Optimizing Lifespan with Therapeutic Plasma Exchange, High Cholesterol Dilemmas, CT Angiography Revelations, Best Cancer Diagnostics & More with Dr. Darshan Shah, MD

My name is Ben Greenfield, and on this episode of the Ben Greenfield Life podcast, the negative effects of high cholesterol, one of them is atherosclerosis.

Atherosclerosis is due to 3 things. Number 1, inflammation, right? Right. Number 2 is due to damage to your arterial wall, most, mostly from hypertension, high blood pressure. And lastly is ApoB particles. Okay, so it's only part of the equation. So high cholesterol is not bad for everybody. It's, it is a problem for many people, and that's why heart attacks are the number one cause of death in the United States.

Fitness, nutrition, biohacking, longevity, life optimization, spirituality, and a whole lot more. Welcome to the Ben Greenfield Life Show. Are you ready to hack your life? Let's do this.

Well, folks, if you are watching the video version of this show, then you'll notice that me and my fine friend here, Dr. Darshan Shah, who's been on my podcast multiple times, are sitting down here at Next Health. We look like bionic men. Do you feel like a cyborg right now?

I definitely feel like we've been taken over by the cyborg.

I'm cyborg-ish. I've got a blood pressure cuff, a heating pad, a tube of blood coming out one arm, a tube of blood coming out the other arm, these massive machines that we'll talk about a little bit. So, first of all, elephant in the room, there's going to be a lot of resources for you guys. And, the shownotes for this show are going to be at BenGreenfieldLife.com/NextHealthLife. That's BenGreenfieldLife.com/NextHealthLife. The reason for that is I've been thinking about a lot of things relative to lifespan, life extension lately. Few things in particular that I really wanted to delve into are your immune system and your detoxification, meaning what you might consider to be like a cleanup of your body, the heart, and what we don't currently look at when it comes to heart health that people should know a lot more about. We're kind of in the dark ages, in my opinion, with the way that we care for people's hearts. And I've learned a lot of very interesting things about that lately. And then finally, cancer. I don't think it's any secret now that I've had a family member, my father namely, struggling with colon cancer. It's also been a topic hot on my mind, and it just so happens that Dr. Shah has some experience with a lot of this stuff. And so, I figure right off the bat, I want to ask you, Darshan, why the heck are we hooked up like robots to these machines? What's going on?

Yeah. So, Ben, you and I have been talking a while about the latest in healthcare and health optimization and longevity. And, I really feel like this is the pinnacle of what we can offer right now. This is called therapeutic plasma exchange.

Therapeutic plasma exchange. Plasma exchange, right? TPE.

TPE, therapeutic plasma exchange. And, what we're doing with these machines and being all hooked up here is blood is being removed from one arm, is going through this machine which is separating the blood into its components of plasma and blood cells. And then the blood cells are being reinfused into this other arm over here.

Remind people real quick what plasma is.

Exactly. So your blood is made up of two components, well, multiple components, but 55% of it is plasma. And plasma is where all of the ions, all of the toxins, all the growth factors, all the communication factors in your blood lives. And then the other 45% is red blood cells, white blood cells, and platelets. So if you ever see like PRP, when you take a tube of blood and you spin it, The platelet-rich plasma.

Yeah, they spin it and they inject the platelets back into the joint or the injured area, right?

Right. Yep, exactly. And so, when you spin a vial of blood in a centrifuge, it'll separate into this top yellow layer and this bottom red layer. And, that's exactly what this machine is doing here for a large volume of blood. And so, when you separate—

So, this is like a full-body PRP type of thing?

Exactly.

Interesting. Okay. I didn't think about that one.

That's what this machine is doing. Full-body PRP, right? Okay. This machine is basically a giant centrifuge, but it's very specific. It can pull out individual types of blood cells. It's extremely complicated and calibrated to do what we're doing here. So what we're doing is removing the plasma and the plasma is gonna be in that bag. You can kind of see my bag full of my old plasma over there. And we're reinfusing albumin instead. Where the plasma was. And the reason you need albumin is because the plasma has a lot of proteins in it. You need to maintain that protein gradient, that osmotic gradient, and that's where you have to put the albumin back in.

Where do you get the albumin?

The albumin is donated albumin. It has no— it's been tested, it's been donated, and it has no like immune factors in it. Albumin is— it doesn't have any immune factors, so you don't have to worry about an immune reaction or an allergic reaction. So, albumin, we use albumin in hospitals every single day. We've been using it for years. And, this machine actually has been used in hospitals for many years. It's FDA-approved. But, just like most of Western medicine, we only use this technology when you're really, really sick. And, what we're doing here is we're bringing it out into health, wellness, longevity, and using this technology that's been around forever basically in Western medicine. But bringing it to helping us live longer.

I didn't know it actually been around for that. So, what diseases would it traditionally have been used to treat?

So, traditionally, this machine is used for autoimmune crisis. Okay. So, when people form autoimmune complexes, those complexes live in your plasma and this extracts it from your plasma. And so, that's what this would be used for is in the ICU for autoimmune type of diseases. That have gone kind of out of control.

Okay. So, you get these autoimmune complexes in the blood if you have a severe autoimmune disease, which technically would kill you if you didn't remove those. And, this would normally be used to filter those out of the blood to remove them. Exactly. And then, to replace what's gone with albumin, which helps to replace the proteins that would naturally be present in blood.

Exactly, exactly.

Okay. Now, for somebody who doesn't have an autoimmune disease, why would they do this? What's it accomplishing?

Okay. So, great question. There's a lot of stuff that lives in our plasma. I have a chart up over here that you can show. We have ions and nutrients that live in our plasma, of course, right? And so, when we take that plasma out, we need to replace that back with IV therapy. So, basically, I have an IV bag also going with your sodium, potassium—

Okay. So, that's replacing all my electrolytes and my nutrients that I'm losing in blood. Okay. So, we got that covered. That's good.

Growth factors.. So, we have hormones and growth factors in our blood as well. Those are going to be regenerated by your body in 24 to 48 hours. So, you do have 24, 48 hours where you don't have those hormones in there, but they do regenerate immediately. They start regenerating immediately and they get back to normal levels within 24 hours.

And by the way, what would a growth factor normally do? If you had it out of your system, what kind of things would you not be able to do?

Well, I mean, for the short amount of time that you don't have a growth factor in your body, it doesn't do anything really.

If you had no growth hormone for a long period of time, that's an issue. You'd see reduction anabolism because that didn't get regenerated.

Exactly. Okay.

That's a good point. That makes sense.

Okay. So, coagulation factors also live in here. So, after this therapy, it takes 36 hours to regenerate your coagulation factors. So, we always tell everyone be a little bit careful the next 36 hours that you don't bump your head or fall or anything like that. You still have some coagulation factors, so it's not too much of an issue, but we just tell people to be careful.

Okay. So, no Monty Python skits where somebody's cutting off your arm because it's going to really swell. Exactly.

Okay.

Exactly.

And then, we have immune globulins. Okay. So, these are what detect infections and we replace those which is called IVIG, IV immune globulin. So, at the end of this, we give IVIG as well.

Okay.

So, that's for your body to recognize infections. Okay.

I could probably also have a colostrum smoothie. That's good for growth factors. I actually love it.

Or you can have it—

cover some of these things you're talking about.

It's interesting. Let me go right next door and get one over at Sunfire. Okay, then proteins. We talked about proteins, replacing that with albumin.

Okay.

And then, you know, you have these exosomes that travel in your blood as well from your stem cells and from other cells that we can replace with exosome therapy after doing this as well. Okay, but those also— your body will regenerate all of this stuff It's regenerating right now as it's being removed. Your body is able to regenerate immediately, but to get to normal levels takes about 24 hours.

Okay. What am I getting rid of that would be considered bad?

Now, this is the key. Okay. So, another reason that people have been using this machine in the past was for familial hypercholesterolemia. Okay. So, when people's cholesterol levels are out of control like 400 or 500, this machine is removing cholesterol as well. So, we're using usefulness in this machine to remove Lp. So, some people have a genetic tendency to have really high Lp, and so we can remove that with this machine as well. So, if you have high cholesterol, this is an expensive high-maintenance way of removing that cholesterol, but some people need it if they have a familial reason for this.

And, the Lp would be associated with the smaller cholesterol particles that will potentially be more atherosclerotic?

Exactly. Lp is a genetic condition By the way, everyone listening to this needs to get their LP measured. 20% of people have disordered LP and you have a genetic condition that causes high LP, which causes atherosclerosis basically. And, I can't tell you the number of people that we discover LP in. And, the hard part about LP is genetic. It's also not manageable by lifestyle factors. So, it doesn't matter how healthy you are, if you have— which which you don't, by the way. We checked yours and you don't have this, but 1 out of every 5 people have high Lp and they have no idea and they're running around with severely stenotic blood vessels and they don't know it.

How's that compared to ApoB? Because you hear about ApoB as a highly atherosclerotic marker as well.

So, ApoB is a protein marker on all the bad cholesterol particles. So, VLDL, LDL, triglycerides, Lp. So, I look at ApoB as a sum total. Of your cholesterol that is atherogenic. And so, I would say we treat for ApoB, we want to look at ApoB, we want to get your levels managed of ApoB. We'll talk about this more when we talk about your CLEARLY scan, by the way. But yeah, so cholesterol is one of the things that are being removed. Now, the main thing that this is removing is inflammatory cytokines, inflammatory molecules, toxins in your blood, so heavy metal toxins and other toxins, and protein complexes as well that are deleterious. So, removing those from your blood is detoxifying you at a very, very high level.

Now, compared to something like, let's say, chelation or one of these metal detoxification protocols, is this considered pretty effective for removing metals?

Oh, yeah. So, chelation, what you're doing is you're binding those metals and you're trying to pee them out and remove them that way. What this is doing is actually directly removing—

Oh, wow.

—particles that live in your plasma.

What about these chronic stealth co-infections like Lyme or mold or Epstein-Barr? Any effect on those?

So, there's a lot of research being done on all these things now finally. And, we're actually treating patients and monitoring their levels as well. So, hopefully, we'll see some effect there. So, right now, this kind of therapies are a little bit of a leap of faith because because we don't have large randomized control studies on people, on humans. But, I mean, the way I look at it is absolutely this stuff lives in your plasma, absolutely removing it is going to be helpful. So, let's give it a shot. Let's try it. This machine is extremely safe. This procedure is super safe because we're not treating you with any medicines. We're not putting any chemicals in your body. We're not treating with any medicines. All we're doing is removing the bad stuff. Now, you know those experiments where they hook up two mice and one is old and one is young? Yeah. And the young—

They exchange blood. I believe the young one gets older. I don't think the old one gets younger. I think the young one gets older, isn't it?

And the old one gets younger. Okay. It goes both ways. Yeah, exactly. So, that's called parabiosis. That's why you have these people up in Silicon Valley that are doing plasma exchange with young people.

You know what I mean?

Yeah, with young healthy donors. Exactly. But, what we're finding now—

You can't have any of my blood, Darshan.

But, what we're finding now though is not really the young blood that is making the old mouse younger. What's happening is removing the plasma from the old mouse that's making them younger.

Oh, so when the plasma comes out, it's not that you're replacing it with the young plasma, instead of removing the old stuff, which is exactly what we're doing right now. Which is exactly what we're doing right now. Now, what do you say to the people who are— not that I want to throw anybody under the bus, but some paleo primal carnivore type of enthusiast who's listening and who's screaming at you right now, Darshan, cholesterol is good. Why are you sucking cholesterol out of the blood? We need that.

I think that unfortunately, the whole cholesterol debate has created two camps, which it is so much more nuanced than that as we know. Cholesterol is not bad for everybody. Having too high of a cholesterol is not bad for everybody. And, we do have overprescribing of cholesterol-lowering medications in general in the United States. We see that. I agree with that. We have overprescribed. Overprescribed, right. However, what I will say is that there are many people people in the world that do need cholesterol-lowering medications. And we talk a lot about population-based medicine versus personalized medicine, right? Yeah. And so, when you make general statements like cholesterol is good or cholesterol is bad and apply that to an entire population, you're really doing each individual a disservice. So, we're going to dive in later once again with your heart scan and how we're going to manage your cholesterol because you you do have some of the negative effects that are building up of high cholesterol. So, we do need to treat this for you. And, the negative effects of high cholesterol, one of them is atherosclerosis. Atherosclerosis is due to 3 things. It's due to, number 1, inflammation. So, this is reducing inflammation. Number 2 is due to damage to your arterial wall, mostly from hypertension, high blood pressure. And thirdly is Or excessive very hard exercise as well.

Exactly.

Yeah, yeah, yeah, yeah. Your lifestyle for many years, you've accumulated a lot of damage to the endothelium of your blood vessels. And lastly is ApoB particles. Okay. So, it's only part of the equation. So, high cholesterol is not bad for everybody. It is a problem for many people and that's why heart attacks are the number one cause of death in the United States and the Western world. And so, we do need to manage for that. But yeah, I try not to get into these debates that people are so one-sided about it because it's so much more nuanced and every individual is a different person and we got to look at each individual.

Ben Greenfield: What do you think about the idea that when it comes to cholesterol, you actually need to be more concerned about tissue cholesterol levels versus blood cholesterol levels? They're just kind they're like a clue, but they don't really tell you what's going on from a tissue standpoint.

Right. So, what do we use cholesterol for is every cell wall needs cholesterol. And so, cells are producing cholesterol and your liver is making extra cholesterol for the cells that don't have enough inside of it. And so, really, if we had a measure of cellular cholesterol levels, that would be the best measure. So, blood Blood cholesterol levels is only used as an indicator for treatment. It's a biomarker that we use when we're instituting treatment and it's a risk factor for disease. So, it's not causing disease, but it is a risk factor we know from massive studies that have been done, a risk factor for heart disease and other types of heart disease.

Probably because if it's elevated in the blood, that's a clue that it could be accumulating. Exactly. As plaque or contributing to plaque accumulation in the heart. But, that doesn't mean that high cholesterol is doing that. However, it's a pretty good sign that it might be. And, that's where other imaging might come in.

Exactly. That's why I try to reframe this whole cholesterol thing with my patients. I'm like, "Look, if you have damaged blood vessels and if you have inflammation, having a lot of ApoB particles is not good because those are the ones are going to get into the vessel wall and cause blockages of your vessel wall. But, if you're super healthy and you have a higher ApoB, it might not happen. And, that's why once again you have to treat each individual looking at what their status is.

Yeah. And so, that kind of leads me into what I wanted to ask you about in a second. But, before we get off the topic of this TPE, this therapeutic plasma exchange, how often How often would somebody do something like this? If you do it once in a lifetime, you're getting good effect, do you come back on a yearly basis? Yeah.

I like to describe it as an oil change for your body, really. And, a lot of the studies have been done on 6-treatment protocols. No one knows right now. Let's talk about the studies a little bit too on therapeutic plasma exchange. There's some really great work being done by Dr. Kiprov up north who we've interacted with and visited with on Alzheimer's disease. And, I've talked to Dr. Dale Bredesen about this as well. And, when you remove the protein complexes, the tau protein and amyloid complexes from the plasma like we are right now and you put albumin in the body, you can suck some more of these protein complexes out of the brain as well. And so, what Dr. Kiprov has studied is using therapeutic plasma exchange with 6 treatments over the course over the course of, I think, 12 weeks, 6 to 12 weeks. And, he showed a decrease in progression of Alzheimer's by somewhere between 15% to 30%. Wow. Massive slowing of Alzheimer's using this treatment. Sadly, insurance doesn't cover it. It's pretty expensive right now. But, hopefully, we get to the point where we can offer this to patients who are developing Alzheimer's to slow their progression and potentially reverse where they're at.

Wow. And it's literally removing a lot of the proteins that would normally cause damage to the brain from Alzheimer's. Exactly. That's crazy. Yeah, incredible.

Yep. So, so, you know, now there are blood tests for tau protein and amyloid protein that you can do, and they have a very strong correlation with PET scans, which are what are diagnostic for Alzheimer's. So, you know, it goes to follow that if you can measure these proteins blood, removing them from the blood can be helpful. Kiprov's studies are showing effect.

How many times have you done TPE?

This is my 4th time doing it. What do you notice after? You don't really notice— I don't really notice a lot of physical sensations other than it's kind of like cryo. You just feel more energetic. You feel clearer for a few days. You just feel like you're able to sleep sleep better, you're able to get more done, exercise more, lift more weight, et cetera. And, I feel that probably for, I would say, 7 to 14 days potentially. But yeah, it's not something you're necessarily going to feel. Right.

It would be more like a pretty hefty preventive lifestyle strategy. Exactly. Yeah. Exactly. Now, we talked briefly about the heart thing. I want to talk a lot more about that And, let me lay down a background for folks a little bit here. If you look at the research, probably James O'Keefe is the guy who's done a lot of the studies on this or brought this to common knowledge. We know that there's a law of diminishing returns with exercise, meaning once you exceed somewhere around about 120 minutes of moderately intense exercise during the week, you see arterial stiffness, you see increased risk of cardiovascular disease, increased risk of stroke, et cetera. We also know that exercise is great for the heart, right? It lowers blood pressure, lowers blood sugar, and within moderate amounts, it's good. We know that from what James O'Keefe has looked at, a lot of ultra marathoners, Ironman triathletes, and people who basically fit into the category of what I did for like 20 years, they tend to have a lot more heart issues than what you would expect from like an aerobically fit population. It's like too much of what might be a good thing in moderate amounts. So, turns out that like, I don't know, Darshan, it was probably like 3 or 4 years ago, you and I met up with this Dr. Dandilaya down there. We did a whole battery of heart tests. We had flow scan, we did EKG, we did ultrasound echocardiogram. And, amongst that battery of tests was included what's called a calcium scan score. Exactly. And, I got my calcium scan score. And, even though just about everything else my heart looked pretty good, I had elevated calcium. And, it was very tightly packed, somewhat stable, the type of patterning you might see in someone who's more fit, but it was concerning nonetheless. And then, 9 months ago, I found out about this new test that's even better than the calcium scan score. It's called a CT angiography, known as a Cleerly scan for diagnostic imaging. I'll let you explain in a minute what that test is looking at, but But layman's explanation here— sorry, ladies, layman's or laywoman's— is that it tells you the amount of plaque that you have in your heart, whether it's stable or unstable, and where it might have accumulated. My score was very high. It was concerningly high. And so, over the past 9 months, I have been doing a lot of things to see if I could get it to lower, namely endothelial glycocalyx support, certain sulfur-based supplements that help to support the lining of the blood vessels, nitric oxide precursors and nitric oxide support for vasodilation, more infrared sauna, more magnesium, less intake of a lot of the saturated fat cuts from the ribeye and the pork, et cetera, a lot more fish and olive oil. And then, I also have been using red yeast rice, which is kind of like nature statin, a little CoQ10, and niacin. That's a pretty hefty stack. And, I feel great, right? I feel great. However, I came into the repeat test and not only has the plaque not budged, it's gotten a little higher. So, we'll address why that is, what we might be able to do about it in a moment. But, I'm saying all this to tell you that folks, when you hear about the natural healthy lifestyle, just take the supplements, type of approach, there might be cases where you need to do a little bit more digging than that. And, if you haven't yet done a scan like this and you're only looking at your lipids, you might have to do a little bit more digging with that too. But, first of all, Darshan, I know I just gave a little mini TED Talk. What is the CT angiography, this Cleerly scan, actually looking at?

Absolutely. Okay. So, the first test I get all my patients to do, I think I pushed you to doing the CT calcium score as well. I think you were 35 when we did it, right? You were pretty young.

I was 35. And, by the way, I was very much high-fat diet, keto, fat, fat, fat, cholesterol is good, had elevated LDL, high HDL, low triglycerides, but also somewhat elevated ApoB, slightly elevated Lp, not super high, but one of those lipid panels that I don't know, someone in the Ancestral Health community would stand proudly about, and I actually did at the time.

Yeah, exactly. And I was like, "Look, let's just check a CT calcium score on you." And we saw the calcification. So, what a CT calcium score is, is a CAT scan of your heart. It's super quick. It's 10 minutes. It's minimal radiation. And it's the most underutilized diagnostic test in healthcare today because insurance doesn't pay for it, and God knows why. And, I love I love that test because it gives us an indicator of if you're forming plaque or not. Now, what that's showing you is little bits of calcium in your blood vessels. And when your blood vessels have plaque and it gets calcified, that's an advanced, more stabilized plaque. So, when I see calcium and someone's calcium score come back positive, I know that they have plaque, number 1. Number 2, they've had plaque for a while. And number 3, it's getting pretty advanced. Plaque always starts off as soft plaque. It doesn't have calcium inside of it and it's soft, meaning that is just cholesterol in the blood vessel wall that's lowering the diameter of that blood vessel wall. So, what the Cleerly scan does is a CT angiogram. Now, this is a longer scan. It takes probably about 30, 45 minutes to do and there is more radiation associated with it, but it's still within tolerable levels. You You don't want to get this done every quarter or every month. You want to do it once every few years. But, it gives us an indication not just of calcified plaque but also the soft plaque. Soft plaque, in my view, is still treatable, whereas hard plaque is more difficult to treat because there's calcified—

So, would soft plaque be considered stable and hard plaque unstable? Opposite. The opposite. Okay. So, hard plaque is stable, soft plaque is unstable, more likely to break loose and cause problems.

Exactly. More likely to get a clot in it, more likely to expand rapidly, etc. So, what we have on the screen here is your left main and left anterior descending.

Oh, these are my results from the one that I just did yesterday.

Exactly. Yeah. Yeah. This is actually your left main and left anterior descending artery.

Left main and left anterior descending artery in my heart.

Exactly. Now, how cool is that though that it can lay out the entire artery and show you exactly where the plaque is. And so, you could see that yellow stuff at the beginning over there, your proximal left anterior descending artery is non-calcified plaque. So, that's plaque that we know is narrowing your artery right now. And, from your previous CLEARLY scan that we did a few years ago, that's actually become worse. Yeah.

And, non-calcified is not good. Exactly. That would be unstable.

It's unstable and also it's in a bad spot. It's called the widowmaker, right? Yeah. Because that can expand rapidly. And, if you block your left anterior descending artery, most of your heart is supplied by this blood vessel, you could die. So, this is how a lot of people find out that they have heart disease the first time is their first heart attack.

They actually get their first heart attack. Exactly. Yeah.

50% of people find out at their first heart attack and 50% of those people die.

We are looking at the left main and left anterior descending arteries of a heart that was under extreme amounts of stress for 20 years. I mean maximum heart rate or above for multiple minutes per day combined with honestly a lot of lifestyle stress, et cetera. And, this is notable for folks eating what could be considered a pretty healthy diet, at least not a standard American diet, being aerobically fit, getting in the sunshine, etc. Now, would you say that if you were to combine— this is a question I'm very curious about, kind of like a bigger picture question. If you were to be into like CrossFit, maybe 2-a-days and ultra-endurance triathlon and marathon, do you think that you would actually aggravate this issue if you were kind of eating like a higher fat high-saturated fat keto type of diet because you'd have more cholesterol to potentially become oxidized? Yeah.

I mean, look, every individual, I can tell you, everyone I see has a different story. You're one of the healthiest people I know and you created a lot of inflammation, I think, by having that endurance athlete lifestyle combined with the moderately elevated cholesterol levels as well. Yes, I think for you, we can definitely see that this has affected your arteries. Now, we see a lot of athletes here and I could tell you this is a pattern I see over and over and over again. So, anecdotally, I can say the answer to your question is probably you're headed in the right direction with that.

And, do you see it over and over again in athletes of all varieties or primarily do you see more notably in endurance and ultra-endurance athletes or people who would be considered overtrainers?

Yeah, I would say it's more the overtrainers, right? Exactly. And so, I think there's a point in your life that you really have to look at the amount of exercise you're doing and how it's positively or negatively affecting your inflammation levels and your metabolic health and your ApoB levels. Those 3 things are, for many people that exercise like an endurance lifestyle, they do cause damage for years and years that builds up and then we have to increase encourage them to have a different tact to the exercise routine that you talked about. So, yeah. So, I mean, I think once again, population medicine will tell you to not check these tests. I think all the people listening out there, if your doctor says, "Oh, you're fine. Your cholesterol level's low. Don't worry about it." I think getting a CT calcium score at the very least is a good idea for anyone who's 40 years old and Yeah. But, what about—

what if somebody can't afford it or their Uncle Jerry who wears a tinfoil hat told them they get more radiation than 1,000 plane flights or whatever? There's reasons that they might not get a CT angiography. Earlier, you and I pulled up on your laptop this other test that can give you markers that could be predictive of this same type of plaque accumulation. It's called Preventia HART test. What do you think about something like that?

Yeah. Some of those tests are actually really good. They're indicators of heart stress. Okay? And so, when you have blockages in your blood vessels, you cause more stress in the heart and then you can pick that up in protein biomarkers. That blood test actually is more expensive than a CT calcium score. The CT calcium score, you can get for $100. So, just call a local radiologist.

Ben Greenfield: And that blood test is north of 400, I think.

Yeah. Joseph Fung: Right, exactly. So, I think the calcium score combined with that blood test is a great workup for atherosclerosis disease. But, at the end of the day, when you see a cardiologist, they're going to do a stress test on you, they can do an echo, there's other testing that needs to be done. And, the cardiologists are experts at testing for this stuff. But most people never get referred to a cardiologist until it's too late. And that's why I try to promote and harp on being the CEO of your own health and getting some of these markers done early so you know earlier and you could talk to your doctor about referring you to a cardiologist.

Most people under the expression this type of diagnostic imaging is prohibitively expensive or only available on executive health plans. You said less than $100. It's not less than $100. Around $100. Yeah. To me, for the knowledge that we're getting from this is incredible. Now, so we're looking at left main, left anterior descending. By the way, again, for those of you who are wanting the video, the images, I'll even put downloads of this if you guys want them. Go to bengreenfieldlife.com/nexthealthlife. bengreenfieldlife.com/nexthealthlife. What else can we glean from this data here?

Yeah. So, what's great here too is that we can see your other blood vessels that are supplying your heart. You have a few lesions here in your right coronary coronary artery that are fairly minimal.

And, when you say a lesion, is a lesion synonymous with plaque accumulation? Yeah. Okay.

Yeah, plaque accumulation. And, you actually get these scores here that are helpful for us to follow as well. So, you can see that you have different plaque stages, you have a plaque score, atheroma volume, and we can follow these numbers over time. Now, precision medicine is going towards treating these numbers and actually reversing plaque with newer therapeutics like PCSK9 inhibitors. Yeah, we'll talk about that for sure. Yeah, exactly. So, we can do a combination of cholesterol-lowering medications. And look, I'm not trying to push statins on everybody. I think statins are some of the most overprescribed medications in the world. However, there is a combination of statin and Zetia and PCSK9 inhibitors as right for each individual patient. And so, there's testing that needs to be done to see what's right for you. And then, we can potentially reverse some of this damage that's been done combined with all the things that you're doing already. You're taking the right supplements. I think modifying the diet, one diet that's been shown and extensively studied to reverse plaque is actually the Mediterranean diet. So— Yeah, absolutely.

The one with the unlimited breadsticks and the canola oil at Olive Garden, that one? No breadsticks. No, no. Or the one with the religious and systematic fasting periods of protein restriction and really good extra virgin olive oil consumption from the actual Mediterranean.

I actually think it's from— yeah, I think it's from the amount of vegetables being 500 to 800 grams of vegetables, high fiber, olive oil, flavonols and polyphenols.

Yeah, I agree. And I'm gradually moving more and more into that type of dietary protocol. Especially the more I learn about my heart, some of these studies. Now, a couple subtle nuances here. On this atherosclerotic chart, you can see I'm stage 2 out of stage 0, 1, 2, and 3. You and I were in Maui at your guys' location down there. We got a Next Health inside the Four Seasons, which is pretty cool. And when we were there, we're at the dinner one night and you told me about this study that you later texted to me that showed the type of proven protocol for from a medication standpoint that would be used to actually treat a stage 1, stage 2, stage 3, and it's like a statin combo, something like that, right?

How does that work? So, it's a combination of statins and Zetia, which lowers the absorption of cholesterol. What's Zetia again? Zetia is ezetimibe. It's a pill that you take that lowers your absorption of cholesterol and a PCSK9 inhibitor as well. So, the combination of Some of these medications can be very helpful in reducing plaque volume if you get to it early enough before it calcifies, which is— the Cleerly scan is great because it tells us how much non-calcified plaque you have. And now, we actually have really good numbers to follow and treat towards. So, I'm not a cardiologist, but we work with Dr. Dandillaya that you've met and he's a cardiologist and he can institute the right protocol for you to turn back some of this damages in that really bad spot. That left anterior descending spot is a bad spot. So, we want to closely monitor and turn that around.

Yeah. And so, you got the ezetimibe. What's the other statin you would take in combination with that?

Crestor. Crestor. Yeah. What's the—? The—

It's sort of an R, Crestor. Yeah, rosuvastatin. Yeah, rosuvastatin. Oh, you want the generic of Crestor. Rosuvastatin. Yeah. Yeah. So, rosuvastatin and ezetimibe, and you would take those I think what you told me was 5 mg of the rosuvastatin. Right, exactly. And, 10 mg of the ezetimibe. Right.

And, you can go up on the dose too.

Yeah. But later, you actually got me a prescription for that. I didn't quite start it because someone told me that some people are genetic non-responders to statins. So, I went and tested my genes and lo and behold, I did one of these tests, SelfDecode, I think, is the one I use for this. And any test, StrateGene, DNA company, many of these tests will show that. It showed I was a statin non-responder.

Is that common? It's not common, but it is definitely a problem for some people. And so, we see this. By the way, I just did a podcast with SelfDecode yesterday.

Oh, with Joe? Yeah, with Joe.

He's great. Yeah, he's done such a deep dive into this stuff. It's amazing.

He likes to take his shirt off a lot now. All of a sudden, I'm not the guy who's half naked all the time.

That's awesome. Yeah. He looks great, but he really has a great platform where we can find these genetic non-responders just using a simple gene test or even you can upload your 23andMe, I think. In the absence of those tools, we learn by prescribing, not making a big difference, moving towards a different class of medications. But, yes, now you can do gene testing and see that there's actual non-responders. Yeah.

And so, then I talked to Dr. Dandelayat and he said, "Well, then the PCSK9 inhibitor would be a good idea for you." So, what is a PCSK9 inhibitor?

So, this is an injectable medication that actually works in your liver to inhibit an enzyme called PCSK9 that breaks down a receptor that catches of cholesterol in your bloodstream. Okay. So, once you inhibit the breakdown of that, you have more of those receptors, you remove more cholesterol from your bloodstream, metabolize it in your liver.

Ben Greenfield: Okay. Would there be— and I know some people are going to ask this, "Well, the body has LDL receptors for a reason. Why would you want to decrease the degradation of those or somehow stop the body's normal process?" of breaking down LDL receptors so you have more to catch the LDL?

Because there's massive studies show that lowering your ApoB by removing LDL, Lp, VLDL particles from your bloodstream reduces your risk of dying from a heart attack. And now, we have more studies using things like CT angiogram showing that using the right treatment protocol could actually reverse plaque. Which is massive. I mean, it used to be like damage is done, the only way we can reverse, we can treat you now is to put a stent in your heart or do bypass surgery. Now, we know that with therapeutics, we can actually reverse some of this damage.

And, would you need to, for something like a plaque reversal or what they call, I think they call melting away plaque, right? And again, I got in all the natural stuff recently and I read the studies about pomegranate juice melts away plaque. I've been doing tons of the reds and the polyphenols obviously didn't make a dent. But, the PCSK9, would that have to be combined with a statin and with Zetia or could that be effective on its own?

So, this is where you really got to get into that personalized medicine part using that study I sent to you. I believe for you, it's a combination therapeutic modality, but I just need to look at exactly how much plaque you have, what the research shows, and what that I remember the chart that you showed me.

It was 5 mgs of the rosuvastatin, 10 of the Zetia, and then the PCSK9 inhibitor as a twice-a-month injection.

Yep.

There you go. And so, that would be the next step for me to actually start to melt this away.

Exactly, exactly. Yeah. It's very targeted now. And, I think that you armed with this data, which you would have never had if we not got that calcium score, we can potentially prevent a heart attack that you might have had when you were in your 50s and your 60s.

Oh, yeah. My wife is going to give you a big hug. PCSK9 and everything, side effects?

Very minimal rate of any side effects. I've had probably 100 people on PCSK9. I've never seen anyone have an untoward reaction to it.

Okay. All right. And, that's just an injection. You can pick it up Pick it up from the pharmacy, take it home. Okay. This is really good information. The ApoB, no surprises here. Mine was elevated. It was up near 120. What do you like to see ApoB at if someone's testing that in conjunction with this?

Right. So, now that we know that you have a lesion, I would try to lower your ApoB to 50 or lower. 50 or lower. 5-0 or lower. Yeah.

And, you said a PCSK9 can help with that. It's incredibly effective with—

Yeah.

You think that's one of the best things to lower ApoB? Yes. Okay. Yes. Uh-huh. Okay.

Good to know. It's definitely the most effective, the most targeted for many people that— in what I've seen with my patients. Now, different people respond differently to different medications. And so, there is a little bit of a discovery time period that we have to go through with people to see what's going to work for them. And so, it's not like a one protocol fits everybody, but at least we know where to start.

Okay. All right. You saved me from dying of heavy metal accumulation and autoimmune diseases. You have stopped my Widowmaker in its tracks, so we're 2 out of 3 here. But, the last piece here is obviously a concern for a lot of people as well, and that's cancer. And, specific to the conversation I wanted to have with you today, colon cancer. And, you have a history with colon cancer, right? Yeah.

Well, I spent the first half of my life being a surgeon and I've I've removed probably over 200 colon cancers in my life surgically. So, a lot of history with colon cancer. I know you said your dad just had surgery for colon cancer.

My dad had surgery for colon cancer. I have 2 cousins who have passed away of colon cancer, another one who has a colonic resection. My grandfather died of colon cancer. Wow. And, it is on both my mom and my dad's side. So, I've got a high risk and my genetics show a high risk for colon cancer. So, I realize some people say, "Well, just do a coffee enema every week and you'll be good to go," but there's got to be a little bit more to it than that. So, I'd be curious to hear your take on this.

Yeah. I was going to show you a picture, but I can just talk to you about it. So basically, colon cancer is incredibly underdiagnosed as well. And whenever I talk about cancer, I always say cancer's biggest enemy is being diagnosed at stage 1, right? Most people don't find out about cancer until they're symptomatic. Symptomatic cancer is almost always stage 3 or stage 4. Now, instead of talking about cure, we're talking about 5-year survival rates with chemo and radiation. You never want to get to that point. Sadly, Western medicine is so geared, once again, to population medicine. You can't do some of these tests on everybody. Not everybody in the world can get an MRI. Not everybody in the country can get an MRI because we just don't have the facilities to do that and it's expensive. However, we would have a much lower spend on treating advanced cancer if we did do stuff like that. Now, cancer in general, there's different ways of diagnosing cancer. And, for different types of cancers, there's different diagnostic protocols. For colon cancer specifically, The most effective way is to do a colonoscopy, as you know. And everyone needs to get their colonoscopy because not only can a colon cancer be diagnosed before it even is stage 1—

Because it's like a tiny little polyps. Exactly.

Because it starts inside of a polyp. When you do a colonoscopy, you can see the polyp and you can actually remove it. And so now you're diagnosing and treating colon cancer at pre- stage 1. So, for you with this extensive family history of colon cancer, rather than waiting until your tummy hurts or you have severe constipation or even worse, why not just do a colonoscopy once every couple years and remove these polyps?

Because people say they're risky. That's why. They say you're getting your colon perforated or there's issues of anesthesia. I even read, this is just a few days ago, I read that you should talk to your physician because they don't they don't properly clean a lot of the equipment used in colonoscopies. And, there's all sorts of fear or fearmongering at least out there about colonoscopies. Yeah.

There's so much fearmongering and I could tell you that the equipment cleaning thing, I mean, someone probably read one article about that somewhere. If you go to a reputable gastroenterologist, they are excellent at cleaning their equipment. Their perforation rate, you should always ask, what is your perforation rate? Is Minimal, minimal. And, the anesthesia is the most minimal anesthesia you can get and it's extremely safe. So, I mean, look, not everyone needs to get a colonoscopy every couple years, but your extensive family history, my advice to you would be to do them more frequently than not do them. Yeah. Yeah.

When you say more frequently, you think if you have a high family risk of a certain type of cancer like colon cancer.

Yearly? Every couple years. Every couple years. Every 2 to 3 years, I would say.

Yeah. And, I recently interviewed Dr. Avi Herskowitz from San Francisco about this. And, I'll certainly link to that podcast in the shownotes. We had a very frank discussion about the rate of cancer growth and how it can be accelerated and also the increased rates of cancer in young populations. We talked a little bit about liquid cancer biopsy, being able to diagnose cancer from a blood like RGCC or or GRAIL test or something like that. You ever mess around with any of those?

Oh, yeah. Our cancer diagnostic protocol for our executive physical patients is to do a full body MRI combined with a liquid biopsy, a full skin evaluation, and then all the regular cancer screening stuff too. So, your mammograms and your OB/GYN exam for women. For men, it's a PSA level prostate exam and colonoscopy for both men and women. And so, we cover the full gamut. Now, the important thing to realize about the liquid biopsy, which I think is a game changer in medicine, let me just talk about what that is real quick. It's a blood test where you're finding cell-free DNA of tumors. So, tumors actually shed DNA when they first develop into your bloodstream. These can now be detected in your bloodstream utilizing DNA sequencing. Sequencers. It's a massive step forward in medicine and cancer diagnostics. It can diagnose some of the highly lethal forms of cancer very easily, like pancreatic cancer, for example, or liver cancer, bile duct cancer. And these are all cancers that are very difficult to diagnose until it's too late. I always say if Steve Jobs was around a few more years, we would have benefit of this technology. And he'd still be alive because we would have found his pancreatic cancer stage 1. Yeah. Yeah. So, you need that combo of these tests, full body MRI, liquid biopsy, and the regular screening in concert to be truly 21st century in cancer diagnostics.

Some people will say, "Well, that's too much. You're going to be finding a bunch of stuff that would normally be benign, would never be an issue. You find a little spot and you go in and cut something out, you never would have had to do that because it wasn't an issue in the first place.

I've heard people say that. Yeah, absolutely. So, there's this thing in MRIs called incidentalomas. And, incidentalomas are finding incidental findings and having to figure out what is that. You might need a couple of extra diagnostic tests like an ultrasound or something else. But, once you diagnose an incidentaloma and you know it's there, the next time you do the MRI, you don't go down that pathway again. It's just a one and done. You've figured it out. Same thing with the GRAIL test. Now, what I will tell you is you have to have a certain psychological fortitude to be able to handle a false positive diagnosis. It's not really a false positive. There's something there. We just don't know if it's a cancer or not a cancer. Does that make sense? So, yes, you need to have that mental fortitude, but I would say that the flip side of that is that you don't diagnose it. You live in blissful ignorance until it's too late. And so, I think it's, in my view, for myself, my family, my friends, I encourage doing some of this testing just so you know earlier rather than later.

Ben Greenfield: How important do you think it is to avoid red meat as far as cancer risk? And, I know this is a loaded question, so I'll just hopefully not softball pull this up for you too much, but I think that heavily processed smoked preservative-laden meat is an issue. But, I've always wondered if there's something about red meat specifically beyond the way it's processed that would make it a risk or if you're having a grass-fed grass-finished cut of beef, you don't have to worry about it.

I think that the WHO made red meat a cancer-causing substance and it's all because all those studies were done on processed, heavily processed, irresponsibly grown meat. And I think as long as you're sticking to super organic, well-raised red meat, you're going to be okay. Most pork is not raised responsibly, so I stay away from pork for that reason. However, I'm a big fan of grass-fed beef and Grass-fed, grass-finished.

Grass-fed and grass-finished, right, exactly, beef.

And, I use this company called KOW, K-O-W, ever use them or—

No, it's a great name though.

Yeah, they have incredible beef. ButcherBox is incredible too. And, I don't limit myself on red meat. I think the opposite is not getting enough protein, which is worse than not getting enough—

Yeah, because protein, This is, I think, something else that's vilified in the industry, excess activation of mTOR and it's insulinogenic and it's got too much methionine in it, which could be anti-life extension. And, the problem is that protein is so satiating, so associated with the drop in frailty, so good at stabilizing blood glucose levels. You ever tried to eat yourself full on chicken breast? Like a leg of turkey. Yeah. There's no way you're going to eat as much as if you had cheesecake or a bowl of cereal. I even had dinner last night with a very smart guy. He said he thinks that within 10 years, nutrition standards will be adjusted up to 1.5 grams per pound of protein for the recommended intake of protein. And, even though that sounds high, I think that more people would benefit from high higher protein intakes from good clean protein sources, especially just to look at frailty, sarcopenia, muscle protein synthesis. So, yeah, I think there's a little bit of protein phobia that goes on that's just—

it's unnecessary. Once again, it's become those religious kind of things like there's one side versus the other side. I have a lot of patients that are vegans and vegetarians and I still talk about getting enough protein. You don't have to eat red meat to get enough protein. There's other protein sources but I do absolutely believe that we're underfed in protein in general, and that's what's leading to a lot of chronic conditions, a lot of chronic disease, frailty like you said, as well, and sarcopenia. And so, I think definitely we do need to revisit how much— the RDA of protein is nothing. It's 0.4 milligrams per kilogram.

My current recommendation is 0.8 grams of protein pound of body weight. Yes. Try to get some of that from amino acids, gelatin, or collagen, like hydrolyzed protein sources or even whey protein. If you're older, use digestive enzymes like a protein digesting enzyme to break it down. And then, if you want a little bit of icing on the cake from a muscle standpoint, vitamin D, fish oil, and creatine. Exactly. And, that would be what I'd tell an old person who wanted to maintain or build muscle to actually use.

I love it. You always break down the exact protocol. That's exactly what you need.

Follow the rules.

8 grams of creatine a day or 5 grams?

5 grams, although creatine can assist with executive function and cognition in a state of sleep deprivation, but all the studies on that use 10 to 20 milligrams or 10 to 20 grams a day. So, use higher dose creatine if you need it for the neurological effects. And, that would be one-off because it'll honestly give you diarrhea using that much frequently. But then, just 5 grams a day and it works perfectly.

I saw one study—

Pure old creatine monohydrate. Yeah, yeah.

And, I saw one study, 8 grams a day decreased risk of cognitive impairment in Alzheimer's.

Yeah. Neuroprotective. Yeah. So, that was as low as 8. I said 10 to 20, but it sounds like you used one as low as 8. Yeah. Yes, that's impressive. Yeah. So, we've got therapeutic plasma exchange. We've got this, this CLEARLY scan. We've got the cancer and the liquid cancer biopsies, the MRIs, the screenings. You guys do a lot more than that at Next Health with your executive panels. And we've talked a lot more about this in the past as well. I'll link to all the previous shows I've done with Darshan at BenGreenfieldLife.com/NextHealthLife. Anything else exciting coming down the pipeline whether it's technologies, events, tests, that you think would be cool for people to know about and give them a preview of?

Oh, yeah. So, we're doing a lot around managing for metabolic disease. And so, we're providing patients with advice around how to manage metabolic disease. I love the continuous glucose monitor. If you don't have one— Wearing one right now.

Yep, you got to get one. Back there somewhere hidden behind all the tubes of blood.

Yeah. Truly understanding how your metabolism works is key. So we're doing a lot with that. We're doing a lot with full-body MRI scanning as part of our executive physical. We do a lot of functional medicine as well. So for people out there that don't have a functional medicine doctor, look into that— about hormone balancing, gut health, also, you know, around brain health and detoxifying your life. We live in the most toxic environment ever in human history right now, so understanding how to detoxify The air you breathe, the water you drink, the food you eat, these chemicals you put on your skin is super important. And then, as far as longevity technology goes, this is the cutting edge right here. We combine this with stem cell exosome therapy as well after the plasma exchange is done. We do a lot of ozone therapy as well for people that are struggling with things like Lyme disease or mold poisoning, etc. I think there's a huge uptick in education around all these things with podcasts like yours, mutual friend Huberman, Attia, all these guys are really talking on scientifically-based protocols to improve your health, wellness, longevity. I really appreciate that, looking at the science. We're doing an event in April that sold out unfortunately, but hopefully we'll do it on a yearly basis. —kind of bringing all the thought leaders like yourself together in Los Angeles. Are you guys going to record that at all? Unfortunately, a lot of the guys won't allow us to record.

Oh man, those bastards. You can record mine. I don't care. Alright, awesome.

We're definitely going to record yours and put it up then. That's fantastic. Yeah, but we will record as many as we can because there's so much good knowledge out there. I think everyone should just know that the amount of knowledge that we're gaining is incredible. Incredible right now. The uptick in the amount of science that's being done, I really believe that the singularity is going to happen where we're going to figure out how to live many, many years longer. So, get yourself educated, understand what's coming out, and just start doing some of this stuff, right? And, I think a lot of people get caught up in the controversy like we're talking about, the religious aspects of meat, no meat, ApoB, don't worry about your cholesterol. I think it's super individualized. You have to discover what works well for you rather than hang your hat on one camp, right? Yeah.

I've always said that I like to think of myself as having one foot in the realm of modern wisdom or ancient wisdom, the other foot in the realm of modern science. And I think part of that comes down to accepting both natural, naturopathic, alternative, hippie remedies like, I don't know, tying a chicken around your neck and eating chicken noodle soup. And also modern allopathic diagnostic precision medicine that tells you the type of stuff that we talked about today. I think you can have both. Like you say, eat a Mediterranean diet, but if you can get a CT angiography too. And, I think that's the takeaway for me from this show is embrace a lot of this stuff that you might not think you need to do because you're healthy, bro, but it turns out that that could be an entirely different story than what's actually going on.

Yeah, you're a living example of everything and that's right, but also you do everything right, but we can still find stuff. And, that's where Western— I'm a reformed Western medical doctor, right? I used to be a surgeon doing everything Western medicine taught me to do. And, I found that that doesn't necessarily lead to optimal health, right? And so, I totally changed my career into functional medicine, nutrition, exercise, and learning more about that. And you're absolutely right, these things work together, right? And so, you got to use the best of both worlds.

Yeah. Well, Darshan, thank you so much. Show notes, folks, are going to be at BenGreenfieldLife.com/NextHealthLife. I'll link to all the other shows I've done with Darshan. You can leave your questions, your comments, your feedback there. Thank you so much for watching. If you saw the live version, hello. And I'm Ben Greenfield along with Darshan Shah of Next Health signing out. Have an amazing week. Thanks, everybody.

Hey, so just a quick thing before we wrap up today's episode. Darshan let me know after this fascinating podcast we recorded as we both became younger that Next Health is actually franchising internationally and already has 30 locations signed up internationally for franchising. And so, if you are interested in Next Health from a business standpoint, go ahead and go to the shownotes contact Darshan, and, uh, you'll be able to go to their website when you access the show notes, and you can actually be operating a Next Health facility yourself, potentially, if you're a physician or a clinician who's interested in getting involved with Next Health. So heads up, and thanks for listening. Want free access to comprehensive show notes, my weekly roundup, cutting-edge research and articles, Tools, my top recommendations for everything that you need to hack your life, and much more, visit BenGreenfieldLife.com. In compliance with the FTC guidelines, please assume the following about links and posts on this site. Most of the links going to products are often affiliate links of which I receive a small commission from sales of certain items, but the price is the same for you. And sometimes, I even get to share a— unique and somewhat significant discount with you. In some cases, I might also be an investor in a company I mention. I'm the founder, for example, of Kion LLC, the makers of Kion-branded supplements and products, which I talk about quite a bit. Regardless of the relationship, if I post or talk about an affiliate link to a product, it is indeed something I personally use, support, and with full authenticity and transparency, recommend in good conscience. I personally vet each and every product that I talk about. My first priority is providing valuable information and resources to you that help you positively optimize your mind, body, and spirit. And I'll only ever link to products or resources, affiliate or otherwise, that fit within this purpose. So, there's your fancy legal disclaimer.