EPI 246: Living To 100 & Beyond With Longevity & Performance Medicine Expert Dr. Vassily Eliopoulos. Full Body Scans, Tests Your Doctor Isn't Running, & What Full Head To Toe Testing Really Looks Like

Welcome back to another episode of the Peak Performance Life Podcast. Today, I am very excited to have an expert on the line with us. His name is Dr. Vasili Eliapoulos, otherwise known as Dr. Voss. And he is a board certified physician with extensive experience in emergency medicine and longevity science. He's a graduate of Cornell University Medical College with a background in neuroscience from Trinity College. And he spent over a decade in high stakes emergency medicine before shifting his focus to proactive performance optimization. And his medical philosophy is deeply informed by his own pursuits as an elite athlete. He's actually a world master champion in bruise, in Brazilian jujitsu, a black belt, as well as a former state champion, wrestler. So he understands firsthand the demands of high level performance and the necessity of resilience. And he is the chief medical officer at longevity health, where he combines rigorous medical data with this athlete's mindset to create strategies that extend health span, optimize output and protect you against industry injury. Dr. Voss, thank you so much for joining us here today. Yeah. Thanks for having me, Talor. It's a pleasure. Yeah, absolutely, man. Really excited about this. I'm super into the biohacking longevity. I have a goal of me and my family all living to over 100 years old as a happy, healthy, thriving family. And so I love to geek out about this stuff and I'm excited to jump into it. Why don't we start with like a little bit of a background? How did you get interested into the work that you're doing today? Yeah, I think there's it was really a personal journey because I have a familial high cholesterolemia where, you know, most of the pretty much all the males on my father's side of the family, he's of Greek descent. And all those men have cholesterol that's through the roof. If I'm not aggressively treated, my cholesterol will run easily in the 400 range. Wow. And so that was identified through me actually through a middle school. Like there was a screening thing that came through my middle school. And when they got the result, they told my parents, like, this is probably a mistake, but you should have it double checked. And then we identified all the males on my dad's side of the family. Basically suffer from the same thing. So I had gotten to a point where I had exhausted all of the traditional medical approaches and recommendations. And my cholesterol still wasn't really adequately under controlled. And so I had to, I do it. I say, like, I had to leave the farm. I had to leave the farm of traditional medicine into this sort of space that a lot of traditional doctors are weary of. And I found solutions there that actually worked for me. And it was really the first time when, you know, I started feeling better. I started looking better. And, you know, ultimately in my professional journey, I got to a point where I wasn't really satisfied with my medical practice. You know, I felt like emergency medicine can be incredibly rewarding. You help a lot of people, but I felt like it was a revolving door. I was just, you know, you patch them up, you see them again. And I was like, I'm doing, I'm doing this for myself, like one thing for myself and something totally different for my patients. And that's really when I, you know, decided to make the switch. And yeah, so that's, that's really how it all started. Amazing. Amazing. Yeah. I love seeing, hearing these stories of kind of medical doctors, traditional medical doctors that then make the switch into the kind of new, more longevity, sometimes holistic kind of things. Yeah. So, and right now, tell us about you run. Is it longevity health clinic? Yeah. Yeah. Longevity health were, you know, sort of a, what we call like the family office for your health, where I think a lot of people are struggling to make sense of this space right now. And also how, you know, how do you integrate this into your life in a way that's manageable, you know, supplements, peptides, medicines, like all the things, you know, cold, like cold plunge exercise, like, you know, not all of us have all day, every day to dedicate to this. We got to like find the most sort of time efficient way to do the most high impact things. And, and that's what, that's what we do. So we bring people in, we do a head to toe sort of executive style workup. And then from that craft a plan and help, help people execute on that with like full nutritionist and, you know, physical therapy slash, you know, strength and mobility support, you know, through their journey. Amazing. Amazing. Yeah. I'm sure I want to get into what you kind of do in that full intake and some of the different tests and stuff that you do. Why don't we jump into that now? Yeah. So someone comes to you and they, you know, where do you start? Yeah, I think we have, you know, I guess my approach is that, you know, most of these executive head to toe physicals that happen, like Mayo clinics, really well known Cleveland clinic, a lot of, you know, Cornell, where I went, you know, a lot of these big university hospitals have these executive workups. And if you actually look at them, the workups are totally obsolete. I mean, completely, totally utterly. They're using testing that's literally decades old, which is kind of shocking, but that's, that's what it is. And so the, the workup that we do is all of the things that your, your, you know, listeners probably know about. We have sort of a baseline that we recommend, you know, whole body, three Tesla MRI, CCT a heart scan with AI analysis. We were, you know, we currently use clearly because they're sort of scientifically validated to be the best, you know, analytic tool for, for that modality currently. We do, you know, if there are any joint issues, this is, you know, it's different than a lot of other sort of head to toe workups. Most, most places just forget about the musculoskeletal system, but that's a huge driver of morbidity, particularly as people age, you know, pain, pain in the low back, pain in the shoulders, pain in the knees, pain in the hips and, and elsewhere, all those ankles. So if there's any sort of early sign of degeneration, we'll image that. And then all the, you know, all the lab testing, you know, 100 plus, it's probably more, it's probably really more like a thousand plus biomarkers. Yeah. Everything from gut microbiome, food sensitivity to traditional, you know, traditional medical biomarkers, liquid cancer, biopsy screening, you know, microplastics, heavy metals, et cetera, et cetera, et cetera. So it's really, it's really the most complete medical workup that I know of. And we've looked at a lot of, you know, other people in this space. And then, you know, of course, VO2 max, strength and mobility assessment, where we have a, you know, really sort of, I think, you know, best in class person who is a doctor of physical therapy, but has done strength and mobility for people for, for many decades with experience and like micro needling and cupping and all of the, you know, the alternative modalities. He, you know, he does an individual strength and mobility assessment. And then from that, we build, you know, the plan, but it's a real, you know, head to toe checkup and everybody's a little different. So for example, if, if you have, you know, I'm trying to think of some examples to make it clear, like some people have, oh, family history of autoimmune issues. Right. Or I'm suffering with post COVID symptoms. So, you know, there, there is unique and individual testing that we can, you know, tailor to your specific needs. If, if there's an issue that needs to be looked at in a particular way. So that's also part of what we do. You know, there's sort of the standard baseline testing that we recommend for pretty much everybody. And then there's the, you know, the unique situations. Yeah. Yeah. It's really interesting. A lot of the affluent people that I know that are not really into health, don't listen to health podcasts or, or really educate themselves on health. They just, they all go to the Mayo clinic or some, you know, one of these big nickers, they say, oh, Mayo clinic, that's well known. They must be the best, right? So I'm going to go to the Mayo clinic and they have this two day, two day or three day thing where they pay, you pay a ton of money. It's not cheap. And you go there and I'm thinking to myself, is this, you know, I've, I've interviewed, you know, a lot of people on this podcast who tell me a lot of the opposite things from, from what a lot of the traditional doctors at the, at the Mayo clinic would, would tell me. And so, you know, I often wonder about that. And I think obviously it depends on who you're getting as a physician, I think, and who's interpreting that data is obviously a big part of it. But yeah, I'm always interested to see that. Uh, so yeah, I don't know if you have any insights on that as well. Yeah. It's, it's hard, right? Because here's, here's how I would frame thinking around this point and other points like it. These institutions are fantastic at what they do. And what they do is they treat disease. That's what we do really well in the system. And that includes Mayo, you know, if you have a bad diagnosis, you know, run, don't walk. But if you're really looking for preventative forward thinking and, um, what I would say is, uh, you know, traditional medicine has blind spots that it's not aware of. And we can kind of get into that. But, but if you're looking for a forward thinking, holistic approach to your health, in general, this, the system and our big institutions don't do that very well. They don't teach it. I mean, most of the stuff that I do in sort of the functional, regenerative, anti-aging medicine space, I did not learn in medical school or in residency or in like a whole career working in the hospitals. I had to leave that space to learn that stuff. Yeah. And so they just, they just don't know it. Yeah. They're not familiar with the testing because they're used to doing the testing that payers cover, you know, Medicare, Medicaid insurers. And unfortunately, like we mentioned a CCT with clearly analysis, that's been an FDA approved diagnostic modality for, I don't even know, five, six, seven years. And what is that exactly for people listening who may not be familiar with that? Yeah. So, um, yeah, great. Thanks for stopping me there. So this is a, this is a CAT scan that looks at, um, the coronary artery. So the arteries that supply blood to the heart and it goes well beyond the a lot of people might be familiar with the calcium score. Um, the CCT is a more in depth CAT scan test, which even that isn't, isn't enough because the radiologists will read that and give you a report. But if you take those images and you load it into an AI diagnostic system, and that's what clearly is heart flow is another sort of their competitors in the same space, they've been evaluated and compared to cardiac catheterization and other objective measures of, you know, plaque measuring plaque buildup in the coronary arteries and clearly based on the current literature is really the best one. Um, but what the clearly bot does is it looks at those images and it will tell you in a quantitative fashion and qualitatively exactly how much plaque is in your coronary arteries, both soft, hard and necrotic plaque. It will show you where that plaque is and you can track that plaque reliably over time. So there's a, there's a dogma in traditional medicine that once plaques there, it's there. I can tell you from clinical experience, that's not true. You can, you can eliminate plaque after it's built up. It's, it's not easy to do, but it can be done. And you can track that on these scans. Um, so yeah, so that's what, you know, CCT is the CAT scan. A clearly analysis is, is another test where you take that result and load it into clearly system and get their analysis with the detailed plaque assessment. That's really good. Yeah. Really good info there. And I know we had a cardiologist on one episode and he said that he actually goes with a mobile ultrasound. And it's the same thing, right? Because you get a traditional, you're, you're once a year, you know, doctor, blood test or whatever your, your traditional blood tests. And they just show you total cholesterol, HDL, LDL, right? They're not even looking at APOB. Forget about doing any kind of scan to actually see if there's anything there. Because like you said, you might have, you know, a super high cholesterol due to some genetic reason, but if your arteries and everything are looking great, you may not need to go on a statin, right? Absolutely. Yeah. And, and a statin, I would argue is sort of the knee jerk reaction. And it's one of many different options. And the testing exists to really identify, like even, even, even, even, even if you're just looking at a traditional cholesterol panel, not looking, if you're doing what regular doctors do and they just get a cholesterol panel and the LDL is high and they tell you, you should go on a statin. The reality is there is a whole host of medications and lifestyle interventions and supplements that can modify those numbers. And there's a deeper, deeper level of cholesterol metabolic testing that can be done that makes it very clear and will tell you, Hey, you know what, this person's way more likely to respond to azetamide or benpedoic acid or rapathoh or like any of the other number of cholesterol medication options. Any doctor can order these tests, but they're not used to doing it. Most of them don't even know they exist. They don't know how to interpret them and then how to, you know, prescribe off of that. And so I think there's this, you know, people are leery of going on statins. And in my opinion on that is the statin itself is a good drug for the people who really need it. And the problem is most doctors are just, frankly, being lazy. And not doing the additional testing or the deeper dive that needs to be done to tell somebody whether it's really the actual right thing for them. And so people are then naturally, intuitively sensing this, even though they don't understand, they may not even know like that there's these other things that could be done, but they're feeling it. And they're like, wait, you're just, you're just telling me to go on this drug. And I've, you know, I've read about these side effects. And, and so, you know, I think it would do, it would be way better for the system. If they were a little more proactive in adopting this testing. And, and, and then they would be able to interpret and know how to prescribe and recommend it based off of that. But anyway, sort of got deeper in the weeds than the, you know, the question. But yeah, it sort of naturally flows. And that question often comes up about statins after we have this conversation. Yeah, absolutely. I'm actually curious, just as a side note here as well, how did you kind of get your hypo cholesterol, can't even pronounce the word, the high cholesterol that you genetically had. And I know also, like, for example, myself, when I started eating lower carb and replacing some of those carbs with healthier fats, you can oftentimes see an increase in your standard cholesterol numbers there. Doesn't mean I necessarily need to go on a statin. I haven't personally done this scan, I would like to. But yeah, and I think my numbers are a little better now. But curious for people who maybe have gone on more of a lower carb diet or someone who has a genetic situation like yourself. What are some things that you've done maybe to get it in check? Well, that was a big one, actually, because at the time, because this is now we're talking, you know, 20, 15, 20 years ago. And it was fat was the enemy. And, you know, I was rigorous about my diet. Eight, no, and it didn't matter. And in fact, often my cholesterol got worse. Well, because guess what? I'm eating more carbs. Yeah. And when when I started approaching this from, you know, sort of at that point in time, you know, I had a colleague who I trained with who she had suffered from lupus. And then sort of had the same journey for herself, but did it before me. And so I saw out her advice when I was like, I don't know who to trust in this space. I know I know Chris is good. So I went to her and she's really traditional, functional medicine, like diet. You know, food is medicine from that school. And she helped me with that. And that when I started and it wasn't my cholesterol numbers at that point because it like genetically, I basically, I need medication. And so almost no matter what I do, even though my numbers got better, they were nowhere near good enough. And yeah, so but it was that shift into, you know, fat's not the enemy. Healthy, healthy fat. Your brain needs it. Your body needs it. You know, the problem is really processed food and the simple carbohydrates. Yeah. And I when I made that shift, I immediately felt better. Like my caught like, I wouldn't say that I had a cognitive problem, but I noticed that I got sharper. Once I made that switch and my inflammation numbers look better. My cholesterol numbers looked a little bit better. But, you know, I need I need. I need I need prescription medication. And so I'm on a statin, I'm on a Zetamide and I'm on Rapatha. And I need all of those to really keep it in an ideal place. But before that shift. Yeah, it was like everything was topsy turvy. Yeah. Yeah. Interesting stuff. So going back to kind of the the full body scans and those kind of things that you do as well. Yeah. So let's actually touch on that one real quick. Full body scans. I know there's a lot of places that are popping up these days where people are doing full body scans. What is your opinion on them? Are there different ones that you do different than what other people are typically doing? What should people look for if they're if they're thinking about getting a full body scan? Yeah. Yeah. Great question. I think here's what you're going to a lot of people go to the regular doctor and they ask like, Hey, what's up with this? Pranovo, whole body MRI. And this is what I would this is how I was trained. This is how these doctors are trained. And and I'll give you a little context. What they're going to tell you is, man, you're going to find a bunch of fastenomas like little things that don't really mean anything. Like we all like listen, our bodies are all different. And some of us have a system in the liver and some in the spleen and some in the pancreas and, you know, that's normal. It's just going to make you worry and it's going to make you have to do follow up studies and it's not worth it. Um, that opinion in in my opinion is jaded based on the fact that traditional doctors don't want to order the scan because they know insurance isn't going to cover it. So what it's going to do, it's on it's going to unleash a torrent of paperwork that they're going to have to go back and forth with the insurer about for weeks. That's going to tie up their time, their staff's time. They don't want to deal with it. And then even if that gets approved, then they're going to have to fight for the follow up scans if any are needed. And so, um, that's the like, that's what a lot of people get from their doctors. Then it confuses them because they don't understand the the school of thought that is sort of, I think, coming into the forefront now is listen, cancer is one of the big, you know, it's one of the big problems in Western society. Um, there are others above it, but it's it's a big one. And cancer when found early is relatively easy to deal with in most scenarios. So why wouldn't you like you're going to find out one way or another? Right. You're going to find out one way or another. And hopefully it's not too late when you find out. It's way better to find out earlier. And this is where layering of diagnostics, there's no one, we don't have one cancer test that can cover you for all cancers, right? Like an appropriate cancer screening regimen for any individual will be based on their age, their family history, so their personal risk. And and then, um, you know, what their sort of personal preference for proactivity is, because, you know, I typically recommend for 50 year olds and above, you know, annual screening with whole body MRI, liquid cancer, biopsy screening, you know, skin, at least once a year skin check, um, you know, make sure the colon, over 50 colonoscopy, you know, colon cancer screening is important. So you can't do a whole body MRI and not get your colonoscopy. And if you're a woman, you can't do a whole body MRI and not do your, your paps and your, you know, your mammograms, et cetera. So I think that's an important point is the whole body MRI doesn't replace everything else. But what it does is it gives you a look at many organs that we don't have another screening test for, um, kidney, liver, pancreas, spleen, you know, you're, there's many, you know, musculoskeletal tumors, bone tumors. Um, so whole body MRI can be an effective, you know, screening tool if used appropriately. And I have 30 year old, you know, um, you know, clients, members, patients who, you know, I'm like, you know, maybe every once every five, every three to five, depending. And they're of the mind and the financial, you know, have the financial support to say, well, like, why, why wouldn't I do it every year? I'm like, well, if you want to do it every year, absolutely. Right. Like I don't know that it's necessary. And, um, I'm not going to argue with you because man, you know, it's, uh, I'm trying to like thread the needle for, you know, what's reasonable financially from a time perspective, you know what I mean, from all these perspectives and, you know, how many 30 year olds actually get diagnosed with like your risk is way lower, you know what I mean? But, um, yeah. So whole body MRI is in my opinion, a very useful tool when used with everything else. And then more specifically to answer your question, you know, ideally you want a three Tesla. So some of the older MRI machines are one and a half Tesla. This is the strength of the magnet because it's a magnetic residence imaging. So they're using a magnet to polarize the, you know, the, basically the water in your body and, um, the stronger the magnet, um, for this type of testing, uh, the better imaging quality you get. And not all whole body MRIs are the same. So a lot of places are selling a whole body MRI and they're doing, you know, chest, abdomen, pelvis, they're doing like basically your torso area, but they're not doing the brain and neck and they're not doing, you know, extra, you know, the extremities. Um, some places do a whole body MRI and it's from the head down. Some places do a whole body MRI and there are specific ways to image the biliary tract, meaning like the, the ducts that come out of the liver and the pancreas and go into the intestine. So there's, there's a sort of a number of different ways to do it. Not, and the only reason I'm bringing this up is not every whole body MRI is the same thing. And so if you, this is where having somebody who understands this to help guide you can be really beneficial because, you know, if your family history is such that, yeah, you really want to image that biliary tract closely, um, you want to make sure that your whole body MRI actually incorporates that into this, into the scan that it's doing. And the same with maybe you really don't need head and neck every year, right? Um, or, um, some places are just doing chest. Right. Um, so just know that there is nuance to what people call, you know, whole body MRI, there's, there's some nuance there. Yeah. Yeah. That's really good to know. I do have to admit in the beginning I was a little, you know, afraid of like, oh, everyone's going to, you know, everyone's going to find something and all that kind of stuff. But a, one doctor gave me a good piece of advice. I thought, which is he's like, look, at least do it once and get your baseline so that you can see in the future. Right. And it's interesting because I actually know someone who did a full body scan and actually the doctor who reviewed it or whatever, they said, yeah, everything's fine, no problem, whatever. And then I think three, four years later, they did it again. And then it was like, oh, there is something, something in your brain, something, uh, you know, I don't know if it's like an aneurysm or a tumor or something. I don't know exactly what it was, but it was like, oh, it's in your brain. And, you know, and then, then, then she had to have followups with specialists and they're like, yeah, to be on the safe side, you should probably get brain surgery basically and take it out and all this kind of stuff. And then, and then it's like, well, was it there on the first scan that we did? And when they go back and it's like, yeah, it was there. Did it grow at all? No, it hasn't grown in three, four years. So now, I mean, look, it's a very confusing situation and they don't really know what to do, but it's, if she didn't, you know, if they didn't have that first scan, then, then you wouldn't even know when you did that, when you did this followup one, if something, so there's a lot of nuances there, but I think it is interesting to get that baseline so that you can see, is this actually growing or is it staying the same for five, 10 years? And is it some, or is it growing as something I need to really, really jump on? Yeah. Yeah, it's a great point. And I think this, this also just sort of sheds a light on, you know, traditional medicine, what it does. I think just people need to reframe their thinking around traditional medicine. We call it healthcare. You know, now your listenership is familiar with, you know, the sick care model, but you know, health, health is what happens to you up until the point that you need the healthcare system. And healthcare is what happens to you after that to take care of the problem. And that's what healthcare is good at. But this is another, like screening a proactive, this is really in my mind, you know, in the future, it will probably have two different systems, meaning once you have disease or a problem, the reactive care, which is necessary and important, and then a proactive system, which is a totally different sort of training and testing system. Cause this, you know, this same philosophy is important for your metabolic markers, like especially your hormones. Yeah. Tell me more about hormones. Yeah. Yeah. Well, you know, and particularly for women, I mean, men are a little bit simpler from a, you know, physiologically, biologically there, but even still, I mean, I would love to have known like, man, even just my total testosterone, like what was it, you know, in my late teens, what was it in, in my twenties, what was it in my thirties, even if, even just having a few snapshots, um, and particularly for women at different points in their cycle, I mean, you know, because your estrogen, you know, when perimenopause happens, um, man, it would be so nice to just know, man, when you're in your prime, your peak, even when you're in your twenties, like what did your cycle look like on, you know, data wise, what were your, what were the estrogen levels, what were the progesterone levels, what were the, you know, free and total testosterone's because then, you know, and it's not that, oh, it's right to, to, to like do therapy back to that because you're physiologically a different person, but it's just like having that context is so, so, so helpful, um, in the few people where it, you like, you even happen to have, oh man, they actually did check my testosterone for whatever reason back when I was 32, it's just so useful to see that. So another thing to think about, you know, it's worthwhile getting a good panel, you know, once a decade, even if everything's going great. Yeah. Yeah. And it's a good point that you made as well. I think women at different times of the month could have very different panels. And that's totally, and that's totally normal and expected. And then when things start, you know, when we hit Andrew pause and menopause, which everybody's going to hit, um, you have a bit of a roadmap, um, which really nobody has at this point because medicine doesn't do proactive testing. Yeah. Yeah. That makes a lot of sense. Yeah. If someone is, if someone in their twenties was never higher than a 800 testosterone, at least they know that when they're in their 50s, 60s, they're not trying to hit a thousand 1100. They don't care. They don't care if I get back to seven, 800, I'm, I'm back to where I was. Yeah. Yeah. Yeah. Yeah. That's interesting. What other tests do you think are really important that not a lot of other people are doing? Yeah. Good question. I think it depends on how old you are. I think, um, you know, up until your, really your thirties, you know, getting like a great place in really the most currently the most financially, um, economical place to get a panel like that is really through function health because that you can get the panel that they're doing for, I think it's like $500, which, you know, for a lot of people, it's still, it's a significant chunk of money, but the lab, the number of labs and the breadth that you get, you're not going to get it cheaper anywhere else. Um, and I, and I think, you know, I don't know, they're, they either have a great deal with their lab, whoever's doing their labs or, or they're subsidizing a bit to try to drive membership. I don't know. But either way, like, you know, if you're young, healthy 2030, that's probably the right place to start. When you, when you start getting older, when things, you know, start to maybe, you know, not work quite as well as they used to, um, you can take it as on an as needed basis, meaning, you know, gut microbiome is a thing that a lot of people struggle with. There, there aren't actually many people who are really good at helping you interpret and deal with the results. So, you know, that's just, you know, eyes open when you go into that, you want to find somebody who has experience like looking at that because my, my perfect microbiome could be totally different than your perfect microbiome. And that's, that's, it's like a unique fingerprint. And so, um, you know, that's another one that, you know, as I'm saying it, maybe that's a worthwhile one to do in your 20s, just to see like, what is my, what is my healthy, great microbiome look like when my guts functioning, you know, really, really well. Um, then food sensitivities is another good one. The problem there is that most labs just do an IgG test and they, they, you know, you're going to, like a lot of people will just ping positive for a million things. What you want to do is you want a lab that will go that next step, which is not just see if you're making an IgG antibody, but see which of those IgG antibodies is actually triggering inflammation because it's, it's a, it's sort of, it's, it's a, it's a next level of testing, which can really narrow down. Okay. What foods do I really need to be careful with? And what foods are just am I eating? Because a lot of people, if they have any leaky gut and guess what? In the United States, almost everybody has some leaky gut. Um, and some people worse than others, we're all generating IgG antibodies to food that we eat. And the question is, you know, do I really need to eliminate all these things? And if you're just doing an IgG test, you're not, you're not getting that information. You need to go that next level deeper. So KBMO is a lab that does that. There, there are some other labs that do that. Um, trying to think, you know, I think the most impactful testing, um, addresses the biggest problems and the biggest problems that we have are, are cardiovascular disease. You know, you know, and, and so the, the testing that we started off talking about CCT, a heart scan with clearly analysis, you know, cholesterol metabolism testing, apoliparotens and inflammatory testing, those are probably some of the highest yield because that's what most of us are going to suffer from later in life. Yeah. Yeah. And you mentioned some people who had maybe plaque in their arteries, we're able to reverse that. How were they able to reverse that? It was it a, was it through diet lifestyle? Yeah. There's, there's a lot of different ways. So, um, you know, Esselstyn Ornish have a protocol. So those are two of the doctors. If you ever watch Forks Over Knives, the documentary, which is really promoting sort of a vegan diet, there's two doctors that they look at there, um, who are sort of pioneers in the nutrition space. And they have a, they have a 12 week protocol, which is dietary. It's free. You can, you know, look it up online, ask chat, you'll give you all the, you know, the details, but basically that protocol, what it does is it, it goes on a very strict no fat diet. Because what it's doing is it's, it's starving your body for fat. Because what is soft plaque? Soft plaque is just fat that's built up in the arteries. Now this isn't something you want to do your round. This is, this is a very strict short term thing, but by starving your body for fat, your body is going to start scrounging for fat everywhere it can, including your plaque. And that's one of the ways that you can get pretty significant soft plaque regression by just basically forcing your body to scavenge the plaque for the fat that it needs for its metabolic purposes. And again, it's not healthy to do over the long term, but for an eight, 10, 12 week intensive protocol, depending on, you know, what you're trying to do that, like, that can be very effective at resorbing plaque. Yeah. Um, I, I V phosphatidylcholine infusions. So a plaque X infusion. So it's sort of the brand name or the trade name. Um, that, now those studies are done in animals, but I, you know, regular IV phosphatidylcholine infusions in animal studies have been shown pretty clearly to help resolve plaque. Another thing that can do that, believe it or not is rapatha, which is the P like, or the PCSK nine inhibitors. Is that one of the pathos? One of those PCSK nine inhibitors? Yeah. And is that, that's different than a statin, right? Cause I had a friend. Yeah. I have a friend who said, Oh yeah, I don't do statin. I take the PCSK nine inhibitor, which I think is just an injection every once in a while. Yeah. Yeah. It's it, a lot of people call it a peptide. It's actually, it's a monoclonal antibody. So it is a protein, but, um, you know, and all like peptides are proteins, but it's a specific type of protein. It's an antibody and it's an antibody that interrupts, um, you know, the way the liver metabolizes, um, you know, the, the LDL receptors, and it allows your body to just suck more LDL out of the bloodstream and process it out of the system. So, um, yeah, that whole class of medication, that's, that's what it does. It's a twice monthly or once monthly injection, depending on the dose. And, um, you know, it's, it's got a very, it's got a very good side effect profile, meaning every medication is going to have side effects. Some people, you know, like, some people could have a life threatening anaphylactic reaction to something that 99% of the other people do fine with. So you have to know, like, there's no drug that's perfect, but, um, yeah, it's a highly effective medication with a very good side effect profile. And a lot of people love it because it's so effective. And in the studies that, that they've done, you know, almost half the people who don't change anything else, but just, you know, they're supposed to be watching their diet. So assuming they're, they're doing the right things with their diet by just adding rapathia, half the people start reserving plaque. Wow. Yeah. So, and, and that's not, I mean, that's, you know, that's scientifically validated. These are the, like the large placebo controlled studies that are done looking, looking at these drugs. Sounds more effective than a statin, uh, with, with potentially less side effects. Right. I wonder why more people aren't talking about this over statins. It's because they're still on patent. So up until very recently, you know, a month's worth could cost you over a thousand dollars. They've been, they've got about, they've been around now, they're, they're not new. They've been around for almost a decade. They've been around for like six, seven years. I can't remember exactly. We could look up the date, but it's, we're, we're in a few, like, we're going to hit a decade soon and prices are starting to come down and insurers are starting to cover it. So if you have, you know, insurance like through work and, um, you know, you have high cholesterol, it's getting easier to actually act. So I have a lot of members in my practice now who like their insurance is covering it for 50 or $75 copay a month. They're, they're able to get it covered. So, um, you know, it's, it's really the, it was, it was a price hurdle. So it's a patent. The company had a patent on it. The patent only lasts for, is it 10 years? It depends. If they do all, like if they do everything they can to preserve the patent and file all the extensions, et cetera, which pretty much everybody is going to do, it's almost 20. It's, if I'm remembering correctly, it's almost 20 years on patent. Got it. And then when it comes off a patent, then everyone can just do generic versions and the price goes way down, but until then they, they're kind of controlling the price here, but insurance companies are starting to realize it's so effective that even at the higher price, it's probably worth. We're going to save, we're going to save on the cardiac catheterizations, which are like one of the biggest, you know, expenses probably that, that they're, you know, so it's, it's really, it's nice to see that they're maybe, maybe they're forward looking or maybe they're just getting a better deal and negotiating. I don't know, but yeah, I mean, that's, you know, that's, that's sort of why they haven't been in the public consciousness and they're, they're, they're going to, like they will, I don't want to say replace statins, but in my experience, both as a patient using it and as a doctor prescribing it, they work way better than stanz, way, way better. Yeah. Yeah. I want to get into a little bit here as well, how, how you eat and your philosophy on food, nutrition, maybe some exercise stuff. Uh, and I know, cause you know, we mentioned, you just mentioned like, Oh, for people who maybe have cardiovascular problems, we do the, they do the vegan diet. Now that's going to be usually a lot higher carb if you're pulling out the fats, right? So maybe you get less cholesterol, maybe comes down, maybe inflammation goes up. If you're not doing it the right way, you know, I've had some people argue that inflammation is really the problem with heart disease more than the cholesterol, right? So you start getting into that battle. I know personally, uh, I'm very concerned about brain health and I don't want to have, you know, dementia like my father currently has. And so, you know, there are some healthy fats that seem to be for me going on a low carb, kind of like, you know, I would say moderate to high protein, moderate to high, I guess moderate fat or so, whatever it is, um, with healthy fats is kind of what I find works well for me. My inflammation is very low. I feel great. I used to have tons of pain and inflammation in my body about 15 years ago, when I was much higher carb and, and, and didn't follow this type of thing. But that may also raise my cholesterol being on this diet, right? So there's all these things that trying to do this balancing act. Yeah. You're, you're, you're doing, you're threading the needle the same way everybody else is. And so here's, here's my perspective, which is there really shouldn't be any confusion around nutrition because the information, the literature, the diagnostic testing, the genetic testing, it's very easy to look at, you know, a metabolic panel, like the one I mentioned earlier that you get through function health or a practice like mine or, um, you, you know, that metabolic panel plus your family history can give most people what they need to know how aggressive they need to be about a particular sec section or sector. Like is it, is it cholesterol in life of proteins? Is it inflammation? Is it blood sugar? Is it antibody production? So there's a, there's sort of like a couple of different ways to chunk up or categorize all the biomarkers. But what, what I would say is that, um, if you have the ability to do the testing, the genetic testing, the food sensitivity, the gut microbiome, the, the imaging we talked about earlier, somebody like me can tell you very specifically exactly what your ideal diet is. And the ideal diet for one person could be very different than the ideal diet for another, which is what makes it hard. And so I think the best, um, the best single resource that I, you know, the person I look up to on nutrition is Walter Longo. Now he's more of a proponent of a plant based. Yeah. We had him on the podcast actually not too long ago. Yeah. Yeah. He, he's brilliant. But what he'll say is, you know, eat at the table of your ancestors. I don't know if he, you know, said that, you know, to you, but, you know, he, I think that's like, that's a great place to start. Is look at what, what your family did two or three generations back is probably, you know, the right sort of nutrition plan for you. But then brought in like getting more, more like detailed, I think, um, the problem we have is that our system and is saturated with processed foods, particularly carbohydrates. And most people are eating way too many simple processed carbs. Yep. And if people, if, if, if, if people spent less time worrying about, you know, red meat and fat and more time worrying about carbohydrates and, and processed foods, we'd be better off as a culture, as a society in general. The problem comes that a lot of people will go keto or close, you know, like go really low carb and it's a little bit of like licensed to eat a lot of like bacon and red meat and it tastes good and I like it, you know, but if you're not managing your biomarker, you can do that if your cardiovascular biomarkers are managed. This is the key that a lot of people skip because you can shift to that, you know, low carb, you know, higher fat, good tasting things. And that, you know, that so, so the keto, you know, that there's, there's the, there's a study where they actually looked at people who went keto and, and looked at, you know, it's the keto, you know, CCT a study where they actually looked using CCT and clearly at what, you know, what was plaque formation in these people. And if you're not managing your biomarkers, the plaque buildup can be terrible. And in fact, they in that particular study, the results showed that if you go pure keto and you're not careful in, you know, with, with the high risk cardiovascular foods, you, you are likely laying down plaque at the level of a type two diabetic at a similar rate, which is shocking because people feel good. Their triglycerides drop. They, you know, they get muscle definition. They're, they have mental clarity. And so by all outward measures, it looks and feels healthy. But when you actually, if you're not, you have to manage the, you have to manage your cardiovascular risk. So that's the one sort of thing I would say you have, we have to be careful of with the higher protein, you know, meet fat, you know, fat, fat, heavier diet, make sure you're managing your cardiovascular risk. Because if you don't, you're going to pay for it later. Yeah. Yeah. I think the dirt, I guess what a lot of people call dirty keto where people are eating just like tons of bacon and cheese and stuff like that. Yeah. That that that'll probably definitely do, you know, not be real good for you. I think like for me, I, you know, I eat red meat maybe a couple times a week. Typically I'll have salmon or some sort of fish a couple of times a week, maybe chicken a couple of times a week. And then eggs I eat every day love eggs. So that's a, you know, I, you could argue that's a high fat, but also kind of high protein. Yeah. Low carb, you know, food, I feel amazing on it. Right. I've been, I am aware of like trying to supplement with some more fiber, uh, since I may not be getting enough fiber if I'm very low carb in many cases. So, um, yeah, it's a never ending balancing act. No. Yeah. I like what you're saying. I like, I mean, I, I, like I eat eggs. I love eggs. Um, I like red meat. Um, the longevity, I mean, the longevity data is pretty clear that when we eat red meat, we're activating M tour. And that is not good for longevity when done on a regular basis. So that said, does it mean you can't eat red meat? No, of course you can eat red meat. Um, you just have to, so the way I would think about it is you want to balance that with something that's going to shut M tour off. And so for me, what I do with my, you know, with my patients is typically, you know, my patients are fasting at least twice a year, meaning three day either fasting, mimicking diet or water, water only diet anywhere between three and five days, depending on what they're, you know, how experienced, the faster there are, that's going to shut down M tour. It's going to drop your IGF one. It's very good for longevity. Um, two a year is probably enough for most people. And so the final thing I'll say on nutrition is what's the point of all this anyway is because we want to live a life that we enjoy. Yeah. And, and nutrition for many of us is just part of enjoying life. And so your, your plan has to allow space for you to not feel like, you know, any sort of plan that feels really restrictive is not good for your longterm health. Yeah. Yeah. You could think of that. One is the red meat one is an interesting one. We've heard, we've heard a lot of different opinions about it. Some people say, Hey, red meat is actually the most nutrient dense food. I'm also suspicious of, uh, I'm also suspicious of like when, when they do these, uh, let's say tests or studies on people that eat meat, are they doing, you know, are these people going and getting a happy meal from McDonald's where they're eating bread and french fries and soda with the meat with this low quality meat, or are they eating, you know, grass fed beef with avocado and lettuce, uh, you know, and are those being factored into the equation? I'm not sure that I've ever seen a study where they're like, yeah, we're studying people who ate meat, but also we're low carb, ate lots of vegetables, ate super healthy. I don't know that they've done a study on that specifically. So there's definitely a lot of nuance. Yeah. I think, you know, so I, I guess, you know, I'll revert back to, you know, my baseline, which is like I eat red meat. I think it's fine to eat red meat. If you're eating red meat every day, you might want to rethink that. Yeah. Um, and so yeah, I don't think cutting red meat out unless it's really cause listen, a lot of people love a good steak or a good burger every once in a while and you should, what, you know, the point of doing all the stuff is so you can enjoy yourself. Yeah. And if that's part of the joie de vivre, like go for it, but I wouldn't do it every day. Good, good, good insights. That's fair. Yeah. Definitely. Dr. Voss, this has been awesome. Where can people follow you? Find you, learn more. Uh, I know you have this concierge program. Uh, it's not, it's not a low cost thing for people who, who are just looking at who only have a few hundred bucks to spend. This is more of a real concierge. You're going deep. You're doing things that practically no one, no one that I know of is doing this kind of full intensive stuff that you're doing, but we'd love to hear a little bit more about where people can, can get in touch with you. Yeah. Thank you. Yeah. The, uh, the clinic website is longevity health.clinic and really the best place is, you know, Instagram at doctor, you know, at Vasili, Dr. Vasili. So it's at Dr. Vasili and, um, you know, follow me there and put out a lot of, I try to put out information that's useful for everybody to talk a lot about. I mean, everything we've talked about is stuff that you could go through my Instagram and get a ton of valuable information around all that, all these topics. Amazing. So at Dr. Vasili on Instagram and then it's longevity health.clinic. Not.com longevity health.clinic as a website. Dr. Vas, this has been amazing. Really enjoyed the conversation. I hope we can do it again sometime. Yeah, we'd love to. Thanks to her. Appreciate it. Thank you. 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