39. Neil Paulvin, DO: Mitochondrial Health: NAD, Peptides & Spermidine

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Before I introduce this week's guests, a quick story time brought to you by LocumStory.com. Today we'll be reading One Job, Two Job. One Job, Two Jobs, Red Blood Blob, No Job. Elective Doc, Emergency Doc, Summon Overstock, Summon Out of Stock. This doc is too abused, this doc is utter used. This doc can't get sick, say, let's try a brand new trick. For all the docs about to cry, here's an idea you can try. Look into Locum Tennis Assignment, a really great option you might find it. Don't forget Locum's pays much better, and you can find assignments in any type of weather. With all this new info, track up in your thinker, go to financialresency.com, slash LocumStory, and use your mouse to thinker. It's here you'll find the unbiased answers you're after, so you can decide if Locum Tennis is your next chapter. Just a quick FYI before we get started, this conversation is going to be one between myself and Dr. Neal Paulvin as ultimately will rejoin us at the next episode. But to introduce our guest, Dr. Neal Paulvin is a board-certified physician in family medicine, anti-aging and regenerative medicine, OMM, and medical acupuncture. He has helped top executives, Olympic athletes, top trainers, and celebrities optimize their health. He has been featured in New York Post, Nutrition's Live, Fasting MD, and other publications and podcasts. He is Basin Manhattan, but he also serves clients in multiple states, including Florida, California, Illinois, New Jersey, and Connecticut, over telemedicine. Dr. Paulvin uses traditional and alternative treatment to help his patients. Patient C. Dr. Paulvin, for his expertise in biohacking and health optimization. In addition, he specializes in helping his patients with hormone optimization, peptide therapy, new atropics, and natural options for pain relief, which some of those options we are going to delve into in today's episode. Now, today we are going to do a general overview of mitochondrial health and why it is so important to target when we are talking about longevity and anti-aging. Now, there are many different ways to optimize your mitochondrial health, but we are going to talk about three supplements that potentially could help. The first one is NAD. The second one is peptide therapy, and the third one is spermedine. So sit back, enjoy, and let's live longer. Dr. Paulvin, what's up, how are you, man? I'm doing good. How are you? Thanks for having me on. Yeah, absolutely. So you're Basin, New York, yeah? Manhattan, yeah. Manhattan, and how long have you been there for now? I've been here solely for about three, three and a half years. Okay. All right. So just before the pandemic, then. And then, that's about to come to the end of my day, yeah, right, the things that got going. Oh, man. Okay. Well, guess things are opening back up so you've been able to enjoy it. Hopefully, you know, most of Manhattan for what it is. Yeah, things are, you have things luckily knock on wood or getting back to someone normally. Awesome. Cool. Well, all right. So for listeners that, you know, don't know what we're going to be talking about. We're going to be talking about mitochondrial health, and I know something that you've really been giving talks on are things like peptides, NAD, spermedine, and interestingly, we actually met through Clubhouse. And I think, you know, early on when Clubhouse started, we were in a couple of of those rooms together, talking about, you know, things in the future, especially with some of those guests. So let's start back from how you started. How did you enter into the field of medicine? I entered kind of the same answer that turns out what got me to more the alternative stuff is I had headaches even before med school. I saw every specialist known a man kind, except I think for a gynecologist and they all put me on these medicines that were sedating, or it's like side effects, or they really didn't help much. And then what I found that kind of helped me was doing things. Again, it was combination of doing things like breath work, and mobility, and yoga, and some kind of keynote supplement. So that kind of opened my life to A, I want to help people who kind of, or have suffering and me that they're not getting listened to, because a lot of times, oh, it's nothing is in your head, that kind of, not the blame game, but just kind of, if we don't know exactly what it is, they just blow you off and say it's in your head type motallion, and also that. In traditional medicines, great for certain things, but also add in the alternative things that have some data behind it. I mean, that's kind of where I kind of fit in, especially now, it's more and more I get more questions about, is this real or is this not, is it, and then what do I do about it? So that's kind of where I kind of, it's just kind of snowball from there. Absolutely. So did you know while you were in med school that you wanted to go down like the functional medicine alternative route, or was that something after you thought about after failing med? You know, it was mostly, it was a family med, I was either going to do sports med, just a straight family. I need a variety, so I just decided not to do sports med solely. And then I was getting, like I said, I was having patients, especially I was kind of in a rural area when I started out of residency, and they weren't all as specials around, and I trained like in a city environment where you're kind of always like trying to use the newest, coolest thing. And I get, I had patients who were just not getting satisfied with the answers they were getting from their docs. So I kind of adding things in here and there, and I just kind of, again, to group, I'm like, wait, this works. Let me do some research on it, and I go to a conference and, oh, maybe this will work. And then I kind of just, you could have the rabbit hole, and I think you never did that. Absolutely. Absolutely. I think that's what's fascinating about the whole lifestyle functional medicine game, though. I mean, it's just, you start to connect the dots, and biochemistry is actually fun, right? And it actually starts to make sense, and all those things you learn in med school, they are like, I'm never going to use this. You maybe start to see some of that come back again, and again, you start to connect all the systems. So that's exactly why I'm interested in it as well. So Dr. Paul, I know you're a jack of all trades, and honestly, we could probably talk for 10 hours here about everything that you're doing. But I want to focus on mitochondrial health, because I know this is something that you've been talking about lately. And honestly, you know, looking at Davidson Claire and Rhonda Patrick, Peter Tia, a lot, this topic has been getting hot. And I think there's a lot of data out there now coming out showing that there's different things. So I just want to ask you, why does the mitochondria matter when we talk about anti-aging and longevity? I don't answer that succinctly. There's a lot to it. I mean, it matters because, I mean, the simple answer, it's usually just called like the motor of the cell, the motor of the body. Now we know it. It does so many other things that we know that it helps your body produce the proteins and helps recycle the DNA that's been damaged. We know that it produces serotonin, which serotonin through the anti-aging molecule was also of other functions now we're learning. That's a whole thing. So Davidson Claire in his book, we know that it helps with that the benefit of getting rid of recharging our batteries and recycling things. People now, two years ago, nobody knew the word autophagy. Now it's almost become a cool buzzword. People are fasting. People are getting you meant to spermidine. I mean, things that people had never even thought about two years ago that only made one or two a couple of dogs who were talking about it now, it's kind of become the understanding. All that revolves around the mitochondria, and again, the mitochondria is the core of the whole foundation of a lot of different things. It's everywhere. It's predominant. The brain's predominant in the heart. Muscle cells, so it's kind of, it's everywhere, so it's kind of like buying out my cheesy now never-pasted. If you don't fix the foundation of the house, you may have a cool bedroom and a nice view. But if the foundation stinks, then you're kind of stuck. That's why everything's kind of reverted back. And honestly, between peptides, and we mentioned spermidine and people not doing like fasting, cold immersion, we now have things treat the problems with that. And the other part of it is we are now somehow we're all constantly in the last year in terms of we're finding a link for longevity and unfortunately the link to the mitochondria knows it's like Alzheimer's, Parkinson's, diabetes, obesity, and they're like, why are you going to unfortunately invest and come out for Alzheimer's last year? Why is it not working? Maybe it's not working on the right thing. So a long answer, but yeah, it's kind of, it's the core of a lot of things. That makes sense, right? I think we learn in grade school. It's the powerhouse, right? It's the buzzword we use, powerhouse of the cells. Absolutely. So let's get into kind of the first topic here, which I think we should start with AD, because I think that's what I think most people may have heard of when we think of mitochondrial health. Can you explain what NAD is? How does it help the mitochondria? Yeah, NAD, there's a couple of different things in the mitochondria. It definitely powers a transport chain in the cell that produces ATP, produces the energy for all those little school people, like producing the power of pellets and pack random that you need. It's getting those things going for you. It also helps to do some certain other chemicals that we know you need, things like impule bay now, where things like alpha-cutor gluturate and acetyl acetate, which now have their own benefits. But it produces a lot of hormones that you, you're not hormones, but it's more end, that's a better word for them, or co-factors. And then also now we know that activates, like I mentioned, activates serotonins, which are anti-aging, also helps with the mitochondria divide, which knows important. It works on what's called your clock gene, which now has become even more, if you are a trauma, you're just a kid in the rhythm it. If you have no NED, just your kid in the rhythm, maybe off, it helps, like, it helps your body repair damage DNA, which occurs in the cell. So it does a lot. I mean, there's other stuff that it does, it helps regulate inflammation in the cell, helps block oxidative stress, which is damage from toxins and inflammation and things like that. So it does a lot. And they're finding more and more things that it does and why it's important. Now, do we supplement NAD because people have low levels of it, or is it something that we're just kind of topping off? Either or. It depends on the person we're talking about. We're starting to finally, there are some beginning tests now that you can actually get a level because before you really had no idea where anybody was. We know at the age of 30, that's when people start having their levels decreased, so that's kind of the assumption. And it's kind of like anything else. You could have, if you have five, six of a gas tank, you're just top, you're only going to do so much. Otherwise, you're not doing much. Same idea with NAD. We're 22 years old. It only made you so much. Again, it may give you a quick brain boost or something, but it activates your tune, but you already have it. And my older patient, anybody over 30 or 40, it's probably doing a lot more, giving you a little more benefit. Like I said, once we get these, no, the next year or two, they're doing some trying to figure out exactly what is, like, we know what your sugar level should be, what your blood pressure should be, we don't know what the right level of NAD is to be optimal yet. So that's going to be one of the new things in the next probably five years. I hope we've less than that. Gotcha. Yeah, I mean, as we get more into precision testing and things, I mean, I'm sure that's going to be one of them. It's interesting. I think a lot of these supplements and ideas of the biohacking that we're looking at for longevity, from the research I've been looking at, it seems like we're seeing more anecdotal evidence at least for, like you said, the patients that are 30, 40 and even more if they're 50 or older, is that the population that you're generally targeting? I mean, not anymore, to be honest, I mean, what I do is, there's been some evidence with, again, I'm going to probably get this a little bit later, NMN has a lot of cool studies, which is one of the versions of the supplements that are out there now, has so much good data in terms of muscle, like, has some preliminary studies in terms of muscle building, sugar metabolism, things like that. So that's where I use it in somebody under the age of 30, if that's, so I use that specific metabolite. Am I giving them NADIVs every week? No. Am I giving them at a nice dose of NMN, yes. So kind of a little bit of a division there. What is NMN stand for? Is that a, is that like a type of peptide or is that? There's something, nicotine monos, something, now you're testing me after, that's, the nicotine mononucleotide, maybe, I've caught my head. Gotcha. Okay. Gotcha. Okay. And that's supposed to support, I guess, the NAD and the mitochondria, that way. Yeah, it's before it becomes, it needs carrying the cell and then the cell can use it for energy and all those things that we've talked about before. Gotcha. Okay. Cool. Well, let's shift gears towards peptides now, because at least when I'm doing a Google search on peptide therapy, I mean, wow. It's insane how much is coming up from cancer therapy to IVD, to muscle building, to, you name it. So what is peptide therapy, why is, why do people need it? For who needs it? Peptide therapy is, it's exploding, I mean, I got, and that's probably the most common thing I get asked. I mean, Laura, I think every day, I'm supposed to really get like 10 questions a day on every, from everywhere across the world at this point. Peptides are small amino acids that have very specific roles. They work on an enzyme system, or they were going to hormone receptor, or they're going to work on, do a specific job, one or the other. And they, like you said, they can, right now, I, I, the most things they can help with. Again, I tell my patients, and I, is that certain things that are kind of going to be the, the primary treatment method, method, or, or at least, or lifestyle therapy. In some cases, they're a nice add-on, but you need to, maybe, you need to find other treatments that go along with it. They're, it's great now, is they used to be all injection-based, now there's no space in creams, and now there's patches, and so a lot of my patients initially used to be needle-phobic, like, well, I can't take it, and now they're like, okay, I'll do the, I'll do the oral, I'll do the nose-freeze, so that, that's what's, it's become very eventatious. A lot of good studies are coming out, like, and now what's kind of, people always were kind of quizzical. Well, there's not great studies on some of these compared to others. I mean, every, the one of pure brain nurses, BBC 157, that has some really good studies from gut health to liver issues, to tendon regeneration, things like that, but some of the other ones had, like, very limited data, so that's finally coming down the pike a little bit, and so that's how it works, and again, it's something that, the one thing I'll say about peptides, if you understand, is that they're not usually meant to be long term monotherapy, or they're meant to be usually a shorter duration, they should be stacked, which means you get, you get, you get more benefit doing them in combo with something else, and the, the total is better than the sum of the parts in terms of a lot of cases, and the other thing is you want to do, quote unquote, psych, and then where you do them for two or three months, maybe four to six months, depending on which one you're talking about, and then if you still have issues, you can switch to something else, but you don't want to be doing the same thing for two years, it's not, that doesn't work. Do you know why it doesn't work? I mean, at least from a side effect profile, I was hearing some other podcasts too, saying, you know, there's minimal to almost none side effects when using peptides, I don't know, you've seen something different. The, that's where the problem is, in the sense of, there's great studies in starting why they work, but we, there's nobody paying right now to do long term studies in terms of side effects, we're going based on mechanism. A lot of these products have, do what's called angiogenesis, which is increased blood vessel growth, and the people, the very, very, very, very slight chance that can lead to cancer and other issues. So that's something you still, again, we don't know, and we, we not know for years. So that's one, the, the immune peptide, you don't want to be stimulating and stimulating and stimulating your immune system, or that knowing what that also could lead to side effects, and then the ones that boost growth hormone, again, if you're boosting growth hormone in perpetuity, then you're going to shut down your natural perform, which is, you're cutting off your nose despite your face. So that's more medical assumption, kind of that, I don't say anecdotes, but that word, but we're assuming things based on what we know from other things out there. So, again, tag, I've had pharmacies who are kind of little, not the mainstream ones, kind of say, you just take them ever, but from the medical side, we know that a lot of these should not be, again, we don't, you don't do most, I mean, you don't do just often, they're, you do things protection from testosterone from, if you're doing a long term, you do things to protect the system. Why would you do is some that are strongly these? So it's right now, but just be careful. That makes sense, absolutely makes sense. Yeah. How many peptides are there? How much are you, how many are you dealing with? I mean, the, the ones that are mainstream now, there's probably 40 to 50 mainstream, there's some that you can get that are quote unquote for lab studies only in air quotes, if you can't see me, that are, have a lot of potential, but aren't really ready for prime time yet. I mean, the main issue that we'd find is when a new one comes out, you don't, it's hard to figure out dosing. dosing is a little tough because you just don't know where that sweet spot is. I mean, we know it is for BBC 157, but the some other ones out there, we'd have no idea. Now does each peptide have a specific receptor that you're targeting, or does it kind of just, you know, how does it exactly work in the body in terms of mechanism? They all work differently. So we have no idea. So we have a really good idea. Again, we know the growth hormone ones are either working on growling or artificial work on the growth hormone receptor. Those, that's easy A to B. We know how some of the, the, the thymus and peptides work. They're working on either the thymus, epineogland, the pituitary, things like that. BBC, we don't know as much. We know what it does. We know, but it's not exactly how it works. So it depends. We don't, they all work differently. MOTC, which has gotten really popular for work on weight loss. That works on the AMP, AMPK, which is getting a mitochondrial pathway, which is energy and weight loss. So they all have different, some have really defined pathways. I said, but some don't. Gotcha. Okay. And then in terms of forms, I know you touched on a bunch, which one's do your patients typically get? You said injection, oral, intranasal. The way some of our eyes to patients is in most cases, I prefer doing oral, I mean, not a real, I prefer doing either IV or injection initially for the first month. So I assume most of my patients have some type of gut issue. So if you're, again, they're not cheap, and that's something, I mean, they're not like $5. So if you're going to spend that much money on something, you want to make sure it works and get the benefit of it. And then I'll switch them to oral. If it's a localized pain issue, then we can use a cream or a pill a little bit more. If it's a brain issue, they're looking for either due of the brain pathology or just want to be a, quote, unquote, biohackram that have an optimized brain, that's what the nose brace will come in. There's also in one called diaxa, which is really great, which is a cream on the back of the neck that works really well. So it depends what you're using, of course, if using more systemically, then I like either the injection in the belly stuff, what we call subcutaneously, or some can be done IV. Yeah, I was reading that a lot of these peptides, especially BPC, have pretty long half lives, especially since it's from, you know, in the stomach, stomach acid isn't going to break it down. And then especially if you do IV, it'll stay in the plasma for a pretty long time, which is the benefit of that super cool, super cool stuff. So who should get peptide therapy? That's a, that's a weighted question. Um, I'm just not going to have to enter it. Uh, I mean, I get my thing, it's most in a vacuum who is easily available to everybody, um, who's an adult, there's something that they could use it for. I mean, either people, patients will have joint pain, muscle pain. I mean, I've seen the, the amazing things I've seen, even the last month from my patients, from patients who've seen, I mean, you're a rather, you probably still see it, the patients with the charts that are just thick. And they've seen every doctor and nothing's helped them. I mean, I had a patient here two days ago, who's had this horrible pain and, and then he's been on the medicine for peptides for like six weeks. And he's like, the first time I've ever had my bike in 25 months or something, over two years. And like literally like in six, in like six weeks. And he's like, I'm a new man. And it's like, so, uh, so, so, and then so almost everybody could find a used form in a vacuum. I mean, again, I'm sure the end of eating possibilities, the, the ability to help recover your mitochondria. Um, this should be given to a 10 year old, not really. I mean, but again, I think every adult should at least do the anti-inflammatory one one for kind of recycle beyond that. Again, it depends what your goals are, what your, I mean, this patient just don't want to take anything. But if you're into healthy lifestyle, those are the ones together. Um, BPC is a good place to start. So there's so many things. Absolutely. Now, are you only seeing functional medicine providers or lifestyle medicine providers work with peptide therapy? Or is this starting to, you know, spread across now to more, to more practices? It's starting to spread. Um, it's, it's definitely become more mainstreamish. Um, the dermatologist are using it now because some cosmetic applications, plastic treatments, um, a lot of the, um, ortho and sports medicine. PNR people are using it now because I use it like it's joined injection to set up doing like a quarter zone shot. Um, and or peer, there's, I know somebody's trying to do a study between this stuff and like PRP, which is, I'm really curious to see what happens there. Um, it's on PRP all over the place too. And you probably know that better than me. Um, so, um, yeah. So I mean, that's where that's where it's becoming. It's a family medicine doctor using it, probably not. But where it is, those type of use case scenarios has become popular. Are they advanced now? They're doing it. No, they know, okay, take this BPC or take this TV for and I think you'll feel better in two months. Yes, that's what they're doing. Sure. And I'm assuming, yeah, I'm assuming interns doesn't cover these things either. It's probably out of pocket. Not at all. No, it's not. Yeah. Right. Right. All right. Cool. Let's move on to the firm. Then, um, interesting compound that I was reading up on, but the name, I think, gets a little bit, you know, gets, gets, gets, gets weird for people. So why is the cost for everything? It is actually there is a relationship to sperm. I don't know where the name come from, specifically. I couldn't even, um, the poll, it's derived from origin in a couple other substances and it just got that name and it, but there is a relationship to sperm and, but there's no sperm in it obviously. It just, yeah. I don't know. I, they just gave it a bad name. It just, it got, right. It was not in line for a good chemical man. Absolutely. Absolutely. So why, why use it? What's the benefit of sperm and what is it? Is it a peptide? Is it just another supplement of molecule? Probably a mean, which is a, not a amino acid, but it has the same a mean group of scientists out there. Um, it, uh, does so many different things. Um, it's derived initially from either nato or wheat germ. Um, you can get some of you wheat, wheat germ or lentils or mushrooms. If you're a mushroom meter, mushrooms have so many benefits including that. Um, and then they work on so many different ways. It works, um, increase the natural oxide, which we're learning the benefits of. It, now we know that it helps. Um, due to a lot of the inflammatory chemicals, things called like NFK, but B is something inflammatory test that we do for patients of chronic inflammatory disease. We know that it can heal the gut lining. A steak came out on that last year. Um, what else to do? It, it may actually regulate the microbiome, which I raised aware of now. Um, we now, it's, you know, across the blood brain barriers who are now using it for, um, potentially some studies with Alzheimer's and other brain pathology. Um, it also has, um, for people who are in the anti-aging space, there's a kind of a checklist of, they call the anti-aging, the nine pillars of anti-aging. It actually does the most anti-aging things of any compound out there. It actually just kind of pass rapid mice and it does seven of the nine. Um, it does stem cells. It works on telomeres. It, um, helps on, works on a mitochondria. It does all those different things, um, in terms, in one little compound with very minimal side effect profile to it. So, um, there's some, they're not using it cosmetically. People are using in their skin care regimen, um, with their, uh, with actually that need. Um, it is skin cream. So it just has so many different possibilities to it. Um, well, that's a, that's a starting point. I mean, it doesn't, it's kind of a very molding mold. Absolutely. And it's gained, and I mean, it's probably since CBD became in simile pop like five or six years ago. Yeah. We both quickly pop everything like, again, let lay people were asking me about it. Not me just bringing it up. Yeah, it's very many. We have absolutely so many benefits again. If anyone wants to take a quick Google search, even if you go to spermydealife.com, I think that's like one of the main organizations for companies out there that are doing research. And, you know, I think Austria's where most of the hub of this research is, and I was reading their website, like 13,343 studies or something on spermadine, um, which is an insane amount. And, you know, Davidson Claire's on the board, um, for that as well. So, and some other heavy hitters. Um, so absolutely in mind. I mean, so now one of the things obviously is autophagy, right? And for the listeners out there. I miss the most important one that it actually got started using autophagy, um, but just by either taking or having enough of it through your diet, um, which is there be no important autophagy in terms of aging that block and limiting the production of senescent cells, um, decreasing information, all these different benefits of autophagy. Um, again, we know there's a relationship with autophagy or gender issues and inflammation. So, um, that's kind of where it got it's cool start from. They don't know the exact mechanism yet. Why does it? Um, but that's right now. And also one thing that's really growing is it kind of is, uh, they're now starting to look at it in terms of fertility because again, they know that some of the issues with infertility with the over in the eggs may be that they're not inducing autophagy and not recycling and so on. So that's some cool and most of this come out there in the last couple of weeks. You know, talking about infertility, I was listening to this podcast episode very interesting because they were talking about longevity back in China, like ancient China. And they had, I guess, these scrolls or written documents about how they were talking about men to gain a rousal, but to not ejaculate. And because of that, you would actually increase and they would think the spermedine in your body and actually gain energy, um, and just gain a multitude of benefits from it, right? And the podcast I was listening to was about spermedine. Um, so again, just a lot of interesting correlates, I think that we're seeing, um, from the past to now, um, but who knows? But for the listeners out there wondering autophagy auto-meaning cell, phagy-meaning breaking down, right? So that cell turnover, it's can be done with fasting, right? This is kind of how fasting started intermittent fasting or time restricted eating, you know, after 48 hours, you're trying to induce that autophagy, kill off the senescent cells and essentially have your weak cells die off, your stronger cells get stronger. Um, so in terms of spermedine and fasting, are you supposed to take it fasting or can you do it while eating? How does that work? You can, in theory, you should not take it during a fast. So either take it before you start fasting because technically in theory, you could have, I mean, especially for the really hard core fasting, I don't know if you'll call them the heads. You may induce insulin spike because of where it's made from because it does have that bit. So I don't have patients do it that way. Could you do it? Yeah. And in the, in the black, if you want, if you want to, black one, answer it right now. Right. So I mean, if you're doing it with eating, I'm assuming those mechanism or the pathways are going to override at least the fed state, right? Where you have that insulin spike and then you're not inducing autophagy? It's been fine. I mean, they tell you taking them what you can do it. If you don't have that patient, see they're taking them. Let me take a step back. So we normally have patients who they're taking them morning before they've eaten. So you're getting there, you haven't eaten yet, or we take it, haven't taken it that time. So you are avoiding that or just not the fasting question is not really you may break your fast. So you don't have a patient taking the middle of the day right after a meal, usually it's either morning or a bedtime. I've now switched and I've talked to some of the, had guys like I've talked to the guys, the two major companies, much over a name drop or you're not. Oh, sure. Yeah. Yeah, the screening life is priming. And those are the two major guys out there, one from here, one from Europe, both great companies. And yeah, they now we're kind of leaning towards the morning unless it has, it does work on chicadian rhythm. They don't, so that's the patients you have take at night. Otherwise, I've switched almost all my patients to take it right in the morning. Awesome. Okay. And I know this question about data constantly comes up, right? I want to remind people that you know, although I don't think there's a ton of human studies right now, there's some in the works currently, as I was looking up, and the data is still, you know, going through the data is getting read. But a lot of the compounds we look at, right? You look at turmeric, you look at all these things, it first kind of starts with anecdotal evidence, right? I mean, from all the podcasts I've heard, when you're over 50 years old is kind of when you start to notice the benefits of sperminine. And the other thing I should mention and you can tell me if I'm wrong here, but you're supposed to take it for at least two to three months before seeing any of the benefits. That correct? No, I mean, I've had patients do it for two weeks and see benefits like anything else. It also depends on the physician you are and so on and so forth. And what the problem is, I mean, I know people who use it, it also depends on dosing to be honest. And even the companies will admit it and they're working on it now that the dosing that's on the bottom now is very, very, very low compared to what the animal studies are and what we're they're heading in the pie the next year to 18 months, the dosing will be much higher. So that's part of the issue too. It just takes so long to build up with the dosing recommend on the bottle. But right now, go to the dosing recommend it by the bottle or by your health care provider. That's the little caveat there. Gotcha. Okay. Okay, yeah, going back to kind of what I was saying, you know, people who question these things, it's important to understand that a lot of research comes after we see some anecdotal evidence, right? When a lot of people take something and they see something work, that's where, you know, questions get raised and say, huh, how is this working? What's going on? Let's actually do some studies and either prove this to be right or wrong. And again, 13,000 studies off that website. It's pretty impressive. And so I'm excited to see kind of what the future holds in terms of the data and really showing the effects of spherid and the mechanism action and all those things. So going back to mitochondrial health. So we talked about NAD. We talked about peptides and we talked about spherid and what's your mental model for when a patient comes in? How do you choose exactly what to start them with? It depends, honestly, depends what's going on. I mean, it's that simple. It's almost like an algorithm in my head at this point. So if we're talking, I mean, pretty much you can even break it down to, if there's an illness versus the longevity type mechanism there. I mean, if you're talking about, you know, the simple part, if there's somebody who's just trying to be longevity and be healthy and more lifestyle vein, that's where you're going more for spheridine. That's where you're using the might what are called, what are called mitochondrial peptides that Matt see I mentioned before this new one that has some really good potential, which is kind of like the way it describes like a 17 year old driving driving a variety at this point. We're not sure exactly where it's going to go, but it usually turns out well. So that says 31. So that's where I'm going with that. And then for everybody, I think everybody now should be doing red light therapy or photo biomodulation. The data is just incredible coming out again. That has a new study every day that is incredible. So that's kind of where I'm leading for that. And then the other case, like you said, if somebody is ill or chronic fatigue or phymaelgia, that's what we're kind of, like I said before, you're kind of trying to build the foundation again, you're giving them the things they need, you're giving them NAD or NMN, you're giving them ALI, which is aflipolic acid, you're giving them the four or five quart of exaflipolic acid, carnitine, resveratrol, ribose, in some cases, sometimes you need to, obviously, coq10, pqq. The one, some of those substance are people now have become more mainstream as well. You need to build the foundation up first and then you can add in the cool new toys, the peptides and other stuff. So it really depends on where they're coming from. Gotcha. Now, most of your patients that come to you, are they on statins or are they on other medications that may damage the mitochondria that you're worried about? I have a very healthy population, just because it's where my practice is skewed a little bit. Two years ago, the answer would be yes. Now, it's not as much. Most of my, so, but, a lot of them are on medications that may do that. If they are on them, then it's kind of a, it's a scale type of thing. I mean, somebody who has a high, somebody who comes in the cholesterol 700, you kind of got it, again, like I tell patients, you have to do certain things. I, and I, again, this may sound cockier, conceited and mo, there's so many things out there in my last two or three years. You can fix a side effects. You've got to still fix the big stuff. So I need to give you some coq10 or give you a shot of coq10. I can do that. You need to protect your heart. Absolutely. That works. So I love the natural stuff, but sometimes you still got to do what you got to do. Yeah, 100% with you on that. I mean, every episode on the show, I think we're always talking about the foundations, right? I mean, if you're not eating well, you're not sleeping well, you're not getting your movement in, you can't, you know, control your stress, then these products, you know, these supplements we're talking about, aren't really going to touch you as much, right? Like, you have to, as Kelly Starrett, one of our guests who just came on last week, what, you know, he talks about getting to base camp, right? We all want to climb out Everest, but let's get to base camp first. Let's get a solid foundation, and then we can start to optimize these things, right? And I think that's the, that's the key word. Now, is it possible to get these through food? It's obviously sperminine we talked about, but do we get a sufficient amount, or do you think, like getting a pill form is the way to do it? It really depends. I mean, the, the, the, the battle, I mean, you technically, you can get Resvera Troll through one, some other foods, trying to think. I mean, any deed, no, I mean, again, it depends, we're talking about any deed, not really, you know, Coke, you tend, and I mean, again, a lot of this, it's hard. I mean, basically, do two thousand, you can, like, saline, and zinc, and those types of things, you can definitely do, um, just going through my head really quickly. Um, yeah, a lot of the amount of conjures, I mean, the B vitamins, I was, you can get, but a lot of the core ones, not as easy, especially with what people are going through now, like you said, between stress, and the, the lack of sleep, and so on, a lot of times, they, they just need it. I mean, especially here in Manhattan, where you have just between the lifestyle, and the, and the smog, and hence, and whatever it's just, yeah, we'll be different than if you're living on a farm in Iowa, we have fresh air, and stuff like that. Absolutely. Absolutely. And again, these things aren't, you know, five bucks, they're, they're the pretty expensive things, and, you know, hopefully in the future, again, as it becomes more mainstream, we'll start to see those prices come down, and more people using it, hopefully one day, even insurance, might even cover these things, but you've got to get that foundation down first and foremost. So I want to go back into the kind of longevity, anti-aging, you mentioned red light. So, how do you recommend people do that? There's so many different things out there, just for the head, there's for the face, there's full body panels. What have you kind of seen the results of your patients? I mean, the simple answer is, if you have one thing right now we're finding, it's the full, it's the full body panels that have both the red, the infrared, and the near infrared frequencies. That's what you want, because they do, some do superficial, some do deep, so you want to get a combination of both. You want to also, certain frequencies target the brain. I guess on IG Live I just did, you want to be 800, 850, specifically target the brain, probably even somewhere low, and there's a bunch of, I think it's like a race now, there's about four or five things coming out specifically, targeting the brain that should be out by the first quarter next year, which would be really, really cool. I'm going to, I'm going to, I'm going to call violates running a bunch of studies now in terms of Alzheimer's and Parkinson's with the red, photobiod modulation or red light. So, in a vacuum, the panel's the best. The face mask, I actually was talking to somebody who does a lot, even who rests one of their big niches, and their concern is how deep the red light's going into. It's great for superficial things, but it's not really curative for, you're not, it's not the same as, for the full body benefit of red light therapy. And again, the wraps are good. I mean, there's a couple of wraps that I recommend to patients if you have a local injury, like a shoulder or a knee. They're much more convenient, because again, you get it right localized in that spot. The thing with the red light, no matter what, is you want to make sure of how strong it is. I mean, now, everyone in fact is putting that on there. If they won't tell you how strong it is, don't buy it. They don't pay how much he and after is. There's some of the earlier ones that had some popularity, had a lot of EMF issues, so they're not as popular anymore. And also, you want to look at the flicker rate as well. So, those are three things you always want to look at, ask the, either look on the website or talk to the rep for the company. If they don't answer or they avoid the questions, you care if there's so many good ones out there now, then just move on. Gotcha. Gotcha. This is interesting. So, I mean, I think a lot of this is, you know, touch on the mitochondria. But when we look at anti-aging, do you think the mitochondria is the number one priority that we should be targeting? Or are there other, you know, cellular function? Yeah. Okay. Right now, mitochondria is number one, two, and three. Okay. And then you get into the things of, but it kind of relapsed. Again, like you mentioned, information, the three other things that kind of relapsed, you know, information, oxidative stress, and senescence, which is still, if we're getting a hold on still, in terms of a lot of different, in terms of, that's, in theory, not ready for prime time yet. I think it'll be ready soon. A lot of things that are out there. That, over last mitochondrial health, so it's kind of, I get everything, it revolves around the mitochondria, because it's everywhere, and all those processes, on go, go on there. So, you need, if you don't, if you mentioned life, exercise, sleep, and so on, that, that to me is, the paradigm is kind of flipped, that it used to be, if your brain, if your memory is going, okay, we're going to focus on the brain, and fixing the neurotransmitters in the brain now, it's like, we just fixed the mitochondria here, and fix your gut health here, that'll make everything else work better. We've gone much, more big picture, which is, we're functional, and it's good, as opposed to just trying to treat a problem, treat the cause, and finally, things are slowly, it's like moving the Titanic, but it's getting there. That's health care for you, right? I mean, slow and steady, hopefully, but you got to have some leaders out there that are willing to break some barriers, and like you said, I mean, yeah, treating the gut, treating the mitochondria, the whole body is connected, right? I mean, we've known this, and we still know it as we go through medical school and stuff, but yet, there just seems to be this disconnect, once you get to residency, and onwards, and you kind of get stuck in your ways of how you were taught, right? And it's hard to kind of break that out, but now, with different modules, functional medicine, lifestyle, medicine boards, integrated medicine, there's so much out there now, where we can kind of take control and learn it for ourselves. So Dr. Paulament, in your own lifestyle, what are those non-negotiables? I'll put that in your quote, because I know, you know, we're not, everyone can do everything, every single day, but what are those routine things that you're doing for at least longevity and anti-aging? Let's say, I guess it all the time. I do supplement a lot. I just actually had an IV right before we had popped on here. I'm an NAD junkie, either NMN or NAD. I love my red light. I try to fast. At least two or three times a week. Sleep, I've been, I'll admit it, I would, I try, I don't get the hours I should be getting, and I'm trying to really, again, I feel like, I'm going to, like, move into the Titanic a little bit, but I'm at least trying to maintain my circadian rhythm, which we're now realizing, it's almost as important as, how you sleep, or when you sleep. So I'm, at least trying to do that and get up to get more sunlight and doing some of those things. So that's what I do. And then I'm really, now that things are opening up here, it was hard. I got sick of doing those Zoom workouts, and everything else admitted, like, I get out of other people, popping that peloton, but I got older after a while. But, nature, I'm really trying to get to the gym, do sometimes, exercise like four or five times a week, because we just, the benefit of muscle, all the muscles in the myocons, the chemicals that the muscles produce, have so many benefits, BDNF, and all these other stuff. Sure. Absolutely. Yeah. You know, you're not taking BDNF. These are all results of setting the foundation, the exercise, the sleep, the movement, all those types of things. So, absolutely, absolutely. So, what's, what's the next for you? You're always on the cutting edge. I mean, you're, you're practicing biohacking. What are some of the things you're excited about? Let's see. There's a bug. I mean, right now, I think there's a couple really cool things coming down. I am, in terms of peptides, peptides are great. There's still some limits to them, and unfortunately, the FDA is coming down on them. They're trying to, there's some five I can think of have been banned in the last six years or so, but you can't really get in the U.S. anymore, but offshoot that is what are called bio-regulators, which also work on specific organ systems. And I know I've just started dabbing with them. I have other colleagues who have really done a deep dab in the last year to 18 months. They came to us from Europe and Russia, and they just have, I've seen even additive benefits in terms of, by joint patients, in terms of my neurodegenerative patients, in terms of, it's more problem-based things, and it's supposed to just longevity, except for a molecule, it'll be able to talk about called epitolom, which is may length and telomeres. But that's, I think you're going to have more and more about those in the next year to 18 months. I'm really excited about that. I'm excited about, I mean, it's for me, and this is again, I'm really, I think that's going to be really cool. I like the fact that two of the things are the testing that's coming out now. It's great to, again, all of us say, it's tasked you so you know, and a lot of these things we kind of guess at. So, again, like I mentioned, the NAD test is coming out. Now, this senescent tell us, a senescent cell test that's coming out in the next couple of months. There's a, a hormone called clatho, which you're probably hearing more and more about, which has anti-aging possibilities and also weight and other things that, we know that patients, such as, came out last week or two, those have less, increased risk of brain issues like dementia and weight gain. There may be things that can treat that. And then the other thing that I said, I'm a tech junkie, and I think a lot of the stuff that I'm fortunate that was kind of backlogged because of the pandemic, now kind of all got released in the last couple of months and they're coming out early, like quarter one next year. Again, I treat brain amount of conduct, kind of become like two things, and then like I said, I mean, the red light helmets are going to be coming out and all these new head gadgets that are designed to optimize brain health and we can assess the brain, and actually kind of know what's going on. I think that's going to be the next level. And also the last thing I'll say, and just going to prove a couple of weeks ago with the FDA, which is amazing, is a VR. So you could take the VR set and back pain, which I actually saw the unironic gloves actually having my practice the two weeks before COVID, the rep came in, and then disappeared because unfortunately, they ever got approved. But now they've got this new VR set, just by watching these, see their calming scenes with some meditations involved, or now, kind of enjoyable things. It recycled, it grabbed recycled. They reset some of the brain and the neurochemicals, and the patient's back pain diminished like 50%. Well, when you've been, especially pain with them, do you know better than me, if I don't have to give somebody, I'd stare at your purchase set or whatever, and I think I don't wear cool goggles, and especially now, it's going on with like the old technology and the meta-version, all that stuff. So I think it's just about to bring it up. Yeah. VR and all that stuff, I think, is going to be the future, because it was, it was, it was come before, and now, I think people were ready, I mean, I think it was about five years ago, and people weren't ready for it yet. Now, that is going to be what, where the next step is. Oh, 100%. It's, it's literally crazy and same times when we think about the integration of everything going digital AI with physiology, even like, right crypto and money, and everything is just going digital. And, I think, yesterday, I saw some news about the, the robots that can regenerate, and now, they're looking, like, they can self-reproduce, and they've never seen anything like it, and now, they're thinking about the implications for that in terms of tissue regeneration stuff. So, absolutely wild. So, 3D printing, and you're good to go. Right. Absolutely. Yeah, there you go, right? So, for the healthcare providers out there, Dr. Pulvitt, I mean, you obviously have a wealth of information. What resources do you recommend healthcare providers go to if they want to become, um, more knowledgeable in terms of longevity, anti-aging, and kind of just biohacking? Yeah. And, there's a couple. I mean, it's definitely, you want to get, a lot of these are not, like I said, some of them are very basic. Some of them, you definitely want to work with the provider, or an organization that's really good at, kind of organizing things. I mean, traditional functional medicine. I mean, IFM is still probably, it's still functional medicine, it's still the core. Um, I know, I went through the fellowship through a company, an organization called A4M, which has a fellowship, just a general anti-aging fellowship. I know, a while has a more, Dr. Wiles a more holistic one. Um, they also now are several peptide fellowships. I'm out there. Um, also I'd recommend somebody I've taken a lot of this course, if you want, really high-end, if you're ready for it, Dr. William Seeds, S-E-D-S. Um, he puts on a clinic. I mean, he does a lot of, so it's not ready for prime time yet, but has really good ideas. Um, and that you could, if you're, if you know that he said, if you know your biochemistry, you can use in your practice every day. Um, so that's kind of, more of a higher. And those are the places to look, Spurmedine, like I said, both the websites for primedine and Spurmedine, like, or have insane amount of resources, um, that they'll reach out to you. I mean, the owners, or, uh, like, I know the owner of prim, actually, the owner of primedine, uh, the last name is Kenny. I think the first thing I've taught my head. I mean, she can, like, I've had her on, I gelat, I've had her all of the social media. And she can answer any question. And, and though, she'll answer anybody's, they'll give you any answers. That's where you go. Go to the companies. They're not trying to sell you anything. They want to get the information out there, which is great. Yeah. I mean, they're, luckily their business is going well. They just want to get the information out there and give you the right information. And they'll tell you what studies are going. They'll talk to you about dosing. So just go, and that, those are the ones, usually say, reach out to the companies. And, you know, you're going to get the idea, and I could always point in the right direction to edit that type of stuff. But, it's great, it's growing and growing. It's just, finding the person is not trying to make money off you, and it's going to give you the information that you can actually use. And that's just going to be buy a $5,000 membership. Exactly. Yep. It's a wary space, right? And it's good to hear, at least you kind of promote them and say, like a trusted company. But I know you're putting a lot of content out on Instagram as well. So tell us where our listeners can find you if they want to follow your journey and kind of learn some of these biohacking tips. Yeah, sure. I mean, the best place to define me or, I mean, right now it's Instagram. I'm really restarting, hopefully, 2022, the YouTube channel. We have a bunch of videos that we just shot that are kind of everything from simple to a little much more deep dive. And then, check out the blog. We're going to be putting, we put a lot of the newer articles in there. Like, there's once a month, we'll say, this is a new, cool stuff that's out there. It's just, I mean, I can't answer any medical questions. I get, at least kind of the same data, like I said, to general question, where to find stuff. I'm glad to help people out as much as I can. Me and my assistant will kind of point them there as we can. Absolutely. And we will link all those in the show notes to your Instagram, your website, everything. And then, last question for you, Dr. Paul, we ask everyone is, how do we put the health back in healthcare? Break it. Break the system down. And start over again. It's, it's gone to the point where, it's like you said, it's, it's just broken. I mean, I, I guess I, I see the light in until finally that some, that, yeah. It's people are realizing it starts from the bottom, it starts with the foundation and, and build it upwards again. And it's not just, on taking medications for the side effects from other medication that you happen to be taking. And again, it's, the simple thing is sleep, exercise, walks the diet, and the health will follow. And then, talk to your doctor, your healthcare provider, for the little things you may need. But it's not something, you control your healthcare, it's not the doctor anymore. Absolutely. Yeah. Couldn't have said it better. Awesome. Well, thank you so much, Dr. Paul, and I'm super, grateful for you coming on here and educating me, educating the listener. So thanks. Cool. Thanks for having me on. That was fun. And that's a wrap. Thanks for tuning in, you know, the field of longevity and anti-aging is the new hot topic and the realm of medicine and science. And we're seeing researchers find new information daily from new biochemical pathways that our bodies producing to new supplements that might target things like mitochondria and inflammation. In the next five, 10, 15 years, we're going to see this huge boom and we're going to learn truths that we've never explored or understood before. And so, my call to action for all of you is to understand why you may want to live longer and why you definitely want to live healthier, right? How do we improve our lifespan and our health span? And understanding those motivations and incentives is critical to changing our habits. It's because of our relationships, our kids, our spouses, our parents, we want to live longer for them. We want to live healthier for them. It's because we are excited to see what the future holds in terms of the world, the rapid progress that it's showing, the virtual reality, the unknown that we have. No idea what might be out there, but it's truly exciting to be a part of. So, really sit down, understand why it is that these things matter to you and how can we change our current habits so that we can further progress to better versions of ourselves. Now, as always, the medical disclaimer. Everything in this podcast is for educational purposes only. It does not constitute the price of medicine and we are not providing medical advice. No physician, patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you see the guidance of your personal physician regarding any specific health-related issues. And for doctors, the story has changed. Visit financialresidency.com or slash LocomStory to see if a LocomTenance assignment is right for you. It's here you'll find the unbiased answers you are after, so you can decide if LocomTenance is your next chapter. All right, everyone, if you love this episode, please share it with your loved ones so that as a team, we can improve our health span and life's length. Please rate, please review, and please subscribe so that you can keep up to date with all the medicine episodes. And we will see you next week with another Lessons Learn. Have a great week. .