Longevity & Age Reversal with Dr. Charles Mok and Regan

So we have multiple tests we do for cancer screening and colonoscopy, pap smeared mammograms, CAT scan for smokers, their lungs. And there's advanced testing that can be done that increases that sensitivity. So we do the regular insurance coverage screening. We pick up about one out of four cancers before they're untreatable. One out of four missed. These are for people who are early adopters, are doing everything possible for wellness already. You can't shortcut health. You can't shortcut your diet and exercise and fitness. You can't shortcut screening for cardiovascular disease, brain disease, and cancer in general. My observation was people love their money more than their health. And if something costs money and it might make them live longer, like, well, my insurance doesn't cover it, I'm not doing it well. I think there's also a big group of people that say, you know, actually, I love my health more than my money. Right. If I theoretically, if I can live longer and be productive longer, well, money becomes less and less of a problem.

Hey, welcome, everybody, to Unreasonable Health. I'm your host, Reagan Archpaud, and we bring you the most cutting edge researchers, scientists, and practicing doctors in the field and share with you some insights on how you can extend your health, extend your life. And I've got one of my great friends, Dr. Chipmock, on today. And Dr. Mok's been practicing for 25 years. After he completed his medical degree, he did his postgraduate training in emergency medicine. He became the vice chair of emergency medical department at Medicine Mount Clemens Hospital in Michigan, now known as McLaren McComb. He has seen countless patients with health emergencies that were completely preventable, which is why he founded Allure Medical in 2003, one of the largest and most successful practices of its kind in the country. Through Allure, he's transitioned and helping patients with disease prevention. Allure is also a leader in elective cosmetic, medical and surgical treatments, as well as treating varicose veins, hormone therapy, and stem cell therapy. In addition to locations in Michigan, Allure has expanded to South Carolina, Wisconsin, Kentucky, Florida, Minnesota, North Carolina, with plans to expand, not stopping anytime soon. We're focused on areas that services are going to save the healthcare industry and help underserved communities. So, Dr. Chip, so good to have you on the show.

Thanks. Great to be here. Thanks, Reagan.

And I've been a fan of yours ever since we first had a conversation. And. And Chip and I are in two groups together. We're in the Da Vinci 50, and he's on the medical advisory board There. And he's always just the jaw dropper in your, your research and what you do personally has, has been amazing. And then Chip and I are also in strategic coach together in the free zone world. But, but right now you're doing a lot on your health. What, what would you say you're most fascinated with when it comes to age reversal? What kind of therapies and techniques?

Yeah. So I think about this more from a pharmacologic standpoint. So what I'm focusing on right now is something that's steps ahead of wellness. And I know you focus a lot on wellness. I think it's very important. We've specifically not gotten into that because a lot of those options around us. But I look at this in terms of different tiers. First you have your baseline health care, which we all need to manage our blood pressure if it's a problem, manage our weight manager diabetes, manage conditions. And then there's wellness stuff that might be, you know, doing your fitness fitness, maybe customized dieting, checking more specific labs, maybe doing like, you know, saunas and cold plunges. Things might all be wellness based fasting. Then one step above that is regenerative medicine that we've been doing for about 10 years. And one of the things we think about regenerative medicine is stem cell therapy or platelet rich plasma. And I got into those basically for personal reasons. My brother was paralyzed from a spinal tumor and we did stem cells into fecal, we put them into a spinal cord so we could walk again. And that was just at the cutting edge. Back in 2014, I learned from some Korean doctors how to create stem cells from fat, which is now much more commonplace. And I personally had a rotator cuff tear. My right shoulder is a 70% subscapularis Care and I was scheduled to have surgery and open surgery and I've been reading about Tiger woods and some other athletes had PRP to repair their tendons. So I learned how to do that. And that's been, you know, 2011, so, so period 13 years later and still perfectly healed. And that was a regenerative step. Then there's, I think about regenerative medicine as well being treating menopause or male andropause male menopause with hormone replacement. It's not truly regenerative, but they're. When you get to the age where you're no longer making enough testosterone in women or estrogen in women and testosterone in men, we start to degenerate. We had rapid decline in our health and we use little pellets of testosterone and estrogen for women and pellets of testosterone for men. It's kind of like they had their ovaries back or their testicles functioning again. We treat a condition called sleep apnea with regenerative treatment, a certain type of laser procedure that can reverse sleep apnea. We also treat a condition in the legs where people get these. These big swollen legs called venous and specialty. So that's a regenerative part of our practice. We've been heavy into that for 10 years, and that's been really something we were trying to launch across the country. And what I've been working on more recently is stepping up one level higher of don't die of anything stupid. And what I mean by that is, you know, obviously, drunk driving me a stupid reason to die.

Yeah.

But the killers are cardiovascular disease, cancer, and neurocognitive decline. And right now, the way it works for heart disease is once you have a heart attack, we know exactly what to do. But 10 years before you get it, we do nothing. In fact, it's not medically necessary by a health insurance to screen for heart disease. We do screening. We do something called a cimt. We use an ultrasound to image the bath, the vessels, and if they're thickened, they're plaques. Even in one spot, you got it everywhere. So typically we look at the upper portion of the neck. That's the most like that's canary in a coal mine. And if somebody has disease there, we do more advanced testing. Again, it's not covered by insurance. Insurance does not want you to screen for stuff like that. It's not medically necessary. But if you're to have a heart attack when you're 70, we can see it when you're 60, you don't go from normal to abnormal in 10 years. Then there's cancer a little bit older, heart disease first, cancer second. So we have multiple tests we do for cancer screening and colonoscopy, Pap smears, mammograms, CAT scan for smokers, their lungs. And there's advanced testing that can be done that increases that sensitivity. So we do the regular insurance coverage screening. We pick up about one out of four cancers before they're untreatable. One out of four missed. So there's two things we offer. One is called a liquid biopsy. Not that good yet, but it's getting better. There's a company called Gallery. They make something called a grail test, where you do a blood test, and it picks small genetic sequences of cancers. And the testing came from Something else or the forensic testing at first they were using for. But now we see these signatures of cancers and then there's a full body mri. It's got to be done at a certain center that specializes in that. We can pick up solid tumors like pancreas, ovary, sarcoma tumors, kidney tumors, liver tumors. You combine those three together, now we can pick up the majority of cancers when they're small. So if you pick up a cancer when it's the size of a peanut, we can cut it out. If it's size of a grapefruit, it's really too late. And the last one is neurocognitive decline, which is Alzheimer's, would be a classic one or Alzheimer's related diseases. And we could pick this up in advance as well. So what happens is you don't just get Alzheimer's, you kind of grow into it. So if you're 50 and your brain has the average size of a 70 year old, you have a high probability of getting Alzheimer's. If you're 50 and you have a average sized brain for a 50 year old, you have an average risk of Alzheimer's, which means when you get to about 90, you probably have about 20% chance. And if your brain is a little younger than you are, you probably won't get Alzheimer's. Well, if you're 50 and your brain looks like it's 60, there's things we can do to reverse brain age. We can actually. The brain is actually plastic, it will grow back. But people aren't going to do those efforts unless they know they're at risk. And we don't generally screen for Alzheimer's until people start having symptoms. The problem with waiting until you start having symptoms, there's much higher, much more difficult get people comply with therapies to reverse it. So that's the. Don't dive anything stupid. And the next thing that I'm spending most of my time thinking about, even though it's not a big part of our practice yet, it will be, is drugs that reverse age. So we can measure age in a few ways. One would be what I talked about, the heart age. So when we give you do your heart screening, it'll give you an age of your heart, your cardiovascular system. So if you're 50 and your heart looks like it's 60, well, there's a problem. We can measure the age of the brain, we can measure some physical ages, such as how much physical performance do you have? It's called a VO2 max is a, it's like A stress test. We can measure your bone density and your strength and your gait. And then we can measure your, what we call the epigenetic age, which it's 10 years old that we've been doing this for the past 10 years, measuring this. But it looks like a good way to track speed of aging because when somebody dies prematurely, their genes were older than they were for the past two decades. And somebody lives to 100, their genes age slower than the calendar. So if you're aging faster than the calendar, which in my case I was slightly faster, not a lot faster, well, then I could do something to reverse it. And if somebody's aging significantly slower than the calendar, they're in pretty good shape. So for drug therapy, we look at the genes that can modify the speed of aging. There's really like seven genes that modify the speed of aging. There's three we can take action on with drugs that are currently FDA available. And again, this is all something that is more evidence based. Medicine is not. These aren't FDA approved yet. It's not by any means mainstay. In fact, most doctors would say you should not tinker with the speed of aging because we're used to it, doctors as people getting old, dying. But genes we can act on. One of them is ampk. Yeah, a lot of people have heard of metformin that does seem to affect ampk. We're not quite clear who should be taking metformin for longevity. Certainly something that's unhealthy or overweight should consider it. It's not clear if it helps with somebody that is lean. And there's alpha ketoglutarate seems to have an effect on ampk. There's different molecules that seem to activate ampk, which slows down the clock. There's another gene called gene and pathway called sirtuin, a silent inflammatory regulator. And there's molecules that can turn that on, which slows down aging. And the one is called amplifying nad. And I don't want to say the name of the molecule because it's a long word. It's part of the Krebs cycle, which is just a crazy biochemical formula. But what happens as we age, Our NAD levels decline and it declines fairly steadily every decade. So somebody that's 60 always has way less than somebody 20. Well, when the NAD level is low in the cell, the cells start aging at a faster rate and we can raise NAD levels in the cells. There's a drug, there's a molecule called nmn. It's a precursor and it was a vitamin until last year. The FDA just declared it a drug. So there's a drug company that's going to be selling it probably for a gajillion dollars. You can still buy it on your own. I bought a six year supply knowing that they're going to, you know, pull it off the market, but you can still get it. But it will be eventually a drug that does appear to slow down the rate of aging. And I met with some people involved with this company that's bringing it out. They think within a year they're going to have it out as a commercial product. And that's something that can slow down aging. And then there's another gene and pathway called mtor. Mtor, it's a mechanistic target of rapamycin. And interestingly, the gene and the pathway is named after the drug that affects the pathway. Now this gene, we want it turned off or slowing it or just intermittently turning it off. So the MTOR pathway seems to protect us from certain conditions. But when it's turned on all the time, we age faster. And what turns it on is eating meat. And I know there's a lot of people doing the keto diet and the carnivore diet. They're turning on mtor. And what turns it off is, could be fasting, it could be having less amino acids, and it could be a drug called rapamycin, the drug that the gene is named after. So there's studies going on right now in humans to see what is the proper dose of rapamycin. And does it, you know, we know it's safe because it's used for other conditions, at least relatively speaking. So what's the dose and does it really make humans live longer? Every animal and plant that has been tested on lives longer. And the other news on it is that it doesn't seem to matter when you start it. So on animal studies, starting in a middle age or older animal, they got just as much longevity as starting in on a young animal. So for a lot of us are thinking about it, it's like there's really no hurry. We can wait for the studies to come out and somebody that is older, they might now consider it because they're at that point where their likelihood of dying goes up. So those are the three genes. Now there's another process we think about and it's called senescent cells. So senescent kind of sounds like senile and that's what it is. So senescence is a system that kind of protects us from cancer so cells divide, divide, divide, divide. And eventually they start getting errors, errors in the genes. And they are programmed to turn off. When that occurs, then they turn off, they become what's called senescent. And they kind of lay there, don't divide, and they get kind of fat and they get these little vacuoles in them and then they start sending out signals. It's called senescence associated secretory phenotype. These little signals to other cells saying, hey, we might be damaged cells, we better stop growing. Well, this appears to be the hallmark of degeneration, this senescent activity. And when you get enough senescent cells in your body, they start causing your joints to get arthritis and your heart to fail and your kidneys to fail. Well, what's happening here is that our body is supposed to clean these senescent cells up and it does it when we're fasting at night. So when you're 30 years old and you stop eating at 8 o' clock at night and start eating at 8 o' clock in the morning, that 12 hours your autophagy, autophagy turning your body eating its dead cells or add bad cells is turned on. When you're 50 years old, it might take two or three days to fast and we just don't do that. So that these autophagy does not occur as easily at 50 as it does at 20 and at 70 it occurs even less, less significant. So it's being studied now are drugs that targets senescent cells. And dasatinib is a chemotherapy agent that's used chemotherapy. Remember you said senescence is kind of a cancer type system or some senescent cells are cancerous and then they might uncontrolled and other senescent cells are just bad cells and this drug does kill them irrespective of their bad cells or cancer cells. And it's used with a couple other agents, a couple of molecules in human studies to kill off senescent cells. And this is something that somebody might do just like three days in a row, once every three or four months. So that's what's sort of being studied right now. And then the last one is regaining your cellular immunity. So as we get older, our cellular immunity kind of kind of tires out. So we have two types of main immunity, one immunity, and that's like IgG and IgM. That's what the COVID vaccine was supposed to target. And it was called cellular immunity. These are B and T cells that go through and they memorize every cell in your body and they know when one is not right, we have this organ called the thymus gland right behind our breastbone. And when you're young, it's this big fat organ and it's checking everything and watching for cancer and killing those cancer cells off and killing those bad cells. But as we age, it disappears. It turns into a little fatty structure with no more, no more endocrine structure in it. And it appears that a old drug called human growth hormone tends to regrow the thymus. Yeah. Now one little RI ripple is that human growth hormone was banned in the 90s to be used for any purpose other than short stature for children. Because at that time they were getting all human growth hormone out of cadavers and there wasn't enough available. If rich people want to live longer, want to take. It's actually back in the 90s, it was a study by Dr. Rudman, University of Wisconsin. We found that giving people growth hormone, they seem to be getting younger. So that had been, it was very popular. We're taking it. But that became banned because of the shortage. Well now it's widely available, but we still have a FDCA restriction on it. So there's drugs that copy growth hormone. Samorin is one that, that we use that is perfectly legal use. Yep. One study done by Dr. Fahey called the TRIM X trial. The TRIM trial, he gave men growth hormone. The reason they chose men is men take less hormone than women, so it's cheaper, it's a very expensive drug. And they gave him the drug in a certain pattern over six months. And they measured their thymus glands with MRI and they measured their epigenetic clock, this genetic clock. And what they found is after one year, the men were a year and a half younger than the day they started. They actually went backwards two and a half years on their epigenetic clock. That is translating to two and a half longer years of life. Theoretically it does. This has not been proven, but those are.

They were using growth hormone consistently throughout the, the course of the year.

No, they did six months and they did it five days a week. Okay. And you take a two day holiday so you continue making your own stuff. And then they did metformin and dhea because growth hormone causes a spike in your blood sugar. So they gave them metformin, which is also being studied as an anti aging drug and DHA which is also being studied as anti aging confounding factors. And then they did it for six months. And actually they did more of the anti aging on their genes in the second six months when they're not on the drug. And this leads us to think that we want these things on and off. So for example, growth hormones, senesculy drugs, these should not be taken on a regular basis. I know people are taking certain senolytic drugs regularly. A low dose, it's probably a bad idea. This is your cancer surveillance system. You don't turn that off. But periodically you want to kill unhealthy cells. Rapamycin, that helps you potentially age long. Let's say we live longer on rapamycin. It also prevents muscle growth. We need muscle growth. And another drug, intermittent basis and growth hormone, well, it causes problem with long term use. Might be something we want to take on an intermittent basis. So the protocol we're using for longevity is a growth hormone releasing hormone four days a week, two months on, two months off. A senolytic three drug cocktail three days in a row every quarter and then rapamycin every two weeks. I know a lot of people are using every week. It's got a half life of 84 hours. If you took it every week, you're on it all the time. And I think that might be not the optimal dosing, but we don't really know. And again, all these things I'm talking about, they're really out there in terms of. These are for people who are early adopters, are doing everything possible for wellness already. You can't shortcut health, you can't shortcut your diet and exercise and fitness. You can't shortcut screening for cardiovascular disease, brain disease and cancer. Because let's say you get longer genetic clock and you're out of shape and you fall and break your hip, that didn't really help as much. So I think these are all different steps and I'm doing these myself. You talked in the introduction. I've been doing things, I'm 60 and when I checked my genetic age, I was a little older than my, than I was, which made sense. My, my dad lived to a young age and he had his first heart attack in his 40s. I've got the heart attack gene is actually a gene that affects people. And I had a little bit of plaque in my, my cardiovascular system, both my heart and my carotids. My vessels were a little thickened. So my cardiovascular age was about two years older than I was. And at that time I was very fit. I was eating super healthy. I wasn't taking any drugs. My cholesterol was kind of managed, but not great.

Which age, what age was this chip?

When you, when you, at that time my heart age was about 58. Okay. So I did a two year intervention which did include some drug therapy and also a lot of botanicals. So I take something called Artisil, another one called arterial Protect. These are plant based molecules that have been shown to reverse plaques. I did a clery scan of my heart, which is a, basically it's a CAT scan that uses artificial intelligence to straighten the arteries out so we can see how much plaques in the softer heart. And there was, there was, I mean there was a fair amount in there. It wasn't anything critical. But the vessels, a lot of them had little, you know, spots in them that were both soft and hard. And soft plaques are growing. Hard plaques are actually perfectly safe. They don't hurt you. So I'm going to take all my soft plaques and turn them into hard ones, which for the most part I've done. And then the thickness of my vessel was 0.7, I believe that's what the number was, 0.7, which put me a little older. Now it's actually 0.6. So the thickness has gotten thinner, which means my arteries are much more soft. My arteries are more like a 45 year old now at 60, whereas before they were a little older than I was. I did a brain age study at the Health Nucleus in San Diego and my brain was at the 88 percentile. They don't actually give you years on your brain, they give you a percentile. So the higher number is good. And the ventricles, which is a liquid, was good. So I was at the top 12% for my age. And I did a one year intervention which involved a few things. One, was only eating five days a week. The brain cannot grow when it's exposed to food, particularly sugar. And then on my fasting days I did some things that were, that was like learning subjects I wasn't interested in or were new at doing some physical tasks that I wasn't experienced with. And I took some supplements as well. And my brain age went to the 90 percentile for a 20 year old. So it's off the charts my own age. And then I was always fit and strong. I've always been working out my whole life. And I lost a, you know, a little bit of strength and I maybe got a little, little bit of fat on my body. So my leanest I was about 8% body fat, 185 pounds, let's say 15 years ago. And then I gained about 5 pounds of fat and lost a little bit of muscle. So my body fat went to 11%, which is still pretty good. But it's, you know, not my optimal and I couldn't shake it. But when I started doing my, my senolytics and my other anti aging things, I was able to improve my muscle function. So I'm back to 185, 8% body fat and I'm 60 years old, 185 pounds. I can squat 610 pounds, which there's probably very few men at my age can do that. And the bone density is that of a young man. So the muscles have no senescent cells in there, presumably. Yeah. The. In my VO2 max is not where I want it. I'm doing well for my age, but I want to get to the, you know, 90 percentile for a 30 year old. And I'm doing some things with. Have you heard of this side, this water, this vibration water that follows your protein?

Yeah. The str.

Yeah.

The nanobee.

Yeah, it'll be. I spot one of those. Oh, great.

Yeah.

I was listening to the study and she said, well, you know, you get 7% more VO2 max. Like all I need is 7% more. And I'm at the 90 have a 35 year old. So I bought it to try to cheat.

Oh, good. She got. Yeah, we've had it for a couple years. I love that machine. But I, when I saw Rowena talk about that study, I was like, that's amazing. I had no clue.

Yeah, so then that's part of the. Well, I think that's back into the wellness. You know, you still got to do that stuff. So my goal now is that we have a practice that largely is cosmetic. My average patient is a 47 half year old woman across all the clinics. And they're trying to look better on the outside, but they tend to be the individuals who are going to want to look better on the inside. And also they make health decisions for their significant others. That's how we get to men is through my patients. And I see that there's a big reluctance on the part of American health care to spend money taking care of yourself. In fact, I would say that in general, my observation was people love their money more than their health. And if something costs money and it might make them live longer, like, well, my insurance doesn't cover it. I'm not doing it well. I think there's also a big group of people. I say, you know, actually I love my health more than my money. Right. If I theoretically, if I can live longer and be productive longer, well, money becomes less and less of a problem. Yeah. And I believe that it's the patients that are doing things like Botox and some cosmetic surgery that are going to be the ones first thing, okay, I feel better on the outside. I look better. I don't want to look at my, my, my hormones. I want to look at my health. Do I have cardiovascular disease? For last more than a decade, we've been treating women in menopause and this is kind of a side story, but back in the 60s and 70s, we were using estrogen for women in menopause and they would take ground up sheep ovaries, we, you know, eat them and your symptoms get better. Then it turned out Premarin, which is pregnant mare urine, they actually got it from horses and now it's synthetically, but it's the composition of a five year old pregnant horse. The estrogen that worked quite well for women's symptoms of menopause. And back in the 80s, there's a study called the Pepi trial. Pepi trial, they found that women on Premarin had a significant reduction in all cause mortality. They lived longer. But one problem happened. They were getting uterine cancer 13 of the time. So we put women on progesterone along with the Premarin and that uterine cancer went away and women were living healthier. And then a drug came out called Provera, a synthetic progesterone. And this combination of Provera became the number one selling drug in the world, not just the United States.

Oh, wow.

And we were routinely putting women on Prempro if they weren't on it in menopause. And then a question was asked, well, should this be used to treat menopause or should be using this drug for any woman of any age to reduce their risk of cardiac mortality. So they did a big study in 2002, 2004, called the WHI Women's Health Initiative trial. And it was probably the biggest disservice to women's health in history. The study was done designed to see should you take a 75 or 80 year old woman who's never been on anything important, on strong aggressive Prempro, which is a synthetic hormone not matching human hormones at all. And the answer was probably not. They had a slightly increased risk of heart disease and breast cancer. Interestingly, the women on estrogen only had lower breast cancer. The women on estrogen with Probera had a higher breast cancer. Wasn't much increase, but it's a significant increase. Doctors interpreted that in the wrong fashion. They said, oh my gosh, I can't put anybody on Prempro while They were wrong. And it took us about seven to 10 years to figure that out. The woman that went on Prempro within 10 years of menopause had a 40% reduction in cardiovascular disease, 26% reduction in all cause mortality. The mistake was we interpreted the study saying nobody should go on it. Turns out you probably should start it when you go into menopause. And if you do, you will live longer, you'll have less heart attacks, less, less everything. And if we use actual hormones versus synthetic drugs, the evidence is even more compelling. So during that time we looked at other countries and they were actually using a different hormone called testosterone. Now we think of testosterone being more of a male hormone and it is. A man has 10 times as much testosterone as women, but a woman has 20 times more testosterone than estrogen. Now your doctor is looking at your labs. The numbers look pretty similar, but we manipulate the units per unit to make all labs have two numbers. If you compare them, the same numbers, picograms or deciliter or nanograms per milliliter, testosterone is 20 times higher than estrogen in women. We picked estrogen because that made sense. Studies in other countries, looking backwards, showed us that women on testosterone with or without estrogen had a remarkable reduction in breast cancer, up to 72%. Wow. Looking further in American studies, there's been large cohorts showing anywhere from a 40 to 70% reduction in breast cancer if you use testosterone with or without estrogen. Now, there was a time we were like staying away from. The whole public was afraid of it. So we put women on testosterone only. It works fine for menopausal symptoms, but estrogen is very, very cardiac protective. In fact, estrogen reverses cardiovascular plaques, but shown to reverse it, it's very, very cardiac protective. This idea that is causing harm to the heart was actually totally misplaced. It was a totally different cohort of women. It was not. So if you're within 10 minute years of menopause and you go on estrogen, you have less heart attacks. And of course that's what you're most likely to die in the next 10 years or 20 years when you're in menopause. So now it's testosterone, estrogen, progesterone, and women have less weight gain, better mind, better sex, better energy, better moods, better skin, less breast cancer, less cardiovascular disease, and less neurocognitive decline. This should be in my mind Automatic now, again, 20 years ago, 25 years ago, automatically we put all women in menopause on hormone replacement therapy. That was across the board and that came to a halt in 2003 because we miss 2002, we misrepresented these studies or misread them. But now doctors, you know, if you're a newer doctor, you're aware of it. A doctor my age just remembers seeing on CNN and Wall Street Journal that hormones cause breast cancer. And of course it was completely misleading.

And that's. Is that the Women's Health Initiative? Is that the study referencing there?

Yeah.

Can you talk about where the flaws were in that study? I know they're using Hyde levels of.

Synthetic estrogen, yet there weren't really many flaws. It was the interpretation. So what happened was we knew that women going into menopause put on HRT regardless of the type, live longer and they were healthier. So then doctors started putting their 80 year old patients on these same drugs. And the question became from a public health standpoint, is it worth the body? We just didn't know because we know a woman in 50 that goes in HRT, she's going to have a healthier lifespan. What about A woman who's 70 has never been on anything? So they enrolled people, the average age was 72 that had never been on anything. And they put them on Premarin only if they had had a hysterectomy, they were not having a uterus or pro permanent probera if they had their uterus. And in 2000 they started in the 90s. And in 2002 they stopped the pre prem pro study saying that there was an increased incidence of breast cancer. It was only 8, 100, so 1%. It was a very tiny increased risk, but it was an increased risk and there was a potential for increased risk of cardiovascular disease. And the press reported it as estrogen causes breast cancer. They actually made that up. So because they never said that in the study, it just said Prempro increases breast cancer. Well then two years later they had the estrogen only study which showed decreased risk of breast cancer. So premium probably inhibits the estrogen estrogen receptor and certainly estrogen can cause breast cancer unopposed. So the flaw in the study was that we designed it to see should we put all women on synthetic steroids regardless of age or not. And the answer is no, probably not. It didn't answer should we put women on say bioidentical estrogen at any age? And it didn't answer should we put women within 10 years of menopause on hormone replacement? So that took a few years to figure out. So in about 2011, almost a decade later, after going through the numbers they said, okay, women who went on this Prempro, which is maybe not our favorite hormone, it's kind of a target to doctors who are practicing more bioidentical medicine, they actually live longer. Okay, we wouldn't know it because it makes them die, but they actually live longer. They had a 40% reduction in cardiovascular disease. So the. The mistake was we were trying to figure out, should you put older women on Prempro? But they mixed a bunch of people together. Was any woman who was eligible, that was over, that was in menopause, had never been anything before. So the women that went on it the way we normally practice medicine, we put women on Prempro when they get into menopause. They should have continued doing that. As a result, though, doctors basically abruptly withdrew women from hrt. A lot of weight gain, more heart attacks, a lot of misery, a lot of suffering. And it was all based on a misinterpretation of the study. Now you're saying, what about the flaws with the hormone pick? Well, when we're looking at doing studies, they're not going to study a generic drug like estradiol, which is your classic horm. Horrible, because there's no money in it. There's no drug company that's going to push for it. And the National Institutes of Health doesn't really favor generic drugs. They just. They just don't. It's already kind of known. So if they had studied estradiol and testosterone and progesterone, they might have had a different answer. But keep it in mind. Testosterone is only FDA approved for women that have breast cancer. So it's approved in 1952. It's actually approved for women before men. And there's no formulation for women that doesn't exist anymore. But it was proof. They did a. They did a. An attempt to make testosterone available for women with hypoactive sexual disorder. So about 2009 or 10, the FDA was approached by one of the big drug companies with a testosterone patch for women that made them have more sex drive. And the FDA, they had a panel of 11 men, no women said that hypoactive sex drive was not a medical condition. Therefore, they would not approve the drug.

Holy cow. And of course, it was all men.

Yep. Amen.

Sorry, ladies.

Yeah. So the. So now there is a drug for hypoactive sexual disorders. Bretton. Alidadine. I don't know the brand name of the drug. It doesn't work really well, but testosterone does work fine. So you can think of testosterone making a woman a little more like, say, sexually Aroused or better ability to have an orgasm. And estrogen makes women feel more like a woman. Women. So they do work synergistically. And in our practice, we were kind of like not using a whole lot of estrogen because it had such a bad public rap. And even though we knew better, it was hard to overcome the fear of estrogen. We put people on estrogen, testosterone and progesterone. Or doctor would take them off everything, say, oh, you can't take this and cause blood clots. Well, nothing's further from the truth. But then we did testosterone, only their doctor didn't know what the hell that meant, so they leave them on it. And then over years, we've been adding estrogen back in, in the right setting if they're within 10 years of menopause. So the question would be, if you're 70, you've never been on anything, would testosterone, estrogen and progesterone help you? That's an unknown. You really don't know? There's not been a study to answer it. I would say that's not part of our practice. We wouldn't do, because there's no, you know, there's no evidence to back it. But if a woman is on something at that age, I might switch her over. Or if a woman's Within 10 years of menopause, we would start it. But there's that group of women who were taken off of it 20 years ago, and we don't know should they start something right now. Logic would dictate that a natural hormone would be protective and the actual risk to the synthetic hormones weren't high, but it was, it was there. But that would be a kind of a opinion or a guess versus, you know, hard clinical science. Say whether or not that's a good idea. Geez, should be on it forever, in my opinion. Not everybody agrees with that. But there's no reason that you should be thrown back into menopause and die sooner.

Yeah, I couldn't agree more. And what about men with testosterone? Do you see, you know, people misusing it? Do you see any, any risks that you've, you've noticed if, if men are, are, you know, in the way that they're using testosterone?

So there's, you know, the approach to testosterone is to physiologically replace your testosterone level, which might have to have a higher level of then when you're taking an exogenous hormone, like for example, women, we have to get their testosterone level about three times higher than it would be naturally for men. You don't have to get it so high. But there's called a pharmacologic blood level. Testosterone versus a physiologic. Physiologics. When you're on nothing and when you take an exogenous hormone, your body tends to make little sort of sponges to eat it up. Albumin, a sex hormone binding globulin. We don't have a good way to measure the free level. These are all just guesses or calculations. So for men that are, say bodybuilding, they're going to take a supra physiological level. They're going to take it where their testosterone, let's say ideals, maybe around 1,000, they might bring up to 4,000. And that does have them unnaturally build muscles or they can take a synthetic testosterone does more. So but if you look at just regular practice of medicine and testosterone. So back in 2016 at the in St. Louis, it was a VA, they looked at 83,000 men. Okay, not only the VA can do this because they had EMR electronic medical records at that time. So 83,000 men, there's virtually no 83,000 person studies for six years. So now we call it person years. 83,000, that's 500,000 person years. Okay, there's maybe five studies in history that were that big. And they looked at men who had been diagnosed with low testosterone on blood work and they looked at men, did they get treated or not? About half the men were never treated. Their doctor figured it wasn't worth it. They didn't even know what the heck that meant. Yeah, old study, it was 2016 and there were some men that were treated. Well, the men that were treated were 1/2 as likely to be dead in the next six years. 1/2, I mean it was linear 1/2. And it was pre cardiovascular disease because they were 66 years old on average. Well, 60, 70, most likely thing he died from is not cancer, but it's heart disease. But it was half. Now what led these doctors not to prescribe Testosterone was in 2013, the FDA black box testosterone, saying it caused heart attacks or possibly caused heart attacks. And the reason they did that was there was a company, Abathy, who makes Botox. Now they were prescribed, they were selling a testosterone patch or gel that was for testosterone replacement. And they had the commercial. Do you have low t? Well, the FDA said, hey, wait a minute here. In the 1950s, we said you can give testosterone. Men that had low testosterone because they're missing their testicles, they have brain damage or they have an extra female chromosome, but it's not indicated for men that have low testosterone due to age. So they sued them for hundreds of millions of dollars at one. And then doctors stopped getting approached by drug reps and stopped prescribing testosterone. And then there was one study was put out in Journal American Medical association that showed there's an increased risk of heart disease in men starting testosterone. The FDA rapidly latched onto that. They put this black label onto testosterone. The study was retracted. It was an error. There's a total screwed up study. There's been over 127 studies showing the opposite. One study came out showing a possibility of cardiovascular disease. FDA latched onto that, blacklisted the drug to dissuade doctors from using it. The study was withdrawn. They left it in there. Every medical society came out against the FDA saying this is wrong. What they're suggesting that men should not be in testosterone unless they're missing a testicle or they don't have brain damage or have an extra female chromosome. So if you have low testosterone due to age, it's not FDA approved, but you can certainly get it from your doctor. And in the large study with the va, you're in the next six years, you're half as likely to die of a heart attack. Now the flip side is there's young men taking testosterone to optimize your testosterone. Probably, you know, that's a different, we don't really practice that way. That is illegal. So that's, that's the anabolic effect. But we're seeing, typically we do see some younger men with low testosterone and we work them up and it's usually somehow environmentally related. Most of our patients are in their 50s, 60s, a few in their 30s and 40s, not as common. And it sort of drifts down once the testosterone gets down to there's a blood level and the cutoff is say 280. And say in Michigan they say, well, if your Testosterone is below 282 days in a row before 10:30 in the morning, you'll low testosterone and we'll give you a pay for your testosterone replacement therapy. Well, that's if you're that low, you already have diabetes. And the other thing is too is that they don't want you to take enough testosterone to get you ideally once you get taken enough testosterone, just get it over 280. So we typically have patients that's paid for it so they can get a legitimate dose. Yeah, and also the frequency of dosing, you know, mostly it's pellets or injectables that the topicals do not have. Safety studies like the pellets or injectables, we like to see that testosterone level, you know, above 8, 900, because of this physiologic versus pharmacologic level. And then in terms of side effects, one thing does occur in testosterone replacement is sometimes you get too many red blood cells, so it's where you grow too many. And men can avoid that by donating blood periodically. We don't see that with pellets very often. We see occasionally shots, but it's pretty uncommon. You basically can donate blood. There is the possibility of atrophy or shrinkage of the testicles because they're no longer making testosterone. And there's. You can live with it. That's certainly fine. It's really cause for infertility. So there's things meant to do. There's some drugs you can take this, sort of make that less likely. Most of our men, they, you know, they don't worry about it. The testicles shrink a little bit. They're not hanging down so low, so it's not a big deal.

Easier to sit down.

Easier to sit down. Yeah.

Yeah. And this is where you can use, like, you know, kisspectin, gonadotropin and clomiphene, things like that. I guess HCG was pretty common in the past. Now it's harder to find.

Yeah. Expensive, too.

Yeah. Barry. Well, holy smokes.

And.

And this is fascinating. We could talk for another couple hours, Chip, but you've written. How many books have you written now?

Nine.

Nine. And what is your book on hormones? Call. Because I think there's a deeper dive people would love to take just. Just hearing that.

That previous. Okay, so one thing is that if you have a catchy title, their books are easier for people to pick up. So for women, it's called Testosterone. Strong enough for a man, but made for a woman. Cool. And that phrase used to be the secret deodorant, but they let their trademark expire. So I grabbed it. And the mail book is even more intriguing. It says, if your testosterone is low, you're going to get fat.

I love that. That is amazing. Well, yeah, pick up some of Chip's books. And then the other one that we didn't get a chance to touch on. And I'd love to do a full podcast just on sleep apnea, because so many people have sleep apnea. And maybe you can just give a high level. And then let's shoot for another conversation in the future, but give us a high level of how risky it is to have sleep apnea.

Okay, so I'm just going to give you one little story to explain it. 1988, the University of Wisconsin, Madison was petitioned by the National Institutes of Health to figure out, why do we care about sleep apnea? Because at that time, there really wasn't treatments available for it. They were clear and we didn't know if we needed to screen for it. So they did a study looking at people 30 to 60 years old. There's 1500 of them, and they had them do a sleep study and they got 1500 people. They went to the sleep study and they were randomized. They were just men and women in different races and different ages, 30 to 60. And then it went back 20 years later. They didn't recommend any treatment or anything. Like they said, hey, this is your score. We'll see you in 20 years. They went back 20 years later and they looked at the death records. The sleep study gives you a score of 0 to say 100. Anything over 30 severe, anything over 15 is moderate, anything or 5 is mild. What they found were the people that had a score of a 30, they were three times as likely to be dead. Three times as likely. They lost on average 6.4 years. And they was mostly cardiovascular disease, where some other, other, other causes of mortality is cardiovascular disease, but three times likely to be dead. And how often do we screen for sleep apnea? Interestingly, the US Healthcare Preventative Task Force, which is a non governmental agency sponsored by the government, they have recommended against routine screening for sleep apnea. They said it wasn't worth the money. So we have a test that costs about $100 to check for sleep apnea. And we have a treatment, we have multiple treatments that are widely available that are, that are effective. And the government is recommending, and basically the recommend against it. So the government doesn't have to pay for it to pay for the, you know, testing. So book on that. This is a very subject I'm very passionate about. If we were just like to screen everybody and treat them, we would save approximately $150 billion a year in health care waste.

Sheesh. Yeah. So, so, and, and this is something we won't. We'll circle back if you're open to it, Chip. And, and I'd love to take a deeper dive because so many people are, they have sleep apnea, don't even know about it, or they don't really take it serious. You know, I'll ask my patients. Are you using your cpap? It's kind of, you know, I don't like it. It doesn't seal right I'm like you got to get that fixed it's such a critical piece and so I really appreciate all the work you've done wealth of information the best thing about you Dr. Mok is you walk the talk A lot of physicians don't I mean you and I see it there you know they they couldn't look more unhealthy and you are you know a 60 year old a six pack looking stronger I see you in the gym every time we're traveling together we're the you know we're consistently there together and so I really appreciate you being who you are and for taking the time to share knowledge with our audience yeah my.

Pleasure look forward to it again yeah.

We'Ll do we'll do it again and everybody if you if you like this show make sure you give us a great review and then share it with your friends, family, loved ones it might just save their life and we will see you next time.

Sa.