Why Poor Nutrition Could Hurt Your Results | Dr. Jazayeri’s Insights

If your body's not optimized to heal, then it, you're not gonna have the, as good of an outcome.

Right.

You don't get well nourished after being in the hospital, you get worse. So this is why it's really important if you have the opportunity before the procedure to really improve the resilience and really optimize it before going in.

All right, good afternoon, good evening, or good morning, whatever time of day you are listening to. This is Matt Gallogly, and welcome to the Practice Profit System. We have a really great interview and webinar for you. If you are watching this on a webinar, or you're listening to this on our podcast, or you're catching bits and pieces of this on YouTube, you're gonna love this topic. Because, you know, when we talk in, in Planic Mavericks about everything that we do, that we teach you is about getting the best-in-class patient outcomes. And it's really the opposite of what we teach, what they teach you to do in the insurance business. In the insurance business, they really only care about the insurance companies. In our case, when we're going directly to the consumer and we're getting them to pay cash, the customer, the consumer wants to have an all-in-one solution. They do not want to have this dripped on them. And so we want to get best-in-class outcomes, which is why when you're doing PRP or BMAC, we have you do shockwave or laser or HBOT or IV or whatever. And the same thing in functional medicine. But in both of those cases, be it functional medicine or biologics, people forget about nutrition. Now, nutrition is not exactly an exciting topic when you think about it in just the context of nutrition. But if you think about nutrition in the context of perioperative and postoperative, or— and I'm using operative in air quotes, it could be just a procedure in office— when you think about the impact that that can have, you can significantly Uh, increase and improve the positive outcomes for your patient, which is why I have Dr. Jaziri here with me today, otherwise known as Dr. Jaz. And if he's not known as Dr. Jaz, then we shall anoint him as that today. And Gray Hunt, who is his chief operating officer. And Dr. Jaz today is going to be diving into the science behind nutrition, why you need to be focusing in on it. And frankly, I believe, uh, having listened to him talk a couple of times before, some of the false beliefs that exist around nutrition and its impact on care. So, Dr. Jaz, thanks for coming. Great. Thanks for being here. So, what do you got for us today, Dr. Jaz?

Matthew, thanks for having me on. This is truly an exciting period because we're finally getting to understand all the different pieces that really play an important role in our patient outcomes. You know, as an orthopedic surgeon, you know, we've gotten really good At fixing things. But just because we fix things, we're realizing that that doesn't necessarily translate into healing. And for me, my practice, taking care of a lot of complicated patients and revisions in these cases that really did require further surgery, we realized that there's an element that we're missing. And so that's where the nutritional aspect has come into play. And we're realizing more and more now the significant impact that has in our bodies. And intuitively it makes sense. What you put into your body will make a significant difference for healing. And particularly during the time of surgery, this is where we're really honing in on and that we're understanding the impact that we can have. So I'm happy to share that with you guys today. Yeah.

And, you know, I didn't do this, so I wanna let everybody know that you are an orthopedic sports medicine specialist and you specialize in doing revisions, correctly? Revision surgeries?

Yes, yeah. Shoulders, knees, ligament surgeries. A lot of these athletes who've been through a couple of operations and now they're, they failed or shoulder arthroplasties, elderly patients who have these, whether they're, they got infected or they haven't healed. And so my practice is kind of taking care of that disaster patient, if you would, you know?

Mm-hmm.

And so when it comes into thinking about what are we going to do this time around? What did the other surgeon do that, you know, what are we going to do differently? These are the variables that kind of come up to play that may, may not be addressed the first time around. And through those mistakes and through these challenges, We've learned how we can improve.

Awesome. Cool. Well, take it away. Let's dive into this. What do you, what do you want to share with us?

So, you know, as surgeons, we've done a lot of different variables in thinking of what our patients' outcomes are going to be dependent on. But this here, the nutritional status and really the metabolic demands, what the body requires to heal, has been overlooked. So this is what we will be looking at today. What, what we're seeing here is, you know, despite all the advances that we've had with surgery, um, we're not getting the results that we want. If you look back at our patients, half of our patients actually come into surgery not optimized. Only half our patients are truly nutritionally optimized to be able to deal with the stress of surgery. So we're leaving half our patients really, uh, or they're behind the 8-ball here. And if you look at all the different things that we can do for our patients, be before we get them to surgery, nutritional status is being recognized as the strongest predictor of complications. And we see here that essentially in every subspecialty, poor nutrition is correlated with complications and increased cost. And what's interesting is we can use albumin. This is a variable that we use to measure nutritional status. And it's important to note that even 40% of our obese patients are malnourished. So these patients are, are, are, are really behind the 8-ball here. And what we see is patients— and you would expect this— who have poor nutritional status, they have heart complications. This kind of makes sense.

Mm-hmm.

And when we supplement them, when we provide them nutritional supplementation for these malnourished patients, they do better. This may seem intuitive, but what's really surprising is on this end, patients like me and you, we think we're healthy. But even these patients who are healthy, when they're supplemented around surgical time, they have improved outcomes. So this has really give us some, shed some light on what's happening to our bodies during surgery, even if we're healthy. And even worse if you're malnourished. During surgery or healing or regenerative medicine, fracture healing, any type that the body, anytime the body needs healing, it really requires an elevated amount Of amino acids, 'cause amino acids are the building blocks. This is stuff that you need for your tissue to repair, for immunity, and your glucose metabolism. This is why we have such an elevated requirement, and most of our patients don't meet this requirement around the surgical time or healing from a fracture or even PRP, any type of procedure that requires this elevated amino acid for this time. Now, for me, this is my, Classic athlete. This is where we started and this is the best-case scenario. I use this as a, as an example. The high school athlete, they're healthy. They come in, they get injured, they lose 20% of their muscle. This is what we see pretty much kind of the natural history of this. We do the surgery, we stabilize them, but if you ask any surgeon who does ACL reconstruction, most of our patients are left with an atrophied leg that looks like this.

Mm-hmm.

And this is what it looks like graphically. They take a, hit from surgery, from the injury. By the time they get to surgery, they have their second hit. And it's not for about 2 years that patients require time to get back, to put back their muscle. So, it's a significant hit that that patient takes during surgery. And this is the best-case scenario. As we get older, 'cause of sarcopenia, this gets magnified. And what we see as we get older, we have this resistance to exercise and nutrition, which means we need even more of a stimulus to even keep up to where we were before. This is what it looks like graphically when someone's had an arthroplasty. They take a bigger hit from surgery, which takes them even further time to recover from. The worst-case scenarios are fragility fractures, hip fractures. We know that 30% of these patients actually die within a year. So regardless of who you are and what kind of surgery you're having, this is a really catabolic time, which means your body's going through a lot of stress, and this is exactly the best time for us to intervene.

Hey, I'm Matthew Gologli, and I'm a Maverick. Well, what is a Maverick? A Maverick goes against the grain. We find our own way. And if you're sick and tired of being pushed around by the insurance companies, come join us. We'll show you the way out and you'll love medicine again. That is just amazing. That's, that's just, I mean, I know for a lot of our clients who are listening to this, like if you're listening to this in the podcast, I mean, you definitely want to go back and take a look at the graphs, but I mean, it's just really stunning. The hip one is mind-blowing to me.

I can't tell you how obvious it is when we see these patients come into the hospital. They're already kind of behind the 8-ball, especially the hip fractures. And then by the time they get through the operation and they, they get out, most, I will tell you this, most patients who come into surgery are not prepared nutritionally and all patients, all patients leave the hospital worse. You don't get well nourished after being in the hospital. You get worse. So this is why it's really important if you have the opportunity before the procedure to really improve the resilience and really optimize it before going in. So this actually leads into this.

You mean the Jell-O and the applesauce they give me in the hospital is not, is not good for my nutrition?

That's exactly— so yeah, exactly. So, so we'll get to that, right? And so, okay, so, you know, I'm, you know, I'm in LA, so we work with a lot of the, you know, professional athletes here and You know, the, what's interesting is we have already been taking care of our elite athletes. We have a blueprint for this.

Mm-hmm.

For our elite athletes, we have a specific plan of we say, look, here's your event. We're gonna nutritionally optimize you before the surgery, during your event, and afterwards for recovery. So essentially, we've taken that exact same blueprint that we've applied for elite athletes. And now we're applying this for our patients. So for me, when I talk to my patients, I talk to them as a surgical athlete. I tell them, look, your surgery is your event. We're gonna get you nutritionally, physically, emotionally prepared for this event. So then when you go into this surgery, your performance is gonna be better. So we're essentially, we mirror what we're doing for our elite athletes.

Mm-hmm.

Now for our patients.

Yeah.

So, we'll get into this a little bit but, you know, ultimately, we're providing the right fuel at the right phase. The body goes through this phase, these 3 phases of surgery where initially you have this catabolic phase. The first 2 to 4 days is really high stress. About a week after, there's a slow turning point and then slowly you get to the anabolic phase of recovery. That's where the healing and the muscle comes back. The goal here is to kind of blunt the catabolic phase, turn the anabolic phase on earlier, and we'll talk about the fuels that kind of can help promote this. And athletes don't perform well fasted. Neither do our patients. And, you know, patients going into surgery, they have complications or issues with this. And not only are patients quote unquote hangry, but there's also metabolic issues with this. And because of this— you will see that when you go into surgery fasted, your glycogen stores are essentially depleted. This really heightens the stress response. So this leads to higher infections, more muscle loss, and decreased wound healing. And this has actually been termed the diabetes of surgery. Because of all these issues, we're actually finally seeing this evolving NPO guidelines where the current guidelines are no longer the old school, you can't have anything to eat. We're actually suggesting and promoting patients to have clear carbohydrates just like the athletes right before their surgery. And because of this, now we're seeing significant improvements in their functional recovery. We have less complications by providing these complex carbohydrates right before surgery. And you can do this now. The anesthesia groups are finally becoming aware of this and we're pushing this. And you can have clear fluids up to 2, sometimes, Some hospitals will do 3, but you want the body to be in that even keel state so you're not starving. And you can do this with complex carbohydrate. Could you do that via—

can it go via IV or is it a liquid that you're drinking?

Great question. You could do it IV, except when you do it IV, you don't take advantage of the oral component where you want the gastric component of the body to be moving. And so you want to promote some oral intake because that helps with overall bodily function. And so if you give it IV, it's, it's, it's, it's helpful, but the nausea and the vomiting is not as helpful.

Mm-hmm.

And, and, and being able to do this with a complex carbohydrate before surgery is more practical for patients because then they can do this at home and it's not an Um, it's not a surgical or a hospital-based protocol. So this is something that makes it easier for the patients as well to consume, and it doesn't require an IV because you actually start the carbohydrate loading ideally the night before. And you want to do this with the complex carbohydrates because the simple sugars like Gatorade, which, uh, which are better than water or better than nothing, they spike up your glucose and then it drops back down. The goal of this is to keep the body in even keel state. And you can do this with these complex carbohydrate solutions. So that, that's the carbohydrate portion for, for the, for the first portion to get to decrease that catabolic breakdown. Now, to get the body to the anabolic phase, you need protein. But really what you're getting after from the protein are the specific amino acids that turn on the anabolic phase of recovery. And if you look, most our patients don't even come close to hitting this target. Even the RDA, the recommended daily allowance, that value was based on healthy— not even patients, healthy people— to consume the amount of protein to avoid being malnourished. That number is way different than the actual number that you need for optimal dose. It's, it's like kind of saying, hey, what's the minimum amount of vitamin C I need to take to avoid scurvy? I mean, that, that's, that's much different than the number that you need to have optimal recovery. This is why we're seeing such a mismatch.

Mm-hmm.

And so, we've seen now throughout the years this evolution of strategies. We would do it with whole food. We tell them, okay, you know, you got to eat a lot more protein. But we realize that's not very practical. You can't have patients eat all that protein around that time without getting the excess calories. And, you know, most patients don't have a huge appetite after surgery. So, really, we're getting much more specific with understanding what are the key amino acids that we need, and we can target that now. And this is where we are now with, with really the formulations, very similar to what the elite athletes are doing, really dialing in the specific, uh, supplementation that we need for that particular event. And in our, in our case, orthopedic recovery, which we'll get to— tendon, muscle, collagen healing. And so, you know, most people know amino acids are the building blocks of the body, but really it's beyond that. They're not only the building blocks for tissue, they have really key functions in metabolic processes and, and cellular signaling. And this is where we can really hone in what we want and target these amino acids to the pathways that we're interested in. So you can take these amino acids and have them code essentially the pathways that we want. For us in orthopedics, it's muscle, fracture healing, and collagen synthesis. And you can really tailor the amino acid formulations for these specific pathways. And the same way we can take whole blood, we can centrifuge it, and we can take PRP, Why? 'Cause PRP we know has the platelets, has those cytokines and the growth factors. Well, we can do the exact same thing with protein, take the peptides and identify the key amino acids we want for those pathways. And so we see here now, what I wanna show with this graph is, you know, healing doesn't just happen once. Yes, if someone comes in with a fracture, we may fix it, put some screws and put a plate on, but it takes time for this to heal, even with a PRP intervention. You may spray that PRP on that area, but the reality is these things take time. This is an extended healing period, and this is why it's much more valuable to have these amino acids not just once, but you want to have it over an extended period of time to allow for better tissue incorporation. This happens on the muscle and the tendon side, and they're both important, particularly on the tendon side because it doesn't get as much blood supply. This is why these amino acids can be curated to have properties for increased blood flow, this is what we were seeing the improvements for wound healing.

Mm-hmm.

And I put this, I put this up here because in the world of orthopedics, we're working a lot with collagen patches. This was a paper that was very interesting. They took 70-year-old women who were healthy. They put a catheter in their shoulders. These catheters were just essentially sponges that were allowed for collagen incorporation. And when you put the particular amino acid in here with the, with the focus for collagen synthesis. These amino acid, uh, group, the women who got the supplementation had 67% more collagen synthesis on that patch after 2 weeks. So this is really exciting.

Wow.

Yes, because it's, it shows that by having the correct amino acids or having the correct nutrition, even for 2 weeks, you can significantly impact the rate of collagen synthesis. And this is why now we're seeing the application of these amino acids in burns, ulcers, wasting disorders. And this has been used for a really long time. Actually, orthopedicists, we're kind of behind. We've been so focused on screws and metals and nails that we've actually overlooked this. And I think it's really been the orthobiologics group that have been really thinking outside the box and, and really thinking about this. So now we're seeing this Collaboration with biologics, with orthopedic hardware, and really thinking about this. And now nutrition is kind of tying all this together. And this is where we talked about with a lot of the orthopedic surgeons who are working with patches for rotator cuff repairs, for example. This is one of the, our biggest issue. Rotator cuff tears, I, I do a lot of them. I do a lot of redos. We do a great job with fixing them whether you do single row, double row, you know. A large portion of these don't heal. So now we're adding patches to it. So, so the patches are helpful to get improved healing, but again, if the patches are not provided with the right building blocks, then they may not do as well. So this is now we're looking at the research now here, looking at the same study I showed with these women who were getting these collagen patches or scaffolds. Now we're looking to feed the patch essentially and provide those amino acids to enhance the healing process. What's interesting is Amino acids have been used for a lot of different reasons, but one of the first people to put this to use was NASA because of the tremendous amount of muscle and skeletal loss that happens when you're out of space. So NASA really led the way with this, and this is where we kind of really started to kind of pick up from where they left off, is seeing, look, you can actually impact this. And deconditioning happens really quickly, whether you're having surgery or you're immobilized from injury Atrophy happens very quickly. It begins as early as 48 hours. And this is why we're seeing such a big issue with patients who are in the hospital after a hip fracture or even someone who's not had a hip fracture. My, some of my young patients who have an osteotomy, they decondition really quickly. So this is where we can intervene with these amino acids. So look, we can't stop it, but we can definitely mitigate it. And this graph really is, is important to kind of think about. It takes 12 weeks to put on the same amount of muscle that's lost in only 2 weeks of immobility. So this really, you know, kind of highlights how important it is for us to preserve the muscle in the first place.

Hey, I'm Matthew Gologli, and I'm a Maverick. Well, what is a Maverick? A Maverick goes against the grain. We find our own way. And if you're sick and tired of being pushed around by the insurance companies, come join us.

We'll show you the way out.

And you'll love medicine again. It's fascinating you say that because, you know, as you know, I travel a lot and working out on the road isn't always the best, right? And I am in my later 50s, almost 57. And it's the other day I was home and I was walking down the step. I'm like, my gosh, my, my legs feel weak. I've never had an issue with my legs feeling weaker, right? And I take everything, BPC-157, HRT. I eat 180 grams at least of protein every single day. My weight's always 190 pounds. I mean, all these things, right? Like, I have about as optimized meal eating as I think you can have. And I noticed that my legs are weak. And that's because all of a sudden I realized when I went back to my journal, I hadn't done any leg workouts for 3 weeks. Yes. And I'll tell you, so like, and I'm healthy, right, Chaz? Like, I'm a, I'm a healthy 57-year-old man, right? I can only imagine if I'm not.

It's scary. It's really, and I'll tell you, it's interesting you said going down the stairs. Because the first muscle that atrophies is your quadriceps, and there's something about our mobility, and it happens. What are your quads? Yeah, half a percent in the young and 1% as an, as an older adult. So you need your quads because that's what you need to come down the stairs. This is why you feel the pressure on your knees. And so yeah, that's the first place you're going to notice it, and that's the first muscle that, that goes. This has been the focus for all our studies that we're doing. We're looking at ultrasounds and MRIs of quad because it's the most sensitive and that's where you lose it. These were a NASA study. These are participants who were in bed for 1 month, okay? I mean, I don't know how you can get through this. They're young guys who are willing to do the study, but for 1 month they did nothing. They just laid in bed, okay?

Yeah.

And they looked at what happens to their muscle and their strength. And amino acids— by providing these amino acids, they were able to preserve their muscle and mitigate the strength loss by just providing the amino acids. They did no exercise. And so this is fascinating because by providing this, you're able to preserve these 2 variables. Well, this is exactly what we care about in orthopedics, preserving muscle and strength loss. This is what essentially is a reflection of your functional recovery. So we essentially took this, and now you're seeing this is, this is a recent Italian study, uh, actually Matteo, we're working with him, uh, with some of the studies that we're going to be doing. And this led to this, this recent article, Nutritional Orthopedics And space nutrition. That's 2 sides of the same coin. So, this is really exciting to see kind of these fields that you would never think have something in common, but now we're working together to kind of better improve both subjects here, you know. There's a recent article that we wrote, Nutritional Orthopedics: Supplementation in Orthopedic Surgery, and now we're seeing decreased complications, improved outcomes, whether it's a rotator cuff repair or a spine fusion or trauma. It's really exciting to see now that we can apply what we've learned into orthopedics. I'm happy to geek out with anyone later about the details about this, but—

This is where I glaze over as a non-medical person.

So, and that's okay.

I know, but everybody loves it. I'm just joking.

It's—

yeah, there's a lot going on.

There's a lot going on, but that's why I simplified it to this, okay? Essentially, we're, you know, we're blocking the pathways that break down and we're enhancing the pathways that make. So we're shifting this to a net anabolic state, okay? And this is where it's important to be able to Block the breakdown and enhance the synthesis. And by doing that, you're able to now shift this to a net anabolic gain. And what's interesting is you can do this on animal studies where you can see this becoming really important in not just the animal studies but specifically with, with the challenges that we have in rotator cuff surgery. So, we all know, you know, the sports surgeons who do rotator cuff, Atrophy in the rotator cuff is a big problem. And so this study was really interesting. When you cut a rotator cuff, the muscle atrophies very quickly. So in the middle here, you got the cut muscle and a normal diet, and this is what you expect to see. You see the muscle just goes away. Here's on the left, sham. They didn't cut the muscle, they gave a normal diet, and it was healthy, everything stayed. But what's interesting on the right, when you cut the muscle but you give them high leucine— and leucine is one of those amino acids that's really been the trigger for muscle protein synthesis, you're able to preserve the muscle here. So, this has a lot of implications now for our rotator cuff patients. By providing these amino acids, whether preoperatively or even after an injury, you can help prevent some of these atrophy issues that we see that end up having a big impact on our patient outcomes. And this is another recent study that just came out looking at the rate of recovery after a rotator cuff repair. And we see here that the direct correlation with the types of foods that you consume, that will actually be able to predict the rate of your recovery. And the food had more protein, had amino acids, these patients had a faster recovery. Again, going back to the fact that what you put into your body around the time of recovery really has an impact.

Mm-hmm.

And we see this again within other studies that have shown with amino acid supplementation and you're able to improve pain scores, And improve MRI findings after surgery, decrease re-rupture rates, and improve healing. For the guys who do orthobiologics, they may be interested in understanding that you can actually stimulate the regenerative cells, right? The satellite cells are the dormant stem cells that lay in our, all our bodies, and they get triggered by a few things. One, they get triggered by exercise. But the, these satellite cells, they call 'em satellite cells, by the way, because they hang out on the periphery of the skeletal muscle. These satellite cells also gets stimulated by these high-dose amino acids, and you're able to kind of improve that. And so what we see here, amino acids play a very important role in stem cell properties. You can influence this. And what we're seeing now is by giving the amino acids in the pathway of these stem cells, you can actually help renew and help differentiate these to upregulate And conversely, in cancer treatment, you can deprive patients and these stem cells of these amino acids and help that as a cancer treatment. So it's really interesting to see, you know, you can modulate the properties and influence how these stem cells will essentially differentiate. This study was really interesting from an orthopedic perspective. These group of patients received amino acid supplementation for 1 week prior to their knee replacement. At the time of knee replacement where the knee was open, they biopsied their tissues. And sure enough, they found an improvement in their satellite cells went up.

Wow.

This same group, yeah, this same group that went, that they studied them, who had the improvement in their satellite cells, went on to have decreased atrophy and improved functional recovery. So now it's really exciting to see that we're going all the way from these rat studies And seeing improvement in satellite cells, now to orthopedics and translating into their functional recovery. This was the winner of the 2020 Ranawat Award. Again, this is another paper, same protocol, and this is the protocol that we're using now. 1 week before, prime the patients, and 2 weeks after, they had less atrophy and they had faster functional recovery. What we're learning now is what happens to our patients at the early postoperative period is reflective of how they're gonna do even 2 years down the line. So, let me say that differently. If you're able to block or mitigate the muscle loss early on, you're able to then preserve that functional capacity. So, these patients who drop down, some patients never recover from that.

Mm-hmm.

But if you're able to kind of blunt that, these patients can come out faster. And this is that same group of patients that initially won the 2020 Roundup Award. They followed these patients 2 years later and they realized the patients who came out and they were doing better at the early 5 to 6, 8-week mark, they were significantly better even 2 years down the line. So, those patients who were, who dropped, they actually never were able to recover the same way. So, this is really fascinating for our patients as it relates to not just like getting our athletes back to play, but the muscle loss, you know, manifests itself in different ways. For example, periprosthetic fractures. People who are weak, balance, they fall again and these complications, readmissions, These things come up. So it's more than just muscle, it's really the functional capacity that goes along with this. The same story holds true with hip fractures, total hip arthroplasty. You're able to get functional recovery improvements with, with supplementation. Some supplementation—

Yeah.

Have gone up to 8 weeks, some 2 weeks. And spine, spine is another really challenging group of patients. We're seeing now with these amino acids and supplementation, we're able to improve their wound healing, infection rates go down, and there are a lot of the IGF and albumin, these are the proxy for nutritional status, these also improve. So we're seeing this improvement amongst all patient population. And again, what I would like to highlight here, none of these patients were malnourished. These were all quote unquote—

That's the fascinating thing to me right now. So, and we know because so much of the American public is malnourished because of the crappy food that we have and the way that they eat, and they're usually coming in overweight, I can only imagine how much worse their recovery is, um, and the results that they're getting. So this is— I mean, this is fascinating to me.

This kind of was something that when I started to look at my own patients that were coming to me, someone sends me an infected shoulder and they're like, you know, can you redo this? I was like, okay. And then I started to ask, well, why'd they get infected in the first place? They put— everything seemed fine. Look, we checked their hemoglobin A1c to make sure their diabetes is well controlled, right? Well, why don't we check their nutritional status? So when I look back on the patients that we received that were infected or had issues, more than 95% of them, almost 100 except 2 other patients, all of them had low nutritional status. They were poor. So to me, I was like, wait, let's pause before we take you back to the operating room. Let's optimize you. Go see a nutritionist. Go improve your diet. The same way we tell them, hey, you know what, your, your hemoglobin A1c is off the, you know, off the charts. Go see your endocrinologist. Get on metformin. Do whatever you need to do and come back. Because I know, I know If you come in with a hemoglobin A1c that's, you know, whatever number is your criteria, 8, 9, whatever, it's too high, then you're gonna get infected. I'm not gonna, I'm not gonna operate on you. So now we gotta have the same perspective when it comes to nutritional status.

Well, you're seeing this data too in the biologic space and non-surgical, just in doing PRP injections, stem cell, you're seeing that improvement as well.

This is why I'm super excited to work with some of the groups like Data Biologics to, to understand Really the nuances of this. Pinpointing nutrition is, is not easy to do.

Yeah.

And there's so many variables involved. And this is our challenge now is to get much more granular, work with, you know, people who are really academics-based and, and want, want to put this together. And this is where now we're seeing much more interest and, and research on this. So, yes, I do think a patient, regardless of what kind of procedure they're having, whether it's a spine surgery or an ACL reconstruction, Or even orthobiological procedure, if your body's not optimized to heal, then you're not going to have as good of an outcome.

I've done 9 PRP procedures on me and did my first one in 2015 back in the erectile dysfunction clinic days. So I had my back done in February, and it was the first time that I focused on my nutrition post. I didn't have time pre because I was, you know, I happened to be at an event. My back had been bothering me. They told me to go get an MRI. Like literally, like within 2 days we were doing, um, uh, Dr. Goyle was doing a procedure on me and Dr., uh, Demers. But from the recovery standpoint, from the nutrition of focusing in on that post, my recovery was incredibly fast. Like, now I'm on HRT, there's a couple of other factors and taking BPC-157 and all of those things. But, you know, I've had my elbow done, my back done, my knee done, and a couple of other, you know, places in the erectile dysfunction space. So, you know, Like the recovery has been just phenomenal with that. So, yeah, just my point of, my point of data.

No, no, no. But, but I think your point of data is, is, is important to note that all the different things that you brought up, there's not one thing. It's all of them.

Yes.

And this is where, as, as, as, you know, as surgeons, as doctors, as healthcare providers, you know, I, I can say for sure, as orthopedic surgeons, we've been super myopic. You know, it's been like, you know, focus on this fracture or focus on the tear and that's it. But, you know, we gotta kinda go back and have a more of a holistic approach and say, okay, yeah, you know, where are their hormones at? Where, you know, is the implant correct? Is it— is your diagnosis correct? Is your indication right? Right? And, and when you look at all these different variables, they're all actually, they're all important, you know. But this is something that we've overlooked and now we see that we, when we put this piece in, It really helps complete the picture. This was another study that, you know, looking at ACLs, and we're seeing here even with the ACLs, you know, the, the graft maturation is improved. To us, that's really exciting because in order for that collagen to incorporate into bone, you, you can get an improvement and enhancement of this incorporation when you have these amino acids on board. This was a trauma study, 200 patients. This is actually my co-faculty where we presented this at last year's Academy instructional course lecture. We got such great feedback, we're coming back again this year. This is Mike Wiley's work from Iowa, uh, trauma patients, 400 total, 200 in each group. These are trauma patients, which means we didn't have time to provide them any supplementation before. They just came with the broken fractures at the hospital. 2 weeks. This is the same supplementation protocol that those Ladies got for 2 weeks. These patients who received the supplementation had less complications, less mortality. They preserved their lean body mass, and they even had better fracture union. This is fascinating. So to be able to see this now in fractures for only 2 weeks, we're really seeing that, look, if you don't address this, your complications are gonna be clearly higher. You kind of touched up on this, you know, in the biologics where we're doing a lot of different things from BMAC and PRP and different type of light therapy. So, you know, these are all important. But in order to address the cellular aspect of it, this is where we can also add this to get a more complete picture. So in order to really address this, you know, this is where we're thinking about now providing this alongside our orthobiologic procedures. Because we know when you do a PRP, you're really kickstarting the signal. That's, that's where you're doing. But this healing process, like we mentioned before, it's not just a one-shot. This is something that requires time, and having this sustained supply over an extended period of time is what we're aiming for to have improved healing. And, and now we're seeing results. Now when you combine, for example, electric therapy with OA with PRP, you're having improving results. So again, the concept here is when you're able to have synergistic modalities work together, you're gonna have improvements in their results. Article again showing that A lot of the mechanisms behind whether it's PRP or light therapy, they actually have synergistic mechanisms. And, and we're able to see now these angiogenesis in particular is, is really the underlying aspect where we're seeing improvement in, in healing and some of these variables. This was a study that looked at OA and patients who received amino acids. And this was a Japanese study. This is low-grade OA and patients were 20 to 60-year-old patients, and all their parameters improved when they received these amino acids. I think again we're seeing here, just— this is done without PRP. So Bob Buford and I were talking about doing a study now looking at combining PRP and the amino acids in this group, and this is what we'll be studying next. So this is kind of where we're at now, particularly when it comes to the orthobiologics. I think having that 1-week pre will help optimize the patients to increase their resilience so they're ready to do their procedure. And then we carry them on for, you know, at least 2 weeks. But some of the procedures that are a little bit larger will go to 4 to 6 weeks. This is important to note that there's a lot of variables here, particularly in the time of, you know, the economics here. There's significant cost savings associated with this. The complications that are associated with this can be avoided. Look, we can't stop everything, but I think this is a variable that We shouldn't overlook. This is our current protocol. We start a week before and we take it for 2 weeks after. This is the most opportune time to intervene because we know this is the time where patients are in this most catabolic state.

Going back to that, the thing I would tell somebody if they're like, well, I'm not an elite athlete, well, but the reality is, is that most people want to have better lives. And, you know, you can learn a lot of things from the practices that elite athletes do or elite performers that you can translate into your life that give you better results, right? I mean, in a lot of these folks, like in the biologic space, a lot of the patients are high achievers, right? The— for what my clients charge and the, the demographic that we're going after, 55+, because those are the ones that spend 4x to 8x more than anybody else, you know, these are people that are used to getting amazing results. So they understand doing the things in order to have a successful life. And when you look at this, like That connection of this is what elite athletes do, you can do the same thing that they do, and it's not going to be uber expensive, or it's, it's not going to be taxing on your life so that you can get a better outcome. I know that our patients would be like, yes, we want to have that as a component because they want the absolute best in life. That's why they're here working with our, with our doctors.

I tell my patients, you may not be an elite athlete, but everybody wants an elite quality of life. Yes.

Absolutely.

And so this is what we're doing for our surgical patients. We do the amino acids one week before and we add in the carbohydrate loading because they're going to be in surgery for, you know, that extended period of time. So we don't want them to be in that kind of NPO starving state. We want to put them in the fed state. That is now what the— a lot of the ERAS, the Enhanced Recovery After Surgery programs, anesthesia groups have also been adopting now. And look, there's no magic here, okay? This is why we always say you have to add this good healthy diet, high protein diet. And of course you have to exercise. That's very important, the resistance training aspect. When you exercise and you take the amino acids at the same time, or, or you're taking a high protein diet, that has a much more impact. So you got to really have this comprehensive approach. And so when we talk to our patients, you know, we call this trifecta, where we say, look, it's not just supplementation, that's one aspect of it, it's your diet.

Mm-hmm.

which we help them with. And the third aspect is the exercise. So those are the 3 variables that we really preach in order to have the, the best outcome possible. We're doing a lot of things here in orthopedics for our patients' outcomes, but this is an important variable that we shouldn't overlook.

I think this is an important topic. Look, again, everything that we teach you at Mavericks is, aside from what we teach you about making money, aside what we teach you about using scripts or what we teach you about creating content for know, like, and trust, The best way to get your pro— your patients, your prospective patients educated and excited about coming to see you so that they know, like, and trust you, so that they spend money without— to you without even worrying about what the cost is. It's about getting amazing outcomes. And if we get best-in-class outcomes, provide a 7-star experience, you become highly referable. It is one of the core tenets of what we teach. So everything that we teach sits under the umbrella of Outstanding patient outcomes. We're going to create that environment that we're going to create amazing patient outcomes, whether it's in functional medicine or biologics, whatever it is. But that's got to be the overriding thing. So, Gray, you've been awfully polite and quiet sitting over there as Dr. Jazz has been going through all of this. How then do people go about implementing this in their practice? They like what they're hearing. They want to learn more. How do they go about learning, learning more about this?

Well, thank you for having us today. You know, I'm constantly learning from Dr. Jazz, so I enjoy listening as well. And you know, when it comes to implementing this into your practice, we understand that everything Dr. Jazieri shared with you today is also a lot of new information. So more than a product or a program, we're really a service to your practice. So when you incorporate nutritional optimization for your patients. We're really available to educate your staff, to be an integral part of this experience for them. So we'll customize a program, a protocol that works for your practice, for your procedure. So the, the gold standard is this 3-week implementation package that we have, or we can start 1 week peri- procedure or perioperative for your patients. They have a patient journey that's implemented where, as a service, we're really every step of the way with your patients, helping to educate them, offering them meal guidelines to support a high-protein diet, giving them blogs, information, answering any questions that come up for them as an extension to your practice. They also, you know, will have a Text line provided, quick, easy reminders to support them. So this becomes a, you know, really a package that your patient is offered to create this optimal environment. And this is where we, we help you out to, to make this an experience for them, more than just a product, more than just a program. And, and This is where your patients, without even, you know, realizing that we're a separate company, are going to thank you for really treating them in a way that you— they know that you're thinking about every aspect of their recovery and giving them these best-in-class outcomes together.

So if somebody wants to learn more and talk to you specifically about their situation and their unique patient base, what's the best way for them to get in contact with you?

So we have A lot of information on our site, which is xrsience.org. You can reach out to me directly at gray@xrsience.org. I'm happy to answer any questions. You know, we can do an educational one-on-one for you and your team at your practice if you'd like to learn more. Dr. Jazz can also be available for your practice too if you have a group that's interested in being educated further. Further and doing a deep dive with a Q&A, we're absolutely available to set anything like that up. And we can customize any materials for you, send over clinical research information to support answers. And xrscience.org is really a great resource of information there for, for anybody that's interested in learning more, and an easy way for us to be contacted as well.

And just remember, Grey is spelled G-R-E-Y. G-R-E-Y. Grey at— say it again— xl—

xlscience.org.

The call is probably about 15 minutes. It can go longer if need be. But if you just want to get some basic information, I will tell you that I have a number of my clients that are using this system. You know, you mentioned Don Buford. I know he's been utilizing it. You know, there's a lot of people that have done— you know, people don't wind up on my podcast because I do a ton of research on the science of this stuff. I am not the person to do the, the background check on the science of the medicine. I trust on— I trust people like Dr. Buford and Dr. Demers and others to really do the vetting process. And so, you know, we're not, we're not some podcast, YouTube webinar thing for hire where people just throw us a bunch of money, we put out Everybody we put in front of you is vetted, and we know that when they're coming on that they're the real deal, that this is not just some BS idea that they've come up with to try and make a bunch of money off of you. So, you know, if you want to get the best-in-class outcomes for your patients, and look, everything we teach you is about don't just do PRP or don't just do hormones, do the whole damn thing. Your patient will pay for it. They want it. They want the amazing results. And, um, and then your business becomes highly, highly referable. And it's a great, it's a, it's a It's a fast-moving flywheel when that starts to happen. So check them out. Um, and Gray, give your email address one more time so that everybody has it.

gray@xrscience.org. X-R-S-C-I-E-N-C-E dot org. And we're happy to help you, you know, customize something for your practice, for your patients, and, uh, really be a part of your service that you're offering to offer these best-in-class options for your patients' recovery and outcomes.

Great. Well, Dr. Jaz, thank you so much for taking the time. I know you're a busy man. Glad we were finally able to get you on there between your schedule and my schedule. And great, thank you. And check them out, folks. Look, we're always here to provide the best information because you're not going to get it from the insurance companies. You're not going to get it from the hospitals. You're going to get it from places like us. And as you know, our mission here at Mavericks is really simple. We're going to free 100,000 doctors worldwide. from insurance by the end of 2033. If you're sick and tired of getting screwed by the insurance companies and the hospitals, and you wanna do this, you wanna get better outcomes for your patients, check them out. Come be a Maverick. Alright, everybody. Thank you. We'll talk to you all soon. Thanks for having— thanks for coming on, Jas, Gray. Thank you so much.

Thank you. We'll be in touch. Take care.