150. Dr. Terry Grossman: Plasma Exchange, Detoxification, and the Future of Longevity Medicine

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 at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system no longer focused on disease management but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and most importantly, extend your health span. Over time, your body is accumulating more than just years, is also accumulating toxins, microplastics, inflammatory proteins, and biological signals that quietly accelerate aging long before symptoms appear. In this episode of Extend, I'm going to sit down with Dr. Terry Grossman. He's a physician and a pioneer in longevity medicine with more than 25 years of clinical experience. He's the founder of the Grossman Wellness Center in Denver, and he and I have had the pleasure of working together on many patients over the years. After starting as a traditional small-town physician in the 1980s, Dr. Grossman began questioning whether medicine should focus more on keeping people healthy rather than just prescribing medications once they're sick. That curiosity led him to explore lifestyle medicine, advanced diagnostics, hormone optimization, toxin testing, and ultimately led to the discovery of the use of therapeutic plasma exchange outside of hospital medicine. We break down how aging is deeply connected to inflammation, toxic burden, hormone decline, and cellular dysfunction, and why conventional medicine often ignores these root drivers. From VO2 Max and HRV as true markers of biological age to genetic testing, heavy metal storage, microplastics, and the emerging role of plasma exchange in removing inflammatory factors, this conversation challenges the way you think about detox, aging, and proactive medicine really looks like. If you've ever wondered whether aging is something to accept or something to actively measure and optimize, this episode is going to completely reframe the conversation. I'm really excited about this episode because we talk about one of my favorite therapies at Nex Health called Therapeutic Plasma Exchange. This is a therapy that's available all throughout the United States at all of our locations, and we think it's a game changer in optimizing health and promoting health span and longevity. And Dr. Grossman also agrees after his 25 years in longevity medicine. Dr. Grossman, this is a true honor to have you here. You are the original longevity doctor, and I take so much inspiration from you, and it's just such an honor that you joined me today. The same, Darshan. I've been following your work, what you're doing, to bring longevity medicine and some of the cutting edge therapies to so many people. It's phenomenal, and I am honored to be here with you. Thank you. You know, when this longevity market kind of blew up after COVID, a lot of people thought that this was something new that people are just now talking about. But you've been in this space for decades, actually, and I'm very curious about your history about when and how did you start thinking about medicine differently? And specifically, what did you train in initially, and then when did this kind of mindset shift occur? Well, my original training was as a family doctor, and I practiced in a small town in the Colorado mountains. And for 15 years, I delivered babies, I did my own serine sections, I did vasectomies and tubal ligations and time selectomies, and just general family medicine that an old-time doctor would do. I carried a black bag, made house calls, and this was back in the 80s. I did this from 80 to 95, and I really, really enjoyed it. And then at that point, I began getting very interested in kind of complementary medicine, treating patients with herbs and vitamins and lifestyle changes. So whereas before, I was just concerned about what would be the best blood pressure medicine for somebody with high blood pressure, I wondered, you know, what we could do in terms of their diet and their lifestyle and what supplements they could take to control their blood pressure more naturally. And I was really shocked as a conventionally trained doctor how many of my patients, like nine out of 10, were interested in it. I thought it was just going to be a few, but almost everybody, I thought they liked taking drugs. No, they didn't. They actually liked the natural approach. So I was in a small town in the Colorado mountains. I was doing this for about six months, and the pharmacist came over to visit me and said, you know, what are you doing? You're killing our prescription business. Wow. Because it was a small town, only three doctors, and I had a large practice, and I'm not really writing as many prescriptions. So I said, listen, I've moved towards kind of the holistic space, so I think you need to add a health food section to your vitamin store. And this is back in the 80s when people really weren't doing that. So they did that, and they were very, very happy. The same thing happened just as an anecdote. I got very interested in weight loss because small towns, a lot of people are overweight, and now it's everybody's. Yeah. A lot of places people are overweight, but I was very committed to helping people to lose weight. So we started to do, you know, keto type of diets and low carb diets and things, and people were very successful, and I got the same kind of visit from the owner of the bakery store. Oh my gosh. He says, you're putting us out of business, though. He's buying things here. So I says, listen, you got to get some low carb things in your store. So they made some keto breads and cakes and things like that, and so everybody was happy once again. So it was just an interesting journey. But my journey into anti-aging medicine began when I was 48. And the reason it began, a lot of times I think you've changed your career from surgery, plastic surgery and things like that to where you are now, longevity. Well, I changed from, you know, doing the things I was doing as a family doctor in the mountains. It was because at 48 I found that things were starting to hurt, you know, whereas before I could do anything, nothing hurt. And I didn't like the changes. I was starting to get a little bit of a belly. I just didn't like what was happening. So I began to explore what I could do in my own life to basically treat the aging process. And right at the same time, there was a, I looked at one of the throwaway medical journals and they were advertising a meeting for an outfit called the American Academy of Anti-Age Medicine, A4M. So I went to their first meeting in Las Vegas. It was held in a tent. And there were 30 doctors there. And from now they have 25,000 members. It's massive now. Yeah. Huge. And I was talking about, this was probably around 92 or so. So I went to that and I was hooked. The idea of being able to treat aging as a disease became just a fascination of mine. So I completely changed. That's what got me into the holistic medicine was really, I'm getting older. I'm having some changes. I don't like them. What can I do? So I made those changes and really I regained my health, was able to do all the things I like to do. I love to snowboard. I live in Colorado. And when you snowboard, this was back in the days you'd have to strap in. And in order to strap in, you'd bend over and you have to kind of put the strap on. Well, I was getting a little potbelly. I couldn't do it. Because I got to change this. So I followed the dietary change, never been on diet in my life. Followed some changes, cut out the sugar, cut out the carbs. All of a sudden I could bend over and strap into my snowboard and things like that. So I think a lot of us become interested in things that apply to our own health, our families. And then we extended as doctors to our patients as well. Yeah, that's exactly my journey too. So I was definitely like a really poor state of my health. I got myself better and then I couldn't help but talk to my patients about it and it killed my surgery business actually because no one needed their surgeries anymore, which is fine. At the end of the day, I think we go into this profession wanting to help people get better. And if you can do that and actually reverse a chronic disease and get them off their medications, you feel good about that, right? Well, the interesting thing is that as physicians, you and I are in a career where really what we're looking to do is put ourselves out of business. Yes. Where people don't need us. Right. But in the wellness space, actually they do need us because what we can do is counsel people on things that they can do so they don't need physicians to take care of them, where they're actually their own physicians. So that's what we're looking to do as wellness doctors. Yeah. I really agree with that. And I think what we're doing in next health year and what you're doing in your practice is you're kind of creating a parallel medical system almost, one that's focused on wellness, one that's to keep them out of the traditional sick care system because we should be using that system for what is meant to be used for, which is emergencies and really bad problems, not for your day-to-day health payments. Exactly. Right. I think that we have the knowledge now. I mean, we're learning more all the time, but I think we now know these are the things that you should eat and these are the things that you should not eat. And this is the kind of exercise that you should get. So we know more and more about how to stay healthy. And these are maybe the supplements that can be of value to most people. And we can do tests now to find out which specific supplements are of value. Maybe this one needs zinc, maybe this one needs copper, whatever it is. All of us need, have deficiency. They've done some interesting studies and 90% of Americans, and we're probably as nutritionally taken care of as anybody in the world, nine out of 10 of us are deficient in one major vitamin or mineral. So all of us need something. Right. I completely agree with you. And I think that there's a lot of backlash against the supplement industry right now, especially because of problems with quality, people selling a lot of almost everyone is selling supplements now, right? And then also, you know, these massive studies that have come out showing that, oh, you know, taking a multivitamin really did not affect rates of cardiovascular events, for example. And they're taking those studies to mean that maybe multivitamins are ineffective. And I'm wondering how you talk to people about that. Well, it's, it's, it's funny because you can take studies and data to come up with a result to say whatever you want. Right. And the studies that denigrate vitamins and supplements, they're designed to fail. They're designed to prove that these things don't work. But when you start to weed, you know, get rid of the bad studies and really start to look, there are a lot of studies out there that show that vitamin D is very good. It's not just good for preventing rickets, which is what we used to think. Right. I mean, it's a great immune support, things like that. The use of calcium. I mean, certain people really need to take that mineral to prevent osteoporosis, men on the other hand, maybe shouldn't be taking it. So we really need to kind of look at things. There are many studies that show that taking a multiple vitamin can be a value in keeping you out of the hospital and disease. There are other studies that say, well, they don't do anything, but they were kind of designed to prove that. So it's really, I think a lot of studies are done with a view towards, let's prove what we want to prove. Yeah. I completely agree with you. And I think that, you know, my contention also is like, look, whether or not taking this vitamin D prevents me from having a heart attack, I know that it's definitely helping me to get sick less, you know, definitely helping me to keep my weight off, keep muscle mass up. There's a lot of other side benefits. And whether or not like this big study shows I'm going to prevent a heart attack or not, it's not addressing the full picture and the spectrum of what this nutrient is doing for us. And a lot of those studies, they're not long enough to prove these benefits. I mean, to do a study for several years. I mean, it's incredibly expensive. And to look at things like a generic vitamin, who has the money to put tens, if not hundreds of millions of dollars into the kind of study over many, many years with a thousand people to prove this. So there's shorter terms. And, you know, so a lot of the studies are flawed is what the problem is. Yeah, exactly. I want to come back to supplements with you in a little while as part of a much broader conversation. But, you know, I just want to go back to your vantage point because you've been doing this, maybe as long or just as long as anybody else out there in the space of anti-aging and longevity. And I'd love to ask you from your vantage point, what do you think are the core fundamentals of what you're always consistently talking to your patients about as kind of like a big picture overview of where what are your thought processes around this space? Well, you know, what's interesting is this idea that we all learned the fundamentals of what we need to know in kindergarten. We would have just paid attention. Yeah. And the same thing applies to anti-aging and to longevity medicine. We really get down to the fundamentals as what are the pillars, the basis. So, you know, I think Jack LaLaine, he was, you know, a fitness, the first fitness gurus. He said, he said it very, very well. He said, exercise is king, diet is queen, put them together and you have a kingdom. So I mean, that's really foundational. So we need to eat right. We need to get the right kind of exercise for starters. And then I think most of us are helped by taking some nutritional supplements. We need to find out what we need to take. And then we can go off by doing, you know, an extent, you know, I think the type of testing that is done in conventional medicine is it's good, but the philosophy that we have in our clinic is good is not good enough. I know that what our patients that are in the wellness space want is optimal health. They don't want just good health. So we need to do in a more extensive series of testing. So when you do the testing, I know that you do, you know, you're checking hormones, how many patients come in, they've never had their hormone levels tested, you know, and they go to endocrinologists and gynecologists, they don't test their hormones. I mean, it's, yeah, you ask people, what's your testosterone? Never had it tested in their, in their 40s or 50s. So we want to do the testing first and find out what people need. So we're not guessing. But then when we can come up with a series of tests, find out what people need, then we can start to optimize. And there are, you know, all of these spaces, the hormone spaces, the detox spaces in addition, you know, to all of the other things that we offer. So this is how we, you know, begin the process. It's, it's a journey. Yeah, it absolutely is. When you're talking about exercise with people, you know, the thought process is around exercise have changed since, since I went through college in the medical school now where I am now. And I remember time when cardio was king, right? Calories in, calories out, work those calories off. And my thoughts have certainly changed as well. So what is your general exercise recommendation protocol for your patients? Well, you know, we have the ability now to look at our genetics. So by doing genomics testing, you can find out, do you need more strengthening training or do you need more cardio training? So that's the place that we begin, is look at people's genetic makeup. And if they need more, I mean, everybody needs both. Yes. But those are the two, I mean, the three types of exercise are cardio training, strength training and flexibility. So everybody needs to do those three things and we can find out what you need more of. So if you are needing more cardio, then we'll come up with a game plan. And the old fashioned way, like you're, I think, hinting at where you go out and you exercise for, you know, cardio 30 or 45 minutes, three times a week. That's kind of been modified today. More and more of us are looking at HIIT training. High intensity interval training that we can accomplish in 20 minutes. What used to take us an hour and a half to do. So I think that with the knowledge we have available and then different types of exercises, you know, like with weight training, doing things slowly, lighter weights is less likely to cause injuries and, you know, tear up your joints than using heavy weights to get bulky and things like that. So we're learning more and more about what constitutes good exercise, healthy exercise. And that's where we are today. Are you using any exercise assessments like VO2 max assessment, for example, in your clinic? Yeah, we have a bicycle or a gometer and a VO2 max tester. And interestingly, the studies show that if you're going to pick one parameter, one number to tell how well your body is handling the aging process, it's the VO2 max. And if your VO2 max is low, VO2 max being the amount of oxygen your body is able to utilize, if your VO2 max is low, your fitness level is low. And you're less likely, I mean, you have a high VO2 max, you can live a lot longer. So yes, we do do it and we feel it's one of the most I regarded as a vital sign, just the same as blood pressure and heart rate. Wow, that's great. Another kind of vital sign that I'm using a lot now is HRV. And, you know, now that with wearables, everyone kind of knows what their HRV is all the time. Right. And it's fantastic because I do think it's another vital sign. That traditionally, like as a physician, we would never even trade. I mean, no one even explained it to me in medical schools. So are you using this metric as well? Oh, well, yeah, there you go. You have your watch on. I have my watch on and it measures my HRV, heart rate, their ability. And that's another one of the important vital signs. I like this, but the only problem I have with the wearables is I'm not sure they're that accurate at really measuring HRV as well as they should be done. Because when I first had my HRV measured, which is probably a dozen years ago, I know I sat in the machine and it took like 15 minutes. And yeah, I think that really is the gold standard. And what this thing does now, I don't know, but one day it says my heart rate variability is great. Next day it's terrible. And I slept just as well on both sides. So I don't know how accurate these are, but knowing what your HRV is is a good start. Absolutely. And a wearable is a good place to get it. Yeah, my general advice on that to people is like, don't worry about the day to day numbers, let's look at trends over time. Exactly. For example, a trend on me was that after I got COVID a few years ago during the COVID economic, my HRV dropped in half and it stayed that way for years, like two years. Yes. That's impressive. Well, that's a lot. Yeah, it was a lot. And so then I had to, you know, definitely do a lot of different techniques to try to get it up and finally is back up to where it used to be. But it took me a long time. And so there's that trend. I would have never noticed that if I wasn't consistently wearing my wearable at that time. Right. And I think that that's one of the really nice features of the wearables that we have available, whether or not the HRV is really perfectly accurate. The trend, as you mentioned, is really what we can look at. And if your trend is down, you can generally find, I think that the two things that affect HRV the most or most commonly are stress and sleep. Yes. So if you're stressed out a lot, your HRV, I think, is going to go down. And the higher your HRV, basically the healthier you are. And I think that's why stress is such a killer. And the same thing applies to sleep. If you're not sleeping well, your HRV is going to be a lot lower than if you're getting enough deep sleep. So those are two things that the watches, the wearables can track for us. Right. Right. Let's go back to testing now. So you mentioned you do a lot of testing in your office. You mentioned genetics as well. Is there a specific genetic panel that you're using in your office? We use a three by four genomics one here. But what about you guys? Well, we've done anything from small individual SNPs. You know, like, yeah, like we want to test this one particular abnormal gene polymorphism. It's called SNP. Do you have a tendency to Alzheimer's for us? Yes. Or do you have a tendency to breast cancer like the BRCA genes? Things like that. So, but we also have designated panels like these are going to tell us like what you should eat. These are going to tell us how you should exercise. And I like those better. We also do the full genome sequencing where we test all the genes in the body. The problem I have with that is you get too much information. We can't make sense of it yet. And we need the computing power now is getting to the point that it's able to put these things together, but it takes a huge amount of computing power to figure out how 20, 30,000 genes interact with one another and how they interact with your lifestyle. So it's really, I think for my own purposes as counseling doc patients is I like, you know, just testing 30 or 50 genes at a time, trying to make sense of 50,000, 30,000 that we have. Yeah, I agree. And so we same kind of protocol we use. We test about 30 to 50 genes about what we call lifestyle genes in forming exercise, nutritional, other patterns that we normally see methylation patterns, for example, as well, that could help us determine foods and also supplements to take. But then I think there are some genes that are very valuable, like a, like the APOE gene, like you mentioned for Alzheimer's, but then these massive panels, there's not much additional information you get. And they're a lot more costly too. Right. Yeah. Well, yeah, that's what I found is, you know, when they first did the full genome, we have, I think 23,000 genes in our body. And the first one to do it was Craig Vettner. Right. And it cost him a billion dollars. Well, now you can get it done for about $300. So the price performance, like everything has gone way, way down. The problem is it's really TMI. Yeah. Too much information. We can't make sense of yet. So I don't really, I mean, I had my own done a few years ago and I got it back and I have a 0.05% increase risk of this and 0.3% increase. It really was not very meaningful to me. Right. Whereas the type of panels that you're talking about, some 30 to 50 lifestyle genes, this makes sense because you can counsel people and people can make sense of that. Sure. What about additional testing beyond that? What are your main panels that you're using? I know we're going to talk about one extensively, the Total Toxin Panel, right? Oh, absolutely. Yeah. Yeah. Well, Because it's not something that people measure a lot. People are never getting their toxins measured really. If you go to a conventional doctor and say, for instance, you're interested in mercury or other toxic heavy metals, mercury, aluminum, lead, you know, things along those lines, cadmium, and you ask a conventional doctor, I'd like to know what my levels are. They are invariably going to say, OK, no problem, we'll get a blood test for you. Well, your blood levels are worthless. Yeah. It doesn't tell you anything. It tells you if you've been recently poisoned by those things. That moment in time. Yeah, exactly. So, you know, you really need to do like a provoke urine test or this. You need people that actually have experience with these things because patients are always, oh, here's my mercury level, here's my aluminum level. And so it's just. Yeah, completely meaningless. So toxins are very, very important because we live in an incredibly toxic world. I mean, I don't care where you are. I mean, if you want to talk about some toxins, it's really, I did some research for this book that I wrote recently on plazamine change, which I'm sure we'll talk about after a little bit, which is such a good therapy for detoxification. But when I looked at a few of the toxins like plastics, we have in the last 100 years when plastics were first introduced, we have produced eight billion tons of plastic. That's, you know, eight billion people on earth. That's a ton of plastic for every man, woman and child alive. When you think about that, I mean, it's almost incomprehensible. When you look at things like pesticides, it's in the, you know, in the hundreds of pounds per person that we're producing. So these toxins, they're not a minor issue that you just don't need to worry about. They're major issues. So when people, you know, see a conventional doctor and there's nothing, it's not addressed. I think that's maybe something that should be addressed. I would hope that conventional medicine will start to take a look at this and start to do some testing along those lines. I worry about it though, because it's still not being taught in medical school at all, right? Maybe because there's not like a specific pharmaceutical therapy, you could apply to it or, you know, but it's also, it's an invisible threat, right? And you don't necessarily see or feel toxins around you. And so people think of it as more existential and it becomes like put into the back of people's mind. Now, obviously I completely agree with you. This needs to be the number one thing that we should be talking about after getting our nutrition and exercise routine or sleep down, right? Is the level of time. I almost look at it the fourth leg of the stool that we need to add for, for health, you know, but because it's so not talked about in traditional medicine, because there's not a lot of research around it. It does get kind of put into back of people's minds. It's funny. I think that a lot of us, both physicians and consumers have the idea that breakthroughs in medicine and new knowledge is rapidly adopted. Yeah. And what's what the reality is, is it takes a long time. So the idea, like it's 15 to 20 years, right, is actually for a new idea to filter, become mainstream. Right. Like for instance, let's just take an example. Let's have to do with toxins, but there's a test to look at like the plaque in your heart. Right. And this test, the screening test called the coronary artery calcium test. We've been doing it for 25 years. It's been around for a long time until the last five years. Firstly, no conventional doctors were doing it. Then about five years ago, which is say 20 years after we started, it became mainstream and now all the conventional doctors are ordering on the patients, which is a great thing. But it took 20 years to get to that point. And I think it's the same thing that applies to toxins. We are now learning, like if you want to talk about plastics and microplastics and things like that. I mean, we have like five to seven grams of microplastics in the average adult's brain. Right. I mean, that's a lot of plastic. And people with dementia have 10 times that much. So there's a lot of plastic floating around in our bodies and our brains. And it creates a lot of problems. So we know this now. The studies are being published. We are now learning how we can get rid of it, what we can do to lower these levels and detoxify ourselves. But unfortunately, if history is any guide, it's going to take a long time for this to filter down and become a mainstream thing. Like in medical school, I went to medical school a long time ago, I don't even want to say a number of decades ago. And my son is also a physician. Yeah. And he went to medical school much more recently. When I was in medical school several decades ago, we had one hour of nutrition training. There was one lecture on vitamins and diet and things like that. In four years of medical school, one hour. Well, here's move forward, you know, a number of decades. My son's in medical school. Things haven't changed. No, this is virtually no education. And this either. So it's just, it's very, very slow to be adopted. And I hope that it won't take so long for this idea that the environmental toxins are really hazardous to our health. I mean, it doesn't matter where you look. There's an infertility epidemic. Absolutely. So many couples have trouble conceiving and they have to go to infertility doctors and clinics to help them to have their families. You know, it's just, and a lot of this, I think, has to do with toxicity. It's one thing after another. I mean, they find that people who have plastics in their arteries when they do these endarterectomies for preventing strokes and things like that, those patients that have plastics in there are tremendously more likely to have a bad outcome than those that don't have those degree of plastics in there. So these are really toxic chemicals that we're all exposed to now. So it would be very nice if this became something that the mainstream were to begin testing more. I agree. And I think, you know, we live in a different time now, thankfully, where people are getting their information from other sources besides waiting for their doctor to tell them. So, you know, this podcast, for example, where people will hear about this, hopefully they'll take it to heart that there's plastic in their arteries, which can lead to strokes and heart attacks. There's plastic in their brain that can lead to Alzheimer's. There's plastic in their testicles and ovaries that can lead to infertility. And once you know that, you know, it's a stark reality that you need to start avoiding plastics. And I think that's step one with all of these toxins, trying to try to start avoiding them. You know, you probably saw the recent article about people that live close to golf courses have a much higher risk of Parkinson's. Parkinson's, prostate cancer, all that things. I know that in my life, when my parents, my father retired from work, he was an avid golfer. So they moved to a golf course. But even then I was already a doctor. I said, you know, dad, you really spray a lot of chemicals on that golf course. Do you really want to live on hole number seven, where they're spraying this pesticides and herbicides and one thing after another? And he went on to develop some complications, which I can't prove that was from exposure, but it was, you know, a few years after he'd moved to the golf course and his health started to deteriorate. So I think that, that, that a lot of these chemicals that were exposed to really do have significant health consequences for us. And you had mentioned prevention, like not drinking out of plastic bottles so much, you know, trying to get your food wrapped in paper, not in plastic. I mean, there's a lot of things we can do. So much of our clothes. Yeah. It's not cotton anymore or natural fibers. You know, when you actually look at what your sweaters may have, it's not uncommon. It's a hundred percent plastic. I mean, it's crazy how much plastic is in the environment now. Right. Yeah. And then you wash those clothes in the washing machine and they get air sliced through your whole house. Right. And then you're breathing them and there's so much plastic found in lungs as well. We eat it. We drink it. We breathe it. When a car drives down the road, it releases, it's in the order of hundreds of millions of micro plastic particles into the atmosphere every minute of driving. We're right now talking in Los Angeles. There are millions of cars out there that are being driven, releasing millions of particles every minute. I mean, it's a serious problem. It's a serious problem. And then, you know, we haven't even talked about all the other forever chemicals found in cosmetics and their endocrine disrupting, their immune system disrupting. So this is a huge problem. And, you know, other than avoidance, which, you know, I have a guide online that I give to my patients, how to detoxify your life in 52 weeks. And so one thing a week, 52 things you can do. And I think it's all predispinable, right? Like there's a few actions you can take that can have a majorly outsized effect. For example, getting air filters in your home, drinking out of glass bottles. Are there pieces of advice you can give people like that that can have a big effect with minimal effort? Sure. I mean, one of the one of the easiest things you can do is get some houseplants. Yeah, there's houseplants. They absorb a lot of these toxins from there. I, like yourself, am a big believer in saunas, particularly the infrared saunas. A lot of toxins come out and sweat. So either, you know, avail yourself of toxin or just exercise to the point of sweating. And when you sweat, the toxins are in the sweat. So wipe it off right away. Because if you wait and let it get absorbed, the toxins just come right back into your body. So as soon as you sweat, wipe them off. So there's a lot of simple things that people can do to detoxify themselves. Fasting. As soon as you go more than 12 hours without eating and I counsel all of my patients every day of your life, do not eat for 12 hours a day minimum. So if you finish supper at seven o'clock at night, don't consume any calories until seven a.m. That's the minimum, bare minimum. Then on top of that, as soon as you go past 12 hours, your body starts to realize that, huh, we don't have any calories. So we need to start cannibalizing your body and starts to eat things. Yes, what it eats first, it eats the bad stuff. So you start to detoxify. So if you go, you skip breakfast a few days a week, what they call time restricted eating. I think that's very healthy to skip breakfast, you know, several days a week. Sure. Now you've got a 16 to 18 hour fast. Well, during that period of time, your body is beginning to detoxify. It's also not just getting rid of toxins. It's starting to eat up those pre-cancerous and cancerous cells. It eats up the bad stuff, the old cells, the inflamed cells. So those are the things that go first. So these are just some simple things that people can do to detoxify themselves. Great advice. Great advice. Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones and they have limited cell phone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoc acid. All of these works synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IMA. I actually have a discount secured for you. If you go to drshaw.com slash IMA or go to IMA health.com slash discount slash Dr. Shaw and you can get 20% off with my discount code Dr. Shaw. You can also find the link below. I want to talk about the testing again. You mentioned doing a provoke test for toxins. Can you talk a little bit more about that test and why that's important doing it that way? Well, I was speaking in particular about heavy metals, which are a big problem. And so we excrete heavy metals just in the course of our life. Our body knows that these things are not supposed to be there, whether it's mercury or lead or aluminum, and it pushes them out. But if we want an accurate assessment of how much we have, we can do what's called a provoked test. And the real gold standard is measure how much your body is putting out of these, you know, get a urine sample, then take a provoking agent, a provocative agent. So whether that's something like EDTA or DMSA, these are specific chemicals that are designed to remove these, do that for like two or three days, then repeat the test, another urine and see how much comes out. And that gives you a much better idea of how much is actually in your body and available to come out. So that's called provoked urine testing for heavy metals. And the idea there is that the toxins don't just live in your blood or your urine, they're actually in your organs, right? So you have the heavy metals in your liver, you have your heavy metals in other organs throughout your body. And the provocation of these medicines that you take, oral pills, will draw them out of the organs, get them into your system. So then you see the difference between a non-provoked versus a provoked. And you know how much you've really stored in your body. Exactly. And so it's not just in your liver and it's not just in your bloodstream and it's not just in your, you know, other organs. Let's take one example, which is lead. Yeah. Children that have higher levels of lead have been found to have learning disabilities. Adults that have higher levels of lead have been found to have higher levels of blood pressure. And whereas lead, a lot of it's stored in your bones. Absolutely. And you know, there is a steady state between bone levels, brain levels and blood levels. So we can't really access your bones directly. We want to get the lead out of your bones. So we can do different therapies. We can do this plasm exchange, which I'm looking forward to talking about. We can do chelation therapy, which is a technique that conventional doctors use to treat poisons. And this is a kind of a place that I think that wellness doctors like ourselves may differ a bit from our mainstream colleagues. They see things as white or black. When it comes to something like lead, you're either poisoned or you're not. Yeah. We tend to see things on a spectrum. Right. You know, we see not white or black. We see shades of gray. Maybe have a little bit of lead. Well, a little bit of lead isn't that good either. And a lot of lead is worse. And then there's a poisonous amount. They kind of come onto the scene to treat poisoning. Well, that's great. But how about all the rest of us that are walking around with toxic levels, but not poisonous levels? Will our health be improved if we get rid of those toxins from our system? Actually, the truth is it will. Our blood pressure will come down. Our thought processes may improve. You know, our sleep may get better. So detoxing is very, very important. And it's not just a white or black, black, poison or not poisoned situation. Right. Right. And I mean, you wrote this incredible book about plasma reset, which I think probably between your clinic and our clinics, we've probably done more plasma exchanges than anyone else in the country between our two clinics. I don't think it's something that's really been adopted that far and wide because it is very new and kind of like this wellness world. But you and I both know we've been using plasma exchange in the hospital for decades. Right. Well, yeah, there's a procedure called plasma foresis. Right. And plasma foresis is just simply we hook up a patient to two IVs. One takes the blood into the machine. The other returns the blood to the patient. And then these machines are very smart and sophisticated. Nowadays, I mean, this has been around for a hundred years. The first five plasma foresis was done over a hundred years ago and it's used. It's an FDA approved used by conventional doctors, but it's only used to treat a very narrow spectrum of diseases that I can guarantee you most people haven't heard about, whether it's Gion beret syndrome, wall and storms and all these problems, macro globular anemia, you know, but it's also good for long COVID. For instance, it's good for Alzheimer's prevention. There are some studies suggesting that it'll remove, you know, the beta amyloid has been associated with Alzheimer's. I mean, it's just good for so many things. But in any event, this plasma foresis procedure now, plasma foresis is generally just used to create blood products. Like if someone needs a platelet transfusion, those are on chemotherapy. Well, we can take a healthy donor and isolate the platelets. We can tell that machine, which is such a sophisticated piece of equipment. Okay, we just want the stem cells. So if a woman is going to undergo a very rigorous course of chemotherapy and then they need to have a stem cell transplant, where are they going to get the stem cells from? Well, one way to do it is to use the plasma foresis to get all their stem cells. In addition to taking some bone marrow from the cells, but we can get whatever we want. We want white cells, playlists, red blood cells, whatever it is. But in our world, where we're looking at detox, so many of the toxins are found in the liquid part of the blood, which is called the plasma. So that's why it's called a therapeutic plasma exchange. And what we call this book, a plasma reset. And Troy Aikman, the football player, said he's undergone plasma exchange. He says, getting a plasma exchange is like changing the oil in your car. And that's a very good analogy because, you know, we're walking around with all of these toxins and our plasma, which is to say, like the oil in our car, it's gotten contaminated with all these toxins. Well, we don't drive our car if we do and we just keep driving it and never change the oil on it. Well, guess what? Eventually something bad is going to happen to the car. Exactly. Maybe the engine is going to need to be replaced. So it's a lot cheaper to change the oil once in a while than it is to replace the engine. And the problem is with the human body, we can't change the engine. So it makes a lot of sense to do this detoxification. And a plasma exchange is one of the best ways to remove those toxins because that, you know, since all of the the toxins effectively are bound to proteins in the. They're either bound to proteins or they're floating around free. Well, this plasma exchange is particularly good at either taking toxins that are free floating, but they have to be a certain size. So if they're too light, and for instance, we've been talking about microplastics. What's interesting is microplastics are tiny. Yeah. And if we just depend on, you know, what happens is the plasma exchange centrifuges, it spins our blood. So on the bottom is the heavier cells and the top is the plasma and in between are different things. Well, if we depend on the centrifugation to remove microplastics, it's not going to work because microplastics are too light. They have to have a certain weight. Well, the good news for us is microplastics tend to conglomerate into these things called coronas. Yep. And coronas are big enough to be removed by plasma exchange. So that's why we've done studies at our clinic where we've measured levels of microplastics before and after people undergo the therapeutic plasma exchange. And we found levels about 40 plus percent lower after three to six plasma exchanges. So this is one way to get rid of that. We've done the same testing on heavy metals. We found aluminum and lead and mercury and cadmium and things like that that are very toxic to our health. These levels are 50, 60, 70, 80 percent lower after we do that. So you have the free floating toxins. You have the toxins that are also bound to proteins. The protein bound toxins, as long as they're mostly found in the bloodstream, are really easy to remove. The problem that you hinted at earlier is they're all over the place. They're in the brain. They're in the liver. They're the most. Well, plasma exchange only filters like the name says, you're a plasma. But there is an equilibrium. Yeah. So let's say, for instance, we have this beta amyloid, which is kind of a protein. It's not unhealthy by itself. Right. But when it clumps together and forms these beta amyloid clumps, that is one of the hallmarks of Alzheimer's. Right. So when we do a plasma exchange on someone, we can remove beta amyloid from the bloodstream. It doesn't cross in the brain. But so here we are, blood. Here we are, brain. We dropped the level of beta amyloid in the blood. Well, nature doesn't like that. It's going to come to a balance. So even though we just pull it out of the blood, we're going to effectively pull out of the brain and we do it a second time. We're going to drop it even more. We're going to keep going like that. So even these toxins that are sequestered in our liver or our bones that are brain, we're not going to get them directly with the plasma exchange, but we're going to get them indirectly because we're going to clean out the blood. And I'm sure you've shown what the plasma looks like. I know what my plasma looks like after I did my first plasma exchange. It was not pretty. I mean, it looked like syrup. Right. It was terrible. It was so loaded with toxins. Now that I've done a few, the plasma looks a lot cleaner after I do the plasma exchange. So it's showing that, you know, we can remove these toxins from the body, from the whole body. So I think something that, that we really should be looking at and using for detoxification, for Alzheimer's prevention and for anti-aging. There are some suggestions that it may be beneficial in treating cancer. I mean, I'm beginning to wonder, you know, I, people ask, well, is it this stuff? Dangerous. I mean, taking your blood out, we're filtering it, we're getting back. This is a dangerous procedure. And what I tell people is the most dangerous thing about plasma exchange is not doing it. Yeah. That's a really safe procedure. We've done, we did probably about two or three hundred last year and we actually did somewhere like around 275 last year and we, you know, knock on wood. We didn't have a single person have any major issues. Some people do get faint when they do it because it is, you know, people just don't like the side of blood. And so if you're one of those people, we put a blanket on you. We make sure. We, you know, I think it's important to have a nice meal before you do or have a good breakfast or you have your energy up before you do a plasma exchange procedure. But other than that, like we have no real problems with this procedure. It's been really pretty smooth. Well, we've done about the same number of procedures per year that you're measuring. Yeah. And we've had the same experience. This is a remarkably safe procedure. Right. We've had a few people get lightheaded and you were kind enough to share your experience about hydrating people real well, giving them a bag of sailing before we started to do that. And people's blood pressures stopped dropping. That was a great piece of advice you shared with me. One of the main complications is low calcium levels. We had people chew a couple of tons before they do it. And that's, I mean, yeah, I mean, and honestly, the biggest problem, if we're going to say there's a problem, it's getting good blood flow. Right. Okay. Some people don't. Penis access. Some people just don't have veins that are big enough. They want to do the procedure. But the good news is all you have to have is one good vein. We can do it through one vein. And what you do is you turn it on when you're taking the blood out and then flip the valve and have it come back. The problem with that is it takes twice as long. So it's not great, but for people who don't have good veins, if they have one decent vein, we can do the procedure. Right. Right. Exactly. If you have two, you're golden. Yeah. Yeah. So I want to talk about a few other indications for it that maybe you've noticed as well. So definitely incredible for detoxification. We've seen same as you after a few treatments, 60, 80% reduction in toxin levels, reduction in microplastics as well. And mycotoxins. The mycotoxins, mold two. Yes. Absolutely. Mold toxins go down. All of the environmental toxins we see decrease. I think we, I also shared with you that we're giving people DMS a couple of days before to, to kind of draw out the heavy metals before we do the procedure to even get a further flushing as well. That's a great idea. Yeah. Yeah. We do it afterwards. I think we all have our own protocols. If we talk to two doctors, you get three opinions. Exactly. But so we all have different ways, but it's, we're working in the same direction. But I think that doing the plasma exchange is just one part of the protocol. We also need to do an oral detox program in addition to it. Like you mentioned, whether that's with DMSA or something, we do do DMSA as well, which is a great mercury detox fire. So yeah, we do that. And I think that makes a lot of sense. Yeah. The other thing that we've seen some improvement on is there's so many people out there now on whether it be remicade or some other autoimmune medications that are suffering from a whole host of autoimmune disease. And these medications are very expensive. And so. They're dangerous. And they're dangerous, right? And so we've seen it. We don't do it, the plasma exchange until it's coming close to them, meaning to have another dose of it. These are like $10,000 a dose sometimes of these meds. Oh, at least. I mean, yeah, some of these are even more expensive. But yeah, this, you talk about a growth industry, autoimmune disease. Right. It's growing like crazy. Right. I mean, so on autoimmune disease, the disease where your body forms antibodies against yourself, autoimmune. So your body mistakes things that are normally found in it and thinks, well, this is foreign and I'm going to create an antibody to get rid of it. Well, it's very confused. It's damaging itself. Yeah. And it's crazy. You know, when I first learned about this in medical school, like lupus, this disease where your body just attacks itself, it was like, it was like, oh, it scared me. And no one knows why. Yeah. There's never a why behind it too, right? No, it's really, really. Anyway, the bottom line is it's growing astronomically in some countries. It's growing 2% a year and other countries growing 7%. But the fact is more and more people are developing it. And I think the reason is the toxins in the environment are confusing our immune system and we're actually forming an antibody against a toxin, which cross reacts with our normal tissues. Right. So for instance, let's say there's some kind of plastic called BPA. Very common. Plastic, dysphinole. So your body recognizes foreign, wants to get rid of it, forms an antibody against it. But that antibody that you form against this particular plastic, it cross reacts with the cartilage in your joints. Now all of a sudden you have rheumatoid arthritis, which is an autoimmune disease. You're attacking your joints. Why? Because you were exposed to a toxin. You ate the wrong thing. Who knows why? We're not exactly sure. But the fact is that these autoimmune diseases are increasing every day. And what are they characterized by? These abnormal antibodies. And how do we remove them? Plasma exchange in its infinite wisdom is able to go through and clean those antibodies out. And it is one of the best treatments for autoimmune diseases that I've ever seen. I mean, I've been in the anti-aging world and longevity world for a long time. Sam. Since it began. Yep. 25, 30 years. You've been in a lot longer than me. So yeah. And of all of the treatments that I've seen to enhance anti-aging and longevity, this is right up close to the top. This is one of the best interventions that I've ever seen because, I mean, granted it is expensive. I'm goes without saying it. Unfortunately, it's expensive and it's not accessible to everybody. But for people that can afford it, it's a wonderful, wonderful anti-aging treatment because as we age, we develop these antibodies against all kinds of things. We develop inflammation. They have this condition called inflamaging. Right. And we develop inflammation in our bodies. I mean, there are measurements of inflammation. The CRP, the Riserite Sedimentation Rate, levels of CRP and ESR go down like 80%. The way we measure inflammation after doing TB, it's really incredible. And if inflammation is one of the hallmarks of aging and we can reduce inflammation with this therapeutic plasma exchange procedure, I mean, this is just really a profound way of helping to slow down, stop and even reverse the aging process. Yeah. Yeah. Because, you know, I think there's a lot of talk about anti-aging therapies out there. Should I take a wrap of my sin? Should I take, you know, metformin? But the reality is, those, we don't know if they're really working or not, but this plasma exchange, it's for sure, you could see it in the biomarkers. Toxin levels go down, inflammatory biomarkers go down, autoimmune symptoms go down. You know, the AMBAR studies that Dobrik Rippov did showed amyloid beta go down. And then they also did another study at Buck and Stuart with Dr. Kiprop showing many markers of cellular aging actually improve as well. Right. Right. The aging process in medicine goes by the technical term, senescence. Right. And there are senescent cell markers and we have the ability to actually measure the number of senescent cells in our body now, which we didn't have the ability to do before. And let's say, for instance, we measure the senescent cells and senescent cells go up with age. Yeah. Are you measuring that with the beta galactoside levels or what level are you using? We send that out to a lab and they measure it for us. Oh, OK, good. But what's really interesting is we can see that before and after doing plasma exchange, the number of senescent cells goes down. Now, we don't want to have zero senescent cells. Senescent cells mean aging cells. They are cells that are every cell in the body is supposed to die. It's got an inherent program in it to, you know, that Japanese procedure called, what's it called, where they eviscerate themselves? Oh, yes. Harry Carey. Yeah, Harry Carey. So every cell in the body is supposed to commit Harry Carey at some point in time, commit suicide. And when does that time come? When they get old, they're not useful anymore. Somehow these senescent cells didn't get the message and they stick around. They don't commit Harry Carey like they're supposed to. And they float around in the bloodstream creating havoc. I mean, everything they touch, they turn to garbage. They're terrible. I mean, even zombie cells. Yeah, they're rogue cells. One in 10,000 senescent cells. One of the studies showed that if one in 10,000 years normal cells was a senescent cell, that's enough to call within four months to cause a premature death. I mean, a very significant increase of death. So these are bad actors. And if we had the ability to get rid of a lot of them, I mean, you need some. It's like inflammation. People say, well, I want to take every anti-inflammatory in the world, get rid of all my inflammation. Well, that's not healthy either. We need inflammation. We need senescent cells too. But we don't need a lot of them. Yeah. I want to have the number of senescent cells is at 18 year old. Uh-huh. You know, that's to me is a good level to have. You know, I want to have the levels of testosterone of a 25 year old or a 35 year old. I don't need to have an 18 year old, but I want lower levels of these things. And the same thing with senescent cells. Yeah. And you can measure these now. And with plasma exchange, you can see these getting better. You know, the other thing that plasma exchange is something that is different about plasma exchange is that we're not giving you a pill. We're not giving you a medication with side effects. This is actually just removing things, right? Exactly. Yeah. People are, you know, people say, well, this is scary. I mean, wow, I mean, you're going to put me in and hook me up to this big machine and worrying and whatever. And you're absolutely right. I mean, aspirin is way dangerous, more dangerous than a plasma exchange. More. I can guarantee if you took 10,000 people and did plasma exchange and 10,000 people and gave them aspirin, a lot more would die from the aspirin than would die from the plasma exchange because aspirin causes bleeding and certain number of people are going to get terrible bleeding. Where's plasma exchange? What's it going to do? I mean, it's just, it's really just taking the toxins out. Yeah. I think, you know, it's, it's really interesting because there's been this therapy that's been around for a while locked up in the medical system, the hospital to only use for very rare diseases or emergencies like didoxo toxicity. And now we're just using it differently. Right. And it's safe. It's effective. And it's just kind of like snuck its way into the longevity speak now. And it really works. And so it's really interesting. You know, I think that the doctors that are practicing anti-aging and practicing longevity are, I regard them more in the cutting edge because they're looking to get, do whatever they can do. They're not, I am not, I'm at an age in my life where I can't wait for every double blind placebo controlled trial to prove that what I'm doing to slow the aging process is perfectly safe and works perfectly well. I'd like to have that data, but honestly, I don't have time to wait. Right. So I'm willing to take a few little risks. I'm not going to do crazy things, but I'm willing to do things that haven't. And I'll be honest with you, sometimes we're wrong. Like you'd mentioned metformin. I take metformin, but maybe there's a study going on now called the TAME trial, a trial to assess metformin and aging being sponsored by the National Institute of Health. Right. It's a big $80 million study. It'll prove whether metformin really works or not. Okay. Well, in the meantime, I'm going to take it. Now, if the study shows that doesn't work, well, I'm going to quit taking it. But for right now, it ain't hurting me. I figure, okay, let's take it the same way with plastic. We may find out in 20 years that there's an issue with it. I don't think so because this stuff's been around for a hundred years. You'd think that if it were a problem, it would have showed up by now. Sure. And that's the same way with metformin. Metformin has been around for almost a hundred years. It's a drug that's been around for about 80 years. If there really were serious problems associated with it, we would know. The only question is, does it work as well as we would like it to? With Plasm Exchange, there's a lot of evidence showing that it does work, that it increases longevity, it improves health, it removes toxins. And we have a lot of data already showing that this is a safe and effective therapy for the things we're trying to accomplish. And it's measurable. Like you can see in the biomarkers that we know lead to disease, things like inflammation, for example. If you have a high HSCRP, you will get sick. You are sick. You are sick. Yeah. And this lowers it. So it's like we know that when it fixes the biomarkers, it's definitely affecting the aging process. Let's say, for instance, you have long COVID. Right. You know, unfortunately, a significant percentage of people that get COVID, they just don't get better. Right. And here they are, you know, afterwards three months, six months, and they just have no energy and they can't think properly. They feel like they've cottoned between theirs. And here we have a therapy that one treatment and they feel dramatically better. I mean, I'm sure you've seen it. I've seen it. Patients that have their lives have been ruined. Yeah. Well, just getting COVID, they just didn't get better. They do one treatment, two treatments. They are cured. So, I mean, we have a treatment for otherwise. I mean, what does conventional have to offer? Conventional medicine have to offer long COVID. I don't think we have anything in our toolkit that really can help those patients. But we do have something actually in conventional medicine that can. It's just an unconventional use for conventional therapy. Yeah. Absolutely. Yeah. Yeah. I really believe it's a game changer and I'm so excited that, you know, we were just seeing consistently good results with it with our patients and we're excited to keep keep doing it. We're doing some research studies. I know you're doing research around it and well, like you said, you can't wait for massive studies to be done. But the good news is we're doing it and we're doing the studies. Both of us are. And we're going to put them out there and show people that this is a. We can do what we can do. I mean, I would love to be able to perform a study that our conventional colleagues would accept. Yeah. The problem is in order to do that, you know, the true gold standard, which is a double blind placebo controlled trial. It's takes a lot of time, years and years, which is not really the problem. It's the expense. Yeah. I mean, it literally is in the tens of millions of dollars at the minimum. And who's going to, who's going to spring for that for a therapy that can't be patented? You know, a drug company, yeah, they're willing to spend hundreds of millions of dollars to patent a new drug and then they're going to turn around and charge $10,000 a dose for it. Exactly. Or $30 a day for the pill. You know, we can't really afford to do that for something like this, right? Because it's not patentable. Absolutely. It's been around for a long time. So we're probably not in the near future going to have the double blind placebo controlled trials that are needed to prove to our colleagues that this is safe and effective. But I don't think we really need that if, you know, there's other ways to show that something is effective and safe without a double blind placebo controlled trial. So we don't have the gold standard, but we do have, you know, a large number of anecdotes and when it's not two anecdotes, but it's several tens of thousands of anecdotes showing that it works. And that's where we're getting to now. We're tens of thousands of these treatments have been done safely. No one's died from it. People are better from it. We have all these markers and laboratory tests showing improvement. I think that we have enough data to, you know, to where we can present it to patients and to our colleagues and publish more and more papers as we get more and more data. Yeah. I just thought of something else. Another really important use of it is, is also patients of a very high Lp little A and there's no good medication out there for Lp little A. And so we've been doing plasma exchange for some of these patients that are very concerned and they have cardiovascular disease and Lp little A is a form of genetic, a genetically high cholesterol that is particularly dangerous for the listeners. And we've seen people lower their Lp little A for four, six, even eight weeks, but with plasma exchange. No, that you're absolutely right. To me, it's fascinating that the plasma exchange is able to pick out this particular chemical in the bloodstream, a type of cholesterol or a type of lipid called lipoprotein little A, which is a serious cardiovascular risk factor. And we've been testing for levels of Lp A for at least 20 years. And only in the last, I would say two years has it gotten to be mainstream to be testing for it. And I had predicted that the following would happen. As long as we don't have a pharmaceutical drug to treat it, conventional doctors aren't going to care very much about it. Well, guess what's on the horizon? Yeah, exactly. A pharmaceutical drug to lower lipoprotein A is probably going to be introduced in the next year. Five years ago, how many articles did you see in the medical literature about LPA? Virtually none. How many doctors tested for it? Virtually none. Now everybody's talking about it. Not a day goes by that you don't see five articles in the medical literature about lipoprotein A, how dangerous it is, why we treat you to it. And guess what? There's probably going to be two drugs introduced this year that lower it. But in the meantime, you're absolutely right. The studies show that a plasma-freezes treatment, a TPE, can lower it dramatically. And it has been done on some people that have astronomically high levels. They have to undergo the procedure regularly and it's keeping them alive so they don't clog up their arteries. Right. So it is life-saving in cases of that. Yeah, so incredible. Yeah. The way I look at someone's longevity treatment is this never really going to be one pill or one treatment or one therapy. It's going to be a combination of things that you do that are targeted to things that we see going on in your biology. And then we add in the right procedures, therapeutics to target those changes that we're noticing in your blood work, basically, your biology. But I really like plasma exchange because it targets so many different things. Right? It really does. It's nice to not have to know what is wrong and just have a treatment that kind of blankets and treats everything. Right. And plasma exchange, I think, is such a treatment where it just goes through and cleans things out that shouldn't be there. So by doing so, people, I don't know how you felt after your first treatment, but after my first treatment, I felt lighter, cleaner, I slept better, my thinking was clearer. And that's what I hear from most of my pages. Once in a great while, Sony said, boy, I really felt washed out afterwards. And I think it's because they were very toxic and the TP stirred up the toxins. But nine out of 10 people, they just say, I really feel a lot better after the treatment. So we've had really great feedback. Right. This episode was also brought to you by Vitaboom. Vitaboom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood-based biomarkers. You could either send them your latest blood test or they will send you a finger stick test for blood analysis. Vitaboom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, Trunyagen, and many others for your custom daily packs. I love mine, especially for travel, since I don't have to bring 10 bottles of supplements with me and just open up a daily pack for every day that I'm taking my vitamins and supplements, go to Vitaboom.com and check it out. What are some of the other things that you're seeing out there in the longevity space that are really moving the needle for you or things that you're introducing to your patients right now? Well, I think in addition to longevity and lifespan, most people that I speak to aren't as interested in lifespan as health span. So what people want is an improved quality of life. And I find, you know, we can look to the Stone Age and our genetic code was really, I mean, our genetic code, they say, you know, people study this paleogeneticists, they look at the genes of 23,000 genes we have. If you go back 50,000 years, 22,954 of them are the same. There's only six that have changed in the last 50 years, 50,000 years. So evolution, it does change things, but on a glacial scale, I mean, it's really, really slow. So let's take, you know, hormone levels. For instance, back in the Stone Age, it made a lot of sense for people's hormone levels, let's say testosterone, DHEA, to specific testosterone is good for muscle growth, good for bone growth, DHEA is good for stress fighting. These hormones, which help us to feel younger, feel better, be stronger. They decline, they kind of maximize in the 30s. And then they start a steady downhill climb. And I think the reason for that steady decline was if you have lower levels of these hormones, your health is not as good as people who have higher levels. And that's one of the reasons right now the Winter Olympics happened to be going on. So we're seeing a lot of 20-somethings, you know, competing in the Olympics. We're not seeing a lot of 50-somethings out there. How come? They trained just as hard because the 50-somethings don't have the hormone levels that the 20-somethings do. Why did nature see, why did evolution see that this is a good thing to do to us? Well, it made sense 50,000 years ago because there just wasn't enough to go around. In particular, there wasn't enough calories to go around. So we have kind of 15 years to develop and grow. And, you know, in the Stone Age, that's at the point that people became fertile. When they went through puberty, then they would reproduce and have children. Then they have another 15 years to take care of the next generation, teach them how to hunt, teach them how to stay safe. And then they're 30. Now they're just another mouth to feed. So we actually have a genetic code, part of which is lowering our hormone levels that says, let's kill these old people off. And old people means people in their 30s. Now that made sense in the Stone Age. It does not make sense today because, and what is happening is we are now living the majority of our life with low hormone levels. You know, women get to be 50-ish and their estrogen and progesterone levels basically fall very, very dramatically. And I kind of liken it to when a woman has, you know, healthy, young levels of estrogen, progesterone and testosterone, I kind of look at them as plums. And when we start to take it away, things change more like prunes. And when we restore those hormone levels to more physiologic levels that they were when women were younger, I mean, women are living now into their 90s by and large and half of their life, they're living without the benefit of hormones. And I think the idea that it's unnatural to take hormones is misguided. I think the reason it's misguided is, yes, our bodies were designed for a reality that no longer exists. It was designed for survival in conditions in the Stone Age, whereas today it doesn't make sense for us to live half of our lives with very low hormone levels. So one of the things, you know, the topic being health span that we can do is restore our hormone levels. So why don't we measure our levels? And I find, I'm actually surprised, many men and women have surprisingly low levels of testosterone and DHA in their 20s and in their 30s, not to speak of in their 70s and 80s. So and I think a lot of that has to do with the fact that we're exposed to so many plumes, plastics and pesticides in particular. Pesticides are Xenoestrogens. They look like estrogen. They mess up our metabolism and our hormones. Plastics, they mess up our hormone levels. They look like estrogen so they can increase our risk of breast cancer and prostate cancer and other things along those lines. So I think that we want to measure our hormone levels. If I find that like a 35 year old patient, they they give a level of testosterone in men. They might say two fifty to eleven hundred is a normal range. And a conventional urologist or anocrinologist, your level is three hundred and five. Oh, you're in the normal range. So you're fine. If you're a man and you have a testosterone level of three hundred or five, five, you are not going to feel fine. You're going to feel like an older individual. If we supplement you, if you're young, we can actually give you something that your body will make more testosterone. If you're older, we'll give you testosterone itself. But we can treat everybody, men and women. And we push that person who has a low normal level to more of a, you know, this philosophy, good is not good enough. We want optimal. So we take them from three or five to say six or seven or eight hundred to a more optimal level. These people feel much, much better, dramatically better. They feel younger. They are able to when they work out there, they grow more muscle. Women get toned more easily. They just feel better. So people are interested in health span as much as lifespan. So this is one of the keys. I think hormone replacement is one of the keys we knew estrogen and progesterone and women, I think is really of critical importance. Now, should a woman take these forever? No, but I think after menopause, taking things like estrogen and progesterone for at least 10 years, even some of our conventional colleagues are coming to agree, what was really interesting was back at the turn of the century. Right around 2001, they did a study. The makers of the most common hormone replacement for women then was premmarin and provera. And the makers of premarin did a study to show how good premmarin was. And unfortunately, it kind of blew up in their faces and backfired. It backfired and they found higher incidences of blood clots and breast cancer. And as a result, the oncologist stopped prescribing hormones for menopausal women. And menopausal women suffered for many years. And then they found that it really wasn't. It was the artificial progesterone. They were using a drug, not a progesterone, not natural progesterone. They were using a drug called provera, which is a progestin. It's a drug that looks like progesterone. And this was what was causing the problems after they found out that the conventional doctors, now they are writing for bioidentical estrogen, bioidentical progesterone, and now women are back to being able to take the benefit. So I think that when women approach menopause, you know, restoring your hormone levels for the next decade or more, it can be very beneficial. Should a woman who's 85 be taking those hormones? Probably not. I think that, you know, the risks outweigh the benefits. But the good news about testosterone is people can take it at any age. Yeah. So hormone replacement therapy is a big piece of the puzzle. Yeah, absolutely. Where have you landed? You know, you mentioned A4M. When I did A4M's coursework, I think 20 years ago now, they were big proponents of growth hormone, exogenous growth hormone. Where do you land on growth hormone now? I often have a slide presentation that I present to new patients about hormone replacement. And on the slide, I have testosterone and I have growth hormone. And I talk about how good testosterone is. And then when it comes to growth hormone, I have a line that goes through it. So perfect. To tell people, don't take it. Now, you're right. I went to that first meeting of A4M back in 92. And it was a growth hormone meeting. Right. They felt there was a Dr. Daniel Rudman. I think it was from the Midwest University of Wisconsin. And he did a study on 65 year old men. And he found that the men who took growth hormone did much better and aged much better than the men who had looked, didn't take growth hormone. And this led to the beginning of anti-aging medicine. We finally have a way to treat aging. So guess what I did? I started taking growth hormone and I took it for two years. And I actually developed an allergy to the injection. So that's why I stopped. But now I wouldn't take it because I think that growth hormone, it kind of follows the Harley Davidson motto, live fast, ride hard, die young. I don't think it's a longevity drug. So it might make you feel better for a while, but in the long run, I don't think it's healthy. Yeah. What do you think about peptides? Peptides are very simply small proteins. They're found naturally. Some of the most common medications used in the country right now, semi-glutide, antiretrosapitide for weight loss, they are peptides. So yeah, I believe in peptides. I mean, every doctor in the country does the way that, I mean, these are probably among the most common drugs prescribed. So peptide therapies are good. Now there are a number of other peptides, BPC 157, which is used for inflammation, Kispeptin, which is used for something else. You know, there are ones that are panelon used for the brain and for sleep and things like that. Those haven't been studied as much. The problem we have is we don't have a lot of studies, but I think that they have benefit and I think used judiciously. They can help our patients and our patients are asking for them. Right. Are you using them in your practice? Yes, we are. I think for me, the sourcing is very important and there's about five or six peptides that I think have good initial research or moderate amounts of good research around them. Like you said, because they can't be patented, it's hard to do the studies that are big enough to convince mainstream medicine, but thousands of anecdotal cases show people heal faster with BPC 157. For example, people are able to get benefits from even like TB 500 for autoimmune disease. So there's a lot of great potential benefits from it. And you know, just like plasmid change, I haven't seen any complications, you know, knock on wood from these. So very, very, very pretty safe as long as you sourcing them well and making sure that you're not getting them like off some random site on the internet. I think they can be beneficial. Yeah. When we talk about, you know, the state of the art of longevity and anti-aging medicine, so plasmid change is one of our hallmarks. And I think peptides can be one of them. Hormone replacement can be one of them. So, you know, there are rejuvenation medicine, regenerative medicine. We haven't really talked about. And I think that's a big one as well. Yeah. You know, you wear out the cartilage in your knee and right now conventional medicine can give you drugs. Unfortunately, those drugs may give you ulcers, other liver problems and things like that. And just to control the symptom of the pain. Right. It's not really helping anything. They can inject some steroids in there. Once again, it'll help the symptoms, but it'll actually make the problem worse, ultimately worse. And then we have regenerative medicine. We can take the patient's own blood, separate out the platelets, create this solution called platelet-rich plasma, inject that into the joint, and the results are remarkable. Incredibly effective. Right. So I think we have some, and I'm really gratified to see, I mean, we've been used in PRP for 20 years in our clinic, but in the last five years, conventional orthopedic surgeons are now adding into their treatment as well. Yeah. A lot of the orthopedic surgeons that I talked to, they love it actually. They're like, you know, why are we giving people steroids when we have PRP? You're going to try the PRP first now. So. And it's that magic 20 years. Exactly. It took 20 years for it to filter down. And now it's becoming mainstream. Yeah. Are you using any stem cells in your practice or exosomes? Yeah, we're using it a little bit. I used it more in the past, but I feel like, you know, I feel that they have a lot of promise and benefit, but they're so controversial. That's really my, my only objective is the controversy surrounding them. Yeah. But I think they're great. And I think they have enormous ability to heal. So in Florida, Montana, and Utah, recently the controversy became a lot less problematic because the state's past law is approving use of them. So I think we're going to see a lot more research and a lot more talk about them as we can now do them and study them. And, you know, we have clinics in Florida, so we're taking much a more aggressive look at these. Oh, that's great. No, I'm glad you, I actually didn't know that. Yeah. I'm glad to hear it. Yeah, just recent, just happened in the last few months, actually, to be honest. And then let's talk about Rapamycin and Metformin, two, you know, doing quotes, longevity drugs. What are your feelings around those? Well, we do use them in our clinic. Uh huh. I think Metformin has been around so long that we can use it safely. The only question is, you know, there are a lot of animal studies, you know, in the hundreds, if not thousands, showing that it reduces the risk of cancer, showing that it increases mice that had Metformin added to their drinking water lived, you know, almost 40% longer. So it's both a longevity drug and an anti-cancer drug. So why not? I mean, this is, we have, you know, potential benefit and almost no harm. So I, and it's inexpensive. So I think this is one that's kind of a no-brainer. And like I said, there's this tame trial going on now. And when the results of that come available, we'll know how good it really is. Hopefully that'll be in the next few years, but we don't have to wait. We can use it now. Rapamycin is an anti-rejection drug. Transplant surgeons use it to help when they give somebody a new, you know, someone else's kidney, you can't have that. You have to reject, you have to suppress the immune system. So what's interesting is we can suppress someone's immune system temporarily. Someone with a liver or kidney transplant has to take Rapamycin every day. Their immune system is suppressed all the time. That is not healthy. They have side effects, but they have to have it. You know, they couldn't live without the kidney and they can't live without the Rapamycin. But what do we do in, in anti-aging medicine, longevity medicine? We take it once a week or once every two weeks. So the image that I like to use, the analogy is a rubber ball. You take a rubber ball, you squeeze it tight and it bounces back. That's our immune system. You take your immune system and you suppress it for a few hours and it bounces back and becomes stronger. So because we're giving people something that suppresses our immune system, Rapamycin, all of the patients that I have on it, I say, if you get sick, call me. I want to know about it. And I don't want you to take Rapamycin that week. Nobody calls me. I get called so rarely because people stop getting sick. There are studies that show that people who take Rapamycin get sick much less commonly than people that don't take it. So for that point of view, it seems benefit. There are a number of studies in animals that show that extends lifespan. It's the only pharmaceutical drug that we have that extends the lifespan of every single animal it's ever been tested on. There are a few that metformin did show. Rapamycin, 100%. So it seems to be the best we have right now. We, when we put someone on Rapamycin, we check their blood several times a year, looking at their immune system markers. We check a full spectrum of blood work because I want the patient to know and I want the patient to be able to tell their doctor that things are fine with their immune system and all of their other blood markers because they want to know, you know, why are you taking an immune system, you know, drug? It's the same thing as going to the gym and working out with weights. What do you do when you work out with weights? You injure your muscles and how do your muscles respond? They get stronger. Rapamycin does the same thing. It suppresses your immune system, but your immune system gets stronger. It's the idea that a little bit of a bad thing is a good thing. Yeah, like a hormetic, right? Exactly. Yeah. Hormesis. Hormesis, right. Okay, so we covered Rapamycin. We met Foreman. I'd love to hear kind of your thought process around supplements. How many supplements do you take a day? I probably take in the neighborhood of 35 pills a day. I used to take 70 pills a day. I don't take as many as I used to. Now there are people that may blanch at the idea of taking 35 pills a day, but each of the ones I take, it's specifically for me. I mean, I take, I have the ApoE4 gene that increases my risk of Alzheimer's. Lithium, which is an element, lithium orate in particular, five milligrams a day has been shown in studies to reduce the likelihood of Alzheimer's. So I take lithium. Someone else doesn't need to take lithium. I take other things like vitamin C and biofibonides because I have a tendency towards allergies. So the things that I take are specifically designed for me. And the things I recommend for my patients, we do the testing on patients. And these are the supplements that are good for them. Now, are there supplements that everybody should take? I think so. I think everybody should take a multiple and mineral. Why? Because 90% of us are deficient on one. It'll take $20,000 for us to check all of those vitamins and mineral oil. Hey, let's take a, for 10 cents a day, let's just take the multiple. Right. Because they're very, very safe. Okay. So that's one. I think something for inflammation like fish oil or flax oil. I think that's very good to take. Coenzyme Q10. I think that increases our energy. It increases the production of ATP, which is what our body uses for energy. I think we should take that vitamin D. Everybody's level is low. I mean, I have never, ever seen somebody with an optimal level of vitamin D who wasn't taking it. Why? Because we don't spend enough time in the sun. We're so worried about getting skin cancer that we don't get enough sun. And even if you did, it's hard to get enough sun. So those are kind of four that I think everybody should take without testing. Those would be good to take. And then, depending on what the testing shows, individualized for what you need to take. Yeah. I would only add to that creatine. I think it's very powerful as well. I mean, creatine is very good. Yeah. Yeah. For muscle development. Yeah. Absolutely. And there's some studies that show it helps if you have a poor night of sleep with the cognition and also potentially can reduce the risk of Alzheimer's as well. So. Yeah. So like, for instance, there's one called vintpossitine. Yeah. Vintpossitine is a prescription drug in Europe. You can't buy vintpossitine over the counter in Europe. It's used to treat dementia. Well, I got a family history of dementia, so I take by vintpossitine. Is that a supplement here, vintpossitine? It's a supplement. Yeah. Oh. A few pennies a day and it's available over the counter. Yeah. You know, it's really funny. In some ways the United States is very restrictive and other studies were very liberal. Yeah. I know Melatonin is a prescription in UK, but it's not here as well. Like in Australia, you can't even get it. Yeah. So yeah. Exactly. It's a hormone, right? Exactly. Yeah. So interesting. Yeah. What are some of the other things that you're seeing in the longevity space that or our health span space that you think are moving the needle for your patients? Well, I think testing is very important. Right. I think we really need to be more comprehensive in the tests we offer our patients. Because if you don't know what's going on with a patient, then you don't know how to treat them adequately. So I think that we need to be more thorough. The average patient, you know, when they get an annual physical, yeah, they check their cholesterol, which is great. They check their blood pressure and their blood sugar and things like that. But I think they need to do, you know, they need to go further. They need to be testing the things we've talked about previously. They need to be testing their toxin levels. They need to be testing, you know, their hormone levels and, you know, things along those lines and then treat what needs to be treated. Right. Right. I agree. I think there's so much testing out there that people don't even know that they can get. And, you know, you and I, we both try to provide this to our patients and it becomes a standard dose, but most people are just getting their CBC and Chem 7, which is like a disease. Like those don't show anything unless you're a really bad problem happening. Yeah, exactly. But that's the standard test that a lot of patients get. And it's not telling them anything about their inflammation levels or hormone levels. A lot of people are getting the standard cholesterol panel done, but you and I both know that very few people get ApoB or help a little A still and. We're in particle size. So many things that you can look at. But, you know, we've talked about so many things that can help people with the aging process, whether it's hormones, whether it's peptides, whether it's therapeutic, plasma exchange, whether it's using saunas. I mean, there's just so many things that are available to us now that 15 years ago, we really didn't know that much about. So thanks to AI, AI is of enormous benefit. It's, you know, it's chewing up all the information and finding out which things work and which things don't. I think that AI is going to help direct us to some novel therapies. You know, there is this thing called rational drug development. The way we develop drugs up until now, the only way we've been able to develop drugs until now is off goes an expedition to South America. They come back with 200 birds, eggs, roots, whatever. They grind them up and they test them. They find out, well, guess what this one does? Yeah. It's not rational. They're just guessing. Well, we know, for instance, that if we want to treat this disease, we need a molecule that looks like this. That's called rational drug design. If we could design a drug that looks like this, what is a drug? A drug is a peptide. It's basically a combination of amino acids. Well, the problem with these amino acids is they wrap around one another and they form these three dimensional shapes. And that's really what we need so that that key will fit into that lock. You could five years ago take all the computers in the world, hook them together and they couldn't figure that out. It was too much. It's too complicated. Well, we are right now on the verge of rational drug design. There have now been some drugs that the scientists said, okay, we need a molecule that looks like this. They were able to crunch the numbers and the computer designed the drug. And here it is. So this is going to be the wave of the future. And it's going to be enormous when we have the ability to. So for instance, I have this ApoE4 gene. Wouldn't it be nice to have something and block that gene? I would lock it. I can't wait for that. Yeah. So these are the kind of things. So I think that the diseases that are killing us now are going to stop killing us. Right. Right. Yeah. I think I think it's a tremendous that we can finally apply this incredible amount of computing power to biology and kind of transcend this old model of just trying to find molecules that do something and then figure out what it does. Absolutely. And I think the GLP one story, it involves some of this because they already had known what GLP one was. The problem is our own GLP one only lasts a few seconds, minutes. But then they knew like they needed a molecule that looked like a GLP one, but had a certain change in it that can make it last longer. And they used computing power, AI basically to test the GLP one of many different species and it turned out the Gila monster GLP one lasts at a week. And so like, I didn't know that story. Now this can become a drug. Yes. And so that was the story of how semi-glutide came about. Right. Yeah. Well, yeah, no, that's that's an example of exactly what you're talking about. Right. And there's so many drugs that we develop. They were designed like minoxidil. Yeah. Minoxidil was designs of blood pressure medicine. Yeah. Well, they discovered that the women that are working in the minoxidil factory and were handling the pills, they were getting hair growing on the back of their hand. And they were complaining about it. So the drug manufacturer was smart enough to think, well, maybe this is a hair growth drug. And now it's you can take the monoxidil, they started with the cream, which didn't work very well. But now they have minoxidil pills and it's a wonderful hair regrowth drug. And we all know that the Viagra story, that was a blood pressure medicine didn't work very good for one thing, but worked very good for something else. You know, a topic that we haven't talked about though, that I think is really important is the two main killers, heart disease and cancer. Yes. And I truly believe that we've now reached the point of medical knowledge that virtually no one needs to die of either of those diseases. I agree. By using the technology that we have today, virtually no one needs to die of a heart attack. And yeah, people may get cancer, people may get heart disease, but they don't need to die of it. We can detect cancer in an early stage now with these new blood tests that are available, detecting it early, then we can treat it early. Stage one cancers that haven't spread are 95% five year survival. Stage four cancers that have spread have abysmal survival rates. So I mean, we can take cancer off the table, heart disease. We have these calcium scores. We have carotid scans. We have virtual angiograms instead of the old fashioned way where they take the tube and put it in the heart and inject the dye costs tens of thousands of dollars in the hospital, dangerous, expensive. We can do that with a CAT scan. Now give a person an injection, put them through the CAT scan, look at their arteries and get clearer images. People have a problem. We can treat it right off the bat. So anytime I hear someone dying suddenly of a heart attack, I feel like it's been a disservice. Physicians, we've really failed them. You know, no one needs to die of heart attack anymore. And I think the same thing, the problem with the cancer stuff is it's still a little bit expensive, the testing, but hopefully the, you know, the testing will come down in time as more and more people are doing it and everybody can be tested. And these diseases that have really been, I mean, 55% of people die of heart attacks or cancer. We can get rid of that. I mean, we've improved the longevity a lot. Absolutely. Absolutely. Yeah. The critical element there is using the technology for early detection early enough and making it more widely available. Exactly. It's such an incredible time we live in. It really is. So one of our friends is Ray Kurzweil who wrote a tremendous body of work and I know that you're very close with him and he's, you know, he's done a lot of predictions about the future and he's right almost all the time he's been right. Right. And so he predicted something called longevity escape velocity, which is where we will learn for every year of scientific discovery, how to extend our life another year. How are you feeling about that theory? I think it was 2042 or something that. Well, Ray and I wrote two books together. Yes. We wrote our first book together in 2004 and our second book together in 2010 and the first book was called Fantastic Voyage. That's right. Live long enough to live forever. And the idea was live long enough. We don't know how to live forever. We didn't know how to do it then. We don't know how to do it now, but the idea was live long enough to take advantages of the therapies that are coming in the future. Live long enough to take advantage of those therapies. So Ray and I would come back from the future in the book. We made up some stories. That's right. Yes. And we would have Ray 2024 and Terry 2043 or whatever. And that's what we were thinking. Back then it was more like 2050 when the singularity would occur. And the singularity is the point of time when you really can't predict what the future holds because the change is going on so quickly. Once we reach the singularity, we've reached this thing that you refer to as longevity escape velocity where it is really meaningless to talk about how long people can live because they can live as long as they want. So back then when we started our communications with one another around 2000, 2002. Yeah, 2050. Then when we wrote our first together, first book together, more like 2043. And we wrote our second book together in 2010, maybe 2035 to 2040. Hey, that's nine or 10 years from now. And, you know, it's really not that unrealistic to think that it may even be sooner than that. So this horizon when we're able to reach this rate of change, Ray Kurzweil is a brilliant entrepreneur and he's a brilliant inventor. I mean, he invented the translating telephone. He invented voice recognition. When you talk to a computer and the computer recognizes your voice and can type according to your voice, that's something that he's the guy that invented that stuff. I mean, he's done some amazing things in his life. But he is also a futurist. Yeah. And he's done as good a job of predicting the future as anyone. And we recently had a conversation about AI. He is, if anyone, he's not the father of AI. He learned from the father of AI. He got into Harvard. He got into stand. He's a bright guy. He got into MIT. And he decided to go to MIT because the guy who is the father of AI was a fellow by the name of Marvin Minsky was teaching there. And that was what Ray was interested in. So he went and studied from Marvin Minsky. And so he's kind of the grandfather of or Minsky was a grandfather and he's the father, but whatever the case may be, he is even, he is astonished by how quickly AI is, is changing the world. I agree. It's going faster than he thought it would. And he's the guy that invented it. So it's going pretty fast. And I think it's affected virtually everybody's lives now. I'm sure you're using it. I'm using it. I mean, we use it every day as part of our, you know, ability to take care of patients in us, helping us a lot. So it's an incredible time. We live in. It is really an incredible time. Keys to stay alive long enough. Live forever. Right. Right. I agree. I agree. Once it's been a fascinating conversation and, you know, truly incredible city with one of the masters of this space. I had a lot of fun. Really appreciate you doing this with me. We covered a lot of topics and it was really enjoyable and there's so much we didn't talk about. Yeah. More to come. We have to do another episode together. One of these days. Sarshan, thank you so much for having me on. Thank you for joining. Where could people learn more from you? So I have a website, grossman wellness.com. So people are welcome to visit our website. We have clinics, as I said, in Denver, Aspen and same kits. We have a book related website about TP plasma reset.com. The name of the book. So thank you for asking about that. And yeah, no, we're just excited, just like you are about what the future holds. And I think that there's a lot that's available now and there's a more available in the near future. Yeah, I love it. Thank you so much. Thank you. Here's my top five takeaways from this episode with Dr. Grossman. Number one, toxins are everywhere and conventional medicine barely addresses heavy metals, microplastics and environmental toxins accumulate in organs over time, yet standard blood panels rarely test for them or treat them until they reach dangerous levels. Number two, therapeutic plasma exchange removes what your body can't. TPE works by filtering out toxic loaded plasma, inflammatory proteins and protein bound waste, physically lowering the body's toxic burden rather than adding another supplement or drug. Number three, inflammation is a hallmark of aging and TPE directly reduces it. Chronic systemic inflammation drives neurodegeneration, cardiovascular disease and metabolic decline. And plasma exchange is one of those few interventions that has been proven to meaningfully lower it. Number four, your body is designed for a world that no longer exists. Genetically, we're nearly identical to humans from 50,000 years ago, but program for scarcity, shorter life spans and early hormonal decline. In today's world of abundance and extended lifespan, that mismatch means we have to intentionally optimize hormones, strength and recovery. If we want to spend more of our life healthier. And number five, testing is the real lever for longevity. The biggest driver of lifespan isn't using guesswork, is using advanced diagnostics. Understanding your genetics, hormone levels, toxic load and inflammatory markers allows you to intervene before decline becomes disease. Thank you so much for listening to the podcast today. Please remember to subscribe if you liked 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 and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and is always important to seek their guidance.