Anti-Aging Medicine: Live Forever or Die Trying

Nipped and Toxxed Episode V: Antiaging Medicine - Now streaming on Spotify, Apple and Google Playlists

Ashley: Welcome to episode five of Nipped and Toxxed with 

Katie: hello 

Ashley: with me, Ashley Robey and Katie Reichert. I'm Dr. Ashley Robey. I'm a board certified plastic surgeon, actually quadruple board certified, and Katie Reichart.

Katie: I forgot that part. Quad board certified. I am a CPCP and permanent makeup artist. 

Ashley: Nice. 

Katie: Also aesthetic aficionado.

Ashley: absolutely. So today we're gonna be talking about anti-aging medicine. 

Katie: I'm all about anti age, me up. 

Ashley: Right. 

Katie: So Dr. Ashley Robey had me go get my blood drawn. 

Ashley: Mm-hmm 

Katie: and she's gonna read my labs and tell me I need to do no, 

Ashley: I will. But I need more than..

Katie: she's gonna do an abbreviated

Ashley: I literally just got them. They're hot off the press here. 

Katie: Right? So we're gonna do a whole remake anti-age meet?

Ashley: Yes. So anti-aging medicine is the field of practice where you are treating aging as a disease process. And so we're thinking about what can we do to slow and or reverse this process? 

Katie: Rewind.

Ashley: Because no one wants to age. Once you're mature. Once you're 20 something you're not particularly interested in...

Katie: what is the age of maturity? Isn't it like 25. Your brain's still growing. 

Ashley: It's like 26.

Katie: 26? Your brain's still growing till 26?

Ashley: You can buy alcohol when you're 21. So you don't have the normal decision making process that a fully developed adult would have. 

Katie: Hey, 26 years old. That's good. Okay. So tell me how to anti-age tell me how to age backwards. 

Ashley: Anti-aging or regenerative medicine, our focus is on those things that are associated with aging, things that make you look older, feel older, taking a look at those aspects, breaking them down and figuring out ways to treat that. So classically, if you were to have an antiaging medicine consult, it would start off just like most doctor's visits with a full history, a questionnaire, exam and then a lab panel as well. So looking at the various biochemistries and the current state of those things in your body and looking to see where you fall with regards to normative data. 

So, literally I'm just looking at your labs now. So 

Katie: while you're looking at that, what I typically think of when I think of antiaging therapies is hormonal drug therapies, which I think I told you this before, but I have been getting a little bit of hormone therapy over the past year mm-hmm cause my primary doctor told me my hormones were a little outta whack.

Ashley: Oh yeah? 

Katie: So I get...

Ashley: Actually I just peeked at one of those. Do you wanna talk about this right now? 

Katie: Yeah. 

Ashley: Well, your testosterone's high. 

Katie: Well that's cuz I get testosterone pellets. 

Ashley: Okay. You're still high. Your cholesterol's high.

Katie: Really? 

Ashley: Yeah. 

Katie: That's interesting. Cause my cholesterol's always been good. 

Ashley: Your vitamin D's low. 

Katie: I take a vitamin D supplement. 

Ashley: Do you really? 

Katie: Right!

Ashley: I mean it's not bad, but it's not optimal. 

Katie: Okay. So I need to sit out in the sun more. I'm a sun lover. 

Ashley: Are you? 

Katie: Yes, I would sit out in the sun every day if I could. I occasionally take a multivitamin. I need to take it more often. When I was pregnant, I took one all the time because you know, because of prenatal. And my hair was amazing then, and then I had babies and then I stopped taking that prenatal vitamin. So I've been taking neutro foil, which is a hair vitamin.

Ashley: Okay. 

Katie: And it doesn't have all the other stuff in it. And sometimes I take you know, whatever, just like a gummy multivitamin, cause I'm lazy. That's vitamin D I take fish oil. And thyroid, I take a thyroid medicine, 40 micrograms 

Ashley: synthroid? 

Katie: Levothyroxine. 

Ashley: Yeah. Nice. 

Katie: So what do you think? 

Ashley: Well, with the 30 seconds that I had to look at your labs, like you're in pretty good shape.

Katie: Okay. 

Ashley: But you need some tweaks. 

Katie: I'm all about the tweaks. Tweak me up. I have to tell you, my husband likes the testosterone. 

Ashley: Yeah.

Katie: Because it obviously enhances your libido. 

Ashley: He likes that you're taking it ?

Katie: Yes. 

Ashley: Okay. 

Katie: yeah, he likes that I'm taking it. 

Ashley: That's funny. 

Katie: Cause you know, after every you have kids, you're like a little bit outta whack, and the testosterone really helped when I used to wake up every morning and my whole body would hurt. 

Ashley: Oh. 

Katie: And so when I started getting the testosterone, it really helped that go away. Cuz doesn't it lubricate your. 

Ashley: I mean the hormones, each of the various sex hormones do a lot of things, and having low levels of any of those is not optimal. 

Katie: Okay. So what else now? What else with my anti-aging? 

Ashley: For anti-aging medicine, there are various subgroups of patients that are coming in here for those kinds of consultations. There is the group that, perhaps like you, comes in and is saying, well, in general, I I'm doing really well, but I am interested in the prospect of aging less... at a reduced rate. So that's one group of patients. Then we have patients that are interested in things like weight loss, people that come in because they have decreased energy- they're fatigued. People that...

Katie: I feel like I'm fatigued, but I have three kids. 

Ashley: Yeah. 

Katie: So I think that's my kids. 

Ashley: Kids are exhausting definitely in some ways, but then obviously it's very fulfilling too. So yeah, we see patients for a myriad of concerns. It just depends on what facet of that antiaging medicine, but because all of those health issues, whether it's being obese or having reduced energy are associated with more of a progressed aging state. So, in the United States, one third of people are at least overweight. Another one third...

Katie: so that's, it's the BMI over 30?

Ashley: Over 25, overweight. Over 30 is obese. 

Katie: Okay. 

Ashley: So that means two thirds of adult Americans are overweight or obese. 

Katie: I'm not shocked by that whatsoever. 

Ashley: It's a problem. Carrying around the extra weight is in and of itself inflammatory. And I think about the analogy of being pregnant and carrying around an extra 30 pounds of pregnancy weight.

Katie: Right. It's hard on your body.

Ashley: But for those patients, they're doing it all the time. So it is really hard on your body and, and it is inflammatory, and those patients tend to have more problems and age faster. 

Katie: So what do you have in the way of options as far as someone who wants to lose weight? If you have someone who's in that BMI in the obese category or overweight category, what would you have to offer them?

Ashley: The crux of any weight loss plan is always going be diet and exercise. Those things are obvious, but you'd be surprised the number of people that don't effectively implement those parts into their lifestyle. Some of it can be convenience. Some of it can be stress. It can be they don't have time to exercise or they don't have time or the money to buy organic, fresh vegetables. Unfortunately those kinds of things do matter. And as a populous, the American people, you know, you're seeing the direct consequences of that. 

Katie: And fast food, convenience into things. Yeah. Not looking at actual labels .

Ashley: Some of it is interesting just from a historical perspective. I feel like when I was a kid the whole low fat trend was popular.

Katie: Right? 

Ashley: But so I was reading, you know, Kellogg cereal. 

Katie: Mm-hmm 

Ashley: the maker of Kellogg cereal actually came up with that cornflake cereal because he described it as a quote "healthy ready- to- eat anti masturbatory morning meal"

Katie: masturbatory?

Ashley: Yeah, he thought that spicy or overly sweet foods would ignite your passions. And he wanted to have a breakfast that was bland so that people would not have their passions ignited and they would not...

Katie: what 

Ashley: fornicate and masturbate, I guess he was married.He's super religious. I know he got married and never consummated the marriage and adopted kids. Oh Lord. 

Katie: Sounds like he had some issues of his own. 

Ashley: The backstory of your Kellogg cornflakes, I suspect the average person...

Katie: I never wanna buy those again .

Ashley: but the interesting thing about it is that the precursor of testosterone and other sex steroids is cholesterol. 

Katie: Okay. 

Ashley: So that's the precursor of all the sex hormones. You need cholesterol to be able to make those sex hormones. You get cholesterol from fatty foods, right? If you are consuming a extremely low fat diet and instead of of healthy fats, you're substituting more carbs or potentially some more proteins, you'll have a lower testosterone level, right. You'll have a lower libido. So, you know, John Kellogg, he is right. And to some extent, interesting, like it does, it does put a damper on things.

Katie: Well, with that test, you had me track my food and it shoving the macros. And I was pretty good about the macros mm-hmm but, man, I should be way skinnier. Like I only eat like 1600, 1800 calories a day. 

Ashley: That's not very much.

Katie: Yeah. So I should be like tinier. So I need you to tell me what I'm doing wrong. 

Ashley: Well, the diet stuff is key and I'll tell patients things like, it takes me a half hour to exercise away. Let's say 400 calories.

Katie: Right.

Ashley: At least a half hour. Do you see high intensity? It takes me like 30 seconds to eat 400 calories. 

Katie: Oh, right. 

Ashley: So, the human body was designed to be in a time of famine. Like we're, mm-hmm, hunters and gatherers food is sparse. There's not a lot of choices we can survive, but that's not the case now - food is a plenty. 

Katie: Yeah. 

Ashley: It's so easy to get calories and it's, it's harder to burn them away. So if you're gonna make some kind of impact - Sure, go to the gym. That's great. That's helpful. It's good for your body building muscle mass burning calories. It's great. But you can't go to the gym a half hour and then eat two trays of lasagna.

Katie: But if you're tracking your calories, you're working out. Let's say, you're one of those people in the obese category, you're serving your calories, you're working out and you offer them an aid mm-hmm to help them lose weight. What are those a so.

Obviously you're a doctor and you're supervising all this.

Ashley: Right, you're already doing the diet exercise components. You're drinking water. you're getting sleep. I mean, I mean, I, I laugh, but it's, it's serious now. I, I wait, let's 

go back. How much water should you drink a day? How much sleep should you get a day 

you should sleep about....

Katie: I love sleep

Ashley: six to eight hours a day. 

Katie: Oh, I would love eight hours of sleep.

Ashley: And as far as how much you drink people say things like eight glasses. Yeah. 

Katie: I've been trying to drink between 75 and a hundred ounces. 

Ashley: If your urine is yellow, like darkish or medium yellow, you're definitely dehydrated, but if it's kind of yellow, you may still be a little bit dehydrated. So it should be just the slightest, hint of yellow. Okay. 

Katie: So keep drinking until you get to light yellow. 

Ashley: yeah, that's tough. Unless your toilet's white, you got like a tan toilet. you gotta get a toilet color.

Katie: and so what options do you have medically to offer people? 

Ashley: We will do things like peptide therapy.

Katie: I'm interested in this, for sure. 

Ashley: Yeah. So semiglutide is a peptide that has been associated with weight loss. Patients will take it for management of glucose issues and prediabetics and diabetics. But we all use different doses for weight loss purposes. 

Katie: I've tried that sublingually but it wasn't consistent. 

Ashley: So we usually do it in the subcutaneous. So like a small injectable yourself, you inject yourself small injectable dose and it has impacts on glucose/ insulin homeostasis.

Katie: and it kinda slows everything down, like the digestion process. 

Ashley: It improves the way your body metabolizes sugars and insulin sensitivity. There are some other peptides that are available. This is the one we've seen to have the most impact . there are some other ones like AOD and CJC 1296 that can help people lose weight. And for lower doses, people will take 'em for anti-aging purposes. Those are some of the growth hormone... 

Katie: What's a low dose?

Ashley: Just a smaller amount than you would take for weight loss, like maybe a third of the amount. But there are things like people being on stimulants, like Adipex right for weight loss. That works while you're taking it. But as soon as you're off the stimulant...

Katie: right, that's just a fat burner.

Ashley: Right. Yeah, it just revs up your metabolism.

Katie: And then when you stop taking it, you don't have that rev anymore, so you better be working out that hard to keep that going . Or you have to eat less. 

Ashley: So I have had patients that have lost weight on it, but then as soon as they stop it, they put it back on. As in a lot of things, if you haven't made the appropriate associated lifestyle changes then it's not gonna be effective. A diet has to really be a lifestyle change. It can't be I'm going to drink peppered lemon water for two weeks and lose a bunch of weight. Like, yeah, you probably will. 

Katie: Right. 

Ashley: Because if all you're drinking is peppered lemon water, you're gonna shed weight like crazy and that's not sustainable. What you called normal. Right. That's not sustainable. Right. So a successful diet has to be a lifestyle change where, in which you can permanently change the way you live and eat.

Katie: Right? 

Ashley: Not temporary. That's why diet don't work, because if they're temporary, right, it's only gonna work while you're doing it. It has to be something that you feel like you can do forever. 

Katie: How long can you do peptide therapy for? 

Ashley: Well, the idea is that you're doing the therapy, you're doing the lifestyle changes. And you continue that therapy till you're the ideal weight. So it's not forever.

Katie: And you have to do maintenance, but ..

Ashley: Yeah, but just maintenance of lifestyle. 

Katie: Right. So like, hey, maybe don't eat that cupcake. Right. Right. I mean, you do have to, I feel like past a certain age.

We all had those stages in college where it's like, yeah, I could eat three pieces of pizza and I'm fine. And I won't gain any weight. And then after I actually feel like it's about 27, 27. Yeah. Right, right. After my frontal lobe stopped crying I was like, wait a minute. I have to start going to the gym. Like, this is not the same. My metabolism is not where it was. I have to change something. 

Ashley: Mm-hmm 

Katie: and then when you have kids, your hormones are kind of outta whack, but also it's not as easy to get to the gym for most people.

Ashley: Yeah. It is harder to find time to set aside for yourself to do things like exercise for sure. But you just have to make the best of it and find a way to incorporate activities with your family that are active. 

Katie: Right? 

Ashley: Like we went, I made my kids go mushroom hunting yesterday. 

Katie: That's fun. 

Ashley: It was really hot. We didn't find anything good, but it was still..

Katie: It's not a good time for mushroom hunting though. 

Ashley: It's a bit early.

Katie: Early?

Ashley: It's a bit early. 

Katie: I feel like spring is good. 

Ashley: Well, it's too late for morels. It's early for chanterelles.

Katie: Yeah. 

Ashley: So no luck. But anyways, there's lots of things that you can do for weight loss, but that's just one of the facets of anti-aging medicine. And the thing is, it really does impact a lot of people here in this country. So it it's certainly significant. 

Katie: Right. 

Ashley: Another thing that we see patients a lot for, in like you were alluding to earlier, the group of patients that are coming in. I feel pretty good, but I wouldn't mind feeling better.

Katie: Right.

Ashley: I can tell that I got, when waking up feeling like I'm 20, some of these insidious instead of 40 aches and pains and a little bit more tired. A lot of aging has to do with inflammation. 

Katie: Well, inflammation leads to disease,

Ashley: All kinds of disease, heart disease, cancer ..

Katie: Attacking this helps you fight off disease.

Ashley: Right. And as people are figuring out more about gut health and the implications of having a healthy gut on your overall health, it seems that is a very significant thing.

Katie: Right. 

Ashley: Even if you are not someone who specifically has the classic gut symptoms, like I don't have diarrhea, constipation, I'm not vomiting. I don't have abdominal pain in my gut's fine. 

Katie: Right. 

Ashley: Well, maybe not. So having a healthy micro flora or amounts of diverse bacteria living in your intestine, that's actually very important to...

Katie: I definitely feel like this happened to me. So I used to have really chronic sinus infections, and I was going from one antibiotic to the other ...

Ashley: mm-hmm 

Katie: and I think it screwed up my stomach 

Ashley: probably.

Katie: And then I developed all these food allergies when I was about 27 years old and it was like, wait a minute. Duh, all these antibiotics definitely kinda had cuz they kept getting stronger and stronger. 

Ashley: Sure, sure. They disrupted the healthy bacteria in your gut. 

Katie: Right. And it's taken me ever since then to get to a good place of taking probiotics and low sugar type situations to you know, but it's so important. I just kept getting chronic sinus infections.

Ashley: Not all probiotics are good.

Katie: Right.. My sister used to work for a probiotic company. And I'm like, is this good? She'll tell me how many live bacteria it needs to be. 

Ashley: Sure. And some of the probiotics are histamine producers and that's not as helpful as other types.

Katie: Right. 

Ashley: So just because you're getting a probiotic doesn't mean it's a helpful probiotic. Having someone guide you and direct you towards the ones that are actually helpful is important.

Katie: So what else besides probiotics, what other supplements? 

Ashley: So, NAD which is nicotinamide adenine dinucleotide.

Katie: I've heard of this in IV . Do you do it in an IV ?

Ashley: Mm-hmm 

Katie: and I've heard it's painful. 

Ashley: Oh, no, it's not painful. 

Katie: It's not painful to get?

Ashley: You've had an IV before, right?

Katie: I haven't not the...

Ashley: not that NAD?

Katie: It's several, right? You can't just get one.

Ashley: Most people do a series of them. What I usually like is to do a series of the IVs, and then I have patients do at home subcutaneous doses. 

Katie: And there's a little bit of downtime.

Ashley: I mean, other than the time to get the IV. 

Katie: Oh, sometimes I go get IVs at this place. Mm-hmm and they have it. And they're like, it's really intense. After the first one, you need to make sure that you do not have like anything big that day. So I've never gotten it .

Ashley: It depends on the rate that it's run in through your veins for the IV. If they run it really high, like you sometimes get this weird chest pressure, tingling.

Katie: Uhhuh. 

Ashley: I wouldn't describe it as pleasant, but it's not bad. It's just, it's weird. 

Katie: Right.

Ashley: You're like that doesn't seem right. But that definitely happens with the NAD infusions. 

Katie: What's the maintenance on that after you have a couple infusions?

Ashley: Then I'll have people do it at home. Not IV it's forever the subq 

Katie: but let's say like a year goes by.

Ashley: You're doing a couple injections a week. 

Katie: Okay. Forever?

Ashley: Or as long as you want to maintain your ideal levels. So the NAD plus versus N ADH, you know, oxidize and non oxidized. The ideal ratio is 700 to one of NAD plus and NADH. And as we age, that ratio goes down and NAD is an enzyme that is part of our energy metabolism pathway.

So our mitochondria are little parts of our cells that produce cellular. They make energy. Yeah. That make energy. So as your ability to make energy goes down, your cellular functioning goes down too. 

Katie: Right.

Ashley: So repleting that has been associated with increased lifespans in animals. A lot of the studies are on animals that classically have shorter lifespans, because that's easier to create statistically. 

Katie: So like my deserve it for shorter period of time. Right.

Ashley: To do it on humans you'd have to have a hundred years. 

Katie: Mm-hmm yeah. 

Ashley: That's a more involved study for sure. But, the NAD reduces dysfunction that occurs in your mitochondria or part of your cells that produces energy. It reduces senescent cells. So senescent cells. Cells in your body that are basically so poorly functioning people describe them as zombie cells ..

Katie: Uhhuh. So where are they? Everywhere?

Ashley: Well, they can be everywhere. And as we age, the percentage of cells that are in that senescent stage increases. 

Katie: Okay. So like that way older people's skin sometimes looks grayish?

Ashley: They have way more senescent the cells.

They just have more cells that function poorly. So not that a zombie's a real thing, but comparing a functioning, normal human to what you think stereotypically a zombie might function. Right?

Katie: Right. 

Ashley: Like they look terrible. They're dissheveled, going through the motions, like jerky movements. They can barely speak. It's kind of like that ..

Katie: Walking dead of cells.

Ashley: Right. So you don't want walking dead cells. You want good cells, right? Because those walking deads, senescent cells don't function properly and they can contribute to disease. They generate more free radicals that damage surrounding cells. They're just bad. So, increasing your NAD levels can help reduce that. The other things that well, that I do personally, other than NAD is epitalin, which is a telomerase so it lengthens your telomeres. 

Katie: Okay. 

Ashley: So telomeres are little caps on the end of your chromosomes.

Katie: Okay.

Ashley: And as we age those caps shorten until the point they're so short, your ability for the cells in your body to divide and replicate is significantly inhibited. So there is some advantage to maintaining that appropriate telomere length. And Katie, I have with me a special guest and her name is Tara Covey. Tara say hello to everyone. 

Tara: Hi guys. It's great to be here and talking with you today 

Ashley: and Tara, tell our audience a little bit about yourself. 

Tara: Yeah, so I'm trained as a family nurse practitioner board certified in traditional medicine and in antiaging medicine, so I'm able have a foot in both worlds and see both sides of the coin. So that makes life interesting. 

Ashley: yeah. So Tara and I both did anti-aging medicine training, and Tara works with me here at my practice and sees more of the non-surgical patients. Although I do see some of those patients myself, I am able to help direct some of those patients that have the non-surgical needs with regards to the anti-aging medicine towards Tara. So, it's been a nice complimentary service to be able to offer people.

Tara: And a good collaboration. I think it really helps having worked in traditional medicine and kind of see where maybe some people's needs aren't being met a hundred percent of the time. And then luckily we have a lot of freedom here to cater to the needs of the patients, you know, are really wanting to focus on and hone in on with their health goals.

Ashley: We already touched on some things during this episode, Tara, what are some of the other things that you feel a lot of patients are coming to see you about? and, or what are some of the favorite things that you like to treat?

Tara: Well, one of the biggest things is people struggling with long term weight loss challenges, you know, that's a big one.

And, it is not a silo health issue. It almost always is accompanied by two or three other things... maybe their cholesterol's been creeping up over a few years. They're resistant to taking some medicine or lifestyle changes on their own just haven't worked. It's scary to be told you're pre-diabetic when you have seen aging family members go down that road.

Ashley: I agree. Whereas there is commonly a presenting concern or a chief complaint in medicine, there are usually multiple other things that can and should be optimized for that patient to get the best results. So whether it's, like you said, concern about your weight. There can be many other things: sleep issues, sleep apnea or diet..

Tara: Fatigue is a big one. You know, everyone's just walking around in a fog. 

Ashley: Mm-hmm. So Sleep. That is an interest for me too. Tara and I both have kids, so getting appropriate sleep not only for ourselves, but for our children is very important. And there are some studies that suggest that, as a child, someone who's still growing, you release most of your growth hormone at night. And I certainly remember growing up with my parents telling me things like. If you don't get to sleep, you're not gonna grow. Do you wanna be taller? Or if you don't get to sleep, you're just gonna be short. So there is actually some truth to that because you're releasing that growth hormone, which is responsible for signaling your body and telling the various body parts to grow at night. So yeah, that is interesting, but sleep is also super important for adults too. 

Tara: Yeah. People downplay the importance of sleep... almost wear it as a badge of pride, you know, like I can get on with just four hours a day. But that's when all of our cellular and body repairs are happening . we're really short changing ourselves. And then that compounds over time. Wouldn't you say?

Ashley: For sure. How many hours of sleep do you say you get a night or do you shoot for? 

Tara: I would love eight hours every night. I don't get that, but that's definitely what I try to set myself up for. 

Ashley: So, there was a study that the American cancer society performed where they followed a million people for about six years and they found that the people that slept seven hours were more likely to be alive at the end of the six year study, as compared to people that slept less than that, or more than that. So it appears that seven hours is kind of the magic number. There was another study that was done in Finland that followed twins over the course of 22 years. And they came to a similar conclusion and that those twins that slept less than seven hours were less likely to be alive at the end of their study than those that slept closer to 7, 8, 8 plus. So there is a correlation between inadequate sleep and disease processes. So during the day, your body is busy doing all the things that you have to do, but at night, your body is trying to repair.

Tara: It's important too people realize we can't bank our sleep and you can't catch up on sleep. This is a try to make good consistent habits kind of thing. Cuz I know a lot of people are working the nine to five and they're not getting much through the week and then they're doing a 10 hour sleep on the weekend. And that as supported by your study is also not beneficial.

Ashley: Do you have advice that you regularly offer patients about good sleep hygiene? 

Tara: Oh yeah. And it's definitely one of the first things we talk about when we go through lifestyle changes. And a lot of it's pretty basic, but it's mostly about setting yourself up with a good routine, and then you know, this is a whole nother topic, but controlling our, our light influences through the day.

Ashley: For sure. So it does make a difference. I try to go to sleep at the same time, every night. That is helpful. And having a normal circadian rhythm for yourself where you're going to sleep at the same time, waking up at the same time. It's also ideal to avoid eating for at least two hours before you go to bed, reduce the amount of electronic use some of the high energy blue light that's emitted by our various electronics: iPhones and tablets...

Tara: And even all this bright white L E D lighting that we're putting in our homes. We just recently did some freshening up in the house and I took a lot of that bright blue light out of my house.

Ashley: Well, it's supposedly more energy efficient, but it can really mess up our sleep wake cycle. That blue light is actually signaling to your brain that it's morning time. Yeah, time you get up. So if you're getting those signals right before you go to bed, it can be difficult to fall asleep. For those patients that you see that do have issues falling to sleep, do you prescribe sleep medications for them regularly?

Tara: We definitely try to make that a second step because we have so many modifiable lifestyle things that maybe we haven't addressed yet. There are some sleep aids that can be beneficial, but we don't wanna get anything that's a habit forming or that then we're lagging in the morning.

Ashley: I agree. And I worry about some of the more popular sleep aids the benzodiazepines, or even the over the counter Benadryl type medications, because they are associated with an increased risk of Alzheimer's disease and dementia. So yeah. As is not sleeping well, so you have to get...

Tara: but also, are you being sedated or are you sleeping? There's a difference between being knocked out and getting restorative sleep. 

Ashley: Absolutely. And then you're right. So those medications that are just knocking you out, it's not the same quality sleep as if getting true restorative sleep. 

Tara: Now, do you wear a sleep tracker? Do you do any sleep data?

Ashley: I do. I wear the Oura ring. I'm not sponsored by Oura, by the way.

Tara: Sure. 

Ashley: Yeah. I wear the Oura ring and it does give me some sleep data. 

Tara: I wear a watch. And I don't think it has quite as much Intel as the ring that you wear, but it is helpful to see what the quality of our sleep is rather than just hours with the head on the pillow.

Ashley: Sure. Some of it is obvious. I mean, if you are out and about the night before hanging out with friends, till the wee hours, you pretty much know your sleep score, which Oura provides you, is going to be not great. So, it reinforces the good decisions that you make: going to sleep consistently, not eating before you go to bed... like, if I eat a late snack, my resting heart rate at night won't be as low as other nights. 

Tara: Sure. 

Ashley: So I do get a lot of that feedback and that's helpful. 

So how about just to switch gears a little bit, how about hormone therapy? I think people are really interested in that. From my perspective and from what I've learned over the course of anti-aging medicine studies is that if, as a woman, you wait until you're already in menopause to start your hormone therapy, that that's suboptimal. Same thing for men. I think there's a lot of advertisement out there for the low T, the andropause, replacing that. And I think that that gets a lot of air time and advertisement time. 

Tara: Hormones are such an interesting topic and always have been to me. In my traditional training, the hormone therapy that we talked about was birth control. And then there was a little bit taboo to talk about replacing hormones in the later stage of life. And so I think it's really important that people are aware of where their hormones are and monitor them and not wait until things are so bad. It's hard to turn around . And I think that there's a lot of great tools, lifestyle wise and then supplementing and making sure that your diet is giving your body the ability to make the hormones that it needs. And there's a lot of extremely restrictive diets that are popular right now that have a huge impact on female hormone production. But then also supplementing hormones before, like you said it's too far gone, you know, so then, and then you're not having to use as much either, which I think is the sweet spot. Just tailoring things to what your body needs. 

Ashley: The interesting thing I think about at least for me as, as someone who's been on birth control pills before, is that taking oral estrogens... it is a known fact that that will increase your risk of breast cancer. And I don't recall as a younger woman, that was something relayed to me. And so many women are on birth control pills as a form of regulating their cycle or decreasing heavy periods or for truly just birth control reasons that there are some disadvantages to that. 

Tara: Yeah. 

Ashley: One thing that with regards to more of the bio identical hormone replacement, which by the way, The birth control pills are not bio identical...

Tara: right.

Ashley: There was a women's health initiative study that came out in the early two thousands. And it showed that if you supplement with oral non-human estrogens and progestins as opposed to biodentical hormones, that there was an increased risk of developing things like breast cancer and heart disease. What do you have to say to people that are concerned about that ...that they ask you? Well, I heard cause it, it, it was pretty big in the news. I heard that this is potentially bad for me. What do you say to those patients? 

Tara: First off, a lot of those patients are just surprised that they are the ones that have to bring up hormones to their provider. It's really never talked about, And so they just need to be armed with knowing what screenings are appropriate. Having a good conversation with their provider about their personal health history and their family health history, and then talk about the best use of safe amounts of hormones and then being monitored while they're on that therapy. But it, it's not one of those things that has to be all or nothing, and I think that's where in the early two thousands, when this data came out okay. So maybe there can be some harm with some equine based or, you know, equine, meaning it comes from horses is where hormones came from. 

Ashley: Tell me more about the difference between synthetic hormones and bio identical, because I think that that's something that most people probably don't think about. 

Tara: Yeah. So these studies were based on the marketed hormones that are equine based. So they come from estrogens from horses and then given to human females.

Ashley: Right, pregnant horse urine is the source of the progestins. 

Tara: Yeah. So the bio identicals are usually soy based or they're compounded in a way that are as close to our natural hormone structure. So the difference being when you have a horse based hormone not horse based, I know horse based equine when you have an equine hormone, it is not as similar to our structure as these 

Ashley: Okay. So hormones derived from pregnant horse urine... your body will metabolize those differently. It's a different chemical than the natural hormone that your body is used to, and so the way your body metabolizes or breaks down that chemical is going to be different. For the synthetics, you can get breakdown products that are more inflammatory, which obviously no one wants more inflammation in their body. From just bio identical oral estrogens, You get more inflammatory byproducts. Do you find that you have many patients that are taking oral estrogen or oral testosterone? 

Tara: No. I really don't see a whole lot of that. Most patients find the best benefit with transdermal medications or maybe even intravaginally or injectables. 

Ashley: Or pellets..

Tara: And then I was gonna say, and then now I think becoming popular as pellets because of the ease of.

Ashley: Yeah, the nice thing about pellets as compared to some of the other routes would be that you can get a pellet or pellets classically placed. And then every three to four months you're getting them replaced. So the pellets will slowly release a sustained level of the hormones. And that tends to be more close to your body delivery. 

Tara: Right. Rather the high peaks and low troughs, you know, the high 

Ashley: that you get with injectables, because usually things like injectable testosterone, maybe you're doing it once or twice a week, but right. You get these really high levels transiently, then you get these low levels. The pellets can make that more uniform and consistent, which is an advantage of that option. 

Tara: From a patient perspective, what patients do you see come in that you think would benefit from hormone therapy? 

Ashley: Anyone that is approaching their peri-menopausal age for women and for men as well, I think that should be part of a workup. you know, you go in and you get lab draws, you get your blood counts checked, you get your cholesterol checked. Getting those hormone levels checked should, I mean, we get our thyroid hormone. Yeah that should be part of a workup. So having an ideal, whether it's an ideal estrogen level or testosterone level, or really in all of the above is going to Allow you to, for example, maintain better bone mass, have improve a muscle, a mass have better cognitive function, have more energy levels. Hormones.. They're essential to normal body function. And so if your goal is to have an optimally functioning body with less disease, less dementia, less bone loss, less fractures, all of those things as you age, then assessing for hormone levels is an imperative part of that treatment. 

Tara: Yeah, we do a hormone assessment on each patient that comes in when we do our baseline workup. And, once we correct those hormones, we see other cascade effects within that patient... an improvement in their lipid profile, their thyroid will work more optimally or will be utilized more optimally. So it definitely is all connected.

Ashley: Yeah. That goes back to what we were saying before. If your chief complaint is being overweight, there's usually a myriad of things that are contributing to that. So in our practice of anti-aging regenerative medicine, it may not be that the first thing that you think is what you want addressed is the first step in your treatment plan. And I think that could potentially be frustrating to people, but there are things that need to be optimized potentially before things like adding biodentical hormones. And in that one specifically. 

Tara: I do hear that a lot, but I like to let my patients know, we're gonna make sure your foundation is good before we just start throwing stuff on top of it, 

Ashley: but putting the walls and roof on?

Tara: That's right. Yeah. 

Ashley: Nice analogy. I think that's super important. So salivary cortisol is one of the hormone levels that we regularly check for patients in the initial workup. Do you find that most of the patients you're seeing have that normal curve? They have normal levels?

Tara: Well, first let's talk about that curve that you referenced. So, a healthy cortisol curve should have a awakening response in the morning where your cortisol levels rise. They taper off through mid-morning and they kind of go to a baseline low through the night during your repair time. And so what I often see will be those bumps that we expect will either be missing or blunted. Rarely do I see people running just consistently high. But it happens, especially afternoon rises due to patients daily stress. We all hear about high cortisol being bad, but low cortisol is just as bad. So making sure that your body has the time to support that cortisol output, and then maintenance of your stress. You know, I talk with my patients a lot about stress as a constant, right? The only thing you can really count on in life is has stress coming your way. 

Ashley: Death, taxes. I want to say laundry, but maybe stress...

Tara: I don't know. I'd put laundry in there too. But yeah, we talk a lot about not how was your stress this month, but how did you handle your stress this month? Cuz it's gonna happen? You know, good stress, bad stress, even like new job, new house that's stressful, right? 

Ashley: Yeah. Those are some of the highest stress events, right?

Tara: Yeah. We like to pile on, right? 

Ashley: It can be a bit overwhelming. And that stress level can be reflected physiologically. 

Tara: Absolutely. 

Ashley: So initially...

Tara: hair loss, right. People come in and their hair thinning. Mm-hmm , it's one of the first things we look at. How's your stress? 

Ashley: Yeah. Hair loss, insomnia, weight gain, right. 

Tara: Libido changes. 

Ashley: Mm-hmm , all of those things. So as in all the other parts of anti-aging medicine and all these pieces are just closely intertwined. So managing your stress levels, whether it's exercise. I mean, there's certainly benefit to relieving some of that stress. You get an endorphin rush during exercise, so that can always be helpful. That always is something that I have utilized... just even getting out and walking, being in nature. 

Katie: Yeah. I was gonna say bonus points if you exercise in a green space, right. 

Ashley: I know it's, it's fascinating that actually is associated with reduced stress levels for people. Going on a hike in nature. 

Tara: Yeah. Meditation. You can meditate at home on your porch, meditate while on your walk. Yoga is good. Yeah. That introspection..

Ashley: Just finding time to be focused on yourself and in our society, there's so much constant input. People don't just sit on your porch, swing and stare out at the sunset anymore. 

Tara: Right. 

Ashley: You're on your phone, looking at websites or playing game. You're just constantly...

Tara: bombarded. 

Ashley: Yeah. 

Tara: Well, and don't you see the change we've had over the last couple years with meaningful relationships, you know, social distancing did a lot of damage there.

Ashley: I think so, but also the social media part too. 

Tara: Oh, polarization 

Ashley: The things that people will say to each other on social media versus you would never say some of those things. Yeah. Filters are gone, just gone. Right. Truly they're gone. And so I worry about the implications for my kids as they're growing up.

Tara: Yeah. 

Ashley: What does that mean for their social interactions? 

Tara: Do you have any healthy stress reduction that you're like trying to really give to your kids as they're growing up in this crazy world? 

Ashley: Well, I do try to minimize their device time. Right. So I think that's important. I want them to exercise regularly, too. And sometimes they'll complain. They're usually pretty good, but just, going for a walk, going for a swim, going for a run. That's helpful. 

Tara: Yeah. 

Ashley: It is stress reducing 

Tara: and it is like a family affair. Right. When you model that behavior, it's hard to say, Hey, go run in the yard if you're not doing it yourself.

Ashley: Right. So, we'll do a lot of those things together. We'll go on a walk. We'll go on a bike ride. I love to go on hikes. So we'll do that. If you want your kids to have a certain lifestyle, one where they exercise one where they don't spend all their time staring at the TV or playing on their phones, then you need to step up and be a good role model.

Tara: now, do you have any favorite adaptogens? You know, those are our nutraceutical supplements that we use to manage stress. Do you have anything that you found to be particularly helpful? 

Ashley: So I take some ashwaganda myself but a lot of these adaptogens will come in combinations. So ashwagandha and, and Rhodiola, ginseng 

Tara: that synergistic activity, working together. I know mushrooms are getting a lot of press for adaptogenic activity lately. 

Ashley: I do like mushrooms. Yeah. Which mushroom is the best one? 

Tara: There's a whole list of them. I hear a lot about lion's mane. 

Ashley: Oh, sure. Lion's mane. That one is one I've never found .

Tara: Out in the wild?

Ashley: Yeah. I would like to.

Tara: If you didn't know, Dr. Robey likes to go hunt for mushrooms. 

Ashley: Yeah. I've never found lion's mane. I really like chicken in the woods. Morell's yeah, but they're seasons too short chanterelles. Great. My kids like finding mushrooms too, so yeah, it goes back to finding activities that aren't TV or device focused. And yes, like you said, there are some nutraceuticals and supplements that can help modulate that response. So these supplements are not just for people that have low cortisol or just for people that have high cortisol, they're for modulating that like a normal, healthy response. So yeah, that's a helpful adjunctive therapy. Yeah. Right.. The nutraceuticals, but just like weight loss, you can't just do whatever you want - that would be ignoring the foundational parts, which are exercise, stress reduction, healthy social interactions. 

Tara: Yes. 

Ashley: All of those things would be more important than, you know, taking some ginseng. But, it's nice to have as something that can be added to your regimen.

Tara: Yeah. I'm sure my patients think I'm a broken record, cuz I'm always well lifestyle. Here's our lifestyle intervention, and then here's something we can consider putting on top of that, but always the lifestyle basis.

Ashley: You were telling me some interesting statistics with regards to people's perceptions about their lifestyle. 

Tara: Yeah. So I was reading a study the other day about our perception of the healthy components of our diet. And that basically it was overestimated by about 80 to 90%. 

Ashley: That's wild.

Tara: But the people that ate poorly overestimated less. So those of us walking around thinking that we're eating well, overestimate more than people that know that they're eating a junk diet. They're like, yeah, I ate a McDonald's . 

Ashley: Oh, sure. So that makes sense. Every person has room for improvement with regards to making healthy choices, just some of us more than others. And, you'll recommend patients to keep journals, right? And that can be certainly eye opening. If you're doing it honestly to see what is it that you're actually putting in your body? I think as humans, we have a tendency to look through rose colored lenses and just kind of block out the parts that don't seem...

Tara: don't fit the narrative. Yeah. yeah. I'm a big fan of tracking for short periods. I love data, so I don't mind tracking for myself, but I know for a lot of people, it's a big burden. that's more we're adding to their stress pile. So I'm a big fan of tracking for a little while and see what our norms are. Because we really rotate through, most families, 14 to 21 meals, and then you have the oddball thing that you eat that's outside of that. But if you know what your mainstay meals consist of getting your portions down appropriately, making sure you're hitting the protein goals that you want, that does a lot to keep us accountable for what we're putting in our body. And then knowing when you do over indulge, you know, life happens. We're gonna go to the celebrations and things. That's okay. Get back on it the next day when you're going back to your norm.

Ashley: That's good advice. So for someone let's say, who is either healthy, but wants to be healthier or someone who feels like they really have a lot of things to tweak from a health perspective, what would be your best advice for them? What should they do as far as our next step in getting to a better place? 

Tara: I think if you haven't had a comprehensive lab review, like we offer, where we dig deeper into what your baseline of foundation of health looks like., I think that's really beneficial. When I do that with patients, I spend 60 minutes with them and we talk about what all your labs mean, which sometimes is a component that's missing in other venues. Right?

Ashley: Sure. 

Tara: Here's your labs. Everything looked good. And we both walk away. We're gonna talk about 'em for about an hour and I'm gonna give you a problem list of things that could be optimized, you know? So even with the healthy person, there's always something that we can say, Hey, we can fix this ratio here. We can tweak this there. And then know your body and know what it needs. 

Ashley: Right. I think education is super important in that way. You can make the patient their own best advocate. So if you just tell them that, okay, your, your cortisol is high, but they don't know that cortisol is a stress hormone that it increases your blood glucose and that it is responsible for your immune responses and digestive system, all those various processes in the body, then they're not gonna care if it's high or low.

Tara: Right.

Ashley: I mean, just, just a number. So you're right, adding that educational component and getting patients to be their own best advocate so they know where they are and where they need to be, and why it would be so important to make that change. 

Tara: Yeah. I'm all about adding years to someone's life, but not only that adding life to those years, what good is living another 10 years, if it's in total care and not able to move.

Ashley: Doesn't sound optimal.

Tara: No, not my way to go. 

Ashley: Well, thanks Tara. That was super fun. And I know we just barely touched on some of the various things that we treat in anti-aging and regenerative medicine. I'd like to have you back on and we can delve into some of these topics in more detail because they certainly could deserve their own hour or multiple hours in and of themselves.

Tara: Yeah, this was great. Thanks for having me, Dr. Robey. 

Ashley: All right. Thanks everyone. Bye.