Welcome, my name's Dr Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand. blood pressure, weight, cholesterol, for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, it's Dr Warwick here and welcome to my podcast and videocastation. I've got the chance today to... have a third interview with dr khan when from the austin regenerative therapy center in austin texas she is the owner operator of that we've been talking anti-aging anti-aging medicine in the first two podcasts we've covered the importance of being proactive around health care and not being reactive waiting till people get sick which is very much our current model and how anti-aging medicine is really trying to be ahead of responding to problems by identifying issues early on, how we can optimise people's wellbeing and how we can use a raft and a range of different tools from hormone replacement therapy to peptides, through to minerals, through to young plasma exchange. Check out the first two podcasts. But this is the third one. Dr. Kahn, thank you so much for joining me again. Hi, it's my pleasure. So for this, for those listening, I've cleared this with Dr. Kahn. And what we'd like to do is maybe share a case study. And I'm a 61 year old male and there might be other 61 year old males out there. We know from what Dr. Kahn said in the first two podcasts that once you pass about 25 to 30 years of age, your hormone levels and various other levels within the body start to drop off. NAD plus drops off, hormone levels drop off and things start to change. So 60 is a fair way down the path. So Dr. Kahn, if I came to see you and said to you, look, I'm... I'm feeling a little bit older. As I exercise or do things, I notice I get aches and pains. I've done some weights and things, and I've got some minor tendon issues. I'm having difficulty maintaining strength and recovering. feel as I get out of bed in the morning a bit slow. I feel like I've got some inflammatory issues and from time to time, if I push myself, I can get run down and get colds. And of course, as we're getting a bit older, we're aware that our sexual function is not like it was 30 odd years ago. How would you start to deal with a patient like that? Yes, absolutely. So those are the symptoms that pretty much, you know, what I hear from a new patient, you know, to some degrees of different severity. So it's very common. And what I do is to start the screening process to just to see where the individual is at. And that includes. kind of like an intake form to look for all the symptoms. We don't miss anything. We look at already known medical issues. We look at a list of medications. We look at family history, any known genetic disposition. And then, of course, a very extensive lab panel. That includes a hormone panel. What I can tell you is my own past medical history includes open heart surgery for a dilated ascending aorta associated with a bicuspid aortic valve. I had a PEARS procedure, which is a wraparound. That surgery was uncomplicated. That was a couple of years ago. I have raised blood pressure and I'm on a blood pressure medication for that. My insulin levels are perfect. I don't carry extra weight. And I've got raised intraocular pressure for which I take drops for on a regular basis. Other than that, I'm not too bad. Gray hair. The visual acuity is down a bit. So I need some new glasses. But that's about it. And then the next thing is. What's your hormone level? So what is your total testosterone? Even just that alone would be very helpful. The few key important blood work that I want to know and I educate all my patients to be aware and track and optimize. To keep it simple, I want to know LPLA just one time. I measure and track lipoprotein, lipoapoprotein B. I track hemoglobin A1C. So I want to know that level. Fasting insulin, eurot acid. We talk about hormones, sex hormones, and then thyroid hormone. Vitamin D level, DHEA level, cortisol level. uh homocysteine level and uh high sensitivity crp so if you know any of that that would be helpful but in terms of hormone replacement uh you know what is the total tertarcial level it would be a good start well i might actually be able to bring those up uh dr khan i'll see if i can i'll see if i can do that because i Like I said, I think I said to you before, I'm due for some up-to-date bloods, but I tend to get them done every six to 12 months. So I can pull some up. For those listening, HSCRP is high sensitivity C-reactive protein and it's a marker of inflammation. So it's a very useful marker and we know that it's increased or it being increased is associated with increased coronary disease, as well as all sorts of other issues, actually. So I get that tracked myself as well. So it is a good thing to know about. Let me see if I can give you some of that information. I can give you... Here we go. I've got my... The server is just firing up my results. We've got here, my insulin level is 2, range 0 to 15. Homer index 0.4. So I tend to be a restricted time eater. That works incredibly well for that. Triglyceride 0.3, which is in millimoles per litre, less than 2. You would use milligrams per deciliter, but I can tell you that's a really low number. My LP little a is normal range. PSA is low. My thyroid is, TSH is 1.0. Reference range 0.3 to 4. So it's very much in the mid-range. PSA is in the normal range. Testosterone. Total testosterone is 17.8 or 18, if you like. Range is 10. to 30 basically, 9.9 to 27.8. So I'm at 18, almost mid-range. For a 60-year-old, right? I reckon that's a 60-year-old range, male range. I don't know if that's a range for young adults. I'd have to check that. But I imagine it's probably for my age, isn't it? Right, exactly. And SHBG, which is sex hormone binding globulin, is elevated at 90. Reference range is normally 48, so it's up high. And that means that my free testosterone is at 176, with the range between 91 and 579. So I'm at the lower end of free testosterone. IGF, which is a marker for... Growth hormone is 13, range 7 to 37. Okay. There you go. And C-reactive protein less than 1. Okay. So the good news is you don't have insulin resistance and you have low inflammation, so that's good news. Yep. And you do have very low testosterone level and it's even lower. given your elevated sex hormone binding clobulin, right? So, and it's not a surprise. It's as expected. And, but at the same time, this is like, this is where I'm like, okay, that's easy. I can find a source to optimize and to quickly get you to feel a lot better, meaning, you know, more energy. more motivation for life, better libido, clearer meditation, memory. And it's something that is really profound. It's really an easy way to improve the quality of life. And also it's good for you in terms of preventing. a lot of medical issues down the road. So, you know, in terms of testosterone replacement, I also look at your PSA and because there is some worry that testosterone will lead to prostate cancer, which is wrong. However, if men already have prostate cancer, testosterone will feed into the cancer cell, but TRT alone does not raise your risk of prostate cancer. It's the opposite. Yeah. Actually, this is really important information for those listening because there has been a cloud over a number of years around testosterone therapy. And my understanding, and I think this is what you're alluding to, Dr. Khan, is in the last couple of years, we've actually seen outcome data where testosterone therapy has reduced or caused mortality in men, which is a reassurance, actually. And also to reduce the risk of prostate cancer. And when we look at the population of men with prostate cancer, they have very low testosterone level and not high. That's confirming that as well. And so given the fact that your TSA is within normal range, your testosterone is expectantly low and you have associated symptoms. So that's easy, right? TRT would be a great option for you. And also the fact that you are 60, you already have children, you know, that will determine which option that will be most appropriate for you. So in terms of TRT for men, what option do we have? We can give... testosterone replacement directly or for younger men we can use anclomiphene or clomiphene or anclomiphene also plus minus hcg with testosterone i don't know about australia but in the u.s recently there was an oral testosterone that was being FDA approved and it's called Kaiser Tracks. So that is another option. And it is metabolized through the lymphatic system. So it's kind of bypassed the liver because in the past, we know that testosterone, you know, we don't give it orally because it's toxic for the liver. But this, you know. We can get away with that. And that option is also viable for young men who are still interested in, you know, having children. Okay. It's not given topically. Is that right, Dr. Khan? Yes. There's, you know, nasal, intranasal and topical, but I almost never use that because it's just really messy. Okay. And, you know, you have a risk of transferring that to your spouse. So if I give your wife topical testosterone, that's fine because she can give it to you and you wouldn't notice. But the other way around would not be ideal. So I don't mess with that. So I would just go straight with testosterone for you. And in terms of that, we have the option of doing testosterone injection at home. preferably twice a week and it could be intramuscular or we can do subcutaneously as well. And it turned out to be even better. And it's, you know, it's easier than a long, big needle. And then we have the option of doing pellet insertion. And pellet is a route where It is an in-office procedure where I will place, you know, in the, like, in the hip area, in the glute muscle. And there's, you know, there's different options, and we just have to discuss with individual, like, what you prefer. In terms of pellet, most people love it. And you feel great and it's a very consistent level. But the downside of that is, you know, you have to come back and have a little procedure done. And after pellet, there is, you know, like a five to seven days of downtime that I ask my patient to not soak in a tub. to not do leg workout just to let that heal yeah so you know those are the main option so we would see for someone in my age range with those sort of testosterone levels that i might get more energy that would help with um i'd have a better uh sexual function um What about healing? Because one of the things I've noticed is sort of like tendonitis from swimming or lifting weights. Would you expect healing to improve or would you be thinking about peptides to support healing at the same time? Things like BPC-157, which people may or may not have heard of. BPC-157 is body protection compound. which is generated from the gut and actually seems to help healing. So do you mix those sort of things together, Dr. Khan? Yeah, it's a very common combination. Again, hormone is the foundation. And then I add peptide on top and what peptide to use is dictated by, you know, the issues, the symptoms from the patient. So like for you, if you have, trouble, recovery, you know, the aches and pains. BPC is wonderful. And also when I start people on testosterone replacement, suddenly you're going to have more energy. You're going to feel motivated going to the gym and then you're going to see gaining muscle easier. But with that, you know, BPC will allow you to. recover faster so you can go back to the gym the next day and hit it hard again without getting injured. So they really complement each other, right? Yeah. And then, you know, your IGF-1 is normal for you, but it's not optimized. So then this is an opportunity to also provide you with the peptide that is in the category of growth hormone. releasing secretalox. And that signals the brain to release more growth hormones. And why do we want that? Growth hormone can get a bad reputation, but in fact, when used appropriately, we know that the level is less with age. And when we bring that up intermittently, it's just amazing across the board. Faster recovery, easier to build muscle. It helps people to get leaner, improve in mental cognition, memory, stronger bone. And it's also great to improve the lipid profile and so forth. Yeah. So the combination of testosterone plus those growth hormone releasing peptides and protein category. and the repair recovery peptide. That is a great combination to allow people to feel great, better energy, and is a very effective way to improve the body composition and also to improve your... energy level so that people will be able to do the aerobic exercise along with strength training. And I say that because VO2 max is a very, very important number to know and to optimize because the higher your VO2 max, the longer you're going to live. And that is the probably the most predictive number to optimize and to improve your VO2 max is the high intensity training that is the most effective way. And the next thing that is really important for health and longevity is your strength, your muscle mass and your muscle strength. And that is weightlifting. So going to the gym alone is a cheap, you know, not fancy, but very powerful tool that it would be a myth to not address or to not do it yourself. Sure. But hormones and peptides allow us to exercise better and to gain the benefit, you know, more benefit out of exercise. So tell me, Dr. Khan, for someone, say, in my position, someone listening, and we've talked about some of the tools in the toolkit. We're thinking about hormone replacement therapy. We're thinking about some peptides potentially. Would you turbocharge that with NAD Plus? Would that be a beneficial add-in to really make sure that the body's cells are maximally utilising those supports? Is that something that would work or that would be considered? Yeah. I used to do a lot of NAD in the past that I do now. Now, NAD for me is more, you know, I focus on people with brain-related issues around the time of, say, you know, somebody training for a big competition. I use that because we, I'm not sure. If, you know, there's a way of measuring the intracellular NAD level. And, you know, for me, as I shared with you on the prior podcast, I've seen the benefit of that on selective cases. I have another patient with ALS and that is part of the toolbox. helpful. So for me, you know, my practice has kind of been progressive and I pivot and I change based on what I experienced, you know, with my own patients and also with other modalities that I have. So in terms of IV vitamins. I use that almost always when I provide patients with therapeutic plasmid change, before stem cell therapy, pre and post traveling. If they're feeling under the weather, if they catch a cold, those are the opportunity to really help people or patients to feel a lot better, faster. Okay. The NAD+, talking about ALS, amitrophic lateral sclerosis, which is sort of a chronic neurological condition. Are you thinking that things like MS, Parkinson's disease would also benefit from NAD plus type? Yeah, you know, for those patients, which I happen to see enough, it's just frustrating because we don't quite understand and, you know, traditional medicine, we don't have any effective way of helping those patients. And luckily, you know, with those patients, that's the more exact, exaggerated example where. I just pretty much throw everything available. So we optimize magnesium level, vitamin D, all the B12 level, NAD, and then we optimize hormones and then a combination of peptides. And this is where young plasma exchange play a big role because Stanford started out with a small pilot study. looking at people with Parkinson's and Alzheimer's dementia. And then they put these patients through the Young Plasma Exchange Protocol. And it showed that these patients across the board have improvement in their mental cognition in daily living activities. And now there are more, you know, I'm part of an ongoing clinical study using Young Plasma for... other conditions including MS, other neurodegenerative conditions, cardiovascular disease, autoimmune disease and or just resilient just for anti-aging and longevity. How long would a young plasma exchange benefit last for? Are we talking days, weeks, months? Yeah, so with the, there was a study looking at Parkinson's and MS patient. It was done in 2019. They measured the benefit and it turned out is, you know, beyond six months and people are still seeing results. For my patient, you know, strictly for longevity optimization, I recommend, you know, if possible, yearly. For somebody with, you know, Alzheimer's, dementia, Parkinson's, ALS, more frequent than that if possible. So it's all based on, you know, their need and what condition we are targeting. Wow. Well, it's an absolutely fascinating area of medicine, Dr. Khan. I think for me, it's been lots to learn over these. through podcasts, and I'm sure that people listening in will have found it valuable and almost verging on a bit of science fiction. And I think what we're going to see is this being some of these techniques, technologies, concepts incorporated more and more into standard care because people would demand that they're maintained well rather than get sick and then be fixed up. So this has been fantastic for me. Is there anything you wanted to wrap up with or anything you wanted to share before we finish up? Yeah, I just want to finish on a positive note and that is the case. And that is, I think that it is a very, very exciting time to live in terms of medicine because now there is more awareness of the shift. Right. And from sick care to health care is trendy to talk about preventive, proactive care and how to live healthier longer and not just to live longer, but to improve and maximize the quality of life. And the combination of quantum physics, AI, you know, AI is going to play. and already play a huge role in medicine to really speed up research and all the computation that I just can't wait to see and be ready. But even as of now, we already have a lot of options to allow patients to be physically active. uh sexually active and you know mentally sharp uh way into the 80s plus right and i don't know about living you know 220 140 uh as of now i don't think so but it's a real possibility in the very near future that i don't know but as of now we're already able to you know you know To have no excuse of being 80 plus and still fit and active and do everything that you wanted to do. We can do that. It's never too late to start and it's never too early to start. So that's the message I want to share. That's beautiful. There is such a lot of excitement ahead. And I think this is an area where the rate of change is going to be exponential and it will be very exciting to be part of it. Right. On behalf of everyone who's listening in, I'd really like to thank you again for sharing. For me, it's been fantastic. It was obviously the universe that put us together to meet so that we could have this conversation, have ongoing collegial discussion and more learning. I've got such a lot I'd love to learn from you. Yes, I appreciate the opportunity to talk about what I love. You know, this is definitely my passion and it's my calling as we share when we first met, right? 100%. Yeah. Dr. Khan Wen from Austin Regenerative Therapy Institute in Austin, Texas. Look her up if you're in that part of the world. Please share, like these podcasts because I think they'll really, open people's eyes and give people a chance to understand what's really available. Very exciting times. Thank you once again, Dr. Khan. For those who are listening, if you have any queries or questions, drop us a note. If I can't answer it, I'll get the answer. And as always, really do appreciate that you've taken the time to listen. and give your valuable time to share with the content that i'm creating if you've got any feedback please let us know if you've got any questions let us know and till next time i hope you live as well as possible for as long as possible take care and bye for now cheers to that join the healthy heart network and become part of our growing community if you're interested in your heart health and risk of heart attack then join the Healthy Heart Network for only $5 as a lifetime member. This represents $55 worth of value. We offer and help people understand their present state of heart health, what their current level of risk is, and the positive steps they can take to improve their risk of heart attack in the future. go to www.healthyheartnetwork.com.au and click the join the family button.
