Ask Dr. Paul Savage: A Live AMA on Toxins, Detox & Advanced TPE Your Questions. Answered Live.

Okay, welcome everybody to MD Lifespan's National Learning Series. This is the first of a monthly event series, Ask Dr. Paul Anything. We've had a ton of questions come in, some excellent questions that Dr. Savage is going to try to get to as many as he can in the time frame. Um, a little introduction of Dr. Savage. He is the founder and chief medical officer of MD Lifespan. Dr. Savage is an emergency medicine physician by training with fellowships in stem cell therapy and metabolic medicine. He has spent the past 2 decades advancing personalized data-driven care, including the development of patent-pending protocols centered around advanced serial therapeutic plasma exchange. His work integrates therapeutic plasma exchange with diagnostics and targeted therapies to address inflammation and toxin burden in complex patients. Dr. Savage is also the author of the newly released book Avoiding Toxins, a trusted resource for reducing toxic exposure and living a more toxin-free life. Without further ado, let me introduce Dr. Paul Savage.

Thanks, Lisa. It's really a pleasure to be here today. As Lisa was saying, I've been a doctor for 40 years now. It's kind of hard to believe. In the last 30 years, I've really focused on the health and wellness industry. It's been quite an enjoyable career. I've built over 100 separate different clinics. I helped build the software system that everybody utilizes. I help build— I help associate with a couple fellowship programs on metabolic medicine, and I'm learning every day. But my real passion started about 4 years ago when it occurred to me that therapeutic plasma exchange was a modality that no one had ever thought about using for these chronic environmental toxins that abide in every one of us now. And so I look forward to all these questions. I'm sure it's going to be interesting. Thank you, Paul. Interesting session here. So, Jessica, go ahead and start teeing them up, would you?

Yep. First section is understanding toxins and exposure. And the first question is, what environmental toxins are people most commonly exposed to today?

That's a really good question. That's a good one to start out with. As a doctor in the health and wellness industry, I've been tracking toxins in patients for over 30 years. So a lot of this is my own personal experience with the multiple clinics that I've had. I can tell you one thing without a question of a doubt: the number of toxins people have today are astronomically higher than they were 10 years ago, 20 years ago, 30 years ago. But when you're looking at what environmental toxins are people most commonly exposed to today, I think we also have to approach the question of You know, what you know how many toxins are in the environment. Currently, the the environmental working group estimates that in 2023, 100 million tons of toxins were introduced into our environment, and this includes more than 86,000 total different types of toxins. Those can be listed on what's called the TCA registry. Of that, about 650 of those toxins only 650 are routinely tracked for industrial. Use under the EPA guidelines. And only about 300 of those toxic chemicals are routinely tracked by the CDC as they measure how much of these, you know, what level of these toxins are in the individuals. But when we're looking at which environmental toxins are mostly— people are mostly exposed to, it's quite a few. And I think the biggest topic or the biggest categories are Air pollution. Air pollution by far accounts for over 65 million tons of toxicants introduced to our environment every year. These are the small particles that we inhale from vehicle exhaust, from industry. It's inhaled in the lung and then enters into the bloodstream and it causes cardiovascular disease, diabetes, cancer, systemic inflammation. Moving on, I think we run into a category of what I call the forever chemicals. These are chemicals that once they're absorbed in your body, they're very difficult to get out. And these types of toxins have really increased in number in the last decade. And what I'm talking about here is the things like the PFAS, the forever chemicals. These are things that you use that are grease-resistant. They're nonstick pans, but you find them everywhere. They're inside Coca-Cola cans. They're in the interior of microwave bags, popcorns, pizza boxes, coffee cups that you get at 7-Eleven. All of these have this lining of this PFAS because it becomes slippery. But as soon as you put a heated product in it, they dissociate from the plastic itself. So it becomes even more and more common. That includes a lot of the things that were our breakdown products of these PFAS, like the plastics. The plastics are Found everywhere now. They're also considered— I consider them a forever chemical. We don't recycle them and they break down and they break down into smaller and smaller bits. So that's a problem because they can break down to so small of a size that they're called nanoparticles and they can actually enter the DNA and interfere with the DNA. Plastics also carry a lot of other chemicals with them and that they leach out like the BPA, which are the phenols, or phthalates, which are what we use to make plastics soft. Other categories I think a lot of people are familiar with, heavy metals, lead, mercury, and arsenic are still very high on the list that we're exposed to. And then we have to look at the chemicals that we use for our agriculture, like the pesticides and herbicides. We know that these things are linked to neurodegenerative disease, cardiovascular disease, and finally the volatile chemicals, which are these solvents that we use in the industry. But you can find them, you know, it's the smell of a new car, it's a new carpet, it's cleaning It's air freshener. So there's a lot of different types of chemicals in the environment which are quite dangerous and increasing in number every year. Next question.

Phew, that's a long list. Is there one major toxin that people should be concerned about?

You know, I would say yes. I mean, personally, and most of the group that I work with, it kind of comes into 2 major toxins. Number one is what I mentioned before, air pollution, this particulate matter. This is why Asthma is on the rise, inflammation is on the rise, cancer is on the rise, because this is responsible, estimated, for air pollution, is 7 million deaths annually. The other one is what I just mentioned to you with the plastics, because the plastics start out as a bag or a bottle, then they break down to particles that start getting smaller than 5 millimeters, and when they even get smaller and smaller, they become nanoparticles. Um, So the problem with these is the plastics is also not only they do everything bad in the body, but they carry with them a lot of other toxicants that are used in the making of the plastics. So plastics also carry with them heavy metals, pesticides, and what we call persistent organic pollutants or POPs. So yeah, I would say the 2 major categories of pollutants that I get mostly concerned about is air pollution and the plastics.

Thanks, Dr. Savage. The next question is, does working in a hospital increase exposure to mold, asbestos, Legionella, and other toxins?

I would say the answer is yes. Working in a hospital can increase your exposure to all of those. But, you know, old houses— it's the age of the hospital that really matters the most, and whether it's under construction or undergoing maintenance, and also kind of what job role you have in that industry. But, you know, any older building is susceptible to starting to develop mold. Legionella comes from anything that has water that is still, but there's also a lot of other toxins as well, like asbestos, but those are really associated not only with hospitals, but with any majorly old building as well.

Thanks, Dr. Savage. Next section is apheresis and TPE explained. Our first question is, are apheresis, plasmapheresis, plasma exchange, and TPE the same thing? What are What are some of the important differences?

TPE is a process by which the body gets— is you take the blood out, you separate the blood into the liquid part and the cellular part, and you throw the plasma part away, which is the liquid part. You recombine the cells with albumin and reinfuse them back in. So, I'm sorry, I just, I didn't hear it.

Is the question—

Yeah.

Are apheresis Plasmapheresis, plasma exchange, and TPE the same thing?

Oh yeah, they're the same. It's the same name for the same procedure, which I just mentioned. So it's very easy for people to get confused when you hear somebody say TPE and someone say therapeutic plasma exchange, or they might just say plasma exchange or plasmapheresis, or for short they say apheresis. Those are all the same machine and the same device, which I just Describe this technique.

Got it. Next question is, is it true that apheresis can remove PFAS and microplastics from the bloodstream? And how does this treatment studied differ from TPE?

That's a great question. If you use Google Chat and/or ChatGPT or Claude and ask that question, it will give you the answer that no known current method of treatment can remove microplastics. It's just not known. And PFAS have some ability on some of the studies to remove when they use plasma exchange. And we're actively researching these things. We've been doing so for 4 years. We've had one of our studies published last year in Medical Hypothesis about the ability of TPE to remove environmental toxins. We just submitted our next paper to major medical journal about our results on the removal of PFAS from the— with using our protocol, which is therapeutic plasma exchange with avoidance therapy with nutrients. And what we've discovered is these forever chemicals were— that were previously unremovable are significantly reduced with our process. We had about an average of 66% decrease in all of the PFAS. The microplastics as well substantially decreased and in most cases were eliminated. That's another one of the papers. that we have submitted to some journals and are currently under review.

Thanks, Dr. Savage. The next question is a 2-part question. Can TPE lower cholesterol and other cardiovascular risk markers? If so, how long might those changes last, and how does it differ from LDL apheresis?

So the difference between apheresis and LDL apheresis is pretty significant. Apheresis, again, is TPE where we're taking the blood out, separating it, Throwing away the plasma and recombining it. It's a dilutional effect. LDL apheresis, it uses the same machine, but what it does is it passes the serum, which is the liquid part of the blood, over an absorbent, and the absorbent draws out the cholesterol and then allows the rest of the plasma to be recombined with the cells for reinfusion in the person. So we're not really removing your plasma with LDL apheresis. We're literally removing the cholesterol with a sponge. Essentially. So the answer is both techniques work to lower cholesterol levels, just that TPE takes out a lot more things than the LDL apheresis. Both of those processes lower the cholesterol level about 2 weeks, which doesn't really make it a very applicable method for keeping somebody's cholesterol down. The, the benefit of the TPE over the LDL apheresis in cardiovascular risk factors, if you're looking at oxidation and the other one is inflammation, then there's no question that TPE is far superior. In our programs, we've been able to show a significant drop in all of the inflammatory markers, cytokines, oxidative markers, because we believe what we're doing is we're timing the TPE, and this is very important, so that we're maximizing the withdrawal of the toxins out of the system. And it is becoming very clear that the toxins are the cause of the inflammation and the oxidation, and it's the inflammation and the oxidation that is the cause of cardiovascular disease. Matter of fact, it's the inflammation and oxidation that is the cause of virtually every chronic inflammatory disease.

Thanks, Dr. Savage. Next section is going to be on mold, mycotoxins, and MCAS. First question is, what is the difference between mold and mycotoxins?

Mold is an organism which is alive, and mycotoxins are the toxins that these live organisms produce to protect themselves. So it's a chemical byproduct of the mold, and not every type of mold produces it, only certain type of mold. So think of the mold more like the factory and the mycotoxins more like the poisonous good.

Gotcha.

Next question is, how do you know whether mold or mycotoxins may be affecting your body?

They always come together. I mean, they always come with each other. So if you have a lot of mycotoxins, you have a lot of mold. And if you have a lot of mold, you have a lot of mycotoxins. So you can't really separate them out. The real story is how much do you have and how much can your DNA Take care of. Because some people can be pretty mold toxic and not feel bad at all, and that's because they got some pretty good genes. Other people have not so good genes, and they don't have to have as much mold or mold toxins to be quite sick. So when we're talking about mold-related illnesses, we're really talking about people who have some pretty significant symptoms. It can be things like brain fog, memory loss, and the big one is trouble focusing. They can have visual changes. They can be tired all the time. It just keeps on going. They get a lot A lot of digestive issues. You know, they get cramps, they get gas, they get pain, but they also have frequently headaches and dizziness. When you go to see these people, when they go to see doctors frequently, they're told that they have chronic fatigue, fibromyalgia. They might be diagnosed with other different, what I call grab bag diagnoses, where if you look under the hood, as it were, and do some testing for toxins, you're going to start seeing a lot more of these patients that actually can be treatable. Okay.

Thanks. Next question is, what is ochratoxin A, where does it come from, and how is exposure addressed?

Ochratoxin A is one of the thousands of different mycotoxins, and this one's produced by a mold called Aspergillus, and to some degree another one called Penicillium. It contains— it's, it's in a lot of products, but it's mainly in things like cereal. So we're talking about, you know, wheat, Rice, corn, barley, but it's also in coffee and dried fruit. The problem with ochratoxin is that it's often— it's a pretty tough toxin to deal with, and it is very frequently associated with kidney disease, cancer, and what we call— what we talked about was oxidative cellular stress. So this is one of those ones that may present like what I just told you, with gut issues and headache and fatigue. And Just nobody can find out what's wrong with you because no one's taking the time to do a comprehensive toxin test for you.

Thank you. The next question is, how should someone evaluate a home and belongings for mold or mycotoxin contamination?

There are a number of different companies out there that have different varying methods of testing for mold and mycotoxins. But I believe in my 30 years experience, probably the best way to test for these type of things is with dust, because a lot of these molds and spores, they don't float in the air, but they're on the ground. So there's a company called, um, Dust— now you got me— um, Dust Test. Yep, the Dust Test. But you can also find that through yesweinspect.com. yesweinspect.com. And I'll have Jessica put those links. This is a company that I have relationship for many, many years. I can really recommend this company. They're very pro-patient advocacy. The testing that they do with the dust test runs about $300, and it tests for a lot of different molds and mycotoxins. It's probably the best way that I know at an inexpensive cost of evaluating your homes and your other belongings.

Awesome. And I'll just add, everyone will be receiving a copy, a digital copy of Avoiding Toxins, the book that Dr. Savage wrote. In there is a code, an MD Lifespan code, where you can get a discount on those tests.

So, right.

Okay, next question, Dr. Savage. How do you safely address visible mold in a bathroom?

Visible mold anywhere, including in a bathroom, you gotta be very careful with this because it's very toxic if it's in an area that's wet, like the bathroom or the basement, or even up in the attic if you don't have good roofing. And to safely remove it, you have to be pretty prepared. You're gonna be looking like you're in a hazmat suit with an N95 mask, gloves, You're gonna have to ventilate the room as well as you can. You need to scrub the hard surfaces using a mixture of dish soap, water, or white vinegar can work as well. And then you have to dry the area completely to keep it from coming back. But quite honestly, in a lot of these cases, the mold has become so ingrained into the wood and the drywall that it may actually involve removal of that wood and that drywall. And replacing. But if you're thinking about doing this yourself, please use very extensive protective gear, especially the respirator, and making sure all of your skin areas are covered. Because this sudden exposure of mold and toxins, when you hit the bingo and you pull up the boards and there's all this black mold, it can be devastating to a patient. That could be— I've seen that send people into years of toxicity. Um, they knew they had it, but they just weren't meeting the right doctors to know how to treat it and how to get it out.

Thank you. Next question is, after recovery, how can someone reduce the risk of future exposure to mold?

That's a great lead-in for what you just talked about. You know, there is, without a question, 2 things that everybody needs to do. Avoiding Toxins. It was written by me and a number of high-ranking toxicologists, a clinical toxicologist, an environmental toxicologist, a mold toxicologist, and a nutritionist. And we put this book together and we really tried to make it very patient-oriented and easy to read. So every chapter is like a part of your life. So we talk about air, we talk about water, we talk about food, and for everybody out there, we talk about beauty products and the chemicals And the household chemicals. There's a lot of different things that you can do because, yes, there's a lot of toxins in the environment. Yes, you're exposed to them every day. But you can reduce the number of toxins that you're exposed to in your immediate environment. And matter of fact, we know this works because we've watched patients who just did avoidance therapy drop their toxic levels year after year after year. And that's all they've actually had to do. Now, these weren't sick patients, but they were patients that we gave the instruction to and they carried this instruction to heart. So the best way for everybody is to read the book Avoiding Toxins. Secondly, it's good for everybody to get tested. I prefer to use a test called Vibrant America. The company's name is Vibrant America. It's called the Total Toxic Burden, and you want to add on the PFAS section. It's an affordable test. It runs about $700 to $900. It gives you a very different range of all sorts of different toxins. It gives you like 20 different mold toxins, 20 different PFAS. It gives you heavy metals, pesticides, herbicides, phthalates, volatile chemicals, phenols, things that, you know, all of these different things. So you get kind of a broad spectrum of the toxins that you have in your body. Please understand though, that there's over 86,000, in some cases up to 100,000 different toxins in the environment, and this test only tests for about 100. So there's another 99,999, or however that goes, that we aren't testing for. We're only testing for about 1 in every 1,000 toxins. So you need to be able to interpret that with a doctor who understands that this is a snapshot of a small section of a very big field.

Thank you. Um, can mold affect the eyes, weight, metabolism, and overall health?

Toxins can affect the eyes, the weight, the metabolism, and overall health. Mold toxin especially. Mold exposure, um, because, you know, you're breathing it in, you're touching the spores, it triggers allergic reactions, it triggers persistent inflammation, it causes hormone disruption, that impact multiple body systems. So a lot of times people with mold toxicity present with their eyes are burning and itching like they have an allergy, but they also have blurry vision and light sensitivity. There is a test that you can get online called vcstest.com, and it's actually a visual test for what we call continuity. And people who have mold exposure, you can tell by them taking this test because their visual changes have occurred to such a degree that it's actually measurable. By a simple test online. But yeah, with the mold and the inflammation, it does affect your weight metabolism. You see, the body doesn't have a lot of place— if it can't get rid of the toxin, it has to hide it. And the way the body hides toxins is either to put it in a cell and shut the door, or wrap it in a protein so that it floats through the system. It's not interacting with anything. The most commonly used cell to store toxins is fat because There's a lot of toxins that are what we call fat favorable. They like, they're lipophilic. They like to be inside fat. So it's a good place to hide those things and lock the door. But the body doesn't wanna open that door again. So it causes weight gain. It's very difficult to lose weight. But the patients that we've treated over 30 years, a lot of times the patients who are resistant to weight loss is because they're toxic and the body just doesn't want to let it go. Get the toxins down lower, and the body is much more, or a lot less resistant for letting those toxins out of fat cells and letting you lose the weight. But the overall health impact of every toxin in mold is significant. They're chronic respiratory, brain fog, immune system dysfunction, along with the metabolic issues and the visual changes as well.

Thank you. Next question is, how do mold toxins interact with mast cell activation syndrome?

So, mast cell activation syndrome is a condition in which the body becomes hypersensitive and starts releasing histamine at a drop of a hat, which sets off the whole allergic reaction down the road. And mold is a very common cause of that trigger. So, it's not uncommon that these things come together. One of the things with mast cell activation syndrome is I do believe that the underlying cause of mast cell, what we call MCAS, It's toxins, including mold. And when people come to me and say, I have mold-induced mast cell activation syndrome, I'm like, no, you have toxin-induced mast cell activation syndrome, including the mold. Because what we're seeing now is every— the body doesn't know the difference between a mold toxin and other type of toxins. It just knows it wants to attack it. But there are certain toxins which are much more dangerous than other toxins, and I would put those categories, as we talked before, as The pesticides, the PFAS, the plastics, and the mold.

Thank you. Next question is, how can someone safely recover from mold-related illnesses?

Well, I have a lot of patients like that. Safely recover from a mold-related illness. The first thing you have to do is get rid of the mold and get rid of the mold toxins. It's a systematic approach that we do in our office. We're teaching people how to eat differently, how to filter their air, how to keep the humidity in the air down. You have to decrease the exposure. That's the first thing. No matter what detox program you're going to do, you have to do this part well because it doesn't do you any good to get things out of the body if they're just coming back in. I always use the bathtub analogy that your body is a bathtub. And now it's filled with this moldy, goopy, toxic water in the bathtub. And the shower faucet is just pouring more of these toxins in, and the drains become so clogged up with gunk, it's not draining anymore. That's your detox pathways. So the first thing you have to do is turn off the shower so that you're not pouring more into the tank as you try to open up the detox pathways and start to drain the tub. So step 1 of any detox program for any reason, for any of the toxins including mold, is to get out of the exposure first. So that means, you know, if you need to vacate— I've had patients that had to vacate their residence because it was just too filled with mold at the time and they were too sick. Controlling the indoor humidity is critical. You need to keep the levels under 50%, and in most cases we need it under 30%. Which is why a lot of people end up moving to Nevada and Arizona where the humidity is very low. You need to look for water damage in your house. That means in your water, your pipes, your kitchens, your bathrooms, because exterior seals crack and they leak, and that leak— leaky water in a warm, damp place is what brings on a lot of this mold toxicity as well. You have to purify the air through a HEPA filter, and you have to change those filters Regularly. I'm laughing a little bit because I have a very nice lady. She's 90 years old. She did very well on some of the programs we did, got her toxin levels down, except for some of them which were related to air toxicity. And I was like, I thought you had these filters in your house. She goes, I do. I have these filters in my house. I've had them here for over 10 years. I said, and when's the last time you changed the filter? She goes, I need to change the filter? I was like, okay, I think we found the problem here. The other thing is, you know, you can manage this with the But a lot of different doctors that consult in toxicology. There's toxicologists, there's functional medicine doctors, and looking at the toxin panel you have, maybe chelation is best for you. Maybe binders is best for you. Infrared sauna. But food always comes into play too because a lot of the things in your body can detox if you drink enough water, you're peeing enough, and you're having good bowel movements. Rinsing nasal passages out. Especially in those patients that have a lot of aerosolized toxins, that's important as well, so that you're supporting the body's ability to naturally cleanse.

Thank you, Dr. Savage. Can mold detox be effective without binders?

Yes, absolutely. It depends on how toxic you are and how quickly you and whoever you're working with is trying to get these mold out. But yeah, the most effective is removing the source, as I keep saying. I can't stress it enough that you've got to get the source out of the way. But also the water has to be filtered and clean. The humidity has to be very low. You have to eat high fiber food because fiber absorbs mold and then it comes out with your poop. And if you're not having bowel movement regularly, we have to work on that too because it has to come out. If it just absorbs the mold and just sits inside you and your poop doesn't move out, then you're really not detoxing at all.

Thank you. The next question is, once exposed— once exposure has been addressed, how should progress be evaluated?

The best evaluation for patients is if they're sick, follow their symptoms. If they're not sick, follow their testing. And that— by that I mean, look at their toxin test and make sure that those levels are coming down.

Okay, great. Our next section is Understanding Therapeutic Plasma Exchange. First question is, how many TPE sessions are typically needed?

So I want to stop here before we get into this section on TPE and how many sections, how many you need to kind of explain to the audience a little bit about what we've been doing at MD Lifespan. There's a lot of people out there doing plasma exchange for longevity. That's actually what got me interested and what gave me the idea of using it to remove environmental toxins, all these different toxins that are in our environment. And so what our question that we had to ask is, if we're doing TPE to remove toxins, how frequently should you do them? Because historically, plasma exchange is usually done on a series of 5 in 1 week or 6 in 2-week period. But we asked the question is, that works really well if the antibodies and the immune complexes and the toxins are in the blood, but what if they're in the tissues? When you do a plasma exchange, you're only exchanging the plasma in the blood with a substitute solution, and then you're generating new plasma as we do every day within a few days, and now your plasma generated is less toxic because it diluted it out. But how long does it take for these toxins to come from the periphery back into the plasma? So we actually measured this in patients by doing toxin testing and then a plasma exchange, and then we tested their toxin levels every week. And what we found out is even though the heavy metals The phenols, the volatile chemicals, they come back within a couple days. When you start— when you're looking at the plastics, the PFAS, the mold, the pesticides, the herbicides, they take considerably longer. They take up to 3.5 weeks before they equilibrate with the plasma. And if your goal is to get the toxins out, you need to separate these plasma exchanges by a month. You can go longer than a month, but if you do it shorter than a month, you're not getting the major benefit from the plasma exchange. From that idea, we then started asking ourselves— we understood with the shower we had to turn the faucet off. That's why we came up and have every patient that goes through our sessions of TPE, they need to be doing that avoidance therapy. I tell them all the time, don't spend money on plasma exchange to remove toxins if you haven't minimized your exposure to begin with. It's just intuitive. The other thing is the toxins do a lot of damage to the body and they break down a lot of biochemical reactions. The enzymes that run the whole chemistry of our body, including your ability to detox. So we also give patients a number of— 65 different supplements which are focused on anti-inflammatories and antioxidants to minimize the effect of the toxins coming out of the tissue as they move into the plasma. We give a lot of supplements that increase your ability to detoxify. We give a lot of supplements that increase the mitochondria so you can have more energy. So there's a lot of things that go into this whole process. So if you ask me how many TPE sessions are typically needed, number one, that depends on what you're coming for. If you're coming for longevity and you want— you're already well and you want to improve your biomarkers of aging, like your telomeres, your inflammation, immune system, probably 3. It could go up to 5 depending on much— a lot of different factors. If you're coming because you have a lot of toxins that you want out, but you're still well, again, 3. Maybe 5. But if you're coming in and you already have an inflammatory disease, if you're already sick from the mold, you already have chronic fatigue, MCAS, chronic inflammatory response syndrome, chronic infections like Lyme or Bartonella or Epstein-Barr, you're going to need more. Probably 5 on average is what you're going to need. Now, the one thing that we've been able to show, when you add the avoidance therapy with the TPE, with the supplements, this whole system starts to respond. So at MD Lifespan, we get better results with 5 TPEs using our protocol than people would get by doing 8 to 10 TPEs on their own. So how many sessions do you typically need? It varies from person to person and condition to condition.

Thank you, Dr. Savage. I think you actually answered the first 2 questions here.

So the next question is gonna be, is TPE appropriate as a preventative medicine That's a really good question that I don't have a really strong answer on yet. You know, right now in MD Lifespan, we focus on getting toxins down. So if somebody comes to me and says, I have a lot of toxins, or we measure them, they have a lot of toxins, and they want to go through the process to get their toxin levels down, yes, we're going to do that. If other people come in because they're already sick and they have a lot of toxins, And even if they don't have a lot of toxins, you know, this is where that DNA susceptibility comes into play. The answer's gonna be yes. Is it preventative medicine at any age? Probably. But we don't have any studies yet to show that the people that were getting better, but they are getting better, who are sick, their quality of life is better, but does that mean they're gonna live longer, as long as everybody else, or even their counterparts who remain sick? We just don't have that answer because We focus on removing the toxins, and we have 4 years of experience and data to back us up. It makes complete sense that if you're removing the toxins, the inflammation's going down, the oxidation's going down, the telomeres are going up, the immune system's coming back online, people are detoxing better, people feel better, their cognitive function is better. Yeah, it makes sense that they're going to live longer too, but I don't have that as definitive proof at this point.

Okay, thank you. Okay, next question is, what might patients expect after completing 3 to 5 sessions?

Again, it depends. Some of the patients come in, they feel great. But it's kind of interesting how the people come to us for longevity, or they have toxins, they want them removed, and they say, no, I feel pretty good, I just want to get the toxins out, or I feel pretty good, I just want to improve my biomarkers of aging. But what's really interesting is when we started again, We didn't know which biomarkers that we needed to look at. There's a couple questions, and you see me here, but trust me, I have 20 medical advisors that are very smart behind me from all sorts of different varying parts of medicine, from toxicology, cardiology, oncology, gynecology, rheumatology, neurology, and we have environmental toxicologists, we have stem cell experts. So we all get together and try to figure out a lot of these answers. We had to ask ourselves early on, what are the markers that we want to test for that would show us that somebody needs to do TPE? And then finally, what— and which of these markers do we need to test for at the end to see if they've done enough TPE? And we did 1,000 different tests on about 50 different patients, and we measured them throughout the whole experience. And what we came away with is not surprising, the toxin test was very pivotal. But also the immune system, especially the lymphocytes. They typically start getting suppressed and confused earlier because your lymphocytes are the part of your immune system that does everything. They're your army and your navy. And we also noted that inflammation and oxidative markers were very important. But what was interesting was the cognitive test that we did for people. And we did this cognitive test on people, and even the people that were feeling great didn't score as high as we expected them to.

Right.

They did well, but they didn't do very well. But by the time they were done with the plasma exchange, they were all scoring significantly higher. And these were people that didn't really complain of brain fog or memory issues at all. So, what do you expect after completing 3 to 5 sessions? The sick people with a lot of symptoms, they start feeling better. I tell people frequently, this isn't the end of being sick. This is the beginning of getting better, because once you get the toxin levels down, Then you can follow up with your functional medicine doctor and we can start doing things to get you better now because the things we were doing before weren't working because the biochemistry wasn't there. For people who already feel good, then frequently they feel better.

Awesome. The next question is, when should toxins and biomarkers be retested after TPE?

So we answered that question as well because we measured everybody for weeks after their final TPE and we found 6 weeks after their final TPE was the right window to see all of the changes that we needed to see at that moment. Now, don't get me wrong. We've also measured people 6 months, a year, and 2 years afterwards, and they continue to get better after we do one of our advanced series TPEs. We've pretty much— now, that may— we have everybody that we've done has lower levels today than they did when we were done with their TPE and better inflammation and better immune systems. But we're following these people out and they continue to improve. That doesn't mean that 5 years and 10 years down the road that the toxins have become so much or they become a little lax on their avoidance therapy that they may need to have some more done. So when you measure the toxins after TPE, we generally do it at 6 weeks, but frequently in patients afterwards, we have them measure it every 6 to 12 months afterwards. I believe very strongly that toxin testing is going to become one of the standard Biomarker testings for every patient on a standard physical yearly.

Perfect. I think you kind of answered this next question, but how can clinicians evaluate what was removed or changed during TPE?

The number one thing to evaluate is the patient. How are they doing? Because it's been very wonderful to see these people that I never thought was going to get better with chronic fatigue and fibromyalgia and mast cell. And CIRS and chronic Lyme, and these people are getting better, and that's been very, very exciting for us. But number 2 is their toxin testing. But also, if you're going to look at the biomarkers, I would look at cognitive testing and immune function testing and inflammation and oxidation.

Thank you. Can TPE be considered for someone who is extremely sensitive or has difficult veins?

I don't know what you mean extremely sensitive. Their veins are extremely sensitive or the patient doesn't tolerate, is very sensitive to their environment?

Yes.

So the answer is yes, TPE can be considered for patients. Now, difficult veins is always an issue with TPE because if you don't get the IV, you don't get the procedure. At MDLifespan, we understood very early on that the nurse's ability to start the IV is a critical component of the entire staff. You don't get that part done, nothing else works. So we've gone to great lengths and great strides to hire in nurses who have multiple years as a nurse, generally working in the intensive care, surgical unit, or step-down unit, or trauma team. They've also come with us— come to us with at least 5 years' experience of ultrasound-guided IV insertions. We also have a number of different techniques To make it so that it's a painless needle insertion and that we can maintain this IV. I can report we do 100 TPEs per month, and there's only one patient out of the last 4 years we weren't able to get an IV on. So yes, TPCAN can be considered for someone with difficult veins. At MDLifespan, we haven't had that to be an issue. If they're extremely sensitive to their environment, they can be considered for TPE, but you have to do the TPE slowly. These people tend to respond with the littlest changes of anything. These are what we call the hypersensitive people. They could be mast cell, they could be chronic inflammatory, but they respond suddenly and pretty dramatically on occasion to smells like mold or perfume or food. And these people typically have EpiPens because they will literally go into an anaphylactic reaction by a smell. They're very sensitive. These are patients that are difficult to get better. Because every time the doctor tries to use anything new, they can't tolerate it. They're extremely sensitive to therapies. This is where TPE is different because we're not giving the patient anything. We're taking it away. So the patient doesn't have anything to become sensitive to. But the trick is understanding that you can't do a full exchange on these type of patients. We generally start at half exchange and work our way up because if you try to do too much on these patients too quickly, It's not the levels that change— levels that problem, it's the change in the levels that give these people. And if you do the change too quickly, you can trigger that effect. So I think I kind of answered both sides.

Yep. Yeah, you definitely did. The next question is, what IV therapies may be considered before or alongside TPE?

We do do IV therapy with our TPEs because TPE removes everything, the good, the bad, and the ugly. That's the thing is when you take You take the blood out and you separate the cells, which is the red cells, the white cells, and the platelets, and the stem cells. And you take the plasma, which is the liquid that carries everything, the good, the bad, the ugly. It carries nutrients and vitamins and hormones. It carries medications, but it also carries toxins and inflammation and antibody complexes. So when you throw the plasma away, you're throwing everything away, including the nutrients. So it is our standard practice that we're giving back IV nutrients after the TPE. And we generally do a pretty fancy IV setup where we're giving some vitamin C and B vitamins, calcium, magnesium, things like that to the patient. We have the IV in them anyway. We just use that IV to set them up for infusion. Which IV therapy can you do in conjunction with TPE? I'm not sure I know how to answer that question. We have patients that do IV therapy, and because we only do TPE once a month, At MD Lifespan, we have patients that are seeing their primary care or their functional medicine doctor and may be getting some other IVIG, they may be getting IV nutrients. That's not a problem for us because TPE, we just want to make sure that they're not being given something prior to the TPE that the TPE is going to be removing it. So that's why we can't really do patients who are on active chemotherapy or people who are on active immunotherapy.

Okay.

That are on medications for asthma or seizures or dangerous abnormal heart rates, because TPE removes that medication too. So that's why one of the things that we do at MD Lifespan is we screen our patients, because the patient safety in this inpatient— or in this in-office procedure is paramount.

Thank you. Next question is, can heavy metals be chelated before TPE?

You can chelate heavy metals before TPE, during TPE, and after TPE. What we found with our toxin protocol is that by adding a chelator into patients with a lot of metals, we get even a little bit bigger boost. Don't get me wrong, TPE does the bulk of this exchange. Matter of fact, I've treated patients with DMSA and EDTA for 20 years, and if you get a 20-30% reduction And the lead and the mercury after you've done multiple different IVs, that's pretty good. With TPE, just after 3 sessions, we're seeing an 80 to 90% reduction in lead and mercury. So it's— TPE is no question, hands down, superior to every different detox method we've ever used. It's— but it's expensive, so it doesn't mean it needs to be the first choice for people who aren't symptomatic. There's a lot of other things, including— here we go again, back to avoidance therapy. is the number one thing you should do.

Thank you. Next question is, how is donor albumin sourced and screened, and what is known about concerns related to spike proteins?

Excellent question, excellent question. I get this one frequently. Yes, you need to use human donor albumin when you're doing TPE. The other alternative is to use somebody's plasma, which is markedly dangerous on an elective procedure. So the only safe choice is human donor albumin. So how is it sourced? Well, the donor albumin is basically a lot of different people giving plasma, and then they bring it to a center, a pharmaceutical that mixes all this plasma together. These patients do undergo a very strict medical history, and there's laboratory testing done for lab-borne, blood-borne viruses and pathogens. The plasma is then collected and it's quarantined. And at this point, the plasma undergoes what's called fractionation, where they use a process of cold alcohol fractionation that separates the albumin out from the rest of the plasma. Once you have the albumin, then the albumin is pasteurized. So this is where the albumin is heated up to a very high degree And for about 10 hours, and this breaks down and kills all pathogens and proteins. So it's really not— the question isn't how safe is albumin. Really, the question should be the source that you're getting the albumin from. How good are they at doing their process? And at MD Lifespan, we only use Grisfol, G-R-I-S-F-O-L, because they are the industry leader in the United States under the FDA. They do very well, extensively for 50 years. They've— we tested plasma samples, uh, the, um, albumin samples for viruses like HIV, hepatitis, COVID. It's not detected. We checked it for proteins, we checked it for mRNA. The whole process by which the albumin is obtained neutralizes and destroys all these other things. So the human source albumin doesn't contain viruses, COVID mRNA, spike proteins. And that doesn't say that the risk is zero, 'cause it depends on where you get your albumin from, but it's incredibly low.

Thank you. And the last question in this section is, how might stem cells or embryonic cell therapies relate to TPE?

I've been in this field for a long time. I've done stem cell therapies for patients. For many different years. There's something that our stem cell expert told me many, many years ago when I met him, when we were doing a study on using stem cells to reverse chronic inflammatory diseases. And we did it for 13 different disease states. We did it for Alzheimer's, emphysema, we did it for pulmonary idiopathic fibrosis. And what we found is it really didn't help at all. And this was 2012, on any of these disease states. And he came up and he goes, I told them so. I said, what do you mean you told them so? He goes, stem cells and exosomes, they're fire— they're foresters. They go in and build the forest. They're not forest fighters, forest firefighters. They don't— they won't go into a house that's on fire. So TPE removes the toxins, which lowers the inflammation, which makes stem cell therapy much more effective. We've known in stem cell therapy for a long time, if you're gonna use it, get the patient in the best state of health first and then go in to repair the cells. So stem cell therapy does relate to TPE, and TPE does relate to stem cell therapy.

Thanks, Dr. Savage. Our next section is on complex conditions, longevity, and next steps. Some of these you might have answered in conjunction with previous questions, but first question is, are toxins connected to ADHD?

Yes. Next question. No, yeah, I mean, yeah, yeah. So without a question, we know environmental toxins are connected to ADHD. Specifically on the younger children, we know this. While genetics plays the biggest role in ADHD, we know that toxins play a role. And remember what I told you about individual susceptibility? That's how the genetics and the toxins play together. So research shows that early exposure to things especially like heavy metal, lead, chemicals, plastics, and pesticides, PFAS, and pollutants, air, during pregnancy and early childhood And very significantly increases the risk of developing ADHD. I'm relatively convinced that it also contributes to adult onset ADHD of adults who become toxic later in life. I think, and it's not been looked at, but we've had so many people do the toxic protocol just because they had a lot of toxins, then their memory scores get better, their attention, and that's what that cognitive test does. Their ADHD goes away after you take the toxins out. We've known for a very long time that anti-inflammatories work on depression because they neutralize inflammation. Why don't you look at the source of inflammation? And if it's toxins, and I believe it is, then there's a connection between all these psychiatric diseases, ADHD, and the toxins.

Awesome.

So you kind of touched on the next questions, which are how might TPE affect neuroinflammation and brain repair, and if TPE can help patients with memory concerns.

We know that TPE helps people with memory concerns, both in patients that have normal brain function that we've looked at, in patients that have early cognitive issues, and even patients that have early and mild, moderate Alzheimer's, because those studies have been done. Because plasma exchange affects— lowers the toxins, which is what causes the neuroinflammation to occur, and you can't You can't fix things when things are on fire, as I keep saying. So removing these circulating factors, these inflammatory cytokines, and these antibodies from the blood removes them from the brain as well. So by resetting the system on the inflammatory environment and replacing the lost proteins with albumin, Plasma Change actually helps lower the blood-brain barrier damage and supports a better internal function. for the whole body, including the brain. Does it help with the memory concerns? As I said, absolutely.

Thank you. Next question is, what role may toxins play in neurological Lyme disease, PANS and PANDAS, and nervous system health?

The only difference between this answer and the answer I just gave is understanding that infections like Lyme PANS, which is more of a strep. Nervous system health is that not only are there environmental toxins, but there's biologic toxins. There's bio— there's called— there's called cytotoxins that occur from almost every infection that a person gets that comes from the infection itself. So these are newly researched, and we call them bacterial cytotoxins. For example, a patient infected with Lyme, it triggers this Big immune response in the nervous system. These infections, these inflammatory responses, they disrupt the brain function, they damage neurons, and they cause cognitive and psychiatric symptoms. So it makes complete sense that getting these— getting the TPE out with the toxins, whether they're environmental or biologic, is going to help these people. The one issue that we— the difficulty we have is a lot of the PANS and the PANDA patients are under 18. And we're in an outpatient setting in an office, and, you know, it's just not legally able to do because of malpractice reasons to treat people under 18. It just becomes cost prohibitive from the malpractice. Also, the other thing is a lot of these adults on the spectrum have PANS and PANDAS, and if they can't cooperate and sit in a chair and follow commands, we're not able to do them as well. So we are looking for— we do have a couple opportunities here. to work with a couple hospital systems on setting up an in-hospital treatment for these type of patients, which is desperately needed.

Thanks, Dr. Savage. The next question is, can TPE help with autoimmune diseases and severe fatigue? Which I think kind of builds on what you've already been saying.

Again, I mean, it's just been amazing to watch people with chronic fatigue, fibromyalgia, mast cell activation syndrome, chronic inflammatory response system, how well they respond to our advanced serial plasma exchange. Not that that's the first thing you need to do, because again, it's quite expensive, but it is a pretty significant— it's not a matter of if we can get the toxin levels down, it's just a matter of how many TPEs do we have to do to get you there. Do patients with CIRS and HLA gene variants Yes, because again, the HLA variations have to do with the detox and the chronic inflammatory response system. We're not interfering with any of that. We're just literally going in and taking out your plasma with all the inflammation, all the pathogens, and all the toxins that are causing the inflammation. And once you get that inflammation, you know, down significantly, the SIRS is controlled significantly. So, I think that's a great question. Chronic inflammatory response syndrome is a matter of the body being overloaded with toxins, including environmental, pathogenic, and allergens and things like that.

Okay, next question. What factors would shape a protocol for eosinophilic fasciitis?

I'm not sure if I said that right. Eosinophilic fasciitis. That's a terrible condition. That's horrible. It's painful. You skin thickening, and I've seen it multiple times in my career. I don't know. We haven't done this protocol for anybody with eosinophilic fasciitis. It'd be interesting to find out what their toxin levels were and see how much of this inflammation— I, I— a lot of the patients that we treated, we've come into this with the only thing that I can tell them is I can get your toxin levels down. That we have data on, that's what we're published on, but that's really where the ballgame lives, in my opinion, because you can get the toxin levels down, the immune system and the whole biochemistry can come back online. If it's the toxins— let's just put it this way— if the toxins aren't causing it, they're certainly not helping with it. So in either case, it's just a matter of seeing to what degree— excuse me— what degree of improvement we can get.

Okay, next question is, how should detoxification be approached when Lyme disease and co-infections are present?

So I don't know if I understand the question. How should it be approached when Lyme disease and co-infections are present? So if you're talking about somebody who already has Lyme and the co-infections and how should they approach detox, I would say if they're a chronic Lyme patient that nothing they're doing with their Lyme is getting them better, they should get TPE because their system is already so overloaded. I've never seen patients with Lyme and co-infections Who have toxins be able to really mount much of a detox with infrared or binders or chelation. It's just the body's just— you have to have machinery in place for that to work in the body. TPE is outside of that. Again, it's independent of your own machinery. It's an oil change. And so you're mechanically diluting out the plasma, which dilutes down the toxins. The benefit is once you get the toxins down, the inflammation goes down, the immune system gets stronger, it gets less confused. Now you have an immune system that's working with you instead of sitting on the sidelines when you try to hit it with all these other various ways of treating chronic Lyme and their co-infections.

Thank you, Dr. Savage. We're actually coming up on the top of the hour, and I know we have a couple of questions that are left, but we can get everybody's questions answered after and send them out via an email so that everybody has them. Really quickly though, Dr. Savage, before we sign off, can you talk a little bit about pricing for TPE and how the protocols are packaged with MD Lifespan?

Sure. Throughout the United States, there's a lot of these centers putting up TPE and offering TPE. I want to caution people to make sure that they're going to somebody who knows how to do TPE. It's a real medical procedure. It can cause some real medical consequences. Patients should be properly screened and Patients need to be properly informed. Patients need to understand what to expect. We've been doing this for 4 years. We haven't had any patient have a significant problem during one of our procedures, but we have also turned many different patients away just because we didn't have the manpower or the ability to treat their condition as it is. Outside of that, you're looking at a price tag between $5,000 and $10,000 for a single TPE. MD Lifespan, we offer TPE, one single session for $6,000, and that's because some people come in, they just want TPE, and we're competitively priced. But not only that, we're very good at doing TPE. Our nurses are specialists in it. That's all we do as a company is medical-grade plasma exchange. So you want to make sure who you're going to are the experts in the field, that the nurses are the best, highest quality. That you can have because this is a real medical procedure. So the other thing about MD Lifespan is we made it a public benefit corporation so that our goal is to drive these prices down. We've been able to lower our prices over the last 4 years so that our price keeps getting more affordable as we expand into more and more markets. But when you're looking at TPE compared to a protocol like ours, which is advanced, where we're integrating avoidance therapy, nutrients, and other regenerative therapies, Then you're looking at a series of TPE, like 3 or 5. Many of these clinics do offer 5 TPEs for— someone just told me today that they just got a quote for 5 TPEs for $60,000. Our total toxic protocol, where we're doing 5 TPEs and all the doctor visits and all the testing before and after and all the IVs and all the immunoglobulins and all the nutrients and everything's included, is $40,000. So, the pricing varies throughout the market, but we have a very good product, much better service, much more inclusive, and a more functional medicine type of effect than anybody else is offering in the market at a very competitive price. And so, I think I've covered all that you asked.

Yes, you have. Thank you, Dr. Savage. We appreciate your time. All the wonderful answers that you've had to everybody's questions. I just want to remind everybody that we've dropped a couple of links into the chat, and if you have any remaining questions, you can send them to us via email. Dr. Savage and the team will work on getting those answered to you as soon as possible. Everybody will be receiving a digital copy of the Avoiding Toxins book that Dr. Savage referenced on the call today. That should be in your email in the next few days. Next few days, and we appreciate your time. Please be on the lookout for additional webinars with guest speakers that'll join Dr. Savage on some different topics, specific topics. Those will be available to you on our website as well.