Free to Choose: Your Guide to Personalized Longevity Medicine - Andrew Wax - Liv Health

You're listening to the Human Upgrade with Dave Asprey. I'm really working this year on making sure that you know why you should listen to each episode of the show so you can make a great decision at the beginning of the show. This is totally going to be interesting. Or, you know what, not my thing. And I want to buy your time back for you. Ideally, every episode of what I do here for you is more than worth the time you spend. I'm curating my guests really carefully and covering topics that you are asking for in the podcast. Feedback and things that I just know are the future of biohacking and living forever. Even if you aren't asking for them because you don't know about them yet. We're going to teach you by the end of this episode how to create a personalized program based on your data so you can live longer. And this is something a lot of people have been asking about. Dave. There's too many techniques. Cold showers. For 10 years you've been telling me to do that. Or is it stick my face in cold water and do I have to exercise and how important is sleep and which of the top 5,000 supplements I should take in order, given that I have one arm and one eye. Like, it's very personalized. Right? And that's the problem we all have. And, oh, maybe you're not a perimenopausal woman. You know, you could be a 25 year old dude or vice versa. Right. We just, we don't know. And so that's why I've steered clear of telling you everything I take. Customize, customize, customize. That's where we're going to talk about today. And our guest is a guy who's actually gone to the trouble of going back and saying, how could I recreate how I look at my medical care and how do I make this so it scales? His name is Andrew Wax and he runs a company called Live Health. He's an integrative health specialist, director of clinical care at a company that's allowing you to have a different interface for your medical and your nutritional supplements and your labs and all of those things so that you can actually make it work the way you want. So, Andrew, welcome to the show.

Thanks so much for having me. It's a pleasure to be here.

All right, how did you get into this, this idea of what you guys are doing at Live Health? In fact, just walk me through what it is. I know what it is because I signed up and I've been enjoying it. But but just walk me through what's different about this versus the way we used to do it and make sure that if people don't want anything to do with live health, you are dropping some knowledge bombs here about how to set it up for them.

Right. Well, we're essentially telemedicine in longevity resources. Right. So anything you need, whenever you need it, in a concierge format, but with access to the doctors who know what they're doing and a team of people who knows what they're doing to help you live a longer life. So you go to your primary care doctor, they're not trying to keep you healthy, they're just trying to make you not sick. So not sick is not a healthful state. It's simply just not sick. So here in this circumstance, we work with people on a one on one basis and achieve what a lot of these algorithmic companies are trying to do. But rather you're working with people to develop a protocol. What do I take? When do I take it? Should I be taking supplements, hormones? What kind of fitness should I be engaging in? What kind of lifestyle changes should I make? We help people implement those things.

When you go into the normal doctor, and there are lots of, quote, normal doctors and a lot of abnormal, that's a compliment. Doctors listening to the show right now, in fact, a surprising number, some even in our live audience from the Upgrade Collective, quite often you don't get a lot of lifestyle advice, but now a lot of doctors are sort of saying, okay, yeah, you need to sleep well or you need to lose weight and here's some things to do. But it feels very fractured, especially if you see multiple people, which happens quite a lot. You see one person for physio or you have someone who does hormones and you have a general care, it's not that integrated. So, I mean, you have an interesting background as a director of clinical care. You're not a doctor, though. What did you study in order to be able to do the synthesis of all this knowledge and then in order to bolt it onto to other people's medical practices, which is kind of where I think the future is going.

Right. Well, I mean, I have some degrees in some sciences, but everything that I've got at this point is experiential. Right. So I do have degrees in biochemistry, human physiology, psychology and neuroscience. I'm an absolute nerd. Thought I wanted to be a doctor for a long time and then I found integrative medicine, cellular medicine, and it really changed things for me. So I've been following doctors around for the last decade. And I just understand the algorithm. So it's my job to interpret, understand, help with the treatment plan. But ultimately I can't deliver medical advice. What's unique about my position is I'm kind of like an encyclopedia. So people reach out to me and they say, well, what can I get from you? And I said, well, I'm basically a nerd. You just tell me what you want to know and if I don't know the answer, I can find it. So again, I have a background in peptides and bioidentical hormone replacement and as well as functional medicine, integrated health, cellular medicine, but it's all experiential. Certainly I have a background that helps me learn all those things, but it's experiential. It's a testament to all the people I work with.

It was interesting when we first started talking because most people listening to this are in the camp where if someone would just do all the synthesis and the research for me and tell me what to do in a reliable fashion to solve a problem, I sure would like that. There are some people listening who are saying, I really enjoy the detective work. I am a guinea pig, a biohacker. I'm always looking for more. And even in that group, which I'm one of, there are times where I'm saying, you know what? I just don't have the time or interest to solve this one problem. Like, can someone do the research? And you're filling a new niche. And this is kind of a biohacker career niche where you're medical researcher, you're working with doctors. And that's what LIV Health does, where you have a variety of doctors who people contract with through the LIV Health platform. So you're working with a doctor, but you have a research assistant kind of who works with a doctor who's not a physician's assistant, who doesn't have to be licensed but is very well schooled. And you and I have talked enough times that you really know what you're talking about. But to be able to go out and say, you know what, you got something weird going on. I think this is a directional thing. Let's check it out with the doc. So then you get a half hour with the doc. Doc says, okay, it checks out. So we're letting functional medicine doctors do way more than they could with a greater hit rate for accuracy. And I think this might be how we fix the problem of accessibility for functional medicine. Anti aging. I don't know if am I explaining this model right in our Model.

It's interesting because we're, we've taken a very different approach, right, where typically in any concierge setting, a doctor maxes out at what I mean, they can accept if they're really killing it, maybe 500 patients, maybe. But in this model, we allow our doctors to not only see more patients and work with more people, but we give a better degree of care. Right, Because I am the concierge. People on our team are the concierge. We're your point people. Whatever you need, whenever you need it, we're your personal accountability partner, your personal performance team, whatever you want to call it. Right? So, Dave, you call me whenever you want, you text me whenever you want. You say, hey, you know, what do you know about this? What's going on here? Hey, what do you know about this paper? Yeah, let me look at that, review it, tell you what I think about the paper. And hey, okay, you want to look at getting this prescription or this supplement, you want to talk to the doctor about it? Yeah, let's do that too. But then how often do you go to a doctor? And 15 minutes after the appointment, you say, Hey, I have 20 questions. I, I, you know, I need to go back in for another appointment. So after every physician appointment, you follow up with your concierge to put your whole care plan into action yet again based on the physician's recommendations. So it's an interesting model in that you have somebody there, you have your point person, and that's, that's your, that, that's your relationship with the platform. You have somebody. And again, most people don't trust their doctors. Right? So now you have somebody who's non medical who can just distribute information and help, you know, help you so that you can make your own decision without giving medical advice per se. Okay, so, Dave, one thing you said that was really interesting was the concept of, hey, sometimes people just want to come in and they want to be told what to do, while others, you know, they want to get into the detail. And I actually ask people that question as soon as they sign on in a very different way. But I'd like to get that information. And I always ask people, you know, do you like to know what time it is or do you want to know how the watch works? Right. And we can do both sides of it. I'm a watchworks type person, as you know. So people are saying, andrew, slow down, Just tell me what time it is. That's, that's enough. Just, just tell me what time it is. But I mean, we're geared up to do both. So we're working with people who are these, you know, high level, tell me what to do, whatever. And then the other people that really want to get into it and let's, let's get into the details. Let's, let's really hammer this out. I want to know everything there is to know about mtor. I want to know everything there is to know about amp rapamycin. How does it work? Why would I use it? Yeah, let's get into it. Let's chat. So it really just depends on the direction that the patient wants to take it. And I like to say that we practice what's called goal based medicine in this. So you come to us with a goal and we help you achieve it. Most of the time it's I want to live to 150. Other times it's, hey, I've been doing testosterone for a long time with just this brick and mortar testosterone clinic. And all of a sudden I heard Dave on a podcast, it sounds like there's more, right? There's more out there than just simply injecting testosterone twice a week, or in some cases it's still antiquated. They're doing a once every two weeks testosterone injection. And that's where we come in, really.

The idea of goal based medicine is so in alignment with biohacking. This is a question from an earlier Upgrade collective call. How do I know what test to get? How do I know what supplements take? Well, what did you want to change and where are you now? Even my whole upgrade labs company. Not a medical company. But the point is, where are you now and what exercise or recovery intervention is going to get you to what's important to you? And if what's important is being chill, it's different than being swole, right? What you do might change.

My goals are very different from your goals, right? So again, people come in and they're like, well, what should I take? What do you take? And same thing is, that's not relevant to you. It's just not. You need to tell me what you're trying to achieve and what you want out of this, and then we can start chatting, then we can really get into this. So, you know, in terms of labs, it's, you know, is there a standard panel? I guess there's a bare minimum. But it's all customized, right? You can't just say, hey, these are the labs that everyone needs and you just get these every three months, period. No, that's not true. It all needs to be customized. The Patient.

I probably don't fully agree with you there. I think there are some basic labs that everyone needs to know on a regular basis, like inflammation panels. Like, look, if you have inflammation. Yes or no.

Right, right.

But someone who's dealing with mold exposure or Lyme disease or something, they probably need a more advanced one and a bigger one. So there's things like vitamin D. Pick that once a year and, like, just make sure your levels are okay.

Well, okay, so let me backtrack. So a CBC with a differential. It's cheap, it's easy. Get it done every time. You get labs done, why not a cmp, Comprehensive metabolic panel? Check your liver functions, your kidney functions, electrolyte balance, total protein, albumin, all that stuff. Yeah, get it done every time. It's $6. Why wouldn't you get it done? But certainly, you know Hashimoto's thyroiditis. Yeah, you should check that. If you have Hashimoto's, you're trying to work on your antibodies, but. But on the other side of it.

It'S a waste of money if you.

Don'T have Hashimoto's, you shouldn't check it. So I have some people that come in and they're like, run a full panel on me every three months. Ah, you really, really don't need that. Let's save you some cash.

There's some data in there that isn't useful. I'm with you there. So I'm still putting on my. I just normally go to the doctor once a year and say, give me a physical. And he hits you on the knee and listens to your lungs and looks at your skin or something and says, you're fit as a fiddle. And then you walk out and literally, this is like 80% of what people expect from going to the doctor. And you get your CBC and, oh, your liver is just fine. That isn't at all what we're talking about. But one thing that I've chatted with you about off camera, but I want to call out when people have a conversation with you or the other. We'll call them health concierges at LIV Health, you're not a doctor, but you are covered by hipaa. So, like, there's health and medical information, but it seems like someone from outside the US Ought to be able to call and say, I want to talk to you about this stuff. Right. Even if I do or don't have an appointment with a doctor. A telemedicine appointment with a doctor.

Let's do it.

But you guys, you are not live In Canada, you are at the end of Q1, and. But if someone calls from Singapore and wants an appointment, are you allowed to do that or are you not allowed to do that?

I mean, I have patients in. So we have a. Essentially a health coaching program is what it is. We have two levels to our program, one of which is a full concierge program, the other of which is a sort of live light, if you will. It's called our core program, which allows you to meet with a health concierge and chat through stuff and work on nutrition and work on fitness and work on a couple of supplement things. And I have patients all over the world doing that.

And then you call the doctor and if you need a doctor, but you don't waste the doctor's time doing the basic health stuff.

Well, so in the core program, you're actually able to get a lab review and a consult with the doctor in that format. Right. And we're not issuing any prescriptions or anything of the sort there. So typically our doctors will meet and talk with the patient, talk about what's going on. Can't typically send, you know, prescriptions directly to them unless they have a United States address and, you know, they figure their own stuff out there. But, I mean, I have people in Dubai. I have another guy in Portugal who's in the UK I have another guy who's in Colombia. People all over the world working with us.

So you just can't send them drugs, but you can do everything else, including get them on the phone with the doctor, but the doctor says it's up to you.

Yeah, absolutely.

And what I think is interesting is I look at disruptive technologies and how models change over time. That's been my whole tech career. What sucks about medicine is there isn't an integration layer in there where you can talk about the health side of things. So I feel like you're taking the load off doctors. You're increasing the fidelity of the. Of the advice for people, but you're backed by doctors, which is something I haven't seen before. I've kind of wanted that. And you also are managing all prescriptions and most supplements in a dashboard. So you can say, I need this thing. And then you actually will mail the supplements or mail the drugs as required or as available, depending, I guess, on where they are, or you call it into a pharmacy, whatever is necessary. So that kind of concierge thing is cool?

Well, it's a very different model, really. It was discovered I used to work with an orthopedic clinic with Dr. Elizabeth Yurth. And I've worked with her for the last eight years, but in a traditional medical setting, she does a lot of regenerative procedures, a lot of exosomes, prp, stuff like that that people don't know anything about. So all of a sudden you're trying to put that into a 15, 20, 30 minute appointment, and Dr. Leaves patients like, what just happened? So I was working as a medical scribe at the time, and I'd sort of sit in there after the fact and say, this is what just happened. Let me take you through that one more time. And that's really where this model came from overall, was, hey, let's find a way to practice medicine so that the doctor can have a high level of scalability, but the patient still receives that career and is comfortable with the plan and the protocol going forward.

Okay. And you've got a certificate in peptide therapy and some neuroscience stuff, degree in psychology. So you're a well rounded, I would say, biohacker. So when you first sat down long before the interview, I kind of asked you all the hard questions. And you want to be able to access someone like that and to do it on a monthly basis. It's a cool idea. And then to be able to say, all right, you're working with Dr. Yurth and you have several other doctors who, you know, can write the scripts. I've been looking for something like that for a while, and if you're listening to this going, I've had a hard time getting access to, oh, things like testosterone. It turns out testosterone isn't very expensive as a medication, and men and women over 40 almost always benefit from a little bit of it dosed correctly based on your biology. But there are some companies that will charge you $500 a month for your testosterone, including a prescription. You have prescriptions for stuff that's necessary, that's built into the service that cost less than 500 bucks a month. So it can kind of pay for itself. If you're on one overpriced thing, the.

Prescriptions, I mean, they, they speak for themselves, right? Everyone knows testosterone works. That's no mystery. Everyone knows CJC and epimoreline work to boost growth hormone, but what's the special thing that someone's provided? Well, it's the knowledge base. It's what you're providing. So, you know, testosterone should be about 20 bucks a month. Truthfully. That's, that's, that's what it should be. You know, peptides tend to be a little bit pricier, but again, you shouldn't be getting gouged for these things. Live Health, we charge for the knowledge that we provide. We charge for the service, we charge for the membership with live. Everything else is whatever it is.

So that was one of the things that made me happy. And what I appreciate about what you're doing at Live Health is you're doing a lot of the upfront thinking and rationality to make a decision. So then when you go and you work with the doctors who are part of the program, the case is already made. There's. There's enough education ahead of time, and it saves the doctor time and stress. And then it saves the patient time and stress because the research has been done. You could say, you know what, Dave, that probably is the wrong test. It's going to cost you $4,000. You're not going to get good result because it's probably this. So let's just do that first. So I just, I want to make that clear. The ability to say, I want testosterone. Is there a case for it? If so, you don't have to make the case yourself because you, Andrew, would make the case for a person who wants to do that. And the doctors are eager to do it because they already know that the boxes have been ticked. So it's like lubrication for making decisions.

Well, it's. The health concierge is in their role not only to advocate for the patient, but teach the patient how to advocate for themselves. Right. So a lot of what we're doing is coaching the patient, hey, how do I work through this jacked up medical model that we have? Well, we're trying to recreate it, and this is how you work in our medical model. And that's just it. Right. Hey, you're interested in modafinil, Great. Here's the reasons why modafinil is typically prescribed. This is all about Modafinil. Typical dosing is something the doctor will probably talk to you about and then we can chat more after that. But maybe, maybe it's a good option for you. Right? Nootropic, not necessarily indicated doctor session. Right.

So you'll figure it out. And this means people working on antifungal strategies for mold or metal chelation. And a lot of people listening to this have heard, oh, this is a thing, and they realize, oh, this is my problem, or I'm dealing with mast cells. I have these weird things going on. I'm histamine intolerant. Lectins are messing with me. I have skin stuff. These are the things where many people have been to 10, 15, 20, 30 different doctors looking for a solution. So for all the listeners who are saying, I don't know, I'm dealing with this weird stuff, having a concierge who's an interface to doctors and lab tests and pharmaceutical prescription services and supplements, it just makes sense. I don't think we can automate that yet, where we have AI doing everything we can for little bits of it. But putting all the data in and working with a smart human is a cool move. That's my question. How many biohackers like you or me are there floating around? It's kind of hard. We're unusual people, I think.

I mean, more than you think. And actually I met most of them at your conference in September. But yeah, I mean, there's a lot of them out there. And it's amazing what you learn from people on a daily basis. It's gotten to the point where I learn more from our patients than I do from the doctors or even my own research anymore. So, I mean, it's amazing to be able to work with people that are so intelligent, care so much about what they're getting into because they bring so many things to the table. It's remarkable working with people who come in and they say, just like what you said and said, this is the panel that I want. I love that actually, this is the panel that I want. Do it this way. And then I can approach it in a very similar manner and say, yeah, very reasonable. Let's, let's order labs, let's do this. This is fun. I'm a data guy, I love data. Let's get this going. And then after the fact, follow up with the doctor and then the doctor has everything laid out in front of them, has all the patient goals, has all the metrics. And the interesting thing, you go to your primary care doctor, or any other doctor for that matter, in a traditional model, and they go, yeah, everything looks good. And they look at your labs. But typically in those lab ranges, you're being compared to the average American, right? 18 to 65, non obese. And what I say to people frequently is, have you walked around Walmart recently? What are the non obese people at Walmart look like right now? That's not a healthy person. You want to be compared to that person? No. So ultimately you get to look at these labs and say, how do I make this perfect? How do I make this number the best it could be? Which is something special if you ask me.

It is. And I just want to be able to make it available for more people at a lower price with less work and less friction because I think it's important. I'm a little concerned about ability to scale. So you know, if, if after this thing I suspect you're going to get a few people interested in it and you know, we talked ahead of time about whether you could even handle that because I don't want to have people on, on the show and talk about this new thing that you can't get. But you assured me that you can, you can handle it. We'll make it up. It's, it's not expensive for what it is, but it's expensive, you know, in, in general terms. But it, it's how much per month for the basic, basic service and then there's two levels of it.

Basic service is 150 bucks a month and the complete program is 250 complete gives you access to labs, access to prescriptions, concierge access to the doctor. Whenever you need an appointment, you get an appointment. Typically turns into an appointment every two to four months with the doctor. An appointment with your concierge every four to six weeks as you need. In the core program, you get an initial lab review with the doctor and you get a once monthly essentially coaching session with your concierge as well as unlimited texting and HIPAA compliant communication with your team. But in either model, I mean it's, it's not expensive. You know, if you consider what people pay on for health insurance, the United States for example, and you.

250 bucks a month to be able to get any prescription that's medically justified and any lab test basically that you want that's available, of course you have to pay for the lab test, but you can get them ordered and get them ordered an appropriate price and a conversation pretty much whenever you want with a health person and doctor. Follow ups whenever you need an appointment. All virtual of course. Um, that is not expensive. In fact, people spend 250 bucks on one or two massages.

Right.

So seems to pencil for me.

Um, I mean you consider most of the doctors that are doing this kind of thing, in a true concierge model, they're charging like a thousand dollars an hour. Okay. You know, I mean it's, it's so when you consider that and getting access to the doctors that we have on our platform, it's, it's really the only reason they work with us is because of how easy we make, we make their lives. I just got off of a call with one of our doctors earlier was like you guys just make it easy for me, which is, I mean, we have a good system. You know, we've optimized through tech. And our team, the people that we've.

Hired into this, some of my closest friends in the world are running small medical, functional medicine practices and, you know, around the country, around the world. And it's always a question of how much money and time and energy do I spend trying to get patients in the door. So you get a patient, you're charging four or five hundred bucks an hour, which is kind of the minimum that doctors charge these days if they're not covered by insurance and all that stuff. So what you're doing is you're saying, look, we'll give you reliable, repeatable. You don't have to do anything but just take a call with someone who's well prepped in a system where all the research is done for me, I can review it. I can have a conversation, answer a few questions, add whatever nuances I know, check a box. And then it's automated so they like it. Patients who work directly with Live Health, they're happy because they're spending this fixed amount per month and getting to talk to the doctor whenever they want without having to go in and spend four or five hundred bucks an hour the way they otherwise would. So it seems like it's win, win, but this is actually like process wise, operations wise. This is smart. What if I had symptoms of intestinal parasites and there was a WHO drug that's been given 4 billion times without substantial side effects, and I needed a prescription for that from, for the worms? Is that something that might be possible?

It sounds like you would need it, right? It sounds like it's something that is absolutely indicated.

All the upgrade collective members are laughing right now. If you're listening to this, you know what I'm talking about? You know what I'm saying? If you know, you know, and if you don't know, you don't know, I don't know what else I could be talking about.

So, sounds indicated. You probably need to take it for, you know, four days and, uh, yeah, it's probably, probably what you need to do.

Yeah, it's just like, like during the right critical four days, it. It could really stop those worms cold.

Yep, Yep. Yeah, absolutely. 100%.

Well played. Well played. And then the other things, it's really hard to get a prescription for Modafinil. And, and I've been saying this for Modafinil can save your life. You should have a couple in your glove box. If you're driving late at night and you're just not going to be able to keep your eyes open at a minimum if you're jet lag, this stuff is super legit and it's, it's just hard to get. Mostly because insurance companies don't want to pay for it. Which brings us to insurance companies. No insurance company is going to pay for live health. In fact, they probably are scared of you guys. But flexible spending accounts in the US this means you can set aside a few thousand dollars a month of pre tax income or a month a year of pre tax dollars and spend them on whatever you want. You can use FSA and HSA for live health.

So the, the FSA tends to be a little bit more strict. It's, you know, F is flex, but it's not that flexible. So we tend to have some issues there just in terms of requiring letters of medical necessity, which kind of hurt us a little bit. But from an HSA standpoint, health spending accounts work great. FSA works 70% of the time. HSA, I've not seen an issue.

Okay, we just had an episode on semaglutide, the prescription drug that makes you lose like 15% of your body weight. This would be the sort of thing if someone's obese and their normal things haven't worked.

They.