready. You have to do everything for sure. So we put everybody through a protocol before we do stem cells that really to try and optimize them. And then you're talking about your surgery about half people like, I don't think I need this anymore. We also use a drug called Pentus and Polysulfate. Let's say that again. Pentus and Polysulfate. Pentus and Polysulfate. The ROTES-PPS. So Pentus and Polysulfate is approved in Australia. It's a drug called, and it's in phase three trials here in the US. It's called Zylasol. And so Zylasol is injectable Pentus and Polysulfate. This is a polysulfate. It's been around since the 80s as a drug called Elmiron. OK. Elmiron is for bladder inflammation. It's a bladder cystic. So chronic bladder cystic. And it came out in the 80s. It was a godsend to be more suffering bladder inflammation. But it like, when you look at the mechanism of drugs, there's a lot of very cool pharmaceutical drugs out there. Sure. So if you look at what what Pentus and Polysulfate does, is it blocks inflammation, but it also blocks degradative enzymes. OK. So there's these enzymes that get accelerated in people who have osteoarthritis. OK. Something called Adam and I'm an MMP-3. Yeah. And that one. We also see acceleration of you're looking one beta, interleukin six. So Pentus actually works on all of those levels. It's because it's blocking this NLRP3 and flamazon, which is kind of the key to starting everything. But it's working on improving blood flow. It's blocking the bad side of the kinds. It's blocking. There's nothing else that blocks these degradative enzymes. Oh, OK. There it is. But it's as easy to do. And so this is like, so they brought it on Australia in 2019 and started working with this as an injectable. So orally, as homeron, 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 a stabilization of arthritis, but actually improvement in carolage. So in a year after being on this drug, we saw 30% improvement in carolage. Wow. So it's a remarkable drug. That is 30% improvement in carolage. Versus the placebo group who declined, it lost 6% of carolage. That's the way we're headed towards a place where joint replacements might be a thing of the past the other day. I think we'll, number one, we're going to get better and better at carolage 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 join 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 Pentecostal polysulfate is a progesterone oral drug. So it's great. We just have a compounding firm to turn it into an injectable drug. And we follow the guidelines. It will come to market in about two years. But 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. Incredible. And it's incredible. This is all such game changing stuff for osteoarthritis. And this podcast episode is, I think it's going to change people's lives, because there's so many people out there suffering with joint aching pains. Right. And there is so much you can do. You have to find an knowledgeable provider. And I think this promise our field, there's not a lot of people focusing, like even in all of our long-dewdy drugs group, if somebody came doing tour their miscups in their knee, you're going to say, oh, go see your orthopedic surgeon. It's a really wrong thing to do. We know that surgery for a tour of 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 R-H and we tear our meniscus, don't go scope it. It's like the worst thing you can do. Apple 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 worse in your arthritis. And in fact, in other countries, they don't let people do surgery anymore for a tour of meniscus because the results are catastrophic. They're horrible. Unfortunately, when all you have is a hammer, the old world is a nail, 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 it all possible now. Yeah. I'm going to add one more of these. When you add on your kind of preventive thing. So the other really good thing to do is hideous amegas, 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 mediated pathway. So a lot of people have heard about pro-resolving mediators. Sure. People even take them as a supplement. They're specialized pro-resolving mediators. But there's this pathway that you take baby aspirin with your amegas. They don't have to be taken at the same time. You actually accelerate this pathway to make these what are called resolvins and protectants that are these pro-resolving mediators that turn off inflammation. So by doing amegas and a low dose aspirin, this is really important after you have an injury. So about three days after an injury, low dose aspirin, and amegas turn off the inflammation and start the healing process. I do it ongoing. I take baby aspirin every night and I take my amegas every day. And you're keeping these pro-resolving mediators at a much higher level. So you're just helping this process of healing and recovery. So interesting. Yeah, and such an easy thing to do. Aspirin is maybe, and baby aspirin is pro, this aspirin mediator, porousolving mediator pathway is really cool. So just by taking a little bit of aspirin, you actually accelerate all these processes of making these amegas and turning them into these magical compounds. Another incredible tip for me. 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, we have to have you on every few months because I talk about something else because I learn so much from you every time. We are at the pinnacle of knowledge with longevity science. And I really appreciate you bringing all those tools. I appreciate you. Give me a time and be here. All right, so no more rice protocol. We're going to do the big protocol. Meet steris. You got it. And we're going to work on nothing else. Meet steris. Take some baby aspirin. Keep your hormones up. Take a few peptides, you'll be good. Exactly. I love it. I love it. The protocol from Dr. George. Where can people find you? 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.borderlonggevity.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 at Dr. Eurus. We actually have a training academy. Just kind of trained. 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&A's that are really fun. So you can go there, follow my YouTube. I try and do a lot of educational stuff. So I try and throw up new stuff in the YouTube of stuff. But the academy's kind of fun. Because we get these questions from people that are just phenomenal. So it's kind of fun. I love it. I love it. And you've been such an incredible monumental force with the Longgevity Dr. community educating all of us. So I thank you for that. I appreciate that. Thank you. Thanks, Darshan. Thank you. Thank you. Wow. 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. Longgevity 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. Sedinary 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 episode. 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. Yerth, 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 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. It 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 is always important to seek their guidance.