Let's Talk Local Podcast | Empowered Health: Simple, Smart, and Within Reach

00:00

Speaker 1

Alright, I'm really looking forward to exploring this entire episode with you. The reason that I wanted to interview Doctor. Agarwal and Mathew Lindenmeyer, a physical and rehabilitation specialist, is because artificial intelligence is drastically and rapidly changing the entire medical industry. The way that we take care of our bodies, the information that we're able to learn about ourselves before seeking any type of treatment is changing swiftly. And because I'm predisposed to a few things that a lot of my genetic testing showed me, I really wanted to bring it to your homes.

00:41

Speaker 1

There's different tests that you can have run. You can approach your doctor and make sure that you're understanding the fulsome parts of your body, your health, and you can run things through different types of AI, whether it's Grok or ChatGPT, to ensure that your supplement routine is not conflicting with natural parts within your body. Either way, I just think this is a good episode that will help open your eyes, it will help you take control of your health, it will help you understand the landscape in which it's changing very rapidly in front of us. As an example, the one particular reason that I had my genome sequence ran through New Amsterdam was because I have extreme muscle stiffness and soreness after workouts and it's been a huge part of my life to be active and physically fit. But in really pressing my concierge doctor, Doctor.

01:41

Speaker 1

Froedter, to have my genome processed so that I could have that full understanding of it, I was left with this understanding and insights to what Brody's myopathy is or Brody's muscle syndrome. And it's pretty rare, but then it helped me understand the regimen that works for my body. And if you or your family have some type of predisposition, me, I'm adopted. I've never met my biological father, don't know who he is, so there's an entire part of my DNA that I just have no understanding of. I used to have a 23andMe, I've since deleted it.

02:21

Speaker 1

But what someone mentioned to me, which I believe is really interesting, is that if you had your kid's DNA ran through 23andMe, if your child had any desire of serving in secret service positions or some type of higher military capacity or I guess country leadership, the type of risk that those people would be predisposed to if that information was readily available through something like 23andMe, it would exclude them from being a viable candidate because a lot of the weaponry that's being actively explored today is that which relates to specific genetic targeting. So you can wipe someone out pretty quickly by having an understanding of what their genome is comprised of. Again the reason I wanted to record this particular episode was because it's an interesting dynamic and shift that's before us. You see someone like Matt Lindenmeyer who is hands on working with his clientpatients to ensure that they're being treated as best as they possibly can but whatever type of genome data is handed to him doesn't really or materially shape the way he interacts with his clientpatients. Yet someone like Doctor.

03:51

Speaker 1

Agarwal, he can absolutely use gene site mapping to ensure that whatever type of prescriptions are prescribed to his patients are actually prescriptions that are going to work well with whatever their predispositions are. Their genetic makeup, it will actually process and metabolize in a friendlier way than just going through basic trial and error which was kind of the way that people have done it in the past. By the way I hope you find this episode to be really useful. I absolutely love the science and if you have any questions feel free to reach out to us. Gentlemen, it's Friday.

04:46

Speaker 1

I'm so happy you're here with me. I have Doctor. Monique Agarwal who was my mother's concierge doctor. My mother has since passed, but I'm so curious to delve into a lot of the specifics that you work with on a day to day basis. And then I have Matt Lindenmeyer here who's been an angel and a godsend to me.

05:04

Speaker 1

He's a rehabilitation and a fitness specialist and has helped me in wonderful ways. So the combined expertise of both of you gentlemen is what I really wanna delve into today. Thank you for being here.

05:17

Speaker 2

Perfect, thank

05:17

Speaker 3

you for having us Yes. Glad to be here.

05:19

Speaker 1

Manik, I loved walking into your office because as you know, I belong to a concierge clinic myself with Doctor. Froedter and all that. My husband is at M Squared. And so I'm pretty well versed in the concierge space. And you were, like I said, just so wonderful and patient with my mother when at the end of her life with dementia and Parkinson's, it was the biggest blessing.

05:49

Speaker 1

So thank you.

05:50

Speaker 2

It's my pleasure, thanks for trusting me.

05:52

Speaker 1

Yes, absolutely. In both of your realms of more boutique relationships with clients and patients, do you find yourself speaking with more people who are very interested in genomic screenings to have an understanding of what their DNA is presenting and how you can work with it?

06:15

Speaker 2

Yeah absolutely. So a lot of the things that we try to do in the office is to figure out what the diagnosis is and what's the best treatment for the patient on that particular day. And it turns out that not everybody responds to the same therapies and not everybody has the same diagnosis or they're not all diagnosed the same way. And so when we use the word genomics, I try to kind of take a step back and say, how do we make this personalized for you? And how do we stratify you in terms of your risk?

06:38

Speaker 2

I've got some patients who have an elevated cholesterol, but they never have heart disease, and I've got other patients that have the same exact elevated cholesterol, and they've got a lot of heart disease. There's something going on behind the scenes and it's our job to now utilize the science to say, this is why we have to be much more proactive with you, whereas for yourself we can kind of lay low. And so that's to me where the personalized kind of precision medicine comes into play.

07:00

Speaker 3

You know, with the the people that I see, that's not the thing that I'm looking at because I Sure.

07:06

Speaker 1

Of course.

07:06

Speaker 3

Primarily with, you know, soft tissue and and how the body moves. Mhmm. And but I will say that when it comes to you know, I always talk about pillars that we're trying to focus on with fitness. And that's, you know, how can we control sleep? How can we control, nutrition?

07:24

Speaker 3

How can we control stress? And then the exercise bucket gets gets to be pretty big. So I focus on those four things initially. And once we make strides in those, if we still feel like there's areas that are deficient or there's areas where we are progressing the way we'd like, then that's where I would refer out to a physician, somebody that's more knowledgeable about the genomic space. Because, you know, I'm a firm believer too in being an expert in what you're an expert at and then referring out to quality people when you're not.

07:58

Speaker 1

I'm really advocating for I guess a bunch of my friends and telling them, you all have to start here at the genome level. It'll really help you understand what you're predisposed to, what's right, what's wrong. And the way this even came up for me was back whenever 23andMe launched, that's whenever I found out that I had some predisposition to the Factor V Leiden mutation, which is not great. And after that, it's kind of been a hobby of mine to become more well versed in how that prohibits me from doing certain things or not. And now it's the Brody's muscle syndrome that is aggravating.

08:45

Speaker 1

My body basically has a whole bunch of ripples after I work out, doctor. The amount of pain and pressure that certain massage therapists have to apply to my muscles to experience any relief is abnormal. And it's just so much. That's why I pushed my now doctor to say, how can I figure out exactly what is going on with my muscle tissue? I just want an understanding of a full panel of it all.

09:14

Speaker 1

That's when New Amsterdam came up in the practice. So do you proactively offer this to your clients? Is this part of a regular conversation?

09:27

Speaker 2

It is in terms of organ specific things. So I haven't gone through the process of New Amsterdam before because that's a comprehensive analysis of the genome. I think the struggle that I've seen with those analyses are we don't know what to do with some of that information. It's not always actionable. See.

09:42

Speaker 2

And so when I start ordering those personalized tests, order them specifically for heart disease, specifically for cancer, and specifically for the risk of Alzheimer's disease. And so that's a lot of risk stratification. So I had a patient recently in the office whose mom and dad both had Alzheimer's. He's 60 and he's feeling some memory loss. That's a big conversation.

10:02

Speaker 2

If I order this particular test on you, we will know if your risk of Alzheimer's is the baseline risk or if it's 10 x.

10:09

Speaker 1

That's

10:09

Speaker 2

right. That's a philosophical conversation at that point. How much do you wanna know? How is it gonna affect your life?

10:13

Speaker 1

That's

10:13

Speaker 2

true. This particular patient went through with the test, had the abnormal gene, and now is really starting to shift the way he thinks.

10:19

Speaker 1

That's right.

10:20

Speaker 2

Right? In terms of what he wants to do with his kids, he wants to do with his business, what he wants to do with his day to day life.

10:24

Speaker 1

That's right.

10:25

Speaker 2

Because he knows that at 60 he's okay, but 65, 70, or what age? And so that's where I order more organ specific genomics as opposed to a comprehensive panel.

10:35

Speaker 1

And for me because of the outcomes of my screening or my panel, I realized that I am at high risk for some gastrointestinal issues, colon issues. I went and I had a colonoscopy and I had three precancerous polyps. I'm at 40. I mean that's, I was so grateful for that. And so for me, that's I think why I'm such a believer in this stuff, and now it helps me to have a better understanding of my own work.

11:04

Speaker 1

So okay, alright, this is good to know. This is good to know. And the age bracket of people, Matt, that you are particularly dealing with, What is your what is your I I know you do a lot of work with kids as well, but I'm saying your practice, what is it comprised of age wise?

11:23

Speaker 3

Oh, I'd say the most the mean age is probably somewhere in the probably mid sixties, early sixties. Ah. I see a lot of people probably in their sixties and seventies. And I think part of that is, you know, you as you get older Yep. You have you know, you reach a stage where you've tried a bunch of different things and your body really just stops working the way you want it to work.

11:54

Speaker 3

And you've had enough time to accumulate potentially some bad movement patterns, some bad lifestyle decisions have compounded. And next thing you know, you you wake up one day and it's hard to not just be athletic, but just move around in your daily life Mhmm. And, you know, participate with your kids or your grandkids maybe in this case. And so and then you start to try things. Yep.

12:20

Speaker 3

And I I feel like when I start to see people, they've tried a lot of different things that might not have had the benefit that they were looking for and they find their way to me at some point. So, I'd say I'm I predominantly work with people at this at this point that are in their sixties. But, I've, you know, I've worked with I've worked with some pro athletes. I've worked with some high school athletes and some younger people. But, my sweet spot's probably in that, you know, sixties and seventies range.

12:49

Speaker 1

Matt, can you tell, Shannon, what some of the kind of the disciplines of study that you focused on and why you have this breadth of understanding that I just haven't encountered before with a lot of my other rehabilitation and physical specialists.

13:05

Speaker 4

Worked with some really great people when I started, started working in business that taught me a ton about kind of assessing the body and you know, how to look for weaknesses asymmetry, really focus on quality, movement patterns and how to really get people to learn how to train and make those movements as strong as as humanly possible. So learned a lot there and I got, you know, licensed by the state in massage therapy, but you know, I've taken muscle activation techniques, I've taken active release techniques, I've taken integrated kinetic neurology That. Which is where I a lot of the current I've used it to kinda help that current modality to kinda help with a lot of the newer isometric positions I get people in. Mhmm. But it's a blend of it's a blend of a lot of different modalities, studying a lot of about, you know, the mechanics of the body, how how joints are designed to work and then just kind of coming up with a framework and being creative, trying to be creative too with individuals with where they're at and and how to get them to respond to what I wanna do, do a lot of soft tissue work, but Uh-huh.

14:43

Speaker 4

I still feel like movement is king and I'm I'm doing this type of work, especially in like Sarah's case, I want her heel to work better. I want her subtailors to work better. I want her trunk to be able to rotate more and all the things that I'm looking at currently in this one acute moment in time. But ultimately I'm doing all of that to prepare her to get up and move on her feet better and teach her how to be more efficient and stronger the movements that she's designed to do which is squat, hinge, push, pull, flex, extend, and rotate because if she can do all those things well, she's gonna be feeling pretty good and able to do pretty much whatever she wants to do in life. So the movement piece, which is what I transition everybody into the movement piece is going, okay, I gotta be able to fully maximally load my limbs individually to the best of, you know, everybody has a kind of a an individual ability to load that wherever they're at on the on the spectrum.

15:49

Speaker 4

So, Sarah's case, I'm trying

15:51

Speaker 3

to get her to load

15:53

Speaker 4

her limbs in in every way she possibly can safely so she can get stronger, gain more mobility, gain

15:59

Speaker 3

more

15:59

Speaker 4

agency in her own life. So the therapeutic arm which is this is just one piece of trying to get somebody in a position where they can move better. Oh, there we go.

16:14

Speaker 2

That feels much better. So as a concierge doc, I take care of people as young as 15, just at the end of high school. Oh. And my oldest patient's 101. And so I see really everything from start to end.

16:25

Speaker 2

I would say my average age is probably late 40s, early 50s, and that's consistent with me being about ten years out of practice.

16:32

Speaker 1

So the

16:32

Speaker 2

goal is over the next twenty five years that these folks will grow with me as I get older. I would say majority of my patients, probably two thirds are male. I would say about half of my patients see me once a year because things work quite well, and the other half of my patients see me multiple times a year because they're either very proactive and they're making lifestyle changes and wanting to get labs done more frequently, or they're just chronically sick people. And we know we need to be on top of their medications and monitoring images and so on and so

17:00

Speaker 1

Okay, so two thirds are male. So do you do any work with women and their hormones?

17:08

Speaker 2

I do. So I've started checking hormone levels over the last couple of years because the more that we learn about hormone deficiency, the more we realize that it affects more than just your mood or more than just hot flashes. It turns out it affects your sleep, and it affects your drive, and it affects your blood pressure, it affects your cholesterol, and so on. And so where I start my practice in terms of hormones is I'll assess the hormones, I'll identify a deficiency, and I'm comfortable managing the early stages of hormone therapy, so patients on estrogen or progesterone. I've got a lot of men that take testosterone and manage all that very comfortably.

17:41

Speaker 2

Once I handle that portion, if the patient isn't doing as well as they need to be doing, that's when I know what I know and I know what I don't know, I'm happy to refer out to a specialist who's gonna help with hormone management. On the male side, that's certainly in my wheelhouse, and so patients that are taking growth hormone, HCG, testosterone, estrogen blockers, that stuff is really important, but for all the listeners, I would really encourage them to go to a trusted doctor to manage it as opposed to a men's clinic because unfortunately those are not as well run and they're not as well monitored, the patients are not. And so I've had patients that have had poor outcomes due to excess amounts of testosterone. Or I've had patients that have had fertility issues because they weren't on HCG at the time when they were taking testosterone.

18:24

Speaker 1

How is it that you work with kids, let's say our youngest, or your youngest son's age, my oldest son's age, when it comes to training, because I know you're constantly like, uh-uh uh-uh. They should not be doing this at this age, they should not be doing that at that age. Talk to me about how you approach prepubescent young boys or girls, and then how you approach someone who has a hormonal shift much later in their Yeah.

18:57

Speaker 3

It's interesting, especially in our culture in Dallas.

19:02

Speaker 2

Yep.

19:02

Speaker 3

We have a very sports forward, sports centric environment for our kids, and they're encouraged to specialize earlier and train earlier. And I'm just not a big fan of prepubescent children putting excessive loads to their body to try to build muscle when they're probably really not, you know, physically and genetically and, you know, ready to do that. Yep. So I'm a more of a fan of encouraging kids that are are boys' ages to play a lot of different sports, run, play, you know, climb, sprint, do all the things. I have worked with my 12 year old on, you know, some body weight movements just to kinda work on having an idea of how to control his body in space.

19:56

Speaker 3

Yep. But that's controlling his body. I'm not adding any external loads to his body. And I do think that there's value in that. I think that there's you know, I'll touch on it at some point, but there's some basic fundamental human movements that we're all designed to do.

20:13

Speaker 3

Not my opinion. It's just how we're made. Yep. So if we can get our kids to just be really good at doing those movements Mhmm. Just with their own body weight, they're gonna be set up for success later when they actually do start training with loads more.

20:32

Speaker 3

Now when they start reaching 14, 15, they start puberty, they're actually, you know, have increases in testosterone growth hormone. They have the capacity to build muscle, then I think that's when you can start having a conversation about what that should look like.

20:48

Speaker 1

What about kids who start puberty at 12? Because there's some of that out there, as you know. I mean, you know, right, doctor? It's How does that change the conversation for those parents and kids?

21:00

Speaker 3

I think it definitely makes it a little bit more of a conversation when they develop earlier. Yep. I still look at it though, you know, I'm very conservative when it comes to training, and I'm I just I'm very wary about the application.

21:16

Speaker 1

Mhmm.

21:16

Speaker 3

You know, there's a very there's a there's a range that, you know, people should train in based on the their individual abilities. That's something we can discuss more later. But I'm just a little bit concerned with young kids, even if they start puberty early, of knowing having the guidance and the coaching of knowing how much load they should put through a young body Mhmm. Even if it's starting to develop early.

21:42

Speaker 1

Why do you think we see so many darn injuries in kids who I mean, there it's crazy to me. But the amount of exercise, athleticism that's demanded, required, it just seems like it's so much more advanced and part of today's culture than it was when I was a child. Again, I wasn't raised in a hyper competitive hub of the world, but

22:11

Speaker 3

I think sports specialization is part of it where these kids don't have an off season. And they play, an unbelievable amount of of games. And especially, you know, because of the sports culture here and the climate Mhmm. Outdoor sports kids play all the time. Yep.

22:27

Speaker 3

I mean, I'm looking back to when my kids were younger, and they're encouraged to specialize at nine years old. Mhmm. You know, I don't wanna say back in my day, but we used to have seasons and you would play. Even if you had a favorite sport, you had a there was a seasonality to it. And you would you would you play football or whatever your fall sport was.

22:46

Speaker 3

And then you'd you'd had a good time with that. Then you transitioned to your winter sport, and then your spring sport. And then you maybe you took some time off in the summer. And your body just not only did it have a chance to recover, but it had a chance to get into a different set of movement patterns because you have different sports that require different loads, different velocities on your spine or your hips or your knees, different ways that you move side to side. Some are more have a lateral component.

23:15

Speaker 3

Some are more straightforward. And, you know, it's it's a bigger it's a bigger concept than just, oh, I need to rest. It's you can theoretically rest your body from one sport to the next because you're kind of moving it in different ways. Mhmm. Now, though, heavy sports specialization, kids are training, you know, good or bad at a younger age.

23:37

Speaker 3

And I also just think as you look at the sports spectrum in general, kids are bigger, stronger, and faster, and they just are able to put more torque on muscles and tendons that I think we're seeing just don't always have the capacity to handle that that stress. And they they break.

23:56

Speaker 1

I mean, do you think kids are bigger, stronger, faster? Or do you think we just have a concentrated amount of hyper athletic families that have gravitated to one particular place in America, who push that on their children? Is that? And I'm in what you have to say about this.

24:16

Speaker 3

I would say that in my observation, I think that it's more I think you're seeing it across multiple cities and multiple places. I don't think it's just an area a Dallas Mhmm. Moment. I think if you looked across, you know, especially the major sports states, California, Florida, where you have great climate, lots of people doing it, I still think you're gonna see a propensity to have greater amounts of injuries. Mhmm.

24:44

Speaker 1

Yeah. I I agree with that. What about you, doctor? What are your insights?

24:49

Speaker 2

So I've got patients that have young kids, and they ask me these kinds of questions. Uh-huh. In addition to what Matt's referring to, which I agree with, I try to emphasize the importance of nutrition and sleep. Mhmm. Because a lot of these kids are going from school, which is obviously an important part of their day, and they're going from sport to sport to practice.

25:04

Speaker 1

The most important part

25:05

Speaker 3

of it.

25:05

Speaker 2

The most important part, yes.

25:06

Speaker 3

And then

25:07

Speaker 2

they're going from practice practice to sport or to the game or to so on, and sleep gets compromised. And then their nutrition, they're just eating on the go from one practice to the other practice. Mhmm. And at some point, you do need a good balance of your proteins and your fats and your carbs. It's not just a high protein diet for a young kid.

25:21

Speaker 2

Right? They need the cholesterol for brain development. They need the cholesterol for sex hormone development.

25:25

Speaker 3

Mhmm.

25:26

Speaker 2

So it's not that I push and say, start having protein shakes on a regular basis, but it's just being aware. Like, having McDonald's on the way from one practice to another doesn't make you a good athlete. That's just not appropriate. And then sleep is the other element here is is that after a long day of using your brain the entire day, but then also using your body for the entire afternoon, you've gotta get rest. Right?

25:46

Speaker 2

You've gotta have restorative sleep.

25:48

Speaker 3

Mhmm.

25:48

Speaker 2

And so I've got some families who are the multi sport athletes, and they've got three kids doing all the great things.

25:53

Speaker 1

I know.

25:54

Speaker 2

But But then they're not sleeping. They sleep at midnight, they wake up at six, and that's not adequate for an adult, much less a grader. Mhmm.

26:01

Speaker 1

It's tough because I believe all parents are hopefully trying to weigh the pros and cons constantly of okay, if my kid is going to get into x program at x school, what do they have to do now in order to be able to play? Sure. Okay. So that's a good think toe dip at least on the hormonal piece. I've always had low progesterone, high testosterone.

26:32

Speaker 1

And then I had the factor five lead mutation which prevented me from being able to carry pregnancies full term. I had a ton of miscarriages. Not a ton, but a few. And so that is interesting because I know my sleep has never been excellent. And as I get older and my biological mother, she's still alive, my biological mother.

26:59

Speaker 1

She is very young, but she started and went through menopause I think by 44. So this is where I am starting to notice, at least in my body, I'm progesterone I've been historically progesterone deficient, and I'm here noticing a lot of these patterns starting to creep up in my body. So what do you say specifically on the supplement side, things to consider? For someone, I know my situation is a little bit unique, but who has these different layered factors involved with their health, but who wants to stay away from hormone therapy, as much as I can, but to not devolve into this space of absolutely no sleep and hormonal hell? And then how I also want to dip over into the physiological space with you, Matt.

28:05

Speaker 1

But how would you even tackle this?

28:07

Speaker 2

So the thing I do is I'm a big advocate for wearable technology. Okay. So we have a lot of tech now that helps us monitor our sleep.

28:13

Speaker 1

Yep.

28:14

Speaker 2

And three or four years ago, would have never given you that answer because the data just wasn't very good or the output wasn't very helpful. Presently, some of the brands out there are really, really good. And so I'll have patients come back and tell me, I had that one tequila on Monday night, and it disrupted my sleep for two nights in a row.

28:29

Speaker 1

That's right.

28:30

Speaker 2

And when I'm That's worked differently. Less for several nights, I sleep really great. Yeah. And so identifying those patterns is I think very helpful with sleep in particular. In terms of hormones, so there's good data on magnesium intake for hormones.

28:42

Speaker 2

There's a new drug out there recently introduced by the FDA that's a non hormonal medication for menopausal symptoms, and so I've advocated for that for a couple of patients. And then I think the thing is, and this is where I think Matt is the expert on it, is your kind of mind body wellness. What are we doing with our muscles, with our joints, going back to the restorative sleep side? A lot of the patients that come to me with menopausal symptoms, it's just profound fatigue. And I'll order all the labs, and then I'll order all the other labs, and all the other other labs, and it's all normal, but you're in menopause, and you went from a hormone positive state to now hormone deficient state.

29:18

Speaker 2

And so I think that's where I rely on really good folks like Matt to say, how can we help this person feel stronger? How can we help this person identify which joints or which muscle groups are the problem, and then move forward?

29:28

Speaker 3

You know, the biggest thing like I talked about earlier is, you know, sleep, nutrition, stress management.

29:36

Speaker 4

Mhmm.

29:37

Speaker 3

And then the bucket of exercises are really the the focus points for me. Any additional, like I said, you know, testing or hormonal things I would refer out to somebody that was specialized in that. But I do feel like there's, you know, a giant avenue that people kind of want to skip past and that is really, do I want to focus on nutrition? Do I want to focus on sleep, stress management and actually going through and consistently committing to doing, I'll call it exercise, but it's really, you know, improving cardiovascular health, know, musculoskeletal training, really improving all of those buckets gives you, I think, a pretty good idea of if you can commit to those, how good can I feel? And if I still feel like I'm lacking, that's where I think additional testing would be, incredibly valuable.

30:32

Speaker 3

And that's not to say that, you know, I would ever say that, you know, getting testing done off when you start a, a new plan, a new goal, a new lifestyle commitment of going, okay. I wanna go get a full blood panel done. I wanna see where I'm deficient in, you know, vitamins, minerals, hormones, all the things. I think there's incredible value there, but I do think that a lot of people will sometimes skip to that before wanting to kind of invest in the things that they might have more control over but are a little bit harder

31:04

Speaker 2

Yep.

31:04

Speaker 3

To invest in. So I think that's, you know, it's kind of where I've always landed.

31:10

Speaker 1

What I'm interested in whether you all are provided this from patients, like a okay, here are the supplements that And then I ran them all through chat GPT because I thought, alright, I want to know what to take at night, what to take in the morning, but I sleep with my Oura Ring, then I have my my fitness scale that reads all of the different data every single morning. And I love data. Love it. I thrive on it. And so I know most, I don't know if a lot of people are this way, but I love it.

31:46

Speaker 1

And so I know what supplements I should take in the morning. I'm acutely aware of what they do to my body at different times of the day. Love magnesium. But again, how often are you all suggesting that people go back to their doctor and revisit this blood work? Do you find that once a year is sufficient?

32:07

Speaker 1

And how often are you recommending your patients to revisit their supplements with you to be able to build a certain amount of muscle? Because I find muscle is so important in our aging, the retention of it. And so I'm constantly fighting despite all of the pain and discomfort that I've been in because of my Brody's muscle stuff and then this herniation tear in my back and all the hip stuff. What are these conversations like? How often are you requiring that your patients and your clients talk to you about this?

32:49

Speaker 1

Is it once a year, twice a year?

32:52

Speaker 2

So it's at least once a year for sure. A lot of my patients, and I think why I really enjoy practicing concierge medicine is I have a lot of patients who are very invested in their health.

32:59

Speaker 1

Yes, I know some of your

33:01

Speaker 2

They come twice a year, they come three times a year, and they'll say, you know what, I'm gonna try intermittent fasting for the next ninety days, but before I do it, I wanna get my lipids and my diabetes things checked out. Not that they have elevated lipids or diabetes, but they wanna see how intermittent fasting for ninety days makes a difference, or they wanna do an intense workout regimen for six months and get pre and post labs. And so two comments that I wanted to make previously was there's this big push for using things like liquid IV, which is a great thing, but I've had more patients Elements and other these big brands. I've had more patients in the last twelve months who have come in for screening labs that have elevated calcium and potassium levels

33:39

Speaker 1

Of course.

33:40

Speaker 2

Than I've ever had in my Yeah. And when you ask these patients, they're like, oh, I do liquid I eat twice a day. Oh

33:46

Speaker 1

my gosh. Do liquid I

33:47

Speaker 2

eat twice a day. I understand if you're particularly dehydrated, if you're hungover,

33:50

Speaker 1

all of habits If coming out of your sauna or something. But

33:53

Speaker 2

the idea of I don't drink water, just drink liquid IV or Element is just an odd way to go. I really encourage patients, I hope all my patients would agree with me, when they step foot in my office, no matter what they're there for, I review their medicines because they'll start adding things on their own or they'll come in with a particular problem. Well it turns out that these two supplements don't agree with each

34:14

Speaker 1

other. Correct.

34:14

Speaker 2

That's You have a toxicity of vitamin D and therefore your calcium went up and therefore you had a kidney stone. So they'll ask like, this is the worst pain I've ever been in my whole life, and it turns out that they kinda did it themselves because they saw something on TikTok to take a bunch of vitamin D. In some ways, it's very educational. I think that's a lot of the core of what I do in the office is, hey, do more of this, do less of this. I think the push for vitamins is aggressive.

34:39

Speaker 1

It is.

34:40

Speaker 2

We try our best to be evidence based, get the labs. If your labs are good, then you're good. You're getting your vitamins through your nutrition. And if you happen to have a b twelve deficiency, we'll treat it. But I think the idea of everybody needing to be on a a plethora of meds is just not the way we should operate.

34:55

Speaker 1

I agree with you. I agree with you.

34:59

Speaker 3

I also agree with you. When it comes to all you know, when it comes to blood work, you know, obviously, that's not something that I personally do. So I would say, where whoever I refer to, I let them kinda obviously be the the quarterback when it comes to that. Mhmm. You know, the the things I said earlier still apply as far as, you know, feeling that, you know, to your point exactly, like, let's test to see where we're deficient Mhmm.

35:24

Speaker 3

And then supplement. That makes very logical sense to me. Just to touch back on your point about muscle, which is probably one of the most underappreciated aspects in the field is not just the building, but the maintaining of muscle as we age. So, you know, one thing I am very adamant about talking to my people about is that they ingest an adequate amount of protein on a daily basis. Mhmm.

35:52

Speaker 3

And that actually, as we age, we have to increase our protein supplementation even a little bit more because we become a little bit more inefficient at, you know, being able to metabolize it. So the two two of the the best ways that we can maintain, preserve, you know, for younger build muscle mass is eat adequate amounts and train our bodies to, you know, a certain degree. Putting a lot of force through our our joints and our muscles so that they are they have the stimulus to wanna grow and and and maintain it because muscle is a very, very expensive resource. And so, you have to prove to your system that you need it in order to maintain it or build it. And in the absence of that, you lose it.

36:39

Speaker 3

We are woefully deficient in our ingested protein as a population. So that's something I really try to encourage people to do and be and be aware of, you know, because that's I know education is probably important thing that we're trying to provide for the people that we work with. And that's one where I think people really have no idea how important it is.

36:58

Speaker 1

What kinds of protein, added protein in either shake form or supplement form. What are your favorite brands?

37:12

Speaker 2

I don't know if I have a favorite brand. What I advise patients is get a mix of animal based and plant based and natural. For my vegetarian or vegan patients, the animal base is out of it. And so that makes it a little bit more difficult. Some patients that really inundate their system with a lot of eggs or a lot of dairy based proteins, it just becomes a lot or they get skin issues as a result of it.

37:31

Speaker 2

Ah. And so I try my best to to mix pea protein, whey protein, and the natural proteins. For my meat eating patients, it's a lot easier. I mean, just having meat as a

37:41

Speaker 1

as a

37:41

Speaker 2

food is a bulk of it. But I find Fairlife to be a good brand if if I had to pick one just because it's a small shake and it's Mhmm. You know, 32 or 38 grams of protein, it's easily accessible. In fact, going back to the kids for a I have my kids split that a lot of mornings. Oh, cool.

37:59

Speaker 4

Because they

37:59

Speaker 2

like it. For them, it's chocolate milk, so they think they're having a treat. My wife and I, we think we're having a treat. Yes. They're having protein to start their day.

38:05

Speaker 2

Oh. And so that's been a nice addition in our house.

38:08

Speaker 1

Great. Thank you. And what about you, Matt?

38:11

Speaker 3

When it comes to recommendations, I mean, I wanna meet people where they're at. I typically refer people to some type of whey is my kind of gold standard. And it depends on kind of their tolerance to, you know, conscience whey protein concentrate is gonna be, a little bit more for those with the sensitive lactose Yep. Kind of, you know, medium, they're gonna have a little bit more trouble with that. Isolate, I think, is a little bit more it's kind of the the whey is broken down a little bit more.

38:40

Speaker 3

So it's a little bit more easily digestible, but then you have to also take into the account of calorically, some of them have

38:47

Speaker 2

Yeah.

38:48

Speaker 3

More calories, more more fillers, more other things. I tend to go for the most boring, unflavored, one ingredient as possible protein that I can possibly find. I'm the the brand's escaped me. I'm happy to give them to you later if you wanna put them in your notes. But, but like I said, if I had a vegetarian or a vegan client, I would promote a plant based protein under the the guys that we wanna make sure that we have a complete, amino acid profile because that's the only, you know, issue when we have vegan, vegetarian Yeah.

39:25

Speaker 3

People that we work with is that not all vegetable or plant not vegetable, plant based proteins are complete.

39:32

Speaker 1

Toggling back over to the genomics portion that are perhaps a little bit more affordable than New Amsterdam. That's I know the concierge it's kinda concierge based. It is, I think, only, and the cost range goes up to about $3,500. But there's Genomine, Nebula, Genomics, Self Decode, Gene by Gene, Veritas Genetics. Do you work with any and all of these, or is there one in particular that you work with, doctor?

40:05

Speaker 2

So like I was saying before, I don't use one of the brands that does genomics for all organs. The ones that we do are more organ specific. So there's a cancer, a big cancer company called Ambry, and so we work closely with them for cancer genetics. I'm thinking like BRCA one and BRCA two, but about 90 other cancer causing genes. So I've got a patient that I take care of right now who has a particular gene that increases their risk of melanoma and pancreas cancer.

40:28

Speaker 2

And so the guidelines for that are we gotta do annual scans on her pancreas. We have to do melanoma screens every couple of months because her risk is just that high. In terms of the brands that you mentioned, I don't have an affinity towards any particular one of them. I would say, I think this is an opportunity to mention that one test that we do order a lot of is food sensitivity testing. Yes.

40:48

Speaker 2

And so there's this push to think about something called leaky gut syndrome

40:52

Speaker 3

Yep.

40:53

Speaker 2

Which is fancy to say that in a in a normal person, if any of us can actually be normal, but a normal person, the gut is its own environment. And nothing should leave the gut, and nothing should enter the gut. Well, we have understood that there are certain chemicals or certain things that you can consume that cause stuff from the gut to leave, and that can cause systemic inflammation, feelings of fatigue, bowel irregularities, and so on. And so a test that's been really helpful for patients is food sensitivity testing, and identify very healthy things like a patient that could have a sensitivity to asparagus and to different fruits and vegetables, and it turns out that that's why they're not feeling well, or that's why they feel more bloated and cramping. So it's not genetics by any means, but clearly there's something about their genetic makeup that is not processing eggs well or white wine well or what have you.

41:37

Speaker 2

And so I certainly believe in the personalized piece of it. I don't have enough experience to comment on one particular brand or the other. We feel like we've got a good handle on the groups that we do use, it's a very actionable set of outcomes and we can do something with that.

41:51

Speaker 1

Do you have anything that you wanna add there to any of these types of tests that are run for the gene site mapping that give people insights into what type of medication they're predisposed to work better with and how that has translated to any conversations or possible conversations with your patients or clients.

42:16

Speaker 3

Yes, clients. You know, I don't, like I said, deal a lot with genomics or genes with the type of work that I do. I do think it's interesting, though, when you look at the research on some of the diseases that we're talking about, being Alzheimer's, dementia, Parkinson's, that one thing I do try to educate my clients on is that my current understanding of the research is that one of the best things that you can do to reduce your risk of all of these diseases is to not only exercise, but to do heavy resistance training and have strong cardiovascular health. So when you look at, you know, all of these diseases, one of the top three recommendations from all experts in all of these Mhmm. These fields is you need to do shrink training and you need to have good cardiovascular health.

43:15

Speaker 3

So because that's my strong suit and my expertise, I tend to make sure I educate people on the value of what we're trying to do in that regard because it it is something that concerns me as well. Mental, you know, dementia, Alzheimer's are things that are on top of mind. I've had it in my family. So one of the reasons why I'm so passionate about the type of work that I do is because it hasn't, in my opinion, one of the the biggest benefits for decreasing that risk. To say that there's no risk, I'm not saying that, but it gives you a better chance of of decreasing your risk of developing some of these diseases based on, some of the research that I've seen.

44:04

Speaker 1

Can you talk a little bit about just some of your clients, especially the ones who are in their 80s and doing competitions, lifting competitions, and the vitality that these people exhibit? It's crazy how how you're, I guess,

44:23

Speaker 4

your Well, the the

44:24

Speaker 3

biggest thing I tell anybody that comes in Mhmm. I might have a, you know, an average age in the sixties and seventies, but the body, the design of the body is the same Yep. For everyone. Now it might start to function differently and there might be some more restrictions as we get older. But if we train it to its potential always, and that means, you know, everybody in my opinion has a a potential that we can try to get to.

44:52

Speaker 3

And if we can train it to a high level and keep it there Mhmm. Age will be a factor, but less of a factor. I have some of my strongest clients are approaching 80, and they're just as strong as any 40 year old that I mean, I I'll put that up there. It's just as strong as any 35 or 40 year old that you're gonna run into as far as their ability to express strength, mobility, no pain Mhmm. Highly functional and have little to no restrictions on what they want to do on a daily basis.

45:28

Speaker 1

What about over to you, doctor, as far as this framework of patients in your practice?

45:35

Speaker 2

Our goal every day is to make healthcare easy. I think it's really hard to navigate which doctors to see, how to get labs done, which tests to get done. Because if you Google it or throw it into chat GPT, you just don't know what the difference is between A versus B versus C. Correct. And so I hope our patients would agree or my patients would agree that we try our best to promote their health and prevent disease, and if we catch something, we treat it aggressively.

46:00

Speaker 2

And I think knowing what we know and knowing what we don't know. So an important part of my practice is having a Rolodex of specialists who are really top notch, that if I don't know how to manage something, I'll give somebody a call and get that patient in quickly.

46:12

Speaker 1

I believe, or hopefully, that over the course of the evolution and introduction of AI into our lives more and more, that your type of setup, I guess both of you in more of a concierge boutique space, will hopefully be the norm as accessibility hopefully becomes more possible. What are your thoughts on that?

46:43

Speaker 2

I hope that's the case. I think the challenge is that corporate medicine is the mainstay of health care in this country. You have to have the mega groups in order to support the hospitals and the surgeons. And so will that ever go away? I don't think it will.

46:59

Speaker 2

The way that insurance is set up, and certainly in this conversation we're not gonna be able to solve that problem. No, no, no. But I think what I would say is that in the world of concierge medicine, it's becoming much more normal. Even five years ago when I started it, it was like, oh, so what is that? What does that mean?

47:12

Speaker 2

And now five years ago it's like, oh yeah, several of my doctors are concierge, I know exactly what that's like. I would tell you from the care deliverer standpoint, I've seen what care is like on my end of it compared to what it used to be when I was not in it, and it's night and day. It's not a coincidence that I got my parents and my in laws into this world because I'm confident that they're gonna get better care, more attentive care, more timely care because of it. And the other comment that I would say about AI is a big part of what my nurse and I do on a regular basis should be replaced by AI, And that would be really nice because we'll be able to spend more time thinking about our patients, being with our patients, researching about our patients, so on. And I think that's gonna play even a bigger role on the corporate side because obviously the volumes that they see are much different than what we do.

47:53

Speaker 2

And if you're able to get AI to just replace these very mundane things like prior authorizations and pre certifications, that stuff is very time consuming and really doesn't require a lot of education. It's something that just has to get done. And so I'm an advocate on the consumer side. Obviously AI will help you understand what your supplements are, but on our side I think it will replace a lot of tasks that otherwise don't need to be done by us.

48:19

Speaker 1

That's right. That's right. Well, gentlemen, is there anything else that you wanna add in for our viewers and listeners with respect to wearable technology, your practices, your patients, clients, anything?

48:33

Speaker 3

I would just say that when it comes to AI Uh-huh. I think in my line of work, I think it's gonna be hard to have AI provide a lot of value and just that like the type of work being very subjective. And so I'm a big proponent of, you know, I guess the the thing I would say the most is that people need to commit a lot of time to truly educating themselves not just on, you know, supplementation and nutrition and things like that, but really, from my standpoint with what I do, a lot of people, most people don't really understand how their bodies are supposed to work

49:18

Speaker 2

Mhmm.

49:19

Speaker 3

And how they're designed to work. Yeah. And that there's a frame and a methodology to go about trying to learn, analyze, and start to perfect movement that you were designed to do to the best of your ability. And that's where I think the type of work that I do is a little bit different in that. I don't think that people have an idea of that there is a particular way that they're designed to move and that the further they get away from it, the the less quality, the less efficiency they have, the worse they feel.

49:57

Speaker 3

And so, you know, having an education and a knowledge and a plan of attack to bring you back into to your own design, not my opinion, your own design, gives you the best chance to feel as good as you possibly can because I think that something that's lacking in a lot of the people that I come across Mhmm. And work with initially at least is they don't understand how their body is supposed to work. And I feel like that is something that everybody should be able to everybody should know, have an idea of how their body's supposed to work.

50:32

Speaker 2

Yep. I think my last comment would be just encouraging patients to be an advocate for themselves. Yes. The number of patients that come into our office who don't know what medicines they take or why they take them, that's an important part of your own health. You have to know why you take what you take and how you can try to avoid taking certain things.

50:51

Speaker 2

And ask questions to your doctor. We're here to help you ultimately. Every one of my patients at the end of a visit I say, is there anything else you wanna talk about? I really mean that because sometimes the most important thing or that one thing that their wife asks them to ask me, that's when it comes up. It turns out that that's actually the most critical part of the whole conversation.

51:08

Speaker 2

And so I would always encourage you that when you have a doctor's visit coming up, matter if it's with your cardiologist or your internist like myself, have a list of questions or have a list of thoughts to say, you know what, this thing is bothering me, or what do you think about this medicine, or hey I read this. And I would argue that most doctors enjoy that conversation. We enjoy taking care of people that wanna be in good health. Yep. And so just being prepared going to a doctor's visit, I think, is really critical.

51:33

Speaker 2

It'll it'll make your health outcomes that much better.

51:35

Speaker 1

Thank you for being here.

51:36

Speaker 2

Of course.

51:36

Speaker 1

Thank you. Yes.

51:37

Speaker 2

It's fun. Yes. Yes.

51:45

Speaker 1

Yes.

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