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Welcome to the Behind the Shield podcast.
As always, my name is James Gearing and this week it is my absolute honor to welcome on
the show neurosurgeon and the medical director for Transcend, Dr. Richard Vayner.
Now in this conversation, we discuss a host of topics from his own journey into medicine,
the world of neurosurgery, Parkinson's disease, the impact of sleep deprivation on the brain,
strokes and then we dive into the world of hormones, peptides and the other elements
that Transcend provides.
Now before we get to this incredible conversation, as I say every week, please just take a moment.
Go to whichever app you listen to this on, subscribe to the show, leave feedback and
leave a rating.
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And this is a free library of well over 1000 episodes now.
So all I ask in return is that you help share these incredible men and women stories so
I can get them to every single person on planet earth who needs to hear them.
And one more side note, my new book, Kinda, the audiobook version is finally out.
It literally went out a few hours before the new year.
So you can now find that on iTunes and Audible.
So with that being said, I introduce to you Dr. Richard Vayner.
Enjoy.
All right.
Well, Dr. B, I want to start by saying two things.
Firstly, thank you to Corey, who is definitely my kind of go-to guy in Transcend, an amazing
human being.
So I want to thank him for kind of making this connection.
And secondly, I want to welcome you onto the Behind the Shield podcast today.
Hey, I appreciate that.
I appreciate the opportunity to discuss some of these issues and I'm excited to talk to
you today.
Corey has been great at linking us together and giving us some of the background of what
you've been doing and the things that you discussed previously.
And like I said, I'm very thankful to be here with you today.
Brilliant.
And how long will Planet Earth be finding you this afternoon?
Oh, boy, I hate to admit it, but I'm in Michigan.
I'm just north of Detroit, about an hour.
And it's a Arctic land up here nowadays.
It's in the 20s and teens, got a fair amount of snow and ice just recently.
So not really my cup of tea.
I'm from Texas, so I'm used to the hot.
Brilliant.
So I've got to survive the next three months.
So say some prayers for me.
My wife's from Michigan originally, but she moved to North Canton, Ohio, very, very, very
young.
So similar kind of weather up there.
So she enjoys Florida.
Yep.
As does everybody.
So you mentioned Texas.
Let's start at the very beginning of your timeline then.
So tell me where you were born and give me a little bit background on your family dynamic,
what your parents did, how many siblings?
Oh, sure.
Yeah, I was born and raised in Houston, Texas, kind of lower middle class.
My two sisters growing up.
So I was the youngest, youngest of the three of us and kind of a southwest part of Houston.
So born and raised there, high school, went to college at Baylor University, which is
just south of Dallas.
I got a degree in biology there and then went back to Houston for my medical school training,
which was good load.
I'm getting old, but over was about 20, 25 years ago.
So did medical school down there, University of Texas.
And then came up for my actual formal neurosurgery training up in Michigan in the Detroit area
and did seven years of brain surgery school.
And then I've been a practicing board certified neurosurgeon for a lot of years, a lot of
years now.
And let's see, married, have four kids and four dogs now.
I just adopted another one.
And so we live a pretty overall busy life.
What about your parents occupations?
We used to random and met someone when you were a young boy or were they doing some other
professions?
I was not.
My dad became a electrical engineer.
He was initially a migrant from Mexico.
I came over in his late teen years, was the oldest of eight children and started working
in the garage, you know, mechanic, was very into education, loved to learn new things.
So, he's first learned English and then, you know, started building on that, took a passion
for electrical things and got his first and associates in electrical engineering and just
kind of built on his career over time.
So that was my dad and he has a couple of brothers at, eventually came from Mexico and
also got engineering degrees, electrical, civil engineering.
So it was a lot of engineers, nobody in the medical field, which even from an early age
they would try to sway me to come into the engineering field.
It was funny.
My dad would be like, hey, come to the office with me this weekend.
I'm going to show you some of the schematics that we draw, you know, and how we do electrical
grids and all this stuff, which of course had zero interest in at all.
But I'll say, sure, dad, let's go hang out with your dad for the day, have some lunch,
whatever.
So go to the office and they back then they did drafting tables.
It was all these roomful of tables and they would sit there literally and draft, hand
write a lot of these sayings, hand draw a lot of these sayings.
My dad had just like the biggest, bulkiest calluses on his, on his elbows from, you know,
being there all day long.
And I just found it incredibly boring to be sitting behind a desk.
I just couldn't do it.
So despite their best efforts to try to sway me into an engineering career that never went
anywhere, never gained any traction.
So what does your dad tell you about the immigration experience in some conversations on mainstream
television?
There's a very negative connotation to immigration.
I am an immigrant from England and so there's so much, I think, gold in these immigration
stories and here you, you know, your dad comes and becomes an electrical engineer.
I became a firefighter paramedic.
So what does he talk about, you know, the experience and the, you know, were there any
kind of stumbling blocks early on as he was trying to find his feet in America?
That's a great question.
I don't get asked that very often.
And I would tell you it's, again, it's, there's some, there's a little bit of, what's the
word I should use?
You got to be, sometimes it's politically sometimes difficult to talk about because
people are very, very passionate on one side of the immigration issue or another.
But I, like my father, this, this country is founded on immigrants.
No one has a problem with migration and immigrants.
There's some great people in this country.
My dad came over dirt poor from Mexican family to make his family better.
And I mean, again, he dropped out of school in seventh or eighth grade, you know, because
his dad died at an early age.
So he was forced as the oldest child to work.
And he would tell me he would get bananas off the trucks, unload the bananas.
He worked as a porter at a hotel, you know, lifting suitcases, things like that, just
to make money to help support all of his siblings that were younger.
Right.
So hardworking guy came over to America, lived the American dream.
So he went from that to a son who became a neurosurgeon.
Right.
And he's been one generation.
Look how he's changed our family tree.
And I have that most respect for my father and what he did and the hard work and sacrifices.
It's again, just the success story of how migration should work.
And so he so he was all about migration.
I'm all about immigrants make the country great.
So much that we have to offer what he was not a fan of.
And he was a very, very vocal about it.
He he didn't pull any punches was the illegal immigration, you know, because he stood in
line.
He did everything the right way.
He did all the paperwork.
It took him years and years and years.
I think it was actually in high school before my dad finally got his citizenship card, which
I never him at the time shown it to me.
He said, look, here's my here's my citizenship card.
And I was like, oh, that's nice, Dad.
I didn't really I was too immature.
Maybe it's too young in life to realize what a what a tremendous deal that was.
And so that's that's pretty cool.
He did everything the right way.
You know, all his siblings that he slowly brought over from Mexico all did things the
right way.
So he was very it would make him very angry, I guess, to see that people would hop over
illegally come to the country without doing the things that he did because he was you
know, he did things the right way.
Obviously, he lived a life that was straight and narrow, loved his family, loved, you know,
his career, always wanted to do things the right way.
So to see people cutting line and running through on the illegal side.
And he was he was not a fan of.
Absolutely.
My son actually came.
Yeah, no, 100 percent.
My son actually came with me to when I became a citizen.
So he was at the swearing in ceremony a few years ago.
So that was kind of cool.
But I mean, I did the same thing, obviously, has jumped through all the hoops and wait
years and years.
But I also look at the way that we do it.
And there obviously are some barriers to entry, especially if you're from a poorer nation.
I came from the UK.
So you know, I wasn't the pound was strong when I was immigrating over here.
So you know, I think there is a happy medium, isn't there, where we can make it easier for
certain people to actually get here legally rather than, you know, just opening borders
and letting people flood in.
Yeah, correct.
Yep, absolutely.
Like I said, it's hard to tiptoe on that tiptoe around that issues.
People are so politically on one side or the other.
But like you said, there's a happy medium somewhere where, you know, we can find ways
to make it better and faster and get people here that need to be here that can really
contribute to, you know, I mean, every aspect of our lives, you know, and make things for
the better.
So I'm definitely I'm definitely pro migration and pro immigrant because of my family history.
Beautiful.
Yeah, I find the people in the middle are the most censored.
The common common sense voice standing looking left and right going, what about here?
This is a little bit a little bit of both of you seems to be the middle.
What's that?
We can't know.
I have to be way over here.
No, I have to be way over here.
No, exactly.
Middle is middle is a nice place to be.
It is.
I find the most normal people are there, to be honest.
Well, what about sports and exercise?
Obviously, you've got into, you know, a profession of health and even with Transcend, you're
working in the health space, too.
Were you an athlete when you were younger?
You know, my that was my dad, my mom, they met my father from a friend at work.
My mom's from Louisiana, Shreveport, Louisiana, and they met and obviously got married and
had kids.
But she was kind of on the opposite in the spectrum in terms of health.
She was always morbidly obese, smoked two packs a day, just very sedentary.
So growing up, that's what I was exposed to all her health problems.
I remember as a child, she made me practice giving insulin shots and, you know, there
was packets of sugar, little glucose things in case her blood sugar went too low.
So even as a child, I was in elementary school when she was showing me how to treat her diabetic
emergencies should they happen.
You know, but just growing up and seeing, you know, the morbid obesity, you know, a
couple of pounds overweight with all the health problems that that entails, you know, the
doctor visits, the hospitalizations.
You know, I just even as a young child, I was like, boy, you know, I don't want to be
I don't want you know, you just see how terribly how terrible it is.
And even as a child, I recognize I didn't want to I wanted to make sure my life was
somewhat healthier.
You know, you know what that means as a kid.
But I was always able to maintain a healthy weight and, you know, just like a regular
kid run around, you know, just doing the regular kid stuff.
And then once I got in high school, I did run some track.
You know, I was small.
I played one year of football and got out before I got killed because, you know, even
in ninth grade, some of those guys, man, they're full grown men, you know, and I was a five
foot four twig.
So I was like, I'm going to get killed playing football.
So I did once one season of that and then to move to the non contact sports.
So doing, you know, just running and training and then going into college.
Same thing.
I was I was always very mindful of health and not, you know, get never smoking.
I learned that from early age, just the terrible, you know, what it looked like to be a smoker
and wanted zero part of that again and just maintaining healthy diet weight.
It was always kind of in the back of my mind.
You know, my mom, you know, obviously my mom and lover, she's, you know, probably the reason
I'm a physician today.
Right.
I'm trying to help her, I think, translated into instilling in me that desire to help
people.
Right.
And ultimately, I became a physician.
So so with all that, also, there's the things that, you know, I didn't want.
And I was always very mindful.
I, you know, I didn't know what to make sure I never gained a lot of weight.
You know, try to stay active, you know, just those basic things.
And then I've always tried to maintain that, you know, just again, just to just to be healthy.
And then trying to, you know, as then becoming a physician and then knowing the importance
of, again, just basic lifestyle choices, right, with the with the diet and your exercise routines,
whatever that is, trying to instill the importance of that on my patients as to, you know, how
essential these are to everyday life and, you know, ultimately, ultimately how your
quality of life is going to be.
So what about when you start going on the medical route and now you're in medical school,
something I've heard from a lot of my guests who have physicians was the woeful, inadequate
amount of education on nutrition, on exercise, on sleep, on all the things that we call the
pillars of health now.
And I'm hoping obviously that's moving forward.
But what was your experience when you were in med school specifically?
Well, you know, I don't have any experience because there wasn't any.
Like seriously hit the nail on the head.
I mean, you spend four years in med school learning about diseases.
Hey, here's a list of a thousand diseases you got to know about.
And here's 10,000 medications to treat those diseases.
But you know, how how much preventative medicine did we get in med school?
Boy, I would tell you zero, but maybe there's a week in there somewhere.
But there is there is no preventative medicine.
There is no you know, how do you how do you how do you counsel people on on on diet, exercise,
nutrition, metabolism?
No, it's like, OK, this person has, you know, Graves disease in their thyroid.
How are you going to treat that?
You know, soon to be Dr. Vana.
Well, I'm going to give Synthroid, you know, I mean, it's just that's how it is, you know,
identifying diseases and treating the disease.
Not how do how do we how do we prevent that altogether?
Zero.
It's crazy.
You know, I think that's probably I think that's changed a little bit, but it's a little
bit otherwise.
There's just I think the sense is there's too much to learn about how to be a physician
and how to manage health and how to manage disease, that there's there's no time to
spend on how to how to prevent disease.
You just mentioned something that I've talked about a lot.
And it's funny because my wife is taking thyroid supplements at the moment from Transcend,
but she's about to finish four years of med school.
So you know, she's been stressed to the max.
So I'm sure that once she takes she's taking her final boards in a couple of weeks and
then hopefully everything will settle down.
And I'm hoping it will be at a, you know, kind of wiener off at that point.
As a paramedic, the number of people that I had conversations with that said, well,
the reason I'm like this is I have a hypothyroid, you know, and I'm always thinking, well, was
that the initial thing or have you now got hypothyroid because of the result of, you
know, the old movement, your ex, your nutrition, et cetera, et cetera.
I know nothing is, you know, black and white and there are kind of anomalies there.
But when we hear about thyroid contributing to weight gain, it's kind of a chicken and
egg situation, I'm assuming.
But is that usually the thyroid just given up on its own or are we actually contributing
to this hypothyroidism that we see so rampant in the States because of inactivity and our
nutrition?
Well, I think it could be both ways.
You know, certainly we see even, you know, at Transcend when we're doing routine screening
blood work for people's symptoms, you'd be surprised how many people we find that are
hypothyroid or having like a functional hypothyroidism where, you know, they're having mild symptoms,
but their blood work looks, you know, terrible, you know, but they're only having mild symptoms.
Okay.
So, yeah, it's a very common problem.
You know, we get the autoimmune ones like the, you know, the Hashimoto's thyroiditis
very common, you know, grave disease where the body's forming antibodies to different
parts of the thyroid gland and it subsequently burns out their thyroid gland.
So they become hypothyroid.
They don't have enough thyroid function anymore.
So that's a, it's pretty, you know, we see that, you know, fairly, fairly common.
So we have that aspect of where there's some really some just inherent reasons why people
will get hypothyroid conditions like as a true medical condition.
And along with that, they get the slower metabolism, right?
Your thyroid hormone tightly regulates your metabolism.
So when you're low, you're not going to have as high a metabolism.
Your basal metabolic rate is going to be lower.
You're not going to burn as many calories the way it can slowly creep on.
So that's certainly a factor.
And then you have the concept of kind of like a chronic stress response, right?
Where you have higher cortisol levels, people that don't manage stress, you know, they're
not sleeping, their lives are overly busy, low-restressed, you know, their diets are
poor.
Then you have this constant ongoing on edge stress response where your body will release
more cortisol to help manage that stress.
That's what cortisol does, right?
Helps your body adapt to stressors in your environment.
The problem with that is that, you know, the cortisol does great for helping to manage
that acute response and that acute inflammation that can come around with that.
But it's also a double-edged sword where those high levels of cortisol can really cause immune
dysregulation, so it causes your thymus gland to kind of change what it's doing in terms
of the types of white blood cells, the types of immune cells that it's putting out.
And that imbalance or that dysregulation can predispose people to having different, you
know, autoimmune conditions and can flare those up.
Like, you know, say like psoriasis, say for example, which is, you know, not immune, you
know, you can't turn on the TV nowadays without seeing one of these immune modulating agents
to treat the psoriasis, right?
They're on commercials all the time.
But you know, people that have these high stress response, high cortisol levels, you
know, people are under stress that can bring on those psoriasis plaques, right?
So there really is that intricate interplay between, you know, chronic stress, high cortisol
levels, immune dysfunction that, you know, can lead to some of the hormone imbalances
that we treat very frequently.
Well, speaking of that, when you were in your residency, you know, we hear historically
how insane some of the work weeks are in your profession.
What was your experience specifically?
You know, neurosurgery is, I think, you know, one of the more challenging residencies out
there, right?
You're dealing with, you know, I think overachievers.
Neurosurgery is seven years of residency training after medical school.
And it's a pretty brutal seven years.
It's a lot, you know, it's a lot of brain surgery, it's spine surgery.
It takes a long time to teach people how to be, you know, safe and effective and have
good surgical judgment when you're treating, you know, very tender, gentle, intricate areas
of the brain.
So, again, seven years is a long time.
And back when I did residency back in the 90s, and I feel old when I say that, but back
in the 90s, you know, that was before they had instituted the 80-hour work week.
So we would literally work 100 hours a week, 110 hours a week in the hospital.
Every fourth night we'd be on call.
So we'd be running around the hospital taking care of all the neurosurgery patients, any
new patients that would come through the ER.
So you'd be up all night, you know, as at a busy trauma center.
So literally you come in at 6 a.m., you're there all day, you're awake all night running
around like a monkey doing all these things, you know, trying to manage, you know, neurosurgery
change, which in general can be very sick, critically ill patients, right?
So you're running around all night, and then the next day comes around and it's a full
day for you.
So you're doing, you know, until the following night, which might be 6 or 8 p.m., you know,
and then by the time you're going home, again, you've been up for 36, 38 hours straight with
no rest, and you do that every fourth night.
So it was pretty, it was pretty, it was pretty brutal.
You know, now fortunately things have changed.
You know, where now they have, you can't work more than 80 hours as a resident.
If you work a 24-hour shift, you have to have, I think it's eight hours off or something
like that.
So you can go home and sleep, you know, collect yourself, and then come back.
So there's work hour restrictions now for residents, which I think is a good thing,
you know.
I mean, I certainly fell asleep at the wheel driving home when I was a resident, you know.
There's residents that have accidents, you know, there's the reason that 80-hour work
week came about is because there's a famous case in New York a while back where there's
a resident that was way overworked and made a critical mistake and a patient died.
So then they started making legislation to limit the work hours, which again, I agree
with, you know, in my personal experience, you know, when you're up that many hours,
you feel okay, you know, you think you're okay, and I think that's part of the danger,
right?
It's like having a few drinks at the bar, you've had three or four beers, like, eh,
fine, I just lived on the road, I'm fine.
You know, when you check your blood alcohol level, actually, no, man, you're not fine.
You know, you're.09 or you're.1L, you're drunk, you know.
And I think that's part of the danger of sleep deprivation is that, you know, you still constantly
might think you're okay, but, you know, driving a car at, you know, 80 miles an hour down
the freeway, having been up 38 or 40 hours, you know, it's, you know, in retrospect, you
know, I feel kind of lucky that I never had any real major accidents or anything.
But yeah, it was pretty brutal back then, you know, and that was before we had physician
assistants, you know, or nurse practitioners to help with the load.
It was it was all you, you know, neurosurgery, there's not a lot of us.
So you know, you were the single resident covering, you know, a hospital with hundreds
of patients.
It's not like the like the general surgery teams with internal medicine teams and entire
teams there, you know, like the trauma surgery team, they had, you know, six or eight residents
there, you know, so they're in the car room, they're playing Xbox, you know, they're catering
in Chinese, you know, and then they're hurrying on the lone wolf neurosurgery resident just
fighting for survival for the night, you know, and they would feel pity on you sometimes
like, hey, man, come on in here for me to have some food, you know.
So yeah, so neurosurgery, it's a it's a unique specialty.
It's a it was a lot of pain and suffering to get get where I am.
Well, it's interesting because it parallels the fire service, you know, especially us
to do fire and EMS together.
So many of these men and women, I mean, 24 hours, you know, you are awake or or completely
disrupt asleep, waiting to be awoken and still waking up three or four times a night, even
if you see the bed for, you know, an hour or two.
And then you add in we've got a crisis at the moment, a recruitment crisis.
So now you're adding in mandatory over time.
So just like you said, the morning comes, you're about to go home, you get a phone
call.
Now you're not.
Now it's another 24 hours, 48 hours without sleep.
And you look at neurosurgery and other medical professions that have these residencies, you
look at our police and fire and, you know, especially fire.
And it's like, why are the one the people that are most critical that we need to be
completely on point and be able to think properly, we work them into a ground.
The person that bags your groceries for 40 hours now, you need to go home.
You know, it's it's so backwards.
Yeah.
The neurosurgery, it's there's just not a lot of again, there's not a lot of neurosurgeons
in the world, right?
There's only about 3000 board certified neurosurgeons in the country.
So you know, just, you know, the amount of new training spots for a new neurosurgery
residence every year is I think 160 last I looked.
So every year we can train 160 new neurosurgery residents.
And then you have guys that are retiring.
And, you know, so it's it's barely enough to fill the needs.
There's a lot of hospitals that don't have neurosurgeons.
If someone comes in with a neurosurgery issue, they have to transfer them out.
It's just not enough neurosurgeons to go around.
So we're all all overworked.
You know, all of us are chronically tired.
You know, we're kind of like a band of brothers kind of thing.
Like we all try to help each other out because we know all of us are woefully, you know,
tired and and sleep deprived.
Yeah.
Maybe just lower the bar.
They'll do it.
Yeah, exactly.
That's what they do in the bar service.
So we just need people 18 and a heartbeat.
You'll be fine.
There's the brain.
Yep.
Well, what about the folklore I've heard many, many times when it comes to residency?
I think this was so I don't know if it was neuroscience specifically, but I think it
was like the turn of last century.
If I'm not mistaken, there was a famous surgeon slash professor who was doing these these
residencies and staying up for hours and hours and hours and days and days.
But then when that when they actually look back, they realize that he was addicted to
cocaine because obviously it was not really frowned upon back then.
So then you go, OK, well, that wasn't healthy.
And I'm sure he probably died not too long after that.
Have you heard that folklore?
Because I hear that quite a bit and it just kind of smacks of that just because you've
always done it that way doesn't mean it's the right way to do it.
Yeah, I've heard a similar story.
Wasn't it like was it Sigmund Freud?
Was that the famous psychologist that was addicted to cocaine?
Yeah, I think he might have been as well.
Yeah.
I mean, a lot of people were, you know, back then.
OK, back then.
Yeah, it was all cool back then.
Yeah, it's no problem.
All right.
Well, well, then while we're staying on the kind of neuroscience before we progress to
hormones, I know one of your areas of specialty is Parkinson's disease.
And one of my close friends actually just lost his father to it a couple of years ago.
And we just did an interview the other day kind of from a, you know, a carer's perspective
and how heartbreaking it was watching his dad slowly disappear.
So what got you into that field of research and what are some of the, you know, the things
to be excited about, hopefully, as far as addressing that issue?
Oh, yeah, great.
You know, as a brain surgeon, the functional neurosurgery part, which I'll describe a little
more, is some of my most favorite operations to do and patients to take care of.
And because what we're doing, this guy's an overview when you're a functional neurosurgeon,
you're modulating or trying to change the function of certain parts of the brain.
And there's been different ways to do that over the years.
But in regards to Parkinson's, when I was again training back in the 90s, it was still
a relatively new procedure to stimulate different parts of the brain, almost like putting in
a heart pacemaker if someone has an arrhythmia, where you get a heart pacemaker to kind of
pace the heart in a more normal way.
Well back in the 90s, it got FDA approval to put a stimulator wire into different parts
of the brain to try to make those neurons, those nerve cells, fire and communicate in
a more normal way to alleviate some of the symptoms they were having.
And in regards to Parkinson's disease, initially, they were burning parts of the brain, destroying
parts of the brain, which would improve function.
But it had a lot of limitations, a lot of side effects when you're destroying a deep
part of the brain like that, right?
And you could only do one side, couldn't do both, et cetera.
There was different problems with that.
So when the concept of, you know, let's stimulate a part of the brain, the nucleus or the subthalamic
nucleus deep in the brain, that will change the way the motor circuitry is going in Parkinson's
disease.
I found it very fascinating and really took a liking to it, did some extra training time
with one of my mentors at a local hospital here.
And then once I finished my seven years of residency training, made sure that I was going
to have surgeries for things like Parkinson's disease as part of my practice.
And so I got a very busy practice doing that.
And I love it.
It's just very fulfilling because as you've, sounds like you've seen, you've talked to
people that have had Parkinson's disease or have Parkinson's disease, people that have
cared for them.
It's just such a debilitating disease, right?
And it's progressive, gets worse over time.
And their level of being able to function, their motor function just deteriorates year
by year.
And what surgery for Parkinson's does is we implant a pacemaker into that part of the
brain that helps them move in a more normal way.
So instead of having their tremor, it makes their tremor stop.
And instead of having that real rigid muscles you've seen with Parkinson's, they just get
real rigid.
They're stiff, tight.
It can help to make their muscles and joints more loosey goosey so that they're normal.
And that slowness of the movement, the bradykinesia, that's why the classic picture of someone
with Parkinson's is them shuffling down the hallway.
There's no arm swing, they're just slowly shuffling.
It's that slowness of movement or bradykinesia that also is alleviated.
People can walk normally, they can dance with their partners, they can travel.
And it's just extremely rewarding to get people that are markedly debilitated from their Parkinson's
and they're taking so much medication to treat the Parkinson's, kind of like most people
have seen, like Michael J. Fox, where he's got those extra movements called dyskinesias
where they're all over the place.
They can't sit still.
You've seen those videos.
Dr. Justin Marchegiani...
Yeah.
Dr. Justin Marchegiani...
But that's a medication side effect.
They're taking so much dopamine type drugs, it gives them those extra movements just to
be able to move.
So it's either they got all these extra movements or they're frozen.
You know, so obviously if you're frozen, you can't function.
So they take these high doses of medicines.
Anyway, so the deep brain stimulators, we put these electrodes in people's brains, you
can drastically reduce the amount of medicines they need.
You know, you replace a lot of their medicines with electricity.
And so you really take people that are debilitating and have lost a lot of function, a lot, lost
a lot of quality of their life over the course of a few years and you can restore them, you
know, their ability to be independent, their ability to take care of themselves, the ability
to enjoy their life by six or eight hours per day of good time that you've given them
back.
So the most thankful patients in the world, you know, they all send Christmas cards, they
all send pictures like, you know, thank you so much, Dr. Vana, I've got my life back,
I can do this.
So it's highly rewarding surgery.
And there's other reasons why we do deep brain stimulation to this functional neurosurgery
and all are equally rewarding.
So again, as a neurosurgeon, it's one of my favorite things to do.
I think I've seen a video on social media of someone having those and I believe unless
I'm just completely naive and it wasn't what I was seeing, they had the ability to turn
it on.
So you saw them prior and then they turned it on and they were they had the tremors and
all of a sudden the tremors just stopped and I forget what he was doing.
I think he was trying to drink a glass of water and before he, you know, he just couldn't
even get his hand close to it and they turned it on and then he picked it up and drank it.
It was amazing to watch.
Yeah, it's a lot of fun.
And we do that in the operating too because the patients are awake for we're doing these
surgeries, which sounds crazy and barbaric.
But you know, whenever we're doing anything painful, they're sedated.
And then once they're awake, as we're putting these probes in the brain to kind of map out
where these abnormal areas are, and then we put the electrode in and we turn it on.
It's a lot of excitement.
You know, patients sometimes cry because, you know, they've had years where they're going
like this, right?
They can't move and you hit the hit the light switch and then it stops.
Right.
So now they they look at this hand like it's an alien hand, you know, because it's now
it's not moving.
And, you know, beforehand and pre-op area, you've had them.
OK, try to write your name and it's like, you know, or try to drink from a cup of water.
It's all over the place.
And now you have them in surgery with this electrode in place.
You flip it on and now they're able to write clearly.
You know, they can bring a cup up to their mouth.
It's you know, you can see some videos on YouTube where they're, you know, they'll play
a violin or, you know, they'll do things like that that are, you know, fun to watch.
I think somewhat unnecessary and overly dramatized, but I'm still waiting to take a drum set in
there.
That would impress me.
So I mean, it's fun.
But, you know, you can have them do simpler things just to show that there's a sudden
dramatic change in their symptoms.
So it's yeah.
So you've seen the videos.
They're out there online.
You know, that's something we do in the operating room.
You know, it's another day at the office for us.
So it's pretty it's really cool stuff.
I love it.
I enjoy it.
Beautiful.
When it comes to the the elements that contribute to someone being more likely to get Parkinson's,
I just sat and listened to a class a few months ago and I think it was a gentleman from the
U.F. here in Florida.
Because I've heard people on the show many times refer to Alzheimer's as type 3 diabetes.
So clearly, obviously, there's some nutritional elements that we can address and lower our
chances there.
But this gentleman, I forget his name, was talking about the contaminants, the pollutants
in the atmosphere and foods and that kind of thing being one of the main contributors
to the Parkinson's disease.
What are you finding on your end?
Well, I think the neurodegenerative conditions that you're seeing, like you're talking about
Parkinson's disease and also Alzheimer's disease.
Yes, there might be some hereditary, maybe some genetic issues and maybe that can predispose
you.
But I think the environmental things likewise, you know, still working out what those contributions
might be.
But I think part of for me, the most fascinating thing I've heard recently, and maybe you've
heard some in your discussions with the other doctors, is the is the whole idea of mitochondria,
which if people remember back to high school science, little mitochondria, little round
oval thing as the powerhouse of the cell, the thing that powers all the energy for each
cell in your body.
In addition to the neurons, same thing with the brain cells, right?
The mitochondria are essential for every cell's function, right?
It helps it metabolize, helps it to burn glucose.
And in these neurodegenerative conditions like Parkinson's and Alzheimer's, we know
that loss of mitochondria or dysregulation of metabolism inside that mitochondria can
cause mitochondrial cell, the mitochondria can die and subsequently the cell dies.
All right, so there's a lot of fascinating work, you know, looking at, you know, how
do you support mitochondrial function to prevent cell death in those critical areas of the
brain that are involved in Parkinson's and in Alzheimer's, like in the amygdala, hippocampus,
other areas for like memory and function, that how do we support those mitochondria
to, you know, so that you don't get loss of brain cells in something like Alzheimer's.
And in the news, if you've noticed lately, there's so much buzz about the GLP-1s, right,
the ozempics and the menzornos.
And there's been a couple of interesting studies released this last couple of years where looking
at Parkinson's patients, right, let's get the Parkinson's theme going, right?
So we look at Parkinson's patients and we have patients that are diagnosed with Parkinson's
disease and say, oh, well, there's a certain segment of those that also have their overweight
or they have diabetes, so we're going to put them on a GLP-1.
Let's put them on semiglutide or tricepidide, whatever.
And when you follow up on those patients a year later, surprisingly, the ones who are
on the GLP-1, their Parkinson's disease, their motor function did not progress.
You know, Parkinson's disease is a progressive loss of function over many years, right?
But the ones that were getting those GLP-1s showed no change in their motor function.
That's a pretty big deal, right?
And also there's a study looking at the same thing, Alzheimer's patients, where when Alzheimer's
patients were put on GLP-1 medications, you know, and you look at them a year, 18 months
later, their cognitive function, their memory, their ability to function was unchanged compared
to the ones who were not, compared to the Alzheimer's patients that were not on GLP-1
medications.
So again, so I think it just goes to, you know, what those GLP-1 medications are doing,
right?
They're very important for how energy is metabolized in the mitochondria, right?
Help for glucose metabolism and regulation, keeps your blood sugar stable.
And so I think that's fascinating that these things are working on that mitochondrial and
that cellular level to prevent further cells from dying and stopping things like Alzheimer's
or Parkinson's disease from doing their natural progression that they normally do.
That you can stop them with managing their blood sugars or at least helping to regulate
that glucose metabolism, you know, with these medications.
I think it's fascinating.
Would that suggest then that even without the GLP-1, if someone had gone to a very clean
whole food diet that was balanced and got as close to homeostasis, that would have the
similar effect?
Well, we know there's certain things that will predispose you to that, right?
Like diabetes, the high blood pressure, the high cholesterol and hyperglycerides.
We certainly know that there is things that are associated with a higher risk of getting
Alzheimer's disease.
Yeah, so those just underlying, like a lot of the diseases that we deal with and cancers
we deal with, so much is based on healthy diet choices and lifestyle.
Even like exercise, talking about Alzheimer's, we know that people that maintain a moderate
level of exercise can have much less chance of getting Alzheimer's.
And patients who do have early cognitive loss or early Alzheimer's disease who get maintained
in an exercise program, again, they're able to maintain or even regain some of their lost
cognitive function.
But that just tells you how important exercise is and getting the blood flow to the brain,
which increases during exercise and how important that can be for maintaining healthy brain
function and heart function and lung function and circulation and everything else.
Wait, they're all connected?
Wait, imagine that.
That's crazy.
Yeah, but I didn't learn this in med school.
This was not in med school.
Interesting.
Yeah, I mean, I didn't either.
This is the thing.
It's literally talking.
I mean, obviously I've been through a medical route, but it's talking to all these experts
in these fields that have kind of slowly created this.
I tell people the Venn diagram, you know, where everything intersects.
You're like, okay, well, there's obviously a truth, you know, a thousand plus conversations
when it comes to, you know, the things that are detrimental to the brain with this incredibly
important lens that you have.
Talk to me about the connection between sleep deprivation and neurodegeneration.
Oh, boy.
Yeah, you know, I think as a neurosurgeon, I don't get enough sleep.
That's for sure.
You know, I frequently operate late into the evening and sometimes overnight.
So you know, I unfortunately I can speak for firsthand experience, you know, sleep deprivation
and you know, how that affects cognition, not only short term, but you know, can affect
you on a long term basis because sleep is very restorative, right?
It's the time when your brain can, the neurons can kind of clear out the toxins from the
day, can help restore your, you know, and get rid of the oxidative stress that you've
had that day.
Everything can kind of reset.
And again, it's time for your brain to kind of cleanse itself over those hours of sleep
so that it's ready for the next day of brain function.
And there's been, you know, countless studies looking at, you know, people that don't get
adequate amounts of sleep as to how that affects, you know, not just your brain function, but
the rest of your body as well.
Right.
I mean, not, you mean, you know, obviously you're going to, if you're tired and you're
having slept on it, you're going to have that brain fog, right?
You're going to be mentally fatigued.
You're going to be limited to what you can learn or what you can take on.
Right.
But also we know that, you know, sleep deprivation can affect like cortisol levels, right?
It can affect hormone levels.
And when you look at the way it affects cortisol levels, you know, if you have this cortisol,
you know, dysregulation, your sleep cycles are off, you know, cortisol can have, although
there might be some benefits of cortisol in the short term, there's, you know, having
chronically elevated cortisol levels as a, you know, from chronic stress, it could certainly
have some profound impact on the body in negative ways.
Right.
So it's, it can be, you know, it can be adverse to your heart tissue and, you know, your thyroid
gland and, you know, just your immune response, your thymus gland, you know, those high levels
of cortisol, which are associated with sleep deprivation.
And then, you know, like I said, so for terms of cognitive function, you know, you got to
sleep enough sleep.
You know, everybody says, you know, six to eight hours of sleep is what you need.
And I'd say, yeah, eight hours is a good goal to shoot for to make sure that, you know,
during that time, you know, your memories can consolidate, your brain can cleanse itself,
the cells can reset and stay as healthy as possible.
What about strokes?
This is an interesting one.
I mean, tragically interesting, but I'm seeing more and more and more strokes in the fire
service of young, especially men for some reason, it seems to be, you know, more on
the male side.
What impact of chronic stress, sleep deprivation, etc.
How does that create an increased chance of a blood vessel in the brain actually, you
know?
I'm saying the word exploding.
That's not the word I'm looking for here.
Breaching.
Burst, rupture.
Thank you.
Yeah.
And yeah, unfortunately, one of the things I have to deal with as a brain surgeon is
the strokes that happen, you know, the hemorrhagic strokes when something bursts and not necessarily
an aneurysm, but probably the number one cause that I see as a neurosurgeon is uncontrolled
or inadequately controlled even, high blood pressure, or, you know, people can call it
the silent killer, right?
Because people walk around with a blood pressure of 160, 180, 200.
I saw a person in the ER just the other night, 220.
You know, and the blood vessels in the brain just aren't designed to carry that kind of
pressure, that kind of load, and they will burst.
And when you have these bursts in the brain, the blood dissects through the brain tissue
and destroys it.
And you can have significant neurologic deficits or even die from these strokes.
And I think for the younger people that we see, again, it's a lot of things that could
be prevented, just getting routine screenings.
Like, you know, no one wants to go to the doctor.
I feel great.
Why don't I want to go to the doctor?
Right?
I'm not having any problems.
But you stick a stick of the arm in a blood pressure machine, like, oh, did you know your
blood pressure is 160 over 110?
Like, oh, no, I didn't know that.
But my mom and dad both have high blood pressure.
You know, and it's like, okay, well, I'm glad you got checked out.
Let's do, let's lose some weight.
Let's do these things.
Let's recheck it.
And if it's not good, you know, maybe they have to go into a blood pressure medicine.
So that's probably the number one cause that we see is just uncontrolled blood pressure.
And the younger folks who are just blissfully unaware that they have this time bomb just
waiting to go off.
So it's always very sad.
Recently saw even a young person, I think she was 42, that died of a massive hemorrhagic
stroke.
I had no idea that she, her family had no idea she had this high blood pressure.
Neither did she.
So, so yeah, it happens.
And I think, excuse me, people at her high stress jobs, you know, the constant adrenaline
response, you know, that maybe they're getting, you know, these rises in blood pressure during
the day that maybe they already have a baseline problem.
Maybe they're walking around 130, 140, you know, 150.
And then they get these high stress jobs where, you know, they're jacked up on adrenaline
running into scenes of whatever, whether it be the fire, EMS, police, and now suddenly
your blood pressure is 180, 190 because, you know, you got so much adrenaline pumped through
your body.
You know, your heart rate's faster, your blood pressure is higher, and that's enough to send
you over the edge to have a blood vessel burst in your brain.
You talked about prescribing, you know, blood pressure medication.
One of the things that I don't see happening in the regular medical world is you have that
patient, you know, they are 50 pounds overweight.
They're not very active and they've got a BP of, you know, like you said, you know,
160 over 110 walking around.
I don't see that conversation of, so let's give you this medication for now.
We don't want your BP going even higher and being a dangerous point, but we need to have
an exit strategy to ultimately get you off it again.
The same with psych meds, the same with so many.
To me, there seems to be this culture of, well, you're going to be on it forever.
It is what it is, which, you know, economically obviously is great for drug companies if you've
got a, you know, a user for life, but I don't think ethically that's a very good philosophy
to have.
And I understand the kind of broken system as far as the minute amount of time a lot
of these physicians get with their patients, but I feel like there needs to be a change
in those, some of these medications have an application, but not for a lifetime use.
Oh boy.
You know, and I think a lot of that falls into the time that it takes to educate patients
on some of these things, right?
Because doctors and, you know, the primary care docs, you know, like I said, God love
them.
I have a lot of great friends that are family practice docs, internal medicine docs.
And yeah, when they have a patient that comes in their office, they have 15 minutes, maybe
less than that and they got to go through their health history, you know, what medicines
are on, what else is going on and how much of that time is left to say, okay, yeah, your
blood pressure is borderline.
Let's talk about how we're going to address it.
So talking about lifestyle and diet and exercise and programs and what else, what other stress
is going on in their life?
How's your sleep?
You know, how, what are you doing to control stress?
You know, all of these things just take time.
And it's, and it's time that honestly, I don't think that they have or that they're able to
spend with patients to do the whole preventative aspect and make an exit plan.
It's like, okay, well yeah, blood pressure is 160.
Here's a prescription for ABC medicine, whatever it is.
And we'll see back in six weeks to check it.
And they come back for their checkup.
Oh yeah, blood pressure is 130.
Now you're good.
I'll call you in refills every 90 days.
Problem solved.
You know, meanwhile, they're still 50 pounds overweight.
They're still smoking a pack of cigarettes or diet sucks.
And they're, they have an exercise since high school.
You know, I mean, it's just, you're right.
It's broken.
And the emphasis is on the wrong things.
And sometimes medications, you know, are absolutely needed.
You have whatever the kidney issues, heart issues, whatever it is, medications are needed.
Absolutely.
But I think we miss a lot of the opportunity to change things in a natural way, get people
healthier to come off those medications.
They're overall healthier.
They don't have the side effects of the medicines.
And we miss those opportunities all the time.
It's a huge, it's a huge break, I think in the healthcare delivery that all of us give
every day.
There seems to be, and again, correct me if I'm wrong, if it's changed now, but there
seems to be a lot of conversations I had almost to kind of poo pooing at the idea that you
could reverse type two diabetes or hypertension with diet and exercise.
And I think that in itself is in a very, very kind of cancerous way of thinking.
Yeah.
I think, you know, sometimes it's also a much easier route to take, right?
So okay, I'm a hundred pounds overweight.
I'm going to take my, I'm going to take med form in and we start on some of the sardis
mincelin blood pressure, arthritis, rides, whatever, give me medicine.
It's no work needed, right?
Just give me a medicine to fix it, right?
Just doctor make me better.
And you know, I think again, a lot of it comes to the education and trying to partner, you
know, with the patient and saying, okay, here's what you got.
You know, if we can't get this diabetes under control, you know, I mean, I can give you
medicine, but there has to be a team approach.
Like patients have to do that.
We have to, you know, make them understand that there's a part that they play in trying
to reduce their chance of morbidity and mortality.
Years later, you know, that we got to, we got to, we got to figure this out now.
Like we have to be a partnership and here's, you know, I'm going to check on you.
I'm going to do this.
Let's start you on this, but I want you to, let's get you in this at the YMCA or whatever.
Let's get you in a gym.
Let's start doing some treadmill.
Let's, you know, to, to, you know, educate them as to what they can do, that's going
to make a difference with these things.
Cause there, it is the easy way out, right?
So doctors give me a pill to fix it, you know, well, it's not, not that easy as much as you
might want to try.
You're still not solving the underlying issues that created it.
And it's not going to be ideal.
It's not going to be optimal.
Absolutely.
Yeah.
But yeah, well, there's people saying, yeah, you're going to be on it for life.
Well, it doesn't have to be, you know, sometimes it is that sucks.
Uh, but it doesn't have to be, you know, someone sitting there in the office, again, they're
a hundred pounds overweight saying, oh, well, you know, you're going to have diabetes.
Well, not necessarily.
How many, how many patients go on GOP one medications and they lose the extra weight
and their diabetes goes away, right?
They're a, the hemoglobin A1C gets back to normal.
Their blood pressure magically goes down from 160 down to 120.
You know, their cholesterol is no longer 300.
It's down to 170, you know?
So, uh, so yes, there are fixes to these problems if they would just be addressed and not take
the just a knee jerk, easy way out.
Like, oh yeah, here's the medicine.
Here's the medicine.
You know, I had a English author, Johann Hari on the show who just did a book on a Zempik
and then the other drugs.
And you know, he's, he's a great, great author and he's obviously putting the pros and then
some of the cons as well.
But one of the areas that I think has huge application, we're talking about medical intervention.
I've lost two friends or my wife's best friend.
And then a guy I went to school with in fire school to a gastric bypass that ultimately,
you know, went wrong inside and then they passed away.
So to me, even on the more extreme side, you know, the, the Zempik style drugs just seem
to be so much safer even with that.
But you hear this kind of reported that they, it kind of resets the way they look at food
and then you have the ability to, to kind of wean off and hopefully carry on that healthy
lifestyle.
Yeah, and actually have a great friend who's a local obesity surgeon.
He did obesity surgery for 20 years, you know, doing gastric bypasses and then the bands,
you know, different procedures that have come along over the years for, for weight loss.
And as you know, there's such a high failure rate, right?
Of those, those operations.
And in some of the show almost a hundred percent failure rate where, you know, if you don't
make appropriate changes to your lifestyle, your, you know, the modifications to your
diet, people are going to gain the weight back, right?
So there's a really, really high failure rate of gastric bypass surgeries because you haven't
solved the underlying problem with, you know, is the, is the issue with the food, right?
The dietary choices, the amount of food, right?
The cravings, right?
So if you're not solving that eventually, you know, people will eat, they'll stretch
their pouch out, whatever it is.
I told you about my mom, she had gastric bypass surgery, didn't lose an ounce of, an ounce
of weight, you know, and those aren't, you know, when I was talking to my good friend,
like I said, the one who does a weight loss surgery, you know, these, these are not like
you, like you pointed out, they're not benign operations.
You know, they, yes, they're much safer than they were years, years ago, but you're operating
on somebody who's way overweight and their risk of complications from surgery is going
to be higher.
So there's blood clot risk, there's heart attack risks.
And certainly they're, you know, they're always quote, you know, 1% risk of death with those
operations.
And I was like, yeah, that's probably about right.
But when I asked my friend, this obesity surgeon, you know, what do you think about the GLP
ones?
And he was super excited about it, you know, because not only changes the, you know, not
only helps them lose weight, but it changes the reason that they've gained the weight,
right?
It changes those, those cravings, right?
They're overeating, you know, they don't, they, they feel full much faster, right?
Again, they don't, they don't eat as much, you know, so, you know, they just, they eat
one third of the hamburger instead of, you know, two hamburgers, you know, so the amount
of food they're consuming is, is way down and their body can metabolize that glucose
in a more normal way.
So the cravings are gone, they feel fuller faster, they don't overeat.
Like I said, so they, they'll lose weight and that's, so it changes their whole mind
the way they're, they're approaching food and much safer.
Obviously, you're giving yourself an injection, you know, the GLP ones, they're not without
side effects, of course, but you know, it's much better than a 1% risk of death.
You know, you don't have so much, you know, there's a lot of nausea and there can be some
vomiting and things you got to work through over time, but certainly a lot safer to do
an injection rather than having a major gastric surgery.
I think sometimes the, the issue becomes, okay, now they've lost the hundred pounds
or they lost the weight that they needed to lose, now what?
Because there's been concerns that if you just stop your semiglutide, stop your resymthic,
that the weight's going to come back.
And to a degree, that's true.
There is certainly is a failure rate with stopping those medications because the old
habits creep back, right?
Oh, I'm starting to crave this again.
And oh, you know, I'm, I started eating this crap again and I've started, my portions are
getting larger.
So all these bad habits kind of start to creep back up over the course of the ensuing few
weeks or months once you stop it.
And that weight will slowly start to gain gain back.
And that's why there's been this recent chatter, which you've probably heard about microdosing
GLP ones, right?
You lose the lose the weight and then rather than just stopping it, okay, well, let's take
a really teeny tiny dose.
Let's take a little toast, a little taste of a GLP one.
Maybe we do half of the starting dose, something real small.
Will that be enough?
Just keep away the cravings, you know, just keep me from overeating.
I don't want to lose any more weight, right?
I'm done my weight loss.
I just don't want to gain it back.
So if we can do a little bit of a tiny micro dose, maybe that'll help keep me from getting
the weight back.
So I know a lot of patients are trying that.
That's some success with that.
But still to be determined, okay, what is that dose?
Is that forever dose?
You know, how do we how do we manage microdosing?
So that's I'm sure that's there'll be more to that to come as the years come back.
Google buy.
Interesting.
I want to hit one more topic and then we'll go to transcend and unpack the whole hormonal
discussion.
But while we're in the neuroscience side, when I was going, you know, learning science
when I was kind of young again, the 90s, someone referred to that as the 1900s the other day,
which really made me sad.
The science seemed to say that once brain tissue was damaged, you know, with a stroke
or a spinal cord or whatever it was, that was it.
Brain doesn't regenerate.
And then as we've gone through the years, you start hearing about neurogenesis and I
find that so, so exciting.
And I've watched some of my friends that have had strokes, you know, not massive, massive
improvements, but improvements, you know, they are getting better slowly.
And you know, will they ever get to full function?
Maybe not, but certainly, you know, X percent better than they were before.
So talk to me about that side.
What was the discussion when you were going through med school and what has been this
revelation that we're seeing of the of the brain, the spine and the brain to actually
somewhat heal itself?
You know, that, yeah, same thing we're taught in med school.
Like you like you've heard those, the nerve cells, the neurons and the pathways, the nerve
fibers have limited regeneration for healing or repair or reconnection.
And to a large sense, that's that's true.
This whole idea of neuroplasticity where a nerve cell can create other connections, you
know, with other nerve cells, which is important for brain function and memory and learning.
Right.
So the more connections, the better.
And when you have a stroke or a brain injury, those connections, those cells die off, the
connections die off or a case of a spinal cord injury.
You know, the spinal cord is cut.
All those all that fiber optic cable, the nerve fibers, you know, that's that's cut.
And you know, it's impossible for those optic, you know, cables to get, you know, start,
you know, functioning again.
You know, the same thing with the nerve cells.
Those fibers just don't reconnect.
So that's why a lot of people who have spinal cord injuries and paralysis frequently don't
get better.
Right.
So it's devastating neurologic injury.
So that's how we're trained in med school.
And a lot of and, you know, from a lot a lot of times, that's true.
But there is has been some work and how how to mitigate the damage, how can restore some
of that function.
And with some of the compounds that are being developed, developed, the so-called neurotrophics
that help the neurons produce more of what's called BDNF or brain derived neurotrophic
factor that helps to stimulate nerve cells to regenerate or grow.
And also to create more of those connections, kind of restore those connections between
other nerve cells and to help modulate the chemicals that are released between neurons,
you know, the neurotransmitters to again, to help the cells communicate and talk to
one another.
And with and with that will be some return of the of the nerve function.
So there's different compounds that are being developed.
There's one that's been recently shown to help spinal cord injured animals and hopefully
humans soon to restore some of those connections.
There's been electrical stimulation to the brain where they put electrical things on
this in the scalp to help pass electrical currents across the brain to try and help
stimulate some of those same thing with the spinal cord injuries.
There's electrical paddles that we can put in on the area of a spinal cord injury that
can stimulate those nerve fibers to try to restore some of the muscle function.
So there are some exciting frontiers, if you will, trying to restore function.
You know, Elon Musk has the whole, you know, neural link with which I think seems incredibly
fascinating with the recent one trying to get people that have been blind to see by
again, put in putting electrical paddles on the occipital lobe, which is the area of the
brain that controls vision and having that whole interface where people can start to
see.
So I think, you know, 10 or 20 years from now, I'm excited to see what's available
to help people restore function, you know, following, you know, following strokes or,
you know, spinal cord injuries.
What about stem cells?
What are your thoughts on where they will be effective?
And then maybe some kind of urban legends on where they were.
Yeah, you know, I think I'll go down again.
The brain is in the spinal cord or very unique.
You know, it's all about how the fibers connect.
And, you know, the stem cells, it's kind of been a bust so far with all the studies that
have been done, you know, to try to, you know, restore some of the function with stem cells
in the brain or spinal cord.
I know there's been experiments, you know, doing intravenous stem cells, different kinds
of stem cells, you know, umbilical stem cells or bone marrow stem cells, giving them in
different ways.
But so far, none that have gained any FDA approval or acceptance because they just so
far haven't worked.
Now that might be great for sticking stem cells in a knee or maybe sticking stem cells
in a degenerated disc.
You know, maybe there's some utility there.
But so far, for the spinal cord and brain, haven't seen too many promising results as
of yet.
Yeah, I'm hoping it will work for the knee.
I've got two meniscus that are missing a large part.
So I'd love for them to figure out how to make that grow back one day.
Yeah, wouldn't that be nice?
All right.
Well, I want to go to Transcend.
I came across them when I did the 7X round the world project with Ryan Parrott.
I think was that two years ago now?
I think it was.
And met Brendan and some of the other guys and was blown away by the foundation, you
know, the fact of, you know, the veteran founder Ernie and obviously his story and the why
behind it and saw such an altruistic organization that was doing this particular area the right
way, in my opinion, says James.
What was it, you know, you're this, you know, as you said, you know, one in a very small
amount of neurosurgeons on the planet, you could probably align with any company you
wanted to.
What was it that drew you towards Transcend?
Oh, you know, Ernie, as you've met, is a very dynamic fellow, highly intelligent.
You know, when you first meet Ernie, as you know, he's a ex-Marine, very intense guy,
you know, big muscular guy, you know, tattoos, you know.
So physically, he's a very impressive man, right?
But when, you know, you spend five minutes talking to Ernie, you realize this guy, he's,
you know, coming from the brain surgeon, he's one of the most intelligent guys I think I've
ever met, just a very dynamic personality, full of creative ideas, and has a roadmap
of how he wants to get there.
So I was very impressed from the first meeting I had with Ernie.
And you know, the vision he has and the reasoning behind it, right?
He didn't want to, you know, he didn't want to just start a company, right?
He didn't want to start an HRT business.
He wanted to start a way that's going to, you know, transforms people's lives and have
a place where people can come to, to get answers to elements and, you know, that they're not
getting it from their standard, you know, medical community.
And it makes people's lives better.
And he had a special slant, you know, through the Transcend Foundation, of helping, you
know, his fellow, you know, special forces guys, you know, the armed forces, first responders,
firemen, policemen, trying to deal with the special needs and the unique circumstances
that they have, and making sure that part of what we're doing can have a focus and help,
help these, help that special, special, that particular group of people that had issues
that were just not being addressed by anyone else.
So from the very beginning, Ernie had this concept of Transcend and along with that Transcend
Foundation from the very early stages of him starting Transcend, because that was his passion
to, to help the first responders.
So this is my perspective.
Otto, please jump in.
Carry on.
Oh, no.
Yeah.
So again, so that was, you know, that's, you know, you always got to be careful who you
hit your wagon to, right?
I mean, I had a love for regenerative medicine and passionate about this area of medicine
outside of, you know, neurosurgery and how it was starting to kind of blend with neurosurgery.
And Ernie knew was going to allow me to kind of, you know, kind of grow this area and get
more of this expertise.
And because this is a pretty unique, unique niche, right?
In medicine, this is not, I think Transcend does a remarkable job in trying to get in
the latest and greatest and, you know, kind of not the typical standard medical care you
get from your dock down the road.
So it's great to be on this cutting edge of these latest and greatest things that potentially
can help people.
So I was very fascinated by it.
We had that same, same personality.
It's like, he's just like a man full of creative ideas and things that he wanted to do.
And we were lockstep with that from the very beginning.
Well, you mentioned the dock down the road.
What's interesting in the last eight years of this podcast, I've again been educated
by all these people and I've realized that the pendulum was one way and it swung completely
the other way.
So Kirk Parsley I had on the show was really listening to him on barbell shrug is why I
started this podcast.
Navy Seal turned physician really unpacked after about a year.
He kind of had the penny dropping moment where he realized, oh, this is sleep.
That's causing my elite war fighters to have, you know, blood results like an 80 year old
woman.
And you start hearing about, you know, the range that most of us were subjected to if
they were even testing our testosterone at all.
So it was the, I forget, was it one or two 50 all the way to nine 50.
And he was saying that in the Northeast, one of the Ivy league schools had studied a town
and the nine 50 was a high school football player and the one or two 50 was the eight
year old sedentary dude, you know, two days from death.
And so you've got these 30 year old first responders going into their annual checkup
and they're like, oh, your T is three.
You're fine.
300 you're fine.
You're within normal limits, but they were not within normal limits.
Then a few years ago, all of a sudden these recharge and men's clinics started popping
up everywhere.
And then I see an absolute epidemic of the same young first responders.
Now we sometimes even without blood tests being given TRT.
And so now it's gone all the way the other way.
No one's talking about sleep or changing the shifts or nutrition or strength training and
all the holistic things that you want to address first.
No one's talking about peptides either.
And so now you've got these young first responders, they haven't been told about losing their
hair infertility, you know, the the for lack of a better word, the bitch tits.
I mean, all the things that come along with, you know, if you're not using it properly.
So I see a complete predatory element to this.
And my men and women are a lot, you know, more often than not, the ones being preyed
upon because they don't know better.
That's James Gearing's perspective.
What have you seen as far as the the hormone supplementation element through your eyes
over the last eight, ten years?
Yeah, you know, it used to be really taboo.
Right.
I mean, you look back further than that 15 years ago, you know, TRT clinics weren't a
thing.
You know, it was testosterone.
It always had a bad connotation.
Oh, you're doing steroids.
Right.
So it was just it had a bad connotation.
Like nobody would talk about TRT.
You never saw advertisements for TRT.
And even the doctors like myself was trained in med school that testosterone is bad, you
know, to give you a heart attack, to give you a stroke, like state, you know, you can't
do any can't do testosterone.
That's how I was trained in med school.
Testosterone is bad.
Right.
And, you know, so so if you went to your doc and your your level was 300, you know, oh,
yeah, the normal is 290.
You're 300.
You're good, man.
You know.
And maybe it was 300, but you got the whole talk where like, oh, well, you know, you're
getting old, man.
Just kind of what happens.
You know, you're you're not 20 year old.
Your testosterone 20 anymore.
Your testosterone is dip dip.
And that's what happens.
You know, this whole concept of, you know, andro-paws, you know, like women go through
menopause when they lose their hormones and men going through andro-paws, you know, just
a fact of life.
You just got to got to got to live with it.
But then, you know, more and more data started coming out showing that not only is quality
of life can be pretty miserable with low testosterone levels, but also the health disadvantages
from having low testosterone levels, right, where you're higher risk for having high blood
pressure, you're higher risk for having diabetes, you're higher risk for having frailty and
ability from loss of your muscle tissue.
You know, you're high risk for having high triglycerides and Alzheimer's, you know, with
low hormone levels for men and women.
So then, like you said, the pendulum started to swing the other way, where it's like, OK,
not only are people suffering quality of life with these low testosterone levels, but are
also setting them up for setting them up for failure later in life over the next 10, 20
years, 30 years, because we didn't properly balance the hormones because they were, you
know, quote unquote, normal.
So you know, there's a way, there's a right way to do it where you check in the blood
work, you're following up clinically, you're following up with patients, you know, making
sure that things you want better are getting better and making sure you're avoiding side
effects.
You've got to be in a place where the doctors are familiar doing that, the clinics are familiar
doing that.
The issue is when people try to, yeah, they go to a clinic, doesn't know, or they're doing
it, getting it from a friend, MIT is low.
And you know, people sometimes have no idea what they're doing.
You know, they get on chat rooms and they'll get all kinds of wild advice on what to do.
And that's when you start to see the real complications, issues, problems arising from
TRT, which should be a safe, you know, thing to do that's important for your overall health.
You know, like at Transcend, we get the, we run through the list.
Okay, what are you doing?
What's your lifestyle like?
What's your exercise program like?
Tell me about your job.
How much stress are you on?
How much alcohol are you drinking?
You know, are there things we can modify that may naturally boost your testosterone up all
by itself without having to go on any medication whatsoever?
So part of what's great about, you know, Transcend, as you've seen, there's wellness specialists,
right?
There's wellness coaches, almost like a life coach where you know, they'll do the intake,
they'll get to know the person and they'll go through all these, all these life factors
that may be contributing to where, where they're at.
Yeah.
But now that there's clinics that are established and able to do this safely, I think doctors
and people, you know, the community nationwide are starting to realize, okay, you know, it's
not taboo to talk about my low testosterone.
You know, I'm not less of a man because my testosterone is 200.
I can actually get help and it's not taboo and I can do it safely and I'll have a doctor
that follows me.
And you know, and then once you get on the TRT and people do so well, you know, people
talk about it, you know, talking about their buddies.
Yeah, man, my test was 300.
The doc said I was fine.
It wasn't fine.
I went to a TRT clinic and now I feel amazing.
I've got my energy back.
I'm working out again, losing my dad bod.
You know, I feel so much more energy.
I'm back in the gym now because I have the energy for it.
I can really crank out more sets.
I'm more motivated.
You know, I'm happier.
I'm not, you know, having the brain fog.
My libido is back.
You know, I'm having sex with my wife again.
You know, all these things that just have, you know, improved quality of life.
You know, people talk about it.
So just like, you know, so many referrals that I get are just like, you know, a friend
or it's a brother or something.
You know, it's just like, you know, people know to come to a place that, you know, where
they can get help.
What was interesting, I was always very mindful during the fire service and I, you know, kept
the same body composition through the whole 14 years.
You know, I've been an athlete, you know, aware of what I eat.
I went through, you know, plant based for a bit and all kinds of stuff and just, you
know, really looking at my blood work each year and going, okay, is this good?
Okay.
The cholesterol is a little high.
Let me, let me take some of the fat out, et cetera, et cetera.
I transition out the fire service.
And when I get my blood work done, I'm still either 50 years old, either side of 700.
But like you said, it's a number.
I still didn't feel like I was, you know, where I needed to be.
And I'm not talking about, you know, size.
I have no interest whatsoever being bigger than I am air quotes, but I know, you know,
the energy levels that I should have.
And I look back and go, well, I did not sleep for 14 years.
That would have taken a toll.
So I already addressed, you know, the lifestyle things.
And so for me, the next step was the peptides and I take, um, um, a clomiphene.
Is that right?
But yeah.
So, um, I had some other ones and I actually tapered down, um, you know, when we were going
through it with, with my, um, counselor from you guys, I was talking to initially it was
too much for me and I tapered down and found the perfect, perfect thing.
So this is, this is the thing, just because your number in a doctor's office says, you
know, whatever you can, you know, lifestyle is the first thing.
Um, I'm obviously an example of that.
You can absolutely elevate it through lifestyle alone.
But if you've been on shift for that many years, you know, it's probably taken its
toll maybe naturally and supposed to be a little bit higher.
So for me, the peptides were the perfect, you know, middle ground.
I didn't have to go on TRT, but they were actually just stimulating my body to just
make a little bit more probably what I would have made had I never been a firefighter.
So talk to me about the world of peptides.
Peptides are fascinating.
The human body, what is a peptide?
It's a definition of a peptide is it's a string of amino acids.
You know, people know amino acids that make proteins, but these are short segments of
amino acids, um, that, uh, have all kinds of ways to, to, um, a different functioning
in the human body.
And there's tens of thousands of peptides that have been identified in the human body,
you know, that have various functions.
And we've only scratched the surface.
I mean, people, everybody sort of insulin, right?
Since the 1950s, um, insulin's a peptide, you know, there's VIP, the ACTH, there's
all kinds of things that are in clinical, um, use at hospitals every day, uh, that are
peptides.
Like we're only scratching the surface.
I believe there's about 70 or 80 peptides that are in clinical use in the United States
out of the thousands, tens of thousands that have been identified.
Um, so there's so many peptides out there.
Um, and peptides are a great compliment to healthcare.
And I've, I've just found great utility and success in patients, um, because they can
do a lot of things on a more natural way to modulate, um, cell function or tissue or tissue
function, um, not radically change it, but, um, you know, help enhance something that
a cell is already doing or an organ is already already doing.
So like you mentioned, uh, like I said, there's, uh, peptides for say, uh, um, say growth hormone.
Um, there's peptides that, um, cause your body to release more of growth hormone out
of your, out of your pituitary gland.
So what is, what does that do?
Uh, well, um, that creates IGF, right?
So these peptides do work in a lot of different functions in the body, including in tissue
repair and regeneration helps you build muscle, helps you burn fat, helps you sleep, have
sexual function, helps change your lipid profile, your triglycerides, you know, so, so these,
there's peptides out there that we can use to kind of supplement.
I almost like to, people have heard of TRT, testosterone replacement therapy.
Um, I like the word PRT, which is, you know, peptide replacement therapy, because these
are all peptides that your body makes.
Um, but like with a lot of the hormones and things that we have in our body, the, the
levels start to diminish with age, right?
Like say testosterone, your levels can drop anywhere from one to 3% per year over the
age of 30.
Um, so it might not sound like a lot, but you know, you had five, 10, 15, 20 years,
you know, there's a fair amount of men out there that now kind of start to dip into the
low testosterone range, right?
And peptides are the same way, you know, peptides can start to diminish with age.
Um, so a lot of what we do is again, peptide replacement.
We're restoring your normal, uh, levels of these peptides that have some very important
and integral functions, uh, in the human body.
Um, so, so peptides, they're everywhere now, right?
I mean, there's peptides, you see them, they're in skincare products, they're in shampoos.
I mean, they're, there's in vitamin drinks.
I mean, there's peptide, peptide, peptide.
Um, but, uh, there, so that's exciting field and certainly we have many that we use every
day, uh, to help, um, help, you know, people, you know, get better.
Yeah.
Well, I can attest, um, one question I have while we're talking about this, I know with
TRT, you know, certainly if you're using it for a certain amount of time, there's a reliance
on it.
The testes are literally atrophying the body's leaning into the exogenous testosterone now.
So that individual is most likely going to have to take that the rest of their life.
What about the peptides?
Is there an ability to come off them or is that something that if you use the body thinks
it's got enough and is actually making less?
Yeah.
So like the, the, the protocol you mentioned within Clomophene, it's been around for decades
and what it does, um, it's, it stimulates your body or pituitary gland to release, um,
two things.
It's a one called FSH, uh, follicle stimulating hormone and LH, a luteinizing hormone.
And one stimulates testosterone production in the testicles and the other one stimulates
sperm production in the testicles.
So when you're taking in Clomophene every day, you're getting a high level of that FSH
and LH.
So you're really sending your testicles into overdrive.
Um, so in the fertility clinic side for guys that have low sperm counts, uh, in Clomophene
can help boost the sperm counts up quite a bit, you know, for fertility purposes.
But for what we use it for, um, is to make those testicles make more testosterone and
you can get some pretty robust changes in testosterone levels from in Clomophene.
I've seen guys go from 200 to 1500.
Of course that's overshooting the mark, uh, but that's how profound the testicles can
respond to in Clomophene to naturally boost, uh, your, uh, your testosterone.
It's like whipping a race, a race horse around the track and you make the horse run faster.
Um, and to answer your question, then with the same analogy, if you come off those medications,
uh, like say you do it for five years, 10 years, whatever, decide you want to come off
for whatever reason that is, most people don't.
Um, but if you decide you want to come off, well, it's okay.
Well, if you stop whipping the horse, it's going to go back down to its trot.
You know, things are going to slow down.
Um, and you're going to drift back down to whatever your natural levels of FSH and LH
were.
Uh, again, you're no longer whipping the horse.
Um, and, uh, let's say, but say 10 years passes.
Okay.
If you're already testosterone was already low and then now you advanced 10 years, you
know, what's going to be 10 years from now, probably lower.
So if you stop, you're in Clomophene and HEG.
Okay.
Well now you're sticking that only to your old levels, but also probably even worse than
your old levels.
Cause now it's 10 years later and you know, guys start to feel like crap again.
All the low testosterone symptoms come back.
Um, so I mean, you can come off of it, but the reality of it is, um, you know, a lot
of people choose to stay on just because they get all those symptoms come, come back and
then some, um, because their testosterone levels sink back down.
I think I responded well because that's all I take now.
And I take dihex, which I want to ask you about in a second.
And then BPC one five seven, which I love for the whole joint health thing, but I forget
the other two I was on, but it got to the point where my nipples hurt and I cried all
the time and it was either used an estrogen blocker or my, my, again, that, that titrate
to effect.
I was like, or not, you know, obviously clearly.
And so by the time I came down, I think just with the clomophene, um, it was still up like
nine 50 ish.
So I'm like, this is perfect.
This, I feel good.
I can, I can exercise.
I can recover.
I'm not lifting anything crazy.
I'm not superhuman.
I haven't put on a bunch of muscle.
It's right in that sweet spot.
So it's, it's so great to see that something is, you know, as safe and, and, uh, uh, like
I said, minimal effective doses of peptide is, is the thing a lot of people don't realize
is out there as well.
And if you are that 30 year old first responder that you don't need to go to TRT, because
as you said, you know, now if your testes are basically not working anymore, you come
off that you're, I mean, you're, you're tanking, aren't you?
You're dropping big time.
Yeah.
I mean, TRT is sometimes it's, you know, we have people that go on TRT, you know, if they're
younger guys, we try the enclomaphen-HTG.
We do the lifestyle modifications, make sure we've done what we can there.
Um, that, you know, some, some guys just go into early testicular failure.
You know, they have for whatever reason, you know, genetically their testicles just, they
stop producing adequate amounts of testosterone.
The brain's trying to force them to make more.
They're not, and testosterone is the right way to go.
Um, but those are, you know, for the young guys, um, usually it's the enclomaphen that
makes a much better choice because we're not altering, you know, their testicles.
We're not, you know, going to shut down their testicles and their fertility, um, on TRT.
Even though there's a ways to try to preserve that.
Um, you know, the non testosterone route, um, is always, uh, you know, preferred over
the, for the younger guys for sure.
I told my wife that it increases sperm count and we, my oldest is about to graduate and
go to college in the summer.
So she's like, okay, you need to stay away from me if I'm even close to being fertile.
Be careful.
All right.
Well, TRT has an application as well.
And certainly, you know, I've had a lot of people, either they're, they're older or,
you know, some of our law enforcement, military, you know, some of the TBIs and things that
they get that can even anatomically stop production.
So talk to me about who would be the right fit.
And again, let's kind of take a deep dive into, um, the, the, the cautions, the things
that, that, you know, might happen as far as fertility and hair loss and that kind of
thing.
And also how transcend specifically how you're able to monitor that, the, the blood tests
that you do to try and try and get these people at the right levels.
Yeah.
Like with anything else, you know, before you start treatment with any that you're going
to go to the doctor before you start any treatment, it's always taken a thorough history, right?
Finding out what's happened in their life, what current medications they're on, lifestyle,
what do they do?
What's their diet, exercise, you know, cover all the bases, right?
So you get to know the patient so you can meet them where they're at.
Right.
So that's first.
You know, do a lot of blood work, you know, do that thorough evaluation again, see where
people are at, uh, see what's potentially modifiable just based on a lifestyle modification.
Um, but let's say all directions, uh, you know, symptoms, blood work, everything's lining
up, um, that say, okay, this man who's 40, um, has testosterone of a, you know, two 50
fills all the symptoms of low testosterone feeling terrible, right?
Uh, the whole list of low testosterone symptoms.
Uh, then yeah, he'd be a great candidate for some type of testosterone and there's different
versions of testosterone on the market, right?
There's pellets, seeing them implanted in your skin, there's creams, there's patches,
there's the roll on deodorant thing.
Um, you know, there's, uh, the ones that dissolve under your tongue, you know, there's all kinds
of formulations of, of testosterone.
Uh, my, my preference or my opinion has always been that the intramuscular injections, uh,
work the best, uh, cause we know you're going to get a hundred percent of your, your dosage,
you know, stuff that you wipe on topically.
There's a problem with transference, which means it rubs off or rubs off to your spouse
or children even.
Um, so you gotta be real careful with the topical stuff.
You know, the pellets, sometimes they can spit out.
It's hard to control the dosing with those, you know, it can take some time to get that
right.
Um, anyway, so if we decide that whatever formulation of testosterone, with my preference
being the injections, if we're going to do testosterone therapy, well, then there's got
to be some follow-up, right?
We're going to start you on to, on the testosterone to try and get you into that sweet spot of
physiologic range.
Shoot for maybe the upper third of the range.
You want to overshoot cause that creates problems.
Uh, but get you kind of upper third of the range.
Uh, it's usually a good range to shoot for.
Um, let them, you know, we start for three or four months doing the, doing the testosterone
and then we recheck blood work, follow up with the patient.
Say, Hey, how you doing?
How's, how's the program going?
Are we seeing some differences?
You know, what differences are you seeing?
Um, are you happy?
Are there any side effects?
So what problems have we, have we caused, if any, um, you know, and then we can, we
check around to blood work.
Okay.
So look, here's where your testosterone was here.
You know, now it is here, you know, we've got to follow estrogen levels because testosterone
will be, uh, metabolized, um, or, uh, into estrogen.
So it's very common that we'll see estrogen levels rise.
Um, very common and in and of itself, it's not a problem.
Uh, some guys are very sensitive to, to estrogen levels and if their estrogen level gets to
50 or 60, they can start to get that nipple sensitivity.
You know, the areolas get sensitive or, you know, they can get swollen.
And if that's not addressed or corrected after many, many months, um, with high levels of
estrogen, uh, then you can get some of the gland in the breast tissue in a man can start
to hypertrophy.
They start to get glandular hypertrophy in the breast tissue.
Um, like what you called earlier, bitch tits, gynecomastia is the, um, is the technical
term.
Uh, and that can be a permanent thing if that tissue hypertrophy is enough, you know, so
then that the only way to get that out is for surgery.
Um, so again, so that's the, that's what happens in the long run.
Of course that transcend, you know, it would never happens because we follow patients clinically,
like they're followed by the physician and our PAs and they're followed by blood work.
Our wellness specialists are checking up.
So any of those problems, even at the first suggestion of those kinds of problems, uh,
we're addressing them.
Um, so again, so we've got to follow estrogen levels very closely.
There's ways to, to manage that.
Usually it's a matter of the dosing issue.
Like, like you said, with urine, clomothine overshot the mark, too much testosterone, too
much estrogen.
You started having problems, you cut down, you're in clomothine and things got better.
Same thing if you're doing testosterone injections.
Okay.
Well, maybe 200 is too much for you.
Let's drop you down to 180 or under 160 milligrams a week and let's, let's see how you're doing
in three months.
Um, you know, sometimes it's guys are just so sensitive that they can have, you know,
even barely, you know, high range estrogen is still in the normal range and they're getting
the same high estrogen symptoms.
And then, you know, we've cut their testosterone dose still doesn't help.
People put them on an estrogen blocker, very judicious, tiny uses of estrogen blockers
because those can have side effects.
So there's ways to manage it, but you got to be on top of that stuff.
Um, you know, like I said, following up clinically in blood work.
The other issue that's common is, uh, there's always a physiological response of your bone
marrow to any type of male hormone, any type of androgen, including testosterone, uh, where
it stimulates the production of red blood cells.
So it's a pretty much every patient who gets put on testosterone, um, will have a rise
in their hermetic rate and hemoglobin, you know, the amount of red blood cells.
That's a physiologic response.
Your bone marrow pumps out more red blood cells.
Uh, that's great.
You know, so now you have more oxygen carrying capacity.
Um, you know, it's great in and of itself, having a high red blood cell count, um, is,
is not dangerous.
Um, so some, some people think if you're on TRT because your blood counts are going to
go a little bit higher than I have to donate blood routinely, no, you don't.
Um, you know, if you look at the Sherpas and Himalayas or you look at, uh, uh, Lance Armstrong,
you know, the cyclist, um, who was busted for doping, he was using a drug called erythropoietin.
What does that do?
It stimulates your bone marrow to make more red blood cells.
Cause you have those higher blood levels.
It means you can carry more oxygen, which means, uh, your aerobic capacity is higher,
right?
So you can't do that.
That's cheating.
I mean, people that live at, live at high altitudes, um, up in the mountains, the Sherpas,
they have higher hemoglobin and hematocrites cause they need more oxygen carrying capacity.
The body just naturally produces more red blood cells for them.
Um, so that they have, uh, they maintain normal oxygen levels.
Um, anyway, so sometimes people will get alarmed, you know, patients get alarmed.
We have to educate them that this is a normal response.
It's no concern.
Um, sometimes the primary care doctors will see the blood levels and want them to donate
blood and that's fine.
If the primary care doctor feels that strongly about it, uh, they can donate blood.
Typically it's not a recommendation.
Um, you know, sometimes people will think, Oh, if I have a high blood count, that means
I'm gonna have a stroke.
Well, the problem is it's often confused, uh, with other blood disorders like polycythemia
of era or other blood, uh, uh, marrow, uh, bone marrow problems where not only are the
red blood cells high, but also the platelet counts are high.
And it's the platelets that cause the clumping of the blood.
So if you have these other conditions, uh, that have right blood, high, high red blood
cells and high platelets, okay, that's the recipe where, you know, uh, we worry about
blood clotting and strokes and the arteries or veins or the brains or the heart attacks.
Um, you know, but that's a completely different disorder.
And unfortunately there's a lot of people just kind of confuse the two.
So people see, Oh, high red blood cell count.
Oh my gosh, I'm going to stroke out.
Uh, it's not the case.
Like I said, that's an expected response, you know, from TRT.
We monitor it, you know, we watch it.
It's extremely rare that someone gets so high that we're like, okay, yeah, maybe she go
donate it a unit of blood.
I mean, I, I don't know the tens of thousands of patients that I've treated, you know, I
can count maybe on one hand, how many times that's been necessary.
So, um, yeah, so we're checking national levels, checking the hemoglobin levels, um, you know,
always keeping an eye on the, the lipid levels of, you know, the triglyceride levels.
Um, yeah, so as long as you're being monitored, you get a physician following you, checking
blood work intermittently, uh, then you can, then it can be done in a safe and reasonable
way.
You know, this isn't, you know, unfortunately people who are uneducated think, Oh, I'm on
TRT, I'm taking anabolic steroids.
Well, okay.
Is testosterone anabolic steroid?
I guess, you know, technically sure.
Uh, but we're doing, you know, physiologic ranges.
We're giving you what you had or what you should have as a normal human male, you know,
keeping a normal healthy range.
And we're not giving you super massive doses, super physiologic doses to gain, you know,
muscle.
You're not doing a cycle for a bodybuilding competition.
You know, we're talking about, you know, small reasonable doses to give people feeling good
and keep them healthy.
What about our female tactical athletes?
Um, you know, obviously we all have most of the same hormones, but, um, you know, when
you look at, for example, HRT, it seems to me, and I might be completely naive, but it
seems to me it's kind of a one size fits all as well, but every woman is going to be different.
So with different hormonal profiles, what are some of the common, um, kind of, uh, medication
prescriptions that you find amongst the females, you know, whether they're military first responders,
um, that maybe are surpassing what they would get if they went to their GP.
Yeah, you know, in our world, in the, in the, in the HRT world, uh, in this health and wellness
realm, uh, women and testosterone is very common.
I prescribe a lot of testosterone for women, which I think, you know, a lot of people just
say, what, you know, give testosterone to women.
Um, and sometimes the primary care doctors, OBGYN doctors, I think some of the newer age
OBGYN docs and the newer trained doctors, uh, understand that testosterone is vital
and essential for women just as much as it is for men and that women make small doses
of testosterone as well.
And the ovaries, every time they cycle, you know, they make, uh, estrogen, progesterone
and testosterone and their adrenal glands also produce, you know, small amounts of testosterone.
Um, so when women have low testosterone, they get the same set of symptoms as men with low
testosterone, right?
They get the energy sucks, they get the brain fog, their libido is shot, you know, they're
by the body composition changes, you know, so for the, so for, um, for females, especially
the ones that are on birth control pills, right?
Which is a big percentage, um, because you're shutting down ovulation, you're shutting down
the maturation, maturation of the follicles every month so they don't ovulate.
Well, can we not going to get the estrogen progesterone and which is covered by the birth
control pills, but testosterone is like, uh, just kind of left out in the cold, like, you
know, that's never addressed.
Okay, let's stop you from cycling and stopping you from ovulating as birth control.
What about the poor little testosterone?
Like you know, it's, it's never, it's never addressed.
And I would tell you, it's not unusual.
In fact, we see it all the time.
If women get their blood work checked and their testosterone levels are close to zero,
if not zero, you know, and then, so those birth control, um, pills can have significant
side effects, you know, get leading to again, leading to the low testosterone symptoms because
it wipes out their testosterone too and is never addressed.
So for, for, um, the women that are savvy enough and they, they understand this or they,
they look into it, they come to transcend, get their blood work checked, say, oh yeah,
you have no testosterone.
So as part of their treatment protocol, you know, if their symptoms are as such, uh, then
doing low doses of testosterone for women is, is great.
They do amazing on low doses of testosterone.
Uh, they're very thankful.
Again, libido comes back, they have more energy, they're, they're, they're workouts are more
intense, you know, they're sleeping better.
There's all these things that come along just like men.
Um, but you know, women sometimes are concerned, oh, I'm gonna, you know, I'm going to get
all jacked, like, you know, I'm gonna get big, you know, no, you're not.
Now we're using, you know, tiny doses just to restore you into a, you know, something
that's good physiologic range.
Um, you know, so we're now you're not there.
So no one's going to get masculinized, right?
They're not going to go on Adam's apple, you know?
Um, sometimes women are worried that they're going to, you know, do those things, but in
reality, you know, testosterone replacement in women is very common, very successful and
very safe, uh, uh, as long as they're being monitored.
So yeah, so the female athletes really appreciate it because again, they, again, they get the
same benefits as the men, their intent, their workouts are stronger, intensity is better.
They're able to get better results with their lean tissue or, you know, building strength,
uh, than when their testosterone's are zero.
Now the other side of the exercise equation obviously is, is injury and inflammation.
I have really been blown away by BPC one five seven.
I mean, my poor body, I was a stunt man, I was a firefighter, I was a martial artist.
It's, it's, it's been battered the last 50 years, but I've been amazed.
I mean, it really absolutely has helped along with the corrective exercises that I continue
to do, you know, parallel to that.
So talk to me about that particular peptide.
Yeah.
BPC one 57.
It's, uh, I love it.
It's an amazing peptide.
I love it.
Uh, prescribe a lot of it because it works so well.
Um, and, uh, basically the, uh, it's, uh, something that was initially found in gastric
juice.
It's called body protective compound and it helps the stomach lining and the intestinal
lining, um, pretty, it protects it from getting broken down by the, all the digestive enzymes
that the acid in your stomach and the digestive, digestive enzymes from your pancreas.
So it helps to protect the stomach lining.
Um, and then they also found out as they did research on it that, Hey, this is actually
very important for inflammation throughout the body.
And it's, you know, BPC is found in every tissue, every cell in your body.
Um, so when you, uh, replace BPC, the orally or through injection, it has a very potent
anti-inflammatory effect.
Um, and, uh, can, and help, you know, ligaments and tissues heal as well.
There's a experiment where they actually cut Achilles heel, um, and gave, uh, BPC 157.
The Achilles heel was able to completely restore itself.
Um, so I was in the one of the early experiments with BPC, but, uh, but anyway, but it's, uh,
it's a very effective, uh, I've used it before.
Same thing.
I had a really sore shoulder from a lifting injury and a few weeks of BPC, you know, and
it was gone and never came back, you know, whereas before I had that nagging thing and,
you know, I would have to take motoring for weeks.
Uh, but, uh, you know, around a BPC and it's been golden.
So, um, so speaking from personal experience too, but yeah, it's, uh, it's a great healing,
you know, anti-inflammatory, uh, compound, you know, people usually run for, do it for
a few weeks, you know, say six weeks or eight weeks.
Like you said, like you did, you do the appropriate physical therapy and just, you know, don't
re-injure it right away.
Um, so BPC is great for those arthritic injuries.
We also use it for oral routes too, uh, for some of the inflammatory bowel disease, you
know, people having digestive issues.
You can work very well as an oral capsule too.
Yeah.
I've been taking the oral ones.
That's something that I should cycle off at some point or is it something you can continue
to take?
You know, you know, it's good for the gut microbiome.
Like I said, it helps to keep a healthy, uh, bacteria and helps reduce the inflammation
and you know, kind of promotes, you know, good healthy immunity in your, in your gut.
Um, but, uh, most people just would cycle it.
You know, they'll do it for, you know, again, a few weeks for, for an injury, um, and then
that come off.
So probably don't need to take a year round.
Okay.
Beautiful.
All right.
I want to hit one more, um, of the products and then we'll kind of round out.
Dihexa.
We're talking obviously about the brain a lot.
A lot of people listening are chronically sleep deprived.
I mean, I was a martial artist, like I said, so I've had deep sleep deprivation and head
trauma, a beautiful, you know, double edged sword there.
So talk to me about that peptide and the different, uh, areas that you see an improvement with
it.
Yeah, you know, the hexa, uh, it's a, a compound kind of falls under the, uh, kind of the heading
or the category of, uh, neurotropics.
And there's several that kind of listed into that category, but they're peptides that are,
um, have most of their usage or most of their function is in, is in brain cells and the
nerve cells.
And what dihexa does, it helps to stimulate the production of that BDNF that I mentioned
earlier, that brain drive neurotrophic factor, uh, which is very important for stimulating
or for modulating, uh, neurotransmitter release like the serotonins and the dopamines and
or a penephrine, uh, you know, between cells.
So it, uh, so it, uh, enhances that enhances that neuroplasticity, which helps development
or of connections or the way cells, the nerve cells will talk to each other.
Um, so that's why BDNF is so important and the dihexa is directly involved with that.
Um, so the, so dihexa and it's, I don't say it's like, it's like an Adderall, it's not
that, it's not a stimulant, uh, but frequently patients will say it's almost like an Adderall
like effect where they can have more focus, more concentration.
Um, personally, when I take it, I feel like I'm funnier.
I don't know.
Um, but people just feel, uh, but people just, they can definitely feel like, you know, they're,
you know, they're learning better.
They can remember things better.
Uh, it really just enhances cognition overall.
Again, kind of like some of the features that Adderall does, uh, but it's not, it's not
a stimulant like that.
It's not addicting like that.
It's just, it's a naturally occurring peptide that stimulates the nerve cells, uh, in that
way.
We've covered a host of things.
Um, you know, some of the, the, the things that the products that, uh, Transcend offers
and you know, the, the blood tests and all these other areas before we close out, are
there any other areas or any other elements of Transcend that you want to discuss?
Uh, you know, I'd like Transcend because it's, you know, we, as the medical, on the medical
side, uh, we're able to offer things that patients can't find anywhere else.
You know, I, I just all day we hear, uh, patients saying, you know, I went to my doctor and
he said, it was fine.
Did you get any blood work?
No.
Any testing done?
No.
He just said, oh yeah, this is normal.
And, but I don't feel normal.
Something's wrong.
I hear that all day long.
And I always say, well, you don't know, you know, you don't know what you don't know.
So you know, you do a full history, listen to people, you check their blood work and
like, say, be surprised how many times we find things like, oh, you know what?
Let's try doing this and see how that helps.
And you know, how many patients were able to help, you know, we see patients come back
and back and back and back.
And I think that's cause we, cause we take good care of them on the medical side.
Again, they get the followup to get the blood work.
They're getting these, uh, you know, these treatments that you just can't find everywhere.
So it's a nice, again, it's a nice kind of niche area of medicine.
We're able to get patients benefit and help them, you know, make them better.
Um, you know, so it's, it's, I have a lot of fun with it.
Patients do great patients.
Very thankful.
Um, it's a lot of fun.
And so, and like I said, I think, um, uh, in terms of your, um, your, um, uh, people
that tune in to listen to your, to your podcast, especially the first responders and, you know,
the military crowd, um, you can, we treat a lot of veterans, treat a lot of first responders,
um, because what we didn't have a chance to talk about, I know we, we covered a lot, but
we could talk for hours and hours.
Um, but it's just in that particular, you know, a group of people, um, you know, with
the brain injuries that we see in the PTSD, uh, they, that we, that we deal with in the
people that we treat on the transcend foundation side, uh, there's so many things that happen
in the brain, you know, not only structurally, but, uh, in the chemistry of the brain that's
associated with the traumatic brain injuries that people get, you know, on the job and
their training, you know, the, the explosions, the falls, you know, um, this, the PTSD even
in and of itself, uh, can cause so much, you know, problems in the brain.
Like I said, not only the structure of the brain, but the function of the brain and the,
and the hormone imbalances that come from even a single traumatic brain injury, you
know, all the veterans that we see that, that, uh, that come through the foundation.
I mean, they've, you know, they've sometimes gone for years, the whole list of problems
and then no one ever thinks to check the hormones.
It's crazy.
You know, whereas if you look at the, on the neurosurgeon side, if you look at my neurosurgeon
data, data, there's lots of studies looking at brain injuries in my neurosurgery journals,
um, that show even after just a single severe traumatic brain and brain injury, up to 30%
of those patients can have growth hormone deficiency later in life, you know, and, uh,
you know, and up to 30 to 50% in some studies will have, um, sex hormone, uh, deficiencies
or imbalances.
Um, so you get people that were spending years in the military and they feel like crap and,
uh, you know, they, no one checks blood work or they check their blood work.
Oh yeah, you're fine.
You're, your testosterone is 300, you know, and this 35 year old man, you know, it's just,
it's just sometimes it's just, uh, uh, you're just taking back sometimes about how people
forget about the hormones, people, you know, about how important these are, um, and how
the brain, um, is intricately, you know, responsible, uh, for, for those hormones.
And then, you know, with all the concussions and the brain injuries, the encephalopathy,
you know, the, the PTSD in and of itself, which can cause hormone dysregulations, it
just goes undiagnosed and unaddressed.
And like I said, I'm glad that I'm in a place like transcend where there's been so much
emphasis on the first responders and, and, you know, Ernie's the veterans, you know,
the Ernie's, Ernie's just such a, such a grand job of making sure that we've, we're taking
really good care of those folks that seek our help.
I've seen some of the foundations videos, you know, the testimonials of, of war fighters,
for example, that were pretty much at the end of their rope and then they actually get
their hormones regulated and all of a sudden they're, they're better again.
And not that that's the only thing, of course, as a psychological element too.
But if physiologically you are not functioning properly, which is sadly so many first responders
because of sleep deprivation has just crushed their, you know, their adrenal system and
their endocrine system, um, just getting that to get them on their feet and then have the
capacity to go seek counseling or do ayahuasca or whatever their magic toolbox is going to
be.
So, you know, addressing the simple hormonal balance that can be found out by a simple
blood test, comprehensive blood tests.
That's absolutely, you know, it should be one of the first things that we do with anyone
who's struggling is that, well, let's, let's test you for us.
Let's see what's going on numerically so we can adjust some of those numbers.
Yep.
Yeah.
It's again, it's amazing how often it's unaddressed and people just don't even think to look at
it.
And otherwise you're like a, you know, a fish trying to swim upstream.
Yeah.
You might make progress.
But, you know, with the depression and the anxiety and the symptoms of all the hormones
that are out of whack, um, and it has to be a critical part of, of treating, uh, those
types of, uh, situations, you know, with the PTSD or the, you know, um, traumatic brain
injuries.
Um, so it's, it's, it's essential.
Otherwise it's going to be so much harder to, to efficiently treat those things.
Absolutely.
Well, for people listening firstly, where can they find Transcend online?
Oh, they have a big, a good Instagram presence, TranscendCompany.com.
Um, and Transcend on Instagram, uh, they do a nice job, uh, with, uh, highlighting, uh,
the services that Transcend has and kind of how we function and what we do, um, on the
wellness specialist side and then on the medical team side.
You know, we have a big team of physician assistants, nurse practitioners, you know,
for Transcend's first point of contact.
Uh, they do an amazing job and then they get to talk to one of the medical providers, you
know, we're licensed at all 50 States.
And then, uh, we get a program going and get people going.
Brilliant.
And then what about you personally?
Were there any places on social media to find you?
Uh, yeah, I, uh, I am on there and Dr. Vana and I'm also on, uh, on the Transcend site
as well.
Brilliant.
Well, I want to thank you so much.
It's been such an amazing conversation.
We could have talked, as you said, we could have talked for hours and hours and hours.
I've got a thousand other questions I wanted to ask you, but I want to be mindful of your
time.
I want to thank you so, so much for being so generous with your time and coming on the
Behind the Shield podcast today.
Oh, James, thanks so much for the invitation.
Like I said, it's, it's, I, you can talk about passion for it and I appreciate the opportunity
to talk to you today.