October 16, 2025 • 38 mins
In this episode of the Gladden Longevity Podcast, Dr. Jeffrey Gladden interviews Khoshal Latifzai, who transitioned from emergency medicine to regenerative medicine. They discuss the challenges of traditional medical practices, the importance of patient-centered care, and the innovative approaches in longevity and health optimization, including stem cell therapy. Koshal shares insights on the impact of genetics on athletic performance and the significance of understanding patient needs to minimize health risks. The conversation highlights the future of health technologies and the potential for optimizing health and longevity.
For Audience
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Takeaways
- Khoshal transitioned from emergency medicine to regenerative medicine for a more fulfilling practice.
- Patient interactions in emergency medicine were limited and unsatisfying.
- Building a patient-centric practice allows for deeper connections and better care.
- Removing insurance from the equation can enhance patient engagement and satisfaction.
- Understanding risk factors is crucial for effective health optimization.
- Stem cell therapy is evolving with a focus on using patients' own cells.
- Athletes may face health issues due to overtraining and genetics.
- Innovations in health technologies are paving the way for longevity.
- The aging process can be viewed as a mosaic of different ages.
- Optimizing health today is essential for a better future.
Chapters
00:00 Introduction to Regenerative Medicine
03:10 Transition from Emergency Medicine to Regenerative Medicine
05:55 Building a Patient-Centric Practice
09:01 App
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
either.
Welcome everybody to this edition of the Gladden Longevity Podcast.
I'm your host, Dr.
Jeffrey Gladden, and I'm here with Koshal Latifzai I think I got that right or close.
So uh Koshal, welcome to the show.
Thank you so much for having me.
And yeah, you got my first name uh spot on, Koshal and my last name is Latifzai.
(00:24):
Yeah.
It's L-A-T-I-F-Z-A-I, Latifzai Xi.
Okay, Latifzai Xi.
Okay, cool.
So, um Koshal you did emergency room uh medicine in your training and now you're doingregenerative medicine.
That's not always an obvious transition.
(00:46):
Tell us a little bit about what happened.
Yeah, I went to medical school at Dartmouth and after graduating medical school, I went toresidency.
And to your point, I was trained in emergency medicine at Yale.
And then I moved to Denver about 12 years ago or so, 13 years ago to the Denver, Boulderarea, started practicing in emergency medicine, did that for a number of years.
(01:13):
And over that time period,
Um, you know, I sort of figured out that, um, you know, the, clinical setting that I hadtransitioned into was quite a distance away from what I had envisioned when I was in
medical school, when I was an undergrad, since I wanted to, to become a doctor, I hadended up in a totally separate space and, um, where I thought I was going to end up.
(01:43):
is a place where you would sit down with patients, get to find out what their medicalissues were, really get to know them on a social level and institute changes that were
sustainable over the long haul.
And where I had ended up is seeing patients uh every 15 minutes and dedicating at least 10minutes of that meeting to charting.
(02:10):
So I'd be there, you know, typing away on a computer.
inputting orders, following up on labs, and my interaction with patients were verylimited.
And I had also noticed that other clinicians were in the same place.
And a lot of them were dissatisfied because the patients on the other side were alsodissatisfied.
(02:36):
I'm sure it wasn't a thrill for them to interact with a physician for five minutes.
Mm-hmm.
and then be given their results and being sent out the door or be admitted to thehospital.
So it was an unfulfilling experience for the patient.
was an unfulfilling experience for the provider.
and I had come to, um you know, look up to these clinicians who had been doing that for anumber of decades.
(03:04):
And I was looking at their uh ability to do that for the long haul.
as something to aspire to.
yeah, yeah, I was kind of in awe and envious of how long they had been doing that when thereality was and something that I came to realize a number of years later is that that, you
(03:27):
know, my inexperience in emergency medicine, ah my lack of, the fact that I hadn't put inseveral decades was really a point of strength for me.
And I shouldn't look at that as a point of weakness.
meaning I had this ability to pivot, to transition into the type of medicine that I hadalways wanted to practice, whereas those clinicians were at a different point in their
(03:49):
careers and they lack that.
And so I wanted to...
I'll just interrupt for a second.
I think the audience probably misses this, but in medicine, when you're going throughtraining, there's such a hierarchy to it.
You know, a first year medical student versus a second year medical student, a second yearversus a third, a third versus a fourth.
(04:11):
Right.
And if you're a freshman medical student and you bump into a fourth year medical student,my God, that's like they're on, they're on a completely different level of reality.
Right.
They live in a parallel universe as far as you're concerned.
Right.
Absolutely.
right.
so then they then you have an intern, right?
Well, an intern is another, you know, level of universe up.
And then you've got the resident and then you've got the fellow and then, my God, you'vegot an attending and then you've got an attending that's been doing this for 20 years.
(04:37):
And and you're you're looking off and it's almost like a JWST uh telescope, right?
You're looking off into these distant galaxies and you're kind of admiring what's outthere.
And you sort of lose track of where you are relative to.
the patient, right?
So I'm just, this is how this happens.
This is why somebody could be doing something they don't like and yet still admire thisother person because you're kind of in this whole thing.
(05:02):
You're kind of in awe of everybody ahead of you because they know so much and have so muchexperience and they've learned so much on all this, right?
So it's really interesting to hear you kind of recount that.
I hadn't really thought about that in a long time.
But if the audience is listening to like, could you even tolerate that for a week?
It's, it's because of this, right?
It's kind of like, my gosh, I'm aspiring to be another galaxy like they are.
(05:25):
Right.
So that's it.
And yeah, thank you for providing that perspective.
And I think it's important because, you know, we're, we're taught to persevere inmedicine, right.
And, if you're uncomfortable, we'll look around you.
Everybody else is uncomfortable.
uh Persevere and, you know, put up a stiff upper lip, as they say, and keep it up and keepgrinding forward.
(05:46):
oh And you know, absolutely, that's exactly what I was going to say is it's verymilitaristic, very hierarchical.
Um, and, and, know, I didn't have to do that.
Now while I was an attending, had other attendings, uh, you know, before me and you know,the, the, I didn't want to keep doing that and keep being unfulfilled and unsatisfied.
(06:10):
You know, we got to a point where I was working eight hour shifts, but it would easilyturn into a 12 hour shift because I was seeing patient after patient after patient, and
then all this extra time in emergency medicine, you know, it's dedicated to charting.
I'm sure.
primary doctors sort of do the same thing, you know?
And so, you know, I wanted to kind of step, you know, out of the hamster wheel, but it wasa challenge for someone in emergency medicine specifically, whereas primary doctors,
(06:38):
OBGYNs, maybe they find that transition easily because they, easy because they have apatient base to migrate with them to this new clinic that they're starting.
um And I didn't have that.
I didn't have that safety.
that safety blanket.
And so it was literally, you know, kind of a leap of faith.
(06:59):
Do I want to keep doing A or do I want to do B?
And B uh sounded like it was more up my alley.
That's what I could sustain for decades to come and raise a family in that setting andpractice medicine on my terms.
And so uh I established a clinic uh here in Boulder.
(07:22):
And, uh, my wife who was training to be a nurse practitioner at the time, eventuallygraduated, became a nurse practitioner.
Um, she came on board and a lot of, know, in those early stages, uh, we were doing a lotof admin work, um, and very little clinical work, but over the years, um, you know, we
(07:46):
pay, we've built a really good patient base where
you.
uh Word is spreading through word of mouth.
We do really poorly in terms of marketing.
That's just not our jam.
That's not our specialty.
ah But our patient roster is really extensive at this point and we really enjoy what wedo.
(08:08):
Yeah, kudos to you.
That's what it's all about, I think, is finding a place where you can really make acontribution, feel good about that.
And um I assume now you actually have quite a bit more time to actually interact with yourclients patients.
beautiful.
I mean, our meetings these days are easily, you know, 90 minute interactions at least, youknow, with the patient that occurs several times annually.
(08:36):
A lot of them come in, you know, uh, in between that.
I know these, but know, Boulder is big in some, in some ways and it's small in other ways.
It is a pretty small town.
I see my patients, you know, picking up their kids and I'm picking up my kids at theirschool.
sure, sure.
yeah, and so, and you know, I go on bike rides or hikes, you know, with my patients.
(08:58):
So it's really, built a really good community and I practice medicine with otherlike-minded individuals um who also want to foster that community feeling.
So individuals that I've sent patients to in terms of orthopedists or physical therapistsor what have you.
um They interact with patients in the same way.
(09:20):
So it's much more enjoyable.
Nice.
I love that.
So obviously you also had to pick up some technical skills because your clinic, um youknow, you transitioned away from sort of treatment street them into really helping people
heal because you're involved with stem cells and uh sounds like peptide therapy,hyperbaric oxygen.
(09:42):
You're looking at certain biomarkers and elements of longevity medicine.
So.
uh
Tell us a little bit about that.
What's your approach when you see somebody?
How do you go about that?
Yeah, I mean, I would probably categorize our patients in two separate categories.
Those individuals who come to us because they want to optimize their athletic output,right?
(10:04):
We're in Boulder, there's a lot of athletes here.
There are certainly individuals really honed in and focused on that objective and we sharethat objective with them.
And I can talk about some of the things that we offer that align with those goals andobjectives.
And then the other category of patients approach us.
with an eye towards longevity specifically.
(10:24):
And when we started the clinic, it was probably really with a goal towards minimizing allthe risk factors that predispose for early death.
And so in this country, that's cardiovascular disease, that's cancer, metabolic disease,diabetes, and other things, and then really low level trauma.
(10:45):
When I used to work in the ER, there'd be no shortage of patients coming in from nursinghomes who were old and frail.
oh
like in their eighties, individuals that I wouldn't consider old now, but then they werecertainly elderly.
So they would come to us with ground level falls, picking up a remote off the ground ortying their shoes, falling, breaking a hip.
(11:07):
And those types of injuries have a really high morbidity and mortality associated withthem.
So when these patients came to us, my question was, okay, what...
is the most common cause of death in this particular age group.
And the CDC has really good research out tracking those cause of morbidity and mortalityin that age group.
And then the next question was, what are the most relevant risk factors that predict thatindividual specific risk profile?
(11:36):
And it turned out there was quite a deviation from what I used to do in the ER and whatthe literature shows to be really highly predictive of.
cardiovascular disease, for instance.
And a lot of that variation is due to the involvement of insurance companies.
In other words, if I'm establishing a patient-doctor relationship with you, but ultimatelythe payer for those services is not even in the room, it's the insurance company, they
(12:06):
have a say in what they will pay for, what they won't pay for.
And that in turn dictates how I practice medicine, what I offer to you.
So one of the things that we did is just remove insurance companies from that equation.
know, we did reach out to Cigna and United, et cetera, et cetera.
And one of the things that they wanted to do is they knew that I was, you know, a clinicthat was just getting established.
(12:33):
So they wanted to sit down and sort of negotiate their rates with me.
And I didn't even want to get in that discussion.
And if you look at most doctors' offices,
they have a whole admin team.
And at this point, they probably outsource a lot of those administrative duties tooverseas uh vendors where they go back and forth with the insurance company, try to
(12:53):
negotiate rates every year, and then also to try to capture that revenue from theinsurance companies.
And so we didn't want to hire a big admin uh staff to do that.
So we said no insurance.
And that was definitely a leap of faith.
I wasn't sure if anybody
was gonna invest in their healthcare if we said we're not gonna take insurance and youhave to pay for this out of pocket.
(13:18):
But it turns out there was a huge interest.
A lot of our clientele are educated, they have insurance, they're financially well off,and they really uh have the ability to invest in this type of healthcare that where their
doctor sits down with them and explains things and kind of highlights what their riskprofile for the most common cause of death are.
(13:41):
and really highlight the steps that need to be taken to minimize their risk of dying andsuccumbing to those causes of death.
So those are sort of the two big categories that our patients fall into.
So these days, when our patients come in, we typically do a really extensive lab panel onthem.
(14:01):
And then they come in periodically several times a year to review those panels, thosebiomarkers that need to be repeated.
because we're tracking them to see how well our interventions are moving the needle in apositive direction.
We meet with them several times annually.
We review those biomarkers with them in TDM.
(14:22):
We send out an email kind of recapping the summary of that visit.
that way several months down the road, if they're discussing their biomarkers with acoworker, with a family member, they know exactly what that...
risk profile looks like, what we're doing about it, how it's impacting those biomarkers,uh et cetera, et So they are very, very engaged in their health.
(14:46):
And then slowly these individuals want, you know, they come to us and they say, okay, nowmy health has been optimized.
My risk of death and morbidity have been minimized.
That's fantastic.
What else do you have to offer to really optimize my health in the here and now so I canget the most out of life?
And then we, that's where we see these two worlds, these two patient groups kind ofmerging together.
(15:10):
Um, because now these individuals, uh, have maybe lost weight, they're much healthier andthey want to engage in athletic endeavors that they had been putting off because of where
their health was, or they want to engage, you know, in trips and, and, and things withtheir family that they previously were not able to do.
(15:31):
And so that's where, you know,
the inter peptides, inter stem cell therapy.
These are ways that I think we kind of marry those two groups together.
know, stem cells, I'm happy to talk about them.
I'm happy to talk about hormones, peptides, et cetera, et cetera.
Here, no, think all that makes sense.
(15:52):
um You know, the way we think about it is um sometimes you gotta pull people out of thefire before you can actually start to think about how you're gonna take them to the next
level.
So um the basic concept of evaluating people, and it sounds like you have a discrete.
(16:12):
number of things you're looking at there to the most common things that people tend tostruggle with and then helping them to actually navigate around that to a point of let's
call it relative health, knowing that they can be optimized further does put them reallyon a parallel pack because the way we think about it, it's really all about the questions
that somebody's asking, right?
So the athlete is asking the question, how do I optimize my performance?
(16:37):
And now you get people
healthy enough to the point where they can ask the same question.
How do I optimize my performance?
Whatever that may be.
uh So yeah, makes perfect sense how that works.
Yeah.
Cool.
and some of these athletes, maybe they're so high functioning in whatever sport thatthey're engaged in that they're completely blind to maybe some family history or some
(17:01):
genetics that's exposing them for certain things.
so, yeah.
We see that a number of athletes
are aging prematurely and you probably see that too.
um So we had a guy in here not long ago uh happens to live in Italy now.
(17:23):
He sold a company and is Canadian and moved uh to Italy, lives in Miami and came into theclinic.
I met him when I gave a talk and he, um you know, wants to be a cyclist.
So he's basically
cycling four hours a day over there in Italy.
He cycled as a kid.
He's 40, 41 years old.
So and yet he's having all these issues, right?
(17:47):
He's getting sick all the time and things like that.
So the obvious thing is, well, maybe you're you know, maybe you're overworking out, right?
Maybe you're over training.
uh But he comes in and we we do our deconstruction process on him.
And what we find out is that uh genetically he doesn't handle oxidative stress very well.
(18:07):
And he has lots of oxidative stress markers that are showing significant damage across hisDNA, his proteins, his lipid membranes, RNA, et cetera.
And then if you look at his oxidative stress age, because we're all a mosaic of many ages,right?
He's 41.
It was 59 and a half.
And he's like, holy crap, I'm really killing myself, aren't I?
(18:29):
It's like, yep, you really are.
So, you know, you're just not built for this, right?
You're just not built for this.
And I'll show you what you are built for.
because it doesn't mean you have to sit on the couch.
uh so it's it's really interesting that athletes as as gifted and talented as they may be,uh it's certainly possible for them to either destroy themselves through injury or through
(18:53):
being involved in in training regimens that they're genetically not built for.
Right.
Not everybody should run a marathon.
So, yeah, pretty interesting.
Yeah, and along those same lines, I have a patient as you were talking, I was thinkingabout an ultra marathon or patient who I have who's in the 30s.
And, you he was having a hard time.
(19:14):
Conceiving with his wife and you know, we checked his hormone levels and sure enough hishis hormones were that of 80 90 year old and uh I think in most instances what would
happen is that individual would probably get on TRT, you know at most most clinics hereand I'm sure nationally also but that really wasn't the solution it wasn't the problem and
(19:40):
and so we you know, I kind of had a similar conversation with them
Mm-hmm.
dialing down the intensity of his training and sure enough, that's all it took.
You know, he was doing everything else right.
You know, sauna, cold plunge, et cetera, et cetera.
Eating right.
Really elite athlete and very, very smart, very accomplished, both passionatelypersonally.
(20:02):
And all it took was just dialing down the intensity of his trainings.
Um, his ex hormones came back online.
So there is such things over training.
absolutely.
Very common in women athletes, um You know, to stop menstruating or to have difficultyconceiving or whatever else.
um So it's an interesting sort of psychological drive that people have.
(20:26):
um In a way, I think it's related to the idea of being externally validated.
And certain people are externally validated by how much money they make or whatneighborhood they live in or who they're married to or.
where their kids go to school or whatever, but other people are externally validated by,you know, how fast they can run a marathon or how many, you know, ultra marathons they can
(20:48):
do.
We just had a guy that just completed a marathon on all seven continents uh just a week orso ago.
uh But in talking with him prior to that, we were looking through his stuff and it's like,you know, these marathons are really beating you up.
He said, I know, but I've just got one more to do.
We're like, okay, we're going to help you get through that one, but make that the lastone, right?
(21:13):
Because, you know, it's, really killing you in a way.
And so he, he went, he did it, he completed it.
And we're all happy that it got done, but I'm really happy that now he can actually focuson his health.
So, the thing about it is rejuvenation technologies, right?
Whether it's stem cells, hexasomes, peptides, you know, all kinds of stuff, that.
(21:34):
We both do, you know, they can only do so much.
And really, I think ultimately gets back to understanding who you are, how you're built,what you're built for, and then leaning into those strengths and kind of avoiding some of
the weaknesses.
Right.
So, uh yeah.
So that's that that's part of the precision medicine, if you will.
ah Yeah, super cool.
(21:58):
So tell us a little bit more about the stem cell work that you are doing.
What are you what are you guys up to there?
Yeah, I mean, I think one of the things that we discovered early on ah is, and it wasn'tus, this has been pretty well documented in literature, is that as a person is getting
older, ah that aging process can be defined, as you said, a mosaic of different ages.
(22:22):
And one of those ages are your stem cells, ah meaning here are a group of cells thatreally
have been positioned as this keystone, this highly important group of cells that aretasked with healing and regeneration uh in the body.
(22:44):
And as individuals are getting older, the number of those cells is declining.
And this has been happening since we were born.
The number of stem cells in our body has been steadily decreasing.
So you're going to have less in your body than you did next year than you did last year.
And in addition to that,
the quality of those stem cells is also decreasing as a person is getting older and itmanifests differently in different individuals.
(23:12):
Some people have, you know, it translates into immune system implications for thatindividual where their shingles is now acting up, they're more prone to infections and
other people, it's musculoskeletal frailty is what it translates into.
So these individuals who want to keep running, keep cycling, keep swimming, keep hiking,
(23:33):
they're injuring themselves and those injuries are slower and slower to heal.
And so we wanted to know how we can harness um that part of you for as long as possibleand possibly augment it even further.
And at the time, one of the things that was popular then I'm sure it's still popular,
(23:55):
is the use of umbilical cord or placental derived stem cells.
And we looked into that and there are certain shortcomings associated with using somebodyelse's cells.
And the short of it is this, when you have somebody else's proteins injected into you,your immune system is gonna take note of that.
(24:17):
and you're going to start to produce antibodies against those proteins.
And that mechanism for manufacturing those antibodies is not fail safe.
Errors are going to be certainly made.
And if there's enough similarity between those antigenic proteins that were just uhinjected into you and your own native proteins, it's quite conceivable that you're going
(24:40):
to develop antibodies that instead of targeting that foreign protein, targets your ownprotein.
and it could give rise to autoimmune conditions that may not fully manifest for years,possibly decades, but when they do, um it can really take a toll on the body.
Think of, for your audience, rheumatoid arthritis or lupus or uh Hashimoto's, type 1diabetes, these are all autoimmune conditions.
(25:09):
And it's always been sort of a puzzle as to how people get these.
these autoimmune conditions, why the immune system acts out of sorts, where it's attackingyour own proteins rather than defending you against, um, against pathogens.
But this is one mechanism by which you can potentiate autoimmune conditions.
(25:30):
if you get massive amounts of these proteins belonging to somebody else introduced intoyour body, and some individuals were doing it, um, you know, over and over again.
So it wasn't a one and done kind of a deal.
So we didn't want to.
you know, potentially um give rise to autoimmune conditions, although I'm sure there'splenty of clinics in the Denver area alone that uses that form of stem cell therapy
(25:57):
referred to as allogenic stem cell therapy, meaning using somebody else's cells, we wantedto really use the person's own cells.
And so we started harvesting stem cells from bone marrow in the early stages of our ourclinic.
And there are certain advantages and disadvantages.
(26:18):
You're certainly using your own stem cells, which are better for you, for all the reasonsthat I alluded to earlier.
um But the big drawback on the one hand is it's a painful procedure.
You do have to punch your holes through the cortex of the bone, the shell of the bone toget to where the bone marrow is.
And then beyond that,
(26:38):
There's several ways of categorizing stem cells, one of the ways is um through the systemwhere some stem cells are referred to as hematopoietic stem cells, which give rise to
blood cells, and then mesenchymal stem cells, which has this ability to transform intoother tissue types.
(26:58):
And when you look at the ratio of hematopoietic versus mesenchymal stem cells in bonemarrow, it favors hematopoietic stem cells.
And it's understandable because that's where a lot of immune cells, white blood cells aresort of born.
um The other way to harvest stem cells is from fat, which is more accessible.
(27:22):
uh We usually target the fat in the lower back or the upper body area.
The downtime is really minimal compared to bone marrow harvesting.
And then that ratio of hematopoietic to mesenchymal stem cells is flipped in the otherdirection, favoring more mesenchymal stem cells in fat.
uh so we started transitioning to using fat.
(27:47):
And we were still getting great results when we utilize these cells, especially formusculoskeletal injuries in our athletes.
uh And like I said, the downtime was a lot less compared to bone marrow harvesting.
And since kind of adopting uh adipose harvesting, meaning fat harvesting for stem cell uhtherapy, we've gone to culture expanding those cells.
(28:15):
ah And the reason we started doing that is this technology had been utilized in veterinarymedicine for decades.
And I was completely oblivious to that.
In medicine, we really own in a really well-trained and obviously human medicine.
We don't refer to it as that, but in veterinary medicine.
(28:36):
uh stem cell harvesting, stem cell culture expansion, and I'll kind of detail that alittle bit.
It's been around for a long time and these stem cells are being utilized in really uhathletic courses, racing thoroughbreds with great effect.
And as we kind of dove into that, there were other forms of therapy.
(29:00):
that we're now using in humans that's been utilized in veterinary medicine for a longtime, and that includes PRP.
But just kind of staying with this stem cell theme, our methods of harvesting stem cellsfrom fat mirrored what was happening in...
in veterinary medicine.
uh And now we went to culture expanding those cells, meaning you would take fat from uhour patients, we through a liposuction procedure done in the office, what during a
(29:32):
procedure that where the patient is awake, so there's no general anesthesia or conscioussedation or anything like that, we just use lidocaine to really, you know, infiltrate that
area, we're going to be harvesting the fat from.
And then we isolate the stem cells within that sample of fat.
And then we take those cells and replicate them in a lab under sterile conditions bytrained staff.
(29:57):
So that's not done here on site.
That's done in a lab.
And after about six weeks, you get thousands of times the number of similar cells thatoccur naturally in the body.
And during that replicative phase,
not only are the number of stem cells increase, but through natural selection, meaningthese cells are having to compete with one another for limited nutrients and resources and
(30:22):
that quote unquote petri dish, those cells that um are not functioning well, they die offbecause they can't keep up with their peers for those nutrients.
And those cells that are able to elbow out their peers,
You know, they kind of rise to the top, so to speak, they're going to replicate again andagain and again.
(30:44):
And then those cells are collected and frozen, and they're available for years for decadesto come.
So as these patients are getting older, those cells are kind of frozen at their currentage in really high numbers and probably better quality than what you would find naturally
occurring in the body.
And then you're using small aliquots of what's frozen to be injected into the knees, intothe hips, shoulders, even intravenously, allowing those cells to respond to the cytokines
(31:17):
and chemokines and chemical signals of injury, wherever they may be emanating from andallowing them to interact with those damaged cells in a way that restores to the extent
possible the function of those damaged cells.
Yeah, no, it's a good approach.
It's really interesting, I think, that veterinary medicine has.
(31:40):
Well, it's not really surprising, really, when you think about the restrictions on humanmedicine per se, but in veterinary medicine.
Oh, my gosh, they've been doing so many innovative things for so long, right?
It's people think that humans have the best medicine on the planet, but actually it's it'sthe it's the horses and, you know, some of the competitive animals that actually have
(32:01):
access to the best medicine.
at least, you know, staying inside the US.
There's a lot of things you can access outside the US.
But um yeah, that's that's fascinating.
Yeah, it's nice to think about planning for the future.
Right.
How do you actually maintain your health if you're going to need it?
Something in the future.
Right.
(32:21):
So there are different strategies that people take around that.
But what you described is certainly one.
um So it sounds like um your practice
you've kind of found a really sort of nice niche for yourself in terms of helping peopleavoid dying and then pulling them out of the fire and then putting them on a road of
(32:44):
optimization and utilizing those technologies.
There's a confluence there for you.
So cool.
and you know, you what I usually tell my patients is when we are trying to minimize yourrisk of early death or early disability, you know, it's not with a promise that we're
going to get to get you to live to be 200.
(33:06):
you know, nobody else has done it.
I'm not sure it's possible, but as long as we're minimizing, you know, the risk of yousuccumbing to what everybody else is succumbing to and getting you to be as functional for
as long as possible, you so you can get the most out of life.
And then the idea is to one day die the way that I would want to die, which is, know, Ienjoy time with my family, doing what I love for as long as possible without being
(33:35):
dependent.
on those around me and be, you know, being a burden to them.
And then on my last day on earth, you just kind of drop dead, so to speak.
It's kind of a crude way of putting it.
But I sort of want to get my patience to that point, just like I want to get to thatpoint.
(33:56):
Yeah, no, I think that's right.
think the way that we think about it is that we actually, while we're here, we want to beI mean, our our concept about longevity itself is that it's the greatest opportunity
humanity's ever really had to level up the human experience.
And so for us, it's when we're 100, we want to have a 30 year old body and a 300 year oldmind.
(34:24):
Because in that in that
combination.
It's a combination that people have never had before.
People that have lived to be a hundred, they've always been struggling with elements ofdecline, right?
Their physical health is, you know, now taking up from five percent of their consciousnessto 95 percent of their consciousness.
And yet if you remove that from the equation, you allow people to expand sort ofpsychospiritually and relationally and emotionally.
(34:50):
It's like, my gosh, what an amazing
Right.
Set of human beings we could have.
What an amazing set of experiences, what amazing communities we could build, et cetera.
Right.
So this is really the concept for us.
And, then you have the joy of all that youthful activity.
And so we talk about if you're going to be a hundred and, uh, you know, fast, agile,strong, quick, balanced, great cardiovascular capacity, reserve recovery and flexibility.
(35:17):
Well, then you need to do that today.
Right.
And and if you're going to do that today, then what does it take to do that today?
And then that's down to the regenerative police, also the training pieces and all of thisas well.
So um I think when people understand that this is actually possible, and I actuallybelieve it is going to be incredibly possible.
(35:40):
And the reason I say that ah is because I don't know if you've been following the quantumcomputing space or the quantum AI space on top of just the regular large language models,
but my gosh.
When you you layer the Willow chip and the Mahorana chip on some of these uh incredibly uhlarge data sets that are full of noise and you watch all the stuff that they pull out,
(36:03):
that's, know, like Voyager one, Voyager two, JWST data, this AI Atlas uh body that'sactually moving through the solar system right now.
uh
When you focus on very complex problems that have lots of data with lots of noise and allof a sudden, because you can parallel process tens of millions of possibilities
(36:26):
simultaneously instead of sequentially, I think longevity and aging is going to be solvedin a weekend once we actually are able to focus this kind of power on it.
Right.
So I'm incredibly optimistic.
And I think if you're listening to this, I think you really should be planning for afuture where
uh You can have a 30 year old body and a 300 year old or 3000 year old mind and maintainthat for maybe a hundred.
(36:50):
Maybe it's 200 years.
I don't know if we survive, you know, the political nonsense that that seems to beperennially circulating, right?
If we can avoid those uh kinds of things.
So it's a, yeah, it's a fascinating time to live.
I don't think just spent a more interesting time on the planet to actually live than rightnow.
So.
(37:10):
Yeah, I agree with that.
Yeah.
So good stuff.
Well, I congratulate you on the work you're doing.
And congratulations on the transition that you made.
It's a brave and bold move.
I did a similar thing coming out of cardiology, right?
So interventional cardiology and based jumping into I didn't know what in 2012, except Iknew I wanted to optimize a lot, you know, health at that point.
(37:33):
So, yeah, it's a big step, but very cool.
made that leap, think.
It sounds like about five years ahead of me.
So yeah, that's great.
I'm sure you're enjoying what you do a hell of a lot more than what you used to do.
yeah, there's no going back.
mean, once you, once you're here, there's no going back, right?
You can never go back to it.
(37:54):
And I've got a lot of family up in the Denver Boulder area.
So I get up there.
one of these times I'll drop in and say, hello.
That'd be good.
Yeah, the name of our clinic is Rocky Mountain Regenerative Medicine.
You have my contact info.
Reach out anytime.
Yeah.
Beautiful.
We'll do that.
All right.
Well, great.
Thanks so much.
Yep.
Yep.
either.
Welcome everybody to this edition of the Gladden Longevity Podcast.
I'm your host, Dr.
Jeffrey Gladden, and I'm here with Koshal Latifzai I think I got that right or close.
So uh Koshal, welcome to the show.
Thank you so much for having me.
And yeah, you got my first name uh spot on, Koshal and my last name is Latifzai.
(00:24):
Yeah.
It's L-A-T-I-F-Z-A-I, Latifzai Xi.
Okay, Latifzai Xi.
Okay, cool.
So, um Koshal you did emergency room uh medicine in your training and now you're doingregenerative medicine.
That's not always an obvious transition.
(00:46):
Tell us a little bit about what happened.
Yeah, I went to medical school at Dartmouth and after graduating medical school, I went toresidency.
And to your point, I was trained in emergency medicine at Yale.
And then I moved to Denver about 12 years ago or so, 13 years ago to the Denver, Boulderarea, started practicing in emergency medicine, did that for a number of years.
(01:13):
And over that time period,
Um, you know, I sort of figured out that, um, you know, the, clinical setting that I hadtransitioned into was quite a distance away from what I had envisioned when I was in
medical school, when I was an undergrad, since I wanted to, to become a doctor, I hadended up in a totally separate space and, um, where I thought I was going to end up.
(01:43):
is a place where you would sit down with patients, get to find out what their medicalissues were, really get to know them on a social level and institute changes that were
sustainable over the long haul.
And where I had ended up is seeing patients uh every 15 minutes and dedicating at least 10minutes of that meeting to charting.
(02:10):
So I'd be there, you know, typing away on a computer.
inputting orders, following up on labs, and my interaction with patients were verylimited.
And I had also noticed that other clinicians were in the same place.
And a lot of them were dissatisfied because the patients on the other side were alsodissatisfied.
(02:36):
I'm sure it wasn't a thrill for them to interact with a physician for five minutes.
Mm-hmm.
and then be given their results and being sent out the door or be admitted to thehospital.
So it was an unfulfilling experience for the patient.
was an unfulfilling experience for the provider.
and I had come to, um you know, look up to these clinicians who had been doing that for anumber of decades.
(03:04):
And I was looking at their uh ability to do that for the long haul.
as something to aspire to.
yeah, yeah, I was kind of in awe and envious of how long they had been doing that when thereality was and something that I came to realize a number of years later is that that, you
(03:27):
know, my inexperience in emergency medicine, ah my lack of, the fact that I hadn't put inseveral decades was really a point of strength for me.
And I shouldn't look at that as a point of weakness.
meaning I had this ability to pivot, to transition into the type of medicine that I hadalways wanted to practice, whereas those clinicians were at a different point in their
(03:49):
careers and they lack that.
And so I wanted to...
I'll just interrupt for a second.
I think the audience probably misses this, but in medicine, when you're going throughtraining, there's such a hierarchy to it.
You know, a first year medical student versus a second year medical student, a second yearversus a third, a third versus a fourth.
(04:11):
Right.
And if you're a freshman medical student and you bump into a fourth year medical student,my God, that's like they're on, they're on a completely different level of reality.
Right.
They live in a parallel universe as far as you're concerned.
Right.
Absolutely.
right.
so then they then you have an intern, right?
Well, an intern is another, you know, level of universe up.
And then you've got the resident and then you've got the fellow and then, my God, you'vegot an attending and then you've got an attending that's been doing this for 20 years.
(04:37):
And and you're you're looking off and it's almost like a JWST uh telescope, right?
You're looking off into these distant galaxies and you're kind of admiring what's outthere.
And you sort of lose track of where you are relative to.
the patient, right?
So I'm just, this is how this happens.
This is why somebody could be doing something they don't like and yet still admire thisother person because you're kind of in this whole thing.
(05:02):
You're kind of in awe of everybody ahead of you because they know so much and have so muchexperience and they've learned so much on all this, right?
So it's really interesting to hear you kind of recount that.
I hadn't really thought about that in a long time.
But if the audience is listening to like, could you even tolerate that for a week?
It's, it's because of this, right?
It's kind of like, my gosh, I'm aspiring to be another galaxy like they are.
(05:25):
Right.
So that's it.
And yeah, thank you for providing that perspective.
And I think it's important because, you know, we're, we're taught to persevere inmedicine, right.
And, if you're uncomfortable, we'll look around you.
Everybody else is uncomfortable.
uh Persevere and, you know, put up a stiff upper lip, as they say, and keep it up and keepgrinding forward.
(05:46):
oh And you know, absolutely, that's exactly what I was going to say is it's verymilitaristic, very hierarchical.
Um, and, and, know, I didn't have to do that.
Now while I was an attending, had other attendings, uh, you know, before me and you know,the, the, I didn't want to keep doing that and keep being unfulfilled and unsatisfied.
(06:10):
You know, we got to a point where I was working eight hour shifts, but it would easilyturn into a 12 hour shift because I was seeing patient after patient after patient, and
then all this extra time in emergency medicine, you know, it's dedicated to charting.
I'm sure.
primary doctors sort of do the same thing, you know?
And so, you know, I wanted to kind of step, you know, out of the hamster wheel, but it wasa challenge for someone in emergency medicine specifically, whereas primary doctors,
(06:38):
OBGYNs, maybe they find that transition easily because they, easy because they have apatient base to migrate with them to this new clinic that they're starting.
um And I didn't have that.
I didn't have that safety.
that safety blanket.
And so it was literally, you know, kind of a leap of faith.
(06:59):
Do I want to keep doing A or do I want to do B?
And B uh sounded like it was more up my alley.
That's what I could sustain for decades to come and raise a family in that setting andpractice medicine on my terms.
And so uh I established a clinic uh here in Boulder.
(07:22):
And, uh, my wife who was training to be a nurse practitioner at the time, eventuallygraduated, became a nurse practitioner.
Um, she came on board and a lot of, know, in those early stages, uh, we were doing a lotof admin work, um, and very little clinical work, but over the years, um, you know, we
(07:46):
pay, we've built a really good patient base where
you.
uh Word is spreading through word of mouth.
We do really poorly in terms of marketing.
That's just not our jam.
That's not our specialty.
ah But our patient roster is really extensive at this point and we really enjoy what wedo.
(08:08):
Yeah, kudos to you.
That's what it's all about, I think, is finding a place where you can really make acontribution, feel good about that.
And um I assume now you actually have quite a bit more time to actually interact with yourclients patients.
beautiful.
I mean, our meetings these days are easily, you know, 90 minute interactions at least, youknow, with the patient that occurs several times annually.
(08:36):
A lot of them come in, you know, uh, in between that.
I know these, but know, Boulder is big in some, in some ways and it's small in other ways.
It is a pretty small town.
I see my patients, you know, picking up their kids and I'm picking up my kids at theirschool.
sure, sure.
yeah, and so, and you know, I go on bike rides or hikes, you know, with my patients.
(08:58):
So it's really, built a really good community and I practice medicine with otherlike-minded individuals um who also want to foster that community feeling.
So individuals that I've sent patients to in terms of orthopedists or physical therapistsor what have you.
um They interact with patients in the same way.
(09:20):
So it's much more enjoyable.
Nice.
I love that.
So obviously you also had to pick up some technical skills because your clinic, um youknow, you transitioned away from sort of treatment street them into really helping people
heal because you're involved with stem cells and uh sounds like peptide therapy,hyperbaric oxygen.
(09:42):
You're looking at certain biomarkers and elements of longevity medicine.
So.
uh
Tell us a little bit about that.
What's your approach when you see somebody?
How do you go about that?
Yeah, I mean, I would probably categorize our patients in two separate categories.
Those individuals who come to us because they want to optimize their athletic output,right?
(10:04):
We're in Boulder, there's a lot of athletes here.
There are certainly individuals really honed in and focused on that objective and we sharethat objective with them.
And I can talk about some of the things that we offer that align with those goals andobjectives.
And then the other category of patients approach us.
with an eye towards longevity specifically.
(10:24):
And when we started the clinic, it was probably really with a goal towards minimizing allthe risk factors that predispose for early death.
And so in this country, that's cardiovascular disease, that's cancer, metabolic disease,diabetes, and other things, and then really low level trauma.
(10:45):
When I used to work in the ER, there'd be no shortage of patients coming in from nursinghomes who were old and frail.
oh
like in their eighties, individuals that I wouldn't consider old now, but then they werecertainly elderly.
So they would come to us with ground level falls, picking up a remote off the ground ortying their shoes, falling, breaking a hip.
(11:07):
And those types of injuries have a really high morbidity and mortality associated withthem.
So when these patients came to us, my question was, okay, what...
is the most common cause of death in this particular age group.
And the CDC has really good research out tracking those cause of morbidity and mortalityin that age group.
And then the next question was, what are the most relevant risk factors that predict thatindividual specific risk profile?
(11:36):
And it turned out there was quite a deviation from what I used to do in the ER and whatthe literature shows to be really highly predictive of.
cardiovascular disease, for instance.
And a lot of that variation is due to the involvement of insurance companies.
In other words, if I'm establishing a patient-doctor relationship with you, but ultimatelythe payer for those services is not even in the room, it's the insurance company, they
(12:06):
have a say in what they will pay for, what they won't pay for.
And that in turn dictates how I practice medicine, what I offer to you.
So one of the things that we did is just remove insurance companies from that equation.
know, we did reach out to Cigna and United, et cetera, et cetera.
And one of the things that they wanted to do is they knew that I was, you know, a clinicthat was just getting established.
(12:33):
So they wanted to sit down and sort of negotiate their rates with me.
And I didn't even want to get in that discussion.
And if you look at most doctors' offices,
they have a whole admin team.
And at this point, they probably outsource a lot of those administrative duties tooverseas uh vendors where they go back and forth with the insurance company, try to
(12:53):
negotiate rates every year, and then also to try to capture that revenue from theinsurance companies.
And so we didn't want to hire a big admin uh staff to do that.
So we said no insurance.
And that was definitely a leap of faith.
I wasn't sure if anybody
was gonna invest in their healthcare if we said we're not gonna take insurance and youhave to pay for this out of pocket.
(13:18):
But it turns out there was a huge interest.
A lot of our clientele are educated, they have insurance, they're financially well off,and they really uh have the ability to invest in this type of healthcare that where their
doctor sits down with them and explains things and kind of highlights what their riskprofile for the most common cause of death are.
(13:41):
and really highlight the steps that need to be taken to minimize their risk of dying andsuccumbing to those causes of death.
So those are sort of the two big categories that our patients fall into.
So these days, when our patients come in, we typically do a really extensive lab panel onthem.
(14:01):
And then they come in periodically several times a year to review those panels, thosebiomarkers that need to be repeated.
because we're tracking them to see how well our interventions are moving the needle in apositive direction.
We meet with them several times annually.
We review those biomarkers with them in TDM.
(14:22):
We send out an email kind of recapping the summary of that visit.
that way several months down the road, if they're discussing their biomarkers with acoworker, with a family member, they know exactly what that...
risk profile looks like, what we're doing about it, how it's impacting those biomarkers,uh et cetera, et So they are very, very engaged in their health.
(14:46):
And then slowly these individuals want, you know, they come to us and they say, okay, nowmy health has been optimized.
My risk of death and morbidity have been minimized.
That's fantastic.
What else do you have to offer to really optimize my health in the here and now so I canget the most out of life?
And then we, that's where we see these two worlds, these two patient groups kind ofmerging together.
(15:10):
Um, because now these individuals, uh, have maybe lost weight, they're much healthier andthey want to engage in athletic endeavors that they had been putting off because of where
their health was, or they want to engage, you know, in trips and, and, and things withtheir family that they previously were not able to do.
(15:31):
And so that's where, you know,
the inter peptides, inter stem cell therapy.
These are ways that I think we kind of marry those two groups together.
know, stem cells, I'm happy to talk about them.
I'm happy to talk about hormones, peptides, et cetera, et cetera.
Here, no, think all that makes sense.
(15:52):
um You know, the way we think about it is um sometimes you gotta pull people out of thefire before you can actually start to think about how you're gonna take them to the next
level.
So um the basic concept of evaluating people, and it sounds like you have a discrete.
(16:12):
number of things you're looking at there to the most common things that people tend tostruggle with and then helping them to actually navigate around that to a point of let's
call it relative health, knowing that they can be optimized further does put them reallyon a parallel pack because the way we think about it, it's really all about the questions
that somebody's asking, right?
So the athlete is asking the question, how do I optimize my performance?
(16:37):
And now you get people
healthy enough to the point where they can ask the same question.
How do I optimize my performance?
Whatever that may be.
uh So yeah, makes perfect sense how that works.
Yeah.
Cool.
and some of these athletes, maybe they're so high functioning in whatever sport thatthey're engaged in that they're completely blind to maybe some family history or some
(17:01):
genetics that's exposing them for certain things.
so, yeah.
We see that a number of athletes
are aging prematurely and you probably see that too.
um So we had a guy in here not long ago uh happens to live in Italy now.
(17:23):
He sold a company and is Canadian and moved uh to Italy, lives in Miami and came into theclinic.
I met him when I gave a talk and he, um you know, wants to be a cyclist.
So he's basically
cycling four hours a day over there in Italy.
He cycled as a kid.
He's 40, 41 years old.
So and yet he's having all these issues, right?
(17:47):
He's getting sick all the time and things like that.
So the obvious thing is, well, maybe you're you know, maybe you're overworking out, right?
Maybe you're over training.
uh But he comes in and we we do our deconstruction process on him.
And what we find out is that uh genetically he doesn't handle oxidative stress very well.
(18:07):
And he has lots of oxidative stress markers that are showing significant damage across hisDNA, his proteins, his lipid membranes, RNA, et cetera.
And then if you look at his oxidative stress age, because we're all a mosaic of many ages,right?
He's 41.
It was 59 and a half.
And he's like, holy crap, I'm really killing myself, aren't I?
(18:29):
It's like, yep, you really are.
So, you know, you're just not built for this, right?
You're just not built for this.
And I'll show you what you are built for.
because it doesn't mean you have to sit on the couch.
uh so it's it's really interesting that athletes as as gifted and talented as they may be,uh it's certainly possible for them to either destroy themselves through injury or through
(18:53):
being involved in in training regimens that they're genetically not built for.
Right.
Not everybody should run a marathon.
So, yeah, pretty interesting.
Yeah, and along those same lines, I have a patient as you were talking, I was thinkingabout an ultra marathon or patient who I have who's in the 30s.
And, you he was having a hard time.
(19:14):
Conceiving with his wife and you know, we checked his hormone levels and sure enough hishis hormones were that of 80 90 year old and uh I think in most instances what would
happen is that individual would probably get on TRT, you know at most most clinics hereand I'm sure nationally also but that really wasn't the solution it wasn't the problem and
(19:40):
and so we you know, I kind of had a similar conversation with them
Mm-hmm.
dialing down the intensity of his training and sure enough, that's all it took.
You know, he was doing everything else right.
You know, sauna, cold plunge, et cetera, et cetera.
Eating right.
Really elite athlete and very, very smart, very accomplished, both passionatelypersonally.
(20:02):
And all it took was just dialing down the intensity of his trainings.
Um, his ex hormones came back online.
So there is such things over training.
absolutely.
Very common in women athletes, um You know, to stop menstruating or to have difficultyconceiving or whatever else.
um So it's an interesting sort of psychological drive that people have.
(20:26):
um In a way, I think it's related to the idea of being externally validated.
And certain people are externally validated by how much money they make or whatneighborhood they live in or who they're married to or.
where their kids go to school or whatever, but other people are externally validated by,you know, how fast they can run a marathon or how many, you know, ultra marathons they can
(20:48):
do.
We just had a guy that just completed a marathon on all seven continents uh just a week orso ago.
uh But in talking with him prior to that, we were looking through his stuff and it's like,you know, these marathons are really beating you up.
He said, I know, but I've just got one more to do.
We're like, okay, we're going to help you get through that one, but make that the lastone, right?
(21:13):
Because, you know, it's, really killing you in a way.
And so he, he went, he did it, he completed it.
And we're all happy that it got done, but I'm really happy that now he can actually focuson his health.
So, the thing about it is rejuvenation technologies, right?
Whether it's stem cells, hexasomes, peptides, you know, all kinds of stuff, that.
(21:34):
We both do, you know, they can only do so much.
And really, I think ultimately gets back to understanding who you are, how you're built,what you're built for, and then leaning into those strengths and kind of avoiding some of
the weaknesses.
Right.
So, uh yeah.
So that's that that's part of the precision medicine, if you will.
ah Yeah, super cool.
(21:58):
So tell us a little bit more about the stem cell work that you are doing.
What are you what are you guys up to there?
Yeah, I mean, I think one of the things that we discovered early on ah is, and it wasn'tus, this has been pretty well documented in literature, is that as a person is getting
older, ah that aging process can be defined, as you said, a mosaic of different ages.
(22:22):
And one of those ages are your stem cells, ah meaning here are a group of cells thatreally
have been positioned as this keystone, this highly important group of cells that aretasked with healing and regeneration uh in the body.
(22:44):
And as individuals are getting older, the number of those cells is declining.
And this has been happening since we were born.
The number of stem cells in our body has been steadily decreasing.
So you're going to have less in your body than you did next year than you did last year.
And in addition to that,
the quality of those stem cells is also decreasing as a person is getting older and itmanifests differently in different individuals.
(23:12):
Some people have, you know, it translates into immune system implications for thatindividual where their shingles is now acting up, they're more prone to infections and
other people, it's musculoskeletal frailty is what it translates into.
So these individuals who want to keep running, keep cycling, keep swimming, keep hiking,
(23:33):
they're injuring themselves and those injuries are slower and slower to heal.
And so we wanted to know how we can harness um that part of you for as long as possibleand possibly augment it even further.
And at the time, one of the things that was popular then I'm sure it's still popular,
(23:55):
is the use of umbilical cord or placental derived stem cells.
And we looked into that and there are certain shortcomings associated with using somebodyelse's cells.
And the short of it is this, when you have somebody else's proteins injected into you,your immune system is gonna take note of that.
(24:17):
and you're going to start to produce antibodies against those proteins.
And that mechanism for manufacturing those antibodies is not fail safe.
Errors are going to be certainly made.
And if there's enough similarity between those antigenic proteins that were just uhinjected into you and your own native proteins, it's quite conceivable that you're going
(24:40):
to develop antibodies that instead of targeting that foreign protein, targets your ownprotein.
and it could give rise to autoimmune conditions that may not fully manifest for years,possibly decades, but when they do, um it can really take a toll on the body.
Think of, for your audience, rheumatoid arthritis or lupus or uh Hashimoto's, type 1diabetes, these are all autoimmune conditions.
(25:09):
And it's always been sort of a puzzle as to how people get these.
these autoimmune conditions, why the immune system acts out of sorts, where it's attackingyour own proteins rather than defending you against, um, against pathogens.
But this is one mechanism by which you can potentiate autoimmune conditions.
(25:30):
if you get massive amounts of these proteins belonging to somebody else introduced intoyour body, and some individuals were doing it, um, you know, over and over again.
So it wasn't a one and done kind of a deal.
So we didn't want to.
you know, potentially um give rise to autoimmune conditions, although I'm sure there'splenty of clinics in the Denver area alone that uses that form of stem cell therapy
(25:57):
referred to as allogenic stem cell therapy, meaning using somebody else's cells, we wantedto really use the person's own cells.
And so we started harvesting stem cells from bone marrow in the early stages of our ourclinic.
And there are certain advantages and disadvantages.
(26:18):
You're certainly using your own stem cells, which are better for you, for all the reasonsthat I alluded to earlier.
um But the big drawback on the one hand is it's a painful procedure.
You do have to punch your holes through the cortex of the bone, the shell of the bone toget to where the bone marrow is.
And then beyond that,
(26:38):
There's several ways of categorizing stem cells, one of the ways is um through the systemwhere some stem cells are referred to as hematopoietic stem cells, which give rise to
blood cells, and then mesenchymal stem cells, which has this ability to transform intoother tissue types.
(26:58):
And when you look at the ratio of hematopoietic versus mesenchymal stem cells in bonemarrow, it favors hematopoietic stem cells.
And it's understandable because that's where a lot of immune cells, white blood cells aresort of born.
um The other way to harvest stem cells is from fat, which is more accessible.
(27:22):
uh We usually target the fat in the lower back or the upper body area.
The downtime is really minimal compared to bone marrow harvesting.
And then that ratio of hematopoietic to mesenchymal stem cells is flipped in the otherdirection, favoring more mesenchymal stem cells in fat.
uh so we started transitioning to using fat.
(27:47):
And we were still getting great results when we utilize these cells, especially formusculoskeletal injuries in our athletes.
uh And like I said, the downtime was a lot less compared to bone marrow harvesting.
And since kind of adopting uh adipose harvesting, meaning fat harvesting for stem cell uhtherapy, we've gone to culture expanding those cells.
(28:15):
ah And the reason we started doing that is this technology had been utilized in veterinarymedicine for decades.
And I was completely oblivious to that.
In medicine, we really own in a really well-trained and obviously human medicine.
We don't refer to it as that, but in veterinary medicine.
(28:36):
uh stem cell harvesting, stem cell culture expansion, and I'll kind of detail that alittle bit.
It's been around for a long time and these stem cells are being utilized in really uhathletic courses, racing thoroughbreds with great effect.
And as we kind of dove into that, there were other forms of therapy.
(29:00):
that we're now using in humans that's been utilized in veterinary medicine for a longtime, and that includes PRP.
But just kind of staying with this stem cell theme, our methods of harvesting stem cellsfrom fat mirrored what was happening in...
in veterinary medicine.
uh And now we went to culture expanding those cells, meaning you would take fat from uhour patients, we through a liposuction procedure done in the office, what during a
(29:32):
procedure that where the patient is awake, so there's no general anesthesia or conscioussedation or anything like that, we just use lidocaine to really, you know, infiltrate that
area, we're going to be harvesting the fat from.
And then we isolate the stem cells within that sample of fat.
And then we take those cells and replicate them in a lab under sterile conditions bytrained staff.
(29:57):
So that's not done here on site.
That's done in a lab.
And after about six weeks, you get thousands of times the number of similar cells thatoccur naturally in the body.
And during that replicative phase,
not only are the number of stem cells increase, but through natural selection, meaningthese cells are having to compete with one another for limited nutrients and resources and
(30:22):
that quote unquote petri dish, those cells that um are not functioning well, they die offbecause they can't keep up with their peers for those nutrients.
And those cells that are able to elbow out their peers,
You know, they kind of rise to the top, so to speak, they're going to replicate again andagain and again.
(30:44):
And then those cells are collected and frozen, and they're available for years for decadesto come.
So as these patients are getting older, those cells are kind of frozen at their currentage in really high numbers and probably better quality than what you would find naturally
occurring in the body.
And then you're using small aliquots of what's frozen to be injected into the knees, intothe hips, shoulders, even intravenously, allowing those cells to respond to the cytokines
(31:17):
and chemokines and chemical signals of injury, wherever they may be emanating from andallowing them to interact with those damaged cells in a way that restores to the extent
possible the function of those damaged cells.
Yeah, no, it's a good approach.
It's really interesting, I think, that veterinary medicine has.
(31:40):
Well, it's not really surprising, really, when you think about the restrictions on humanmedicine per se, but in veterinary medicine.
Oh, my gosh, they've been doing so many innovative things for so long, right?
It's people think that humans have the best medicine on the planet, but actually it's it'sthe it's the horses and, you know, some of the competitive animals that actually have
(32:01):
access to the best medicine.
at least, you know, staying inside the US.
There's a lot of things you can access outside the US.
But um yeah, that's that's fascinating.
Yeah, it's nice to think about planning for the future.
Right.
How do you actually maintain your health if you're going to need it?
Something in the future.
Right.
(32:21):
So there are different strategies that people take around that.
But what you described is certainly one.
um So it sounds like um your practice
you've kind of found a really sort of nice niche for yourself in terms of helping peopleavoid dying and then pulling them out of the fire and then putting them on a road of
(32:44):
optimization and utilizing those technologies.
There's a confluence there for you.
So cool.
and you know, you what I usually tell my patients is when we are trying to minimize yourrisk of early death or early disability, you know, it's not with a promise that we're
going to get to get you to live to be 200.
(33:06):
you know, nobody else has done it.
I'm not sure it's possible, but as long as we're minimizing, you know, the risk of yousuccumbing to what everybody else is succumbing to and getting you to be as functional for
as long as possible, you so you can get the most out of life.
And then the idea is to one day die the way that I would want to die, which is, know, Ienjoy time with my family, doing what I love for as long as possible without being
(33:35):
dependent.
on those around me and be, you know, being a burden to them.
And then on my last day on earth, you just kind of drop dead, so to speak.
It's kind of a crude way of putting it.
But I sort of want to get my patience to that point, just like I want to get to thatpoint.
(33:56):
Yeah, no, I think that's right.
think the way that we think about it is that we actually, while we're here, we want to beI mean, our our concept about longevity itself is that it's the greatest opportunity
humanity's ever really had to level up the human experience.
And so for us, it's when we're 100, we want to have a 30 year old body and a 300 year oldmind.
(34:24):
Because in that in that
combination.
It's a combination that people have never had before.
People that have lived to be a hundred, they've always been struggling with elements ofdecline, right?
Their physical health is, you know, now taking up from five percent of their consciousnessto 95 percent of their consciousness.
And yet if you remove that from the equation, you allow people to expand sort ofpsychospiritually and relationally and emotionally.
(34:50):
It's like, my gosh, what an amazing
Right.
Set of human beings we could have.
What an amazing set of experiences, what amazing communities we could build, et cetera.
Right.
So this is really the concept for us.
And, then you have the joy of all that youthful activity.
And so we talk about if you're going to be a hundred and, uh, you know, fast, agile,strong, quick, balanced, great cardiovascular capacity, reserve recovery and flexibility.
(35:17):
Well, then you need to do that today.
Right.
And and if you're going to do that today, then what does it take to do that today?
And then that's down to the regenerative police, also the training pieces and all of thisas well.
So um I think when people understand that this is actually possible, and I actuallybelieve it is going to be incredibly possible.
(35:40):
And the reason I say that ah is because I don't know if you've been following the quantumcomputing space or the quantum AI space on top of just the regular large language models,
but my gosh.
When you you layer the Willow chip and the Mahorana chip on some of these uh incredibly uhlarge data sets that are full of noise and you watch all the stuff that they pull out,
(36:03):
that's, know, like Voyager one, Voyager two, JWST data, this AI Atlas uh body that'sactually moving through the solar system right now.
uh
When you focus on very complex problems that have lots of data with lots of noise and allof a sudden, because you can parallel process tens of millions of possibilities
(36:26):
simultaneously instead of sequentially, I think longevity and aging is going to be solvedin a weekend once we actually are able to focus this kind of power on it.
Right.
So I'm incredibly optimistic.
And I think if you're listening to this, I think you really should be planning for afuture where
uh You can have a 30 year old body and a 300 year old or 3000 year old mind and maintainthat for maybe a hundred.
(36:50):
Maybe it's 200 years.
I don't know if we survive, you know, the political nonsense that that seems to beperennially circulating, right?
If we can avoid those uh kinds of things.
So it's a, yeah, it's a fascinating time to live.
I don't think just spent a more interesting time on the planet to actually live than rightnow.
So.
(37:10):
Yeah, I agree with that.
Yeah.
So good stuff.
Well, I congratulate you on the work you're doing.
And congratulations on the transition that you made.
It's a brave and bold move.
I did a similar thing coming out of cardiology, right?
So interventional cardiology and based jumping into I didn't know what in 2012, except Iknew I wanted to optimize a lot, you know, health at that point.
(37:33):
So, yeah, it's a big step, but very cool.
made that leap, think.
It sounds like about five years ahead of me.
So yeah, that's great.
I'm sure you're enjoying what you do a hell of a lot more than what you used to do.
yeah, there's no going back.
mean, once you, once you're here, there's no going back, right?
You can never go back to it.
(37:54):
And I've got a lot of family up in the Denver Boulder area.
So I get up there.
one of these times I'll drop in and say, hello.
That'd be good.
Yeah, the name of our clinic is Rocky Mountain Regenerative Medicine.
You have my contact info.
Reach out anytime.
Yeah.
Beautiful.
We'll do that.
All right.
Well, great.
Thanks so much.
Yep.
Yep.
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