I am delighted to connect with Dr. Darshan Shah today. He is a health and wellness specialist, a board-certified surgeon, a published author, an entrepreneur, and the founder of Next Health, the world's first and largest health optimization clinic.
In our discussion today, we dive into the current state of U.S. healthcare, contrasting how the traditional allopathic model focuses on acute care and disease treatment with a preventative approach. We cover the health of children and teens, mitochondrial dysfunction, the impact of shift work on circadian rhythms, hormonal regulation through HRT and lifestyle changes, looking at Akkermansia, gut physiology, and the implications of ultra-processed foods. We also explore cutting-edge therapies like IV NAD and exosome treatments.
I am sure you will love this enlightening and informative conversation with Dr. Darshan Shah as much as I did.
IN THIS EPISODE YOU WILL LEARN:
The present state of healthcare in the United States
Why we need to be personally responsible for our health
How modern lifestyles impact mitochondrial health
The impact of shift work on healthcare providers
The interplay between gut health and hormonal changes
Why it is essential to address gut health and hormone deficiencies concurrently
The health implications of eating ultra-processed foods
Why do we need to track biomarkers regularly?
The benefits of novel therapies like IV NAD and exosome therapy
Some tips for making simple and nutrient-dense meals
Bio: Dr. Drashan Shah
Dr. Shah graduated from the accelerated 6-year MD/BS program at the University of Missouri, Kansas City, and earned his medical degree at the age of 21, becoming one of the youngest physicians in the country. He then continued his training in general surgery and trauma in Kern County, California where he performed over 10,000 operations on all body systems.
From trauma surgery to reconstructive surgery, Dr. Shah has seen and done it all. He was also prolific in writing many articles published in dozens of academic journals, started a surgical education website, and was an outstanding teacher of fellow medical students and residents.
“Ultra-processed food is just a chemical mess. Even though it technically has carbohydrates in it, it is not food.”
-Dr. Darshan Shah
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Connect with Dr. Darshan Shah
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with Dr. Darshan Shah. He is a health and wellness specialist, a board-certified surgeon, published author, entrepreneur, and founder of Next Health, the world's first and largest health optimization and longevity clinic. Today, we spoke at length about the state of US healthcare, including the traditional allopathic model that is focused on acute care medicine and treatment of disease as opposed to prevention, the impact of health of our children and teens, the role of mitochondrial dysfunction, the impact of shift work on disruption of circadian patterns, hormones and hormonal regulation, especially HRT and lifestyle, gut physiology, the role of Akkermansia and food-like substances, ultra-processed foods, biomarkers for health and lastly, novel therapies like IV NAD and exosome therapies. I know you will enjoy this conversation as much as I did recording it.
[00:01:34] Welcome, Dr. Shah. I'm so glad we were able to finally make this conversation happen. We met in February in New York City and it literally has taken this long to coordinate our calendars, so welcome.
Dr. Darshan Shah: [00:01:45] Thank you so much for having me, Cynthia, such an honor and a pleasure to be here.
Cynthia Thurlow: [00:01:49] Absolutely. I would love to get your perspectives as a traditionally trained allopathic medicine surgeon on the state of US healthcare. I think this is a hot topic and I was actually going through research and data last night to have, you know real time statistics to be able to speak to when I do my intro later. What are your thoughts on the state of healthcare? Because obviously over the past 25 years, in many ways, I think we as a nation have really started to head in the wrong direction. Like, there's all these good intentions, but yet healthcare is shifting in ways that are significant and profound.
Dr. Darshan Shah: [00:02:27] Yes, absolutely. And I think we share a unique perspective, being trained in that allopathic world for so many years and me practicing in it for so many years, that I can see very clearly what happened. Like everyone wants to know what happened. Like, “Why are we in such a horrible state where 80% of people have metabolic disease and most of us will suffer from one of the chronic diseases as we age.” And it really is a combination of multiple factors about what happened. And I saw this whole thing happening as going through my training and then also practicing. And it's sad to say, it's like a train wreck in slow motion. [chuckles] And that's kind of where we at. And like you said, “I think there are a lot of good intentions that went wrong.”
[00:03:12] Allopathic physicians and practitioners, we were all trained to handle acute situations and treat disease. And unfortunately, there was very little education on how to prevent disease in the first place. Prevention was not really a huge topic at all in our training, especially in my training back when I trained in the late 1990s. I think that we all have the stories like we only had one hour of nutrition training, we had zero hour of exercise training. Zero, there was really zero. Because what was our job? Our job was to diagnose disease and figure out how to treat it right? And being a surgeon basically, we saw people at the end of their rope for a lot of diseases, liver failure, we're doing liver transplants, they have metabolic disease and they have cancer that came from that. And we're treating the cancers now. And so, it's really at the end of the cycle, that's where traditional medicine was meant to be and meant to focus.
[00:04:10] And I'm really encouraged actually right now, Cynthia, because I think people finally get it that they need to take their health into their own hands. They need to be personally responsible for their health, they need to learn, they need to educate themselves. That's why people are listening to this podcast right now because no one is going to do that for them. And really, I think we need to have a mindset shift in western culture that the allopathic system is there for when you're in real bad trouble. The rest of it is up to you. And really, all of these diseases start in your 20s and 30s when you're not even going to the doctor in the first place, or you don't even care about going to the doctor. That's when these diseases start. And that's when you need to start taking personal responsibility for your own health, for your own nutrition, for your own exercise and movement, all of it.
[00:04:55] So, you really understand what direction you're headed in, because one of your jobs is to prevent getting to the allopathic system in the first place. So, I really encouraged by this upswell of what I call health span, life span kind of talk and chatter now, there’s a lot of bad players out there saying things that aren’t really true, and there’s a lot of people making money off of this. And there’s a lot of influencers saying things and biohackers, but I think at the end of the day, we’re going to really see a mindset shift where people are no longer outsourcing their health to their primary care doctor to a 15-minute visit with five blood markers tested once a year. That's just completely the wrong way to do it. And I'm happy to be here to talk more about how we educate our clients and what they need to do to take personal responsibility for their health.
Cynthia Thurlow: [00:05:43] Well, and what you're really speaking to is health advocacy, which is something that I think many of our patients have not been conditioned to do that. My hope and my intent with this podcast and conversations that you and I are having and so many of us are having in this space is helping people understand you are your own best advocate. We cannot depend on our healthcare providers because they are, many instances, overworked, overstressed, especially coming out of the pandemic. You look at the statistics on provider fatigue and not just that, but thinking about the degree of people that are leaving clinical medicine, we don't want that to be happening. But for so many people, they're frustrated with the system. They're frustrated with seeing 30, 40 patients a day only getting 15 minutes. I can assure you that every person that's listening, your providers, do not want to be in that situation where they can only spend 5- or 10-minute speaking to you and praying you don't bring up a topic that necessitates them having to send you to the ER or send you to the hospital, they're hoping everything is stable.
[00:06:45] But I agree with you. I have teenagers now and one is going off to college, and we've had to start having these conversations about, when you leave for college in August, mom and dad are not going to be cooking your meals. You're going to be making decisions independently. And as he's getting more social and spending more time with his peers than he is at home, he'll come home and he'll say to me, “We ate at ‘insert any fast-food place’ that most teenagers are eating at.” And he'll tell me he was like, “I come home and I'm sick to my stomach. I feel terrible.” It tastes good in the moment and then I have to have the conversation to say, “Making good choices is going to be very important, especially when your parents are no longer as actively involved in everything that you're doing.” The same applies to younger people that listen to this podcast, because so much of this podcast is focused on people in middle age that suddenly find what they were doing in their 20s and 30s that's no longer working.
[00:07:40] And to your point, this lifestyle modification piece is critically important. It is far more important than prescribing medication. And unfortunately, in many instances, that is what we have conditioned our patients to ask for, is the pill instead of doing the hard work, which is getting more sleep, changing your diet, becoming more physically active. And a lot of these chronic diseases that we're speaking to are really a byproduct of mitochondrial dysfunction. And so, certainly my listeners are tuned to what the mitochondria are. But let's speak to how our modern-day lifestyle is influencing the health of our mitochondria and down to that cellular level, which is quite significant.
Dr. Darshan Shah: [00:08:23] Right, Cynthia, you bring up a really important topic as our kids, and I just want to talk about that a little bit. My dream is to make a month-long course that is taught in every high school freshman year during biology. Like, we need to have a chapter in every biology textbook about your personal health so people can learn. You learn about mitochondria, but you really don't understand how these little energy producing organelles really contribute and have everything to do with our incredible rise of chronic disease in our society. And it all starts from childhood, teenage years. Like you were saying, “There's a constant assault on the mitochondria.” So, between all of the things that we are doing and we subject ourselves in modern life to are all affecting our mitochondria. Thank God, we have a large number of them, and they're highly productive when we're young. But we assault them every day with ultra-processed food, with lack of movement, with high degrees and high levels of stress in our life, with reducing our sleep patterns and shift work, etc. And this assault to our mitochondria decreases their number and decreases their function over time.
[00:09:37] And I think because our bodies have so much resiliency built in, we don’t see the effects of that until we turn 40, 50, and then definitely by the 60s is when there’s a massive drop off. But it doesn’t need to be that way. We’ve done such an incredible job of being able to extend lifespan over the last 80 years because we have all these pharmaceuticals and these surgeries that we've created, but none of that would even really be necessary if we just took care of our mitochondria from a young age. And we just kept the number high and their function high. And so, I always talk about the Pareto principle. The Pareto principle is the 20% of things that you can do that give you 80% of the result. And that 20% is really not doing anything special, except what we were meant to do is avoiding ultra-processed food and eating organic whole food. It's getting the 8 hours of sleep that we need or everyone's a little bit different in how much sleep they actually need. But getting that sleep and prioritizing it and then moving as much as you can during the day, those three activities, before I give anyone their supplement recommendations or their hormone recommendations, I say, “You got to get those three things right. That's the Pareto principle. Without that, you're not going to have any success with any of the other things that we can potentially do.”
Cynthia Thurlow: Well, I love that. Let me just touch on the fact that you have a desire to create this course for teenagers. I think that is a brilliant idea and something that can be easily adopted. What I find fascinating is that I call it majoring in the minors. There are so many people that want to do cryotherapy. They want to do infrared sauna. They want to have all these intricate hormetic stressors, and yet they haven't majored on the big things that have the largest net impact. You mentioned the 20% that really governs 80%, the sleep, the stress management, nutrition. And for everyone listening, that's the stuff that's so important and I know it's not sexy. I think cold plunging is sexy. And infrared sauna is a thing right now. And those things are important. But if you haven't already dialed in on these very, very basic lifestyle pieces, no supplement or medication is going to save you from your lifestyle choices. And I think that's an important distinction to make.
Dr. Darshan Shah: [00:11:54] Yes, absolutely. I talk every day with my patients about the science of infrared therapy, the science of cryo. But what I really love about those things is, like you said, “You implement those after you get that 20% right, right?” However, it brings the conversation up, and I guess people refocus on their health. And so now we're talking about infrared sauna, we're talking about cryotherapy, we're talking about these different things. But now people are really understanding, like, “Oh, I'm doing these infrared saunas and these cryotherapies because I've caused so much damage over years of not living the lifestyle that I should be focusing on.” And so it helps. I agree with you like there's a lot of talk about these things that are majoring in the minors, but it does kind of shift mindsets, which I'm really loving. I'm loving the mindset shift of the people that we're seeing. Like people actually taking personal responsibility to learn about health and actually dedicating some time to it. So, I think we've grown up in an environment and society over the last 50 years where there's very little dedication other than the hour at the gym to your own personal health. And I think that mindset is changing now.
Cynthia Thurlow: [00:13:03] Yeah. And what are your thoughts about, you know you and I both worked nights and you were probably on call and coming in the middle of the night dealing with emergencies for listeners that might be licensed healthcare providers or people that are cops or teachers or anyone that's working shift work. How can they navigate lifestyle choices when sometimes they don't have as much control as they would like to? Because I get a lot of questions around this and I know that the last night shift I worked was 19 years ago, so it was a long time ago, but I know how disruptive that was to trying to navigate days off and sleeping and everything else. But for shift workers, irrespective of what you do, how do you speak to these patients in particular who may not have as much control as someone who works a 09:00 to 05:00 job?
Dr. Darshan Shah: [00:13:54] It's a real problem in our society that we've developed shift work, but it is there. And like you said, “I took trauma call for many, many years and someone needs to handle the traumas at night. They happen and someone has to be there for that. What I would say is, first of all, have a long-term plan. How are you going to get off of shift work in the long term? It could be a 10-year plan, but you can’t live like this forever, right? It works in your 20s, it gets harder in your 30s. And then once you hit 40, it really starts being a detriment to your biology. So, you need to have a long-term plan to eventually get off of it. I would also say that decrease the percentage of time per month that you spend in those states, in that shift work. So, say you’re working shift work-- I talk to a lot of nurses, a lot of nurses are my patients and we work with a lot of nurses and they're like, “I'm just going to do three nights in a week and then I'll be done with all my work.” And I tell them, like, “Okay, that's great to have it over with, but those three-night shifts that you're doing and then not getting good sleep for three nights in a row, you're spending the next four days just recovering from that. Why don't we instead do one night shift a week instead of three-night shifts and spread them out over the month instead?”
[00:15:01] And that's going to be so much better for your biology. And so, I think there's some planning that can be done in your overall schedule. And these things take time and you're in the mercy sometimes of your employer. But I think employers are also realizing that they can have more productive staff. The less tired they are, the more healthier that they are. And I think also you have to plan after shift work. The next 24 hours has to be a time of recovery. So, shift work recovery, shift work recovery and you just can't dive back into normal stressful life after the shift. So, I think it's just planning. You know, I sit down and we go over people's schedule a lot when I talk to my patients. I'm sure you're doing kind of the same thing. And we just try to get their heads wrapped around. How do we change our schedule over the next six months, year, 2 years, 5 years, 10 years to really get to a place where you can live your normal circadian biology? Because that's really where we need to be living.
Cynthia Thurlow: [00:15:55] Yeah. And it's so interesting because I love your pragmatism because you're not saying stop doing shift work, you're just saying let's find an exit strategy. And I actually have a team member who speaks very openly about this. She’s a nurse anesthetist. And when we were looking at her labs, when she was working nights versus working days, it was such a significant shift that she got to a point where she now no longer works night shifts. But having to educate her employer to talk about like, this is what it’s doing to my health. And I really need in my 40s to get to a point where I’m working during the days. Maybe that means I’m not getting the hospital that I want to work at. Maybe I'm traveling a little bit more, but I'm willing to do that so that I'm sleeping at home or I'm at least sleeping when it's dark outside. What is the research suggesting about this disruption to our circadian biology? You alluded to this, and I think for a lot of shift workers, they may not realize that not sleeping when we are in alignment with our circadian clocks has a detrimental impact on our health overall.
Dr. Darshan Shah: [00:16:58] Yes, absolutely. Research is very clear on this actually, that not sleeping with your circadian pattern leads to an increased rate of metabolic disease. There’s actually an increased rate of cancer, there’s actually an increased rate of cardiovascular disease as well. And even though the studies are still being done on Alzheimer’s disease and neurodegenerative disease, there’s definitely an association between long-term shift work and neurodegenerative disease as well. So basically, you've checked off almost all of the top 10 causes that the CDC lists as causes of death by working shift work. So, you're slowly marching over time towards an increased risk of all these diseases. That's just a fact and I think every employer needs to know those facts and if they don't, then we should be talking to employers about these facts. And so look, our bodies are very resilient in our 20s we know that, maybe you start off your career doing those kind of things, but the eventual game plan needs to be to get off of that shift work and really, really understanding your circadian biology. We've evolved over hundreds of thousands of years right, to wake up with the sun and go to sleep when it's dark. And that's kind of what we need to get to at some point.
Cynthia Thurlow: [00:18:07] Yeah, it's interesting. In the very beginning of my ER nurse days in inner city, Baltimore, I worked nights because as a new grad, they never took new grads. I was the only new grad and they put me on night shift and I am not a night shift person. It was a struggle to stay awake and I eventually acclimated. But two years in, I remember, because I was also in graduate school, asking my nurse manager, I said, “On my days off, I am wrecked. I cannot sleep.” The only way that I could describe it was I had such a tremendous amount of brain fog. I felt like I was walking around, but in a fog, I couldn't think clearly, I was dangerous driving home from those shifts, I would sometimes fall asleep at a light and I didn't even live that far from the hospital.
[00:18:46] So imagine cumulatively over time I was in my 20s then. I can't imagine if I were still doing night shift, I would probably be a menace on the road for sure. Now, one of the big topics that we discuss on the podcast is navigating hormonal changes in our 40s and 50s. So, we're talking perimenopause, menopause, andropause for men, what specifically do you feel like are the higher-level concepts when you're working with patients to help them understand what is going on physiologically and what do they need to change? We've talked about how our 20s and 30s, we can get away with a lot. Things start to change in our 40s and 50s. What were able to do when were younger, suddenly does not work quite as well at this stage of life.
Dr. Darshan Shah: [00:19:29] Right. So, this is a conversation I have almost daily as well. And I think there's always like this chicken and egg conversation that we have with hormonal changes is like, “Can I get my lifestyle better?” And I'll do that first before I look into kind of manipulating my hormones. And however, I tell people, “You're absolutely right, you absolutely want to institute lifestyle changes not just for your hormones but also for your overall health.” However, women go through menopause, it's just a fact of life, and you are going to still experience hormonal changes. Men will go through andropause it's just a fact of life as well. So really the question is not should we be manipulating hormones? Is really like when to get your head wrapped around this, right?
[00:20:14] And so I think that's a conversation that we have with almost every single patient. And look, some people are just completely against hormone replacement therapy, and I get it, that's completely fine. But I think there's also a little bit of misguided optimism around just natural hormonal therapies being able to eventually keep you in that right spot. And if you're fine with aging gracefully, I totally get it. I'm actually fine with aging gracefully myself. [chuckles] And so I probably won't be on hormone replacement therapy myself forever, but at this point in my life, I'm in my 50s, I utilize hormone replacement therapy for myself because I feel like I can only get so far with my lifestyle changes and it's just still not there where I'm going to be preventing chronic disease with low testosterone levels, it's just not there. And so I think that's a reality that I think people should just kind of really think about and talk to their practitioner about and see what's going to work the best for them.
Cynthia Thurlow: [00:21:09] Yeah. And I think the concept of informed consent is so important. I certainly was coming of age as a new nurse practitioner when the Women's Health Initiative came out. Although I was working in cardiology, I can't tell you how many women would come to the office and they would cry about the fact that they had their estrogen stopped and their progesterone. And for many of them, it was so impactful that I think it set a series of things in motion that really had a profoundly negative impact on them navigating their early menopause years. And certainly, I have permission for my mom to talk about this. My mom's 78, and she was one of those women where all her hormones were stopped, and she had musculoskeletal syndrome of menopause. She had achy joints all the time. She was one of those people that was put on Vioxx years ago, and then that got stopped. And I remember her talking about how she had just this progressive chronic joint pain, did not have rheumatoid arthritis, but it was just related to these shifts in hormones that were so significant.
[00:22:13] And certainly, menopause and andropause are going to happen if we live long enough. But it does not per se mean that no hormones or less hormones is optimal. And I think that's an important distinction. That's why I think the informed consent, irrespective of what you and your provider decide to do, giving you the options and giving you the full scope of whichever choice you make, that you understand what that can ultimately lead to. One thing that I've started to find really, really interesting is the interplay between gut physiology, the gut microbiome, and certainly for women, those changes in estrogen impacting immune function quite significantly. Are you seeing this in your patients when you're doing diagnostic testing, that suddenly they're more prone to opportunistic infections, they're more likely to be dealing with leaky gut, autoimmunity, etc.?
Dr. Darshan Shah: [00:23:04] Absolutely, Cynthia. Just touch a little bit more on the hormone replacement question before we move on to gut health is I always look at every single person as part of where do they fit on a bell-shaped curve. And for your listeners, a bell-shaped curve is basically a graph that's shaped like a bell. And people either fall somewhere in the middle, to the left of middle, to the right of the middle, and then also to the outsides of that as well. And so, the moral of that story is everyone is different. And you can definitely find them somewhere in this bell-shaped curve about where they fit physiologically into whether or not they need hormone replacement therapy, but also where they are mentally around hormone replacement therapy.
[00:23:45] And there are just some people that should not be on hormone replacement therapy just because they are just not ready for it. It’s just too much to get their heads wrapped around. And so, you always want to meet patients where they are. And I think if you’re seeing a practitioner that's not having these conversations with you, you mentioned, you called it informed consent, not telling you like, “These are the different types of people that can be on hormone replacement therapy. This is where you need to get your head wrapped around it mentally.” I think there's a problem there, right? And so you really want to find a practitioner that's going to meet you, where you are physiologically and also mentally, where your attitudes and where your feelings are about this and slowly usher you into where you feel comfortable with it or not. Maybe you never should be on hormone replacement therapy due to a multitude of reasons.
[00:24:27] So I think it's very important for all your listeners to recognize that there are different biology, physiology than every other patient, and you need to have these-- That's why I really feel like, the profession of being a physician or a practitioner is probably not going to go away for a long time because every single person is an individual in their emotions and their biology. So with that, with gut health, I'm also finding a lot of the same. I think there's some women and men that I see that are going through andropause, menopause, and they have significant gut health issues. And I think they're both so interrelated. I think every aspect of our biology affects every other aspect of our biology bidirectionally. So having poor gut health is going to cause hormone deficiencies and dysregulation, but also hormone deficiency and dysregulation will lead to leaky gut.
[00:25:17] And so, both things need to be addressed concurrently. And so, you'll find much more power in addressing both things concurrently. And so, when we see a patient, I have this whole tired end that I use called the wellness wheel. And the wellness wheel is 12 different aspects of health, and we always work on all of them simultaneously because the wellness wheel is kind of like a flywheel. When you work on things simultaneously, all things will improve at the same time, at the same level almost. So that's how I address those factors.
Cynthia Thurlow: [00:25:48] No, I think it's so important for people to understand that stress impacts the health of our gut microbiome and ultra-processed foods, which I think it's 70% of Americans. And thinking about Shawn Stevenson's conversation with me earlier this year, 70% of Americans are eating ultra-processed foods, which we know are devoid of fiber and oftentimes good quality protein and can drive this inflammatory process that we're seeing in so many patients. And what I find really interesting is 90% of our immune function is in our gut. I think so many people are surprised to know that and that the surface area of this gut microbiome and our gut in general is exponential. And on so many levels, the more we learn about the gut microbiome, the more humbled that I am, because it's so fascinating, these multilayers, not just of the physiology, like the mucin layer and mechanical layers, and then we've got enterocytes and all these different things that impact the health of this very, very important part of our body.
[00:26:50] And helping people understand that we want to be doing things to nurture this. Because when I look at stool testing and inflammatory markers, I can almost always get a sense for where people are, even if they're not telling me like, “I'm super stressed and I'm not sleeping well. I'm now in menopause.” I can oftentimes see a lot of really good information. Maybe not ideally where we want to be, but it gives us a place to work from. When I'm looking at those results, and I can actually objectively talk about your keystone bacteria, and you've got these opportunistic infections, and you're not able to break down fat in your stool. I mean, it's just so many things that can impact our health quite significantly.
Dr. Darshan Shah: [00:27:31] Yeah. And so, you know what's so interesting about the gut too, Cynthia, and you might agree with me on this one, is that it was kind of hidden from view of traditional health education as well. Very little do we focus on gut health and the microbiome in allopathic medicine. And now it's taken such, like, put into the spotlight now. And I'm so happy about this because, like you mentioned, the surface area of our gut is the size of a football field. It's protecting us from the outside environment much more than our skin is. However, our skin is multiple layers thick. Our gut is only one cell layer thick of enterocytes. And this one cell layer is aided by two things, the mucin layer and our microbiome. The mucin layer is produced by the enterocytes and is helped by the gut microbiome.
[00:28:22] So really, between you and the outside environment, the gut microbiome is the only thing fighting for you, right? [chuckles] And so, you got to take care of your gut microbiome, because right behind the gut microbiome is your enterocytes trying to take in good nutrients and keep out the toxins. And like you mentioned, 90% of our immune system is there too. So having this new renewed focus on your gut health is so incredibly important. And I think even today, if you see an allopathic trained doctor or primary care doctor, there's very little conversation around gut health beyond reflux disease or constipation, but that's all they really talk about. But I love what you're saying about looking at stool testing and keystone bacteria. I think everyone needs to at some point get some of this testing done and talk to a functional medicine practitioner that understands these tests to really help them get their gut in order. Because like you said and alluded to earlier too, “Getting that gut microbiome optimized is going to have profound, massive effects on your disease risk for all of the diseases of aging.”
Cynthia Thurlow: [00:29:26] Are you finding that you're talking more to your patients about, specific keystone bacteria like Akkermansia? I feel Akkermansia is really having a moment, but something that's so important not just for the mucin lining, but endogenous GLP-1 production and short-chain fatty acid production in the body. And for everyone that's listening, these are very important things. But the more I understand about Akkermansia, the more I'm humbled by how much research is kind of emerging in this area.
Dr. Darshan Shah: [00:29:54] Yeah. I'm a big fan of Akkermansia right now because of the quality of the research being done around it as well. I interviewed Colleen Cutcliffe a while ago with Pendulum, and they're making one of the Akkermansia supplements out there. And it's just incredible to think that there is a bacteria in our gut that regulates our hunger and it's who'd have ever thought? And so having a healthy supply of Akkermansia will make you less hungry, because just like the way Ozempic does, by creating more GLP-1. However, ultra-processed food is like a nuclear bomb to Akkermansia. And so, this is why we're hungry. We are always wondering like, “Why are we so hungry nowadays?” And I think a large part of this is because of the assault on our gut bacteria with ultra-processed food, alcohol, those type of things.
Cynthia Thurlow: [00:30:40] Yeah. And it's so interesting because it's obviously easier said than done because we've been conditioned as a culture that cooking is too hard. Many people aren't learning those skills as children or even young adults. And so, they go to the grocery store and they presume everything that they see is healthy. And so maybe spending a minute to talk about what it is about ultra-processed food that is tricking our brains into thinking we are not satiated, that we need more food, that the food that we're eating is actually food, but it's more like a food-like substance. What is it around this? It's not just a mechanical, physical thing. It is also an emotional, it hijacks our neurotransmitters. There's so much nuanced ultra-processed foods and how that impacts how we see food as individuals.
Dr. Darshan Shah: [00:31:32] Right, absolutely. It's so funny, I just got into a big social media war with some people.
[laughter]
[00:31:38] I posted a video saying that, “It's actually cheaper to eat healthy now than it is eating ultra-processed food.” And so many people were like, “You're absolutely wrong. I can't afford to eat healthy. Everything's so expensive.” And I said, “Look, I actually went to the grocery store, looked at prices of a box of Cap’n Crunch cereal, a carton of orange juice and a box of waffles. Costs double it would to just buy a carton of eggs, frozen blueberries, and make a breakfast out of that.” And so, I think there’s a lot of misconception around ultra-processed food being cheaper than eating healthy. Obviously, organic food is going to be more expensive, organic fresh produces. But there’s a whole host of other things that you can buy that are less expensive. And so I think, that just brings up the point of how people really need to get educated about food again. We’ve conditioned ourselves a society that it’s too hard to cook, it’s too hard to buy a healthy food. Let’s just buy this package, ultra process stuff, and that’ll make life easy.
[00:32:39] And it can’t be that bad, but it is really that bad. I think there’s a couple of reasons. One is that I think a lot of people think that their level of hunger has to do with the amount of food in their stomach. And that is true partially, but that’s a small reason for what makes you feel full, what really makes you feel full, is how nutrient dense your food is. And so ultra-processed food is basically chemicals put together, and they call it food. And there's very little nutrition in that. And we don't know a lot about nutrition. And specifically, we know there's a bunch of vitamins, we know there's these phytonutrients now. But really, it's the interaction between those vitamins, the phytonutrients, and the macronutrients that really make food healthy and create that sense of society as well and affect GLP-1 production and affect our microbiome. And so, you’re not getting any of that with ultra-processed food. Your microbiome can’t stand ultra-processed food because it’s killing the microbiome. Your ultra-processed food is made hyper palatable by chemicals added to the food.
[00:33:41] I’d been doing a little bit of research around these ultra-processed food companies. A lot of them came from the nicotine industry, the cigarette industry, actually creating food companies when they figured out, like, “Oh, we can use chemicals to get people to buy more things.” And so, I think the hyper palatability of this food tricks our brain as well. And also, I think that a lot of people find it just easier and less time consuming to eat ultra-processed food. And once again, just getting into my soapbox, we just need to dedicate more time to our health and I think it doesn't take a lot more time, but it is going to take some time to go to the supermarket, purchase your food, understand what's healthy, shop on the outside of the supermarket, not the inside of the supermarket where all the boxes are stored. And I always tell people, like, “It's healthier in your house potentially to get rid of your pantry where you keep all this boxed crap basically, and turn into a wine cellar that's actually healthier.”
[laughter]
[00:34:33] So at our house, we don't have a pantry, we just have a couple of shells or we keep our produce, but other than that, we don't keep box food anymore. So, I think making changes like that to your environment are extremely important and then to your routines as well.
Cynthia Thurlow: [00:34:49] Yeah, it's so interesting. There is a book I read called Salt Sugar Fat, and you know the concept of the bliss point, and these food scientists, and for anyone who's listening, that whether it's a bag of Doritos or Cheetos, you can't just eat one. They are designed to be that way. That bliss point is designed to trick our brains into thinking we haven't eaten as much as we have. And what's interesting to me, I have teenagers and they do-- I guess the blessing of the pandemic was that they learned how to cook because we were on four different schedules at home and my kids know how to pull a pound or two of like ground bison or ground beef out of the freezer, defrost it, cook it. We jokingly have something that we refer to as hamburger salad, but on some days, they may cook a pound of meat and they're teenagers, and sometimes they'll eat two pounds, but they'll throw that over pasta or rice. And they're very athletic and very lean. And I'll put it over salad, and I'll add ketchup and mustard. And I know that probably sounds gross. But sometimes, you just can keep things so simple,-
Dr. Darshan Shah: [00:35:49] Yeah.
Cynthia Thurlow: [00:35:50] -like throwing any protein on top of a salad that you can make at home. I think it was Dr. Robynne Chutkan who said, “Thirty plants in a week, which sounds daunting, but if you add five different vegetables to your salad, you throw in some seeds and some nuts and something else, and you throw some protein, you might have already gotten through 10 out of 30 different plant varieties that you can have in a week.” And I love that you have a pantry that's really designed to be minimal and also focused on wine as opposed to a bunch of bag junk. It's interesting, until my kids were probably late middle school, early high school, it was a whole lot easier. Now they know there's a lot more stuff out in the world. And so, we sometimes have to have negotiations. Like, we have organic ice cream in our house that is like, even for my husband, that is one of their greatest joys. And I always say, “If I buy half a gallon of ice cream, when it's gone, its gone.” Or if you want to buy a clean like Siete makes some chips that are clean, the bag is small, and the bag has maybe a third of a bag full of chips. So, when they are gone, they are gone.
[00:36:57] But understanding you can make better food choices, you just have to do a little bit of detective work. And I'm of the belief system, our meals do not need to look Instagram worthy. I know there are a lot of very talented people out there that probably make 50 plates of the same thing. Take thousands of photos, pick one, put it on Instagram or any other social media platform. I'm like, “As long as it tastes good, it doesn't have to be Instagram worthy.” So, take the pressure off yourself and understand that giving yourself the benefit of learning how to cook even very simple meals can yield much better choices. I feel like one of the things I always relearn during the summer, and my husband and I really don’t eat out very much. I love stone fruits. And during the summer ill have an apricot at the end of my meal. And it’s amazing having a protein-centric meal with vegetables and then I have a piece of fruit at the end. I’m totally full.
[00:37:50] I don’t even have a desire to have anything else. And it’s because you get a little bit of protein, a little bit of fat, a little bit of fiber, and I'm completely satiated. So, demonizing carbohydrates seems to be another kind of prevailing thing that goes on. And I remind people a piece of stone fruit is not the same as having these hyper processed carbohydrates that keep you wanting more and more and more because they're hijacking your reward system in your brain.
Dr. Darshan Shah: [00:38:16] Absolutely. And I think people need to realize that carbohydrates is a food group, but ultra-processed food is not food. So, you can't even call it a carbohydrate. It's just like a chemical mess. And even though it does have technically carbohydrate in it, it's not really food. And so, on that point we talk a lot about, my kids are 10 and 7 actually, and I was so proud of them yesterday. They made breakfast for themselves. And so, my seven-year-old cut up some string beans and put that in with butter and my son cooked it up and they made some eggs and then that was their breakfast. And they were so happy. They loved it. [chuckles] And they made that in 10 minutes. Just the two of them together, working together to make their breakfast. And so much better than taking those frozen Eggo waffles out of the fridge and putting those in with a bunch of syrup that's not even really syrup from a tree, it's just high-fructose corn syrup. We don't even have that stuff in the house anymore. We used to and it took us COVID to change everything. But it was a blessing in disguise that our kids learned to cook as well.
Cynthia Thurlow: [00:39:15] Yeah, it's funny. I was raised by an Italian mother, and that's like one of her gifts that she gave my brother and I. We both know how to cook. We enjoy cooking. And she was very progressive. We were eating organ meats. We made our own bread. I mean, we rarely-- my parents couldn't afford to, we didn't eat out; we ate only at home. But it was like everything that we ate at home, she made from scratch. And so that was kind of the basis from which we started from. And I always say that is such a blessing and a gift. And I acknowledge that my mother was probably unusual, but having said that, she gave us a really firm foundation. And for each one of us, even if our kids are older, you can still help them understand.
[00:39:55] Like, we do a lot of batch cooking, otherwise we would starve because the teenagers eat so much food. Wait until you get to that stage when they're 18 and 16 and they eat two dinners, two lunches, massive breakfast, and then they look at you a couple hours later, and I'm like, “How could you possibly be hungry?” And they really are that hungry. They're just these very lean, muscular machines. Let's talk a little bit about lab testing, because I always love asking other clinicians, what are the labs that you feel like are critically important with your patients, especially when we're dealing with middle-aged individuals, people that are north of 40. What are the markers that you feel like are the most important beyond the conventional stuff? Like, all of us can talk about a CMP or a CBC or a lipid panel. What are the higher-level tests that you are consistently ordering or you think are very important in terms of advocacy?
Dr. Darshan Shah: [00:40:50] Yeah, absolutely. And this is where I really educate my patients about becoming the CEO of their own health, or I call them the boss of your own biology. No one runs their business by letting a consultant pick the numbers that they're going to look at, and look at those once a year for 15 minutes and only tell you when you're in a disaster state. You're not going to run your business that way so why would you run your out that way? So, I educate my patients to follow at least five or six different biomarkers on a quarterly basis. And I know that might sound like a lot, but directionality, just like weighing yourself once a week is so much better than weighing yourself once a month. The directionality is what really matters because you can make adjustments sooner. And so those biomarkers that I really like for people to follow are, number one, we talk about metabolic health. And so, this is where we were looking at hemoglobin A1c and insulin levels. So, a lot of people can't get an insulin level from their physician because they just won't order it.
Cynthia Thurlow: [00:41:47] It's criminal.
Dr. Darshan Shah: [00:41:48] I know. Exactly. I'm like, insulin changes way before your hemoglobin A1c does and so fasting insulin is very important. You can get these biomarkers on your own now. So, you can actually go to the websites for like Quest and LabCorp, which has labs all over the place, and you can get these labs for yourself now. So, you have to understand like what's normal, what's optimal and where are you at and how are you going to directionally get yourself in the right place? So hemoglobin A1c, insulin, and triglyceride levels are extremely important. I also like to use triglyceride to HDL ratio. So even though the lipid panel I think is kind of a little bit outdated, but looking at the HDL is important there. And I like ApoB as a good indicator. ApoB for those of you who don't know is a collection of all of “The bad forms of cholesterol that are actually atherogenic.” Atherogenic meaning this can deposit into your blood vessels. Well, things like LDL, VLDL, Lp(a) this kind of a collection of all of those.
[00:42:45] So look, keeping track of ApoB and extremely important is keeping track of your hsCRP. This can change really rapidly based on inflammation developing in your body somewhere, your gut health is where most of hsCRP problems are probably located. And part of your gut is your mouth. And so having poor oral health also is very highly associated, the Alzheimer's and cardiovascular disease. So hsCRP is a marker that can kind of guide you as to the amount of inflammation in your body. And then I also have people look at their hormone levels once a year. So, we do a hormone panel once a year looking at things like testosterone, estrogen, thyroid hormones, cortisol. And that's where they really need to sit down with a practitioner to truly understand these. But those, I think, are my big hits there. And I have people create a spreadsheet and follow their own. [chuckles] So I'm like, “Okay, you can get apps, you can find different services that'll follow these for you and track these for you. But to be really responsible for five numbers over the course of many years, create a spreadsheet, just follow your own and plug them in so you know where you're going.” And so, I really encourage people to do that.
Cynthia Thurlow: [00:43:54] Well, I love that. Because in cardiology, I always knew my engineer patients because they would bring in these elaborate spreadsheets for me and I’m married an engineer. So that of course made me chuckle. I love that you incorporated those. I particularly am a huge fan of ApoB and listeners to this podcast, we did a five-part lipid series with Dr. Thomas Dayspring and really emphasize why this is such an important marker to be checking. And just to remind people that some of this is genetically mediated, I very transparently talk about the fact that I inherited a lot of good things from my parents, but one of the things that I inherited was this genetic propensity to having a high ApoB. And even with lifestyle, I take Zetia because I'm a hyper absorber of cholesterol. And now my numbers are pristine and perfect. So just know that you should not even after if you're doing all the right lifestyle things, if you need some medication, there's no shame in that. I like to be very transparent and just say, I'm on hormone replacement therapy and I still needed a little bit of Zetia, which is generic and it's cheap. And gosh, when I first started working with that drug years ago, it was super expensive, and I used to stockpile samples in my office to give to patients, but thankfully, now it's very, very inexpensive.
[00:45:07] What about, do you have therapies? You know, we talked about looking at the macros, so sleep and stress and exercise. When someone has dialed in all of that, let's talk about some of the new novel therapies that you're doing in your offices. Obviously, you have offices in California and throughout the United States. Let's talk about some of these novel therapies including IV NAD. We got a lot of questions about IV NAD, and I don't feel like I'm in a position to speak to the level at which you can. So, let's talk about some of these novel therapies that you're using with your patients after they've dialed in on their lifestyle piece.
Dr. Darshan Shah: [00:45:44] Absolutely, Cynthia. Yeah, so we have centers, like you said, all over the United States now developing, and we provide some of these new therapies. And we talked a little about cryo and infrared light and heat sauna therapy. I mean, those are all nice things to have in your routine. And a lot of people don't have access to those therapies in their home. And so, our locations are close to gyms and lifestyle centers where people can pop in for an hour, do cryo, do LED, do some sauna therapy, and just add that to their health routine. Beyond that, we do IV therapy at our centers as well, that one of the most popular IVs is IV NAD. And for people who don’t know what NAD is, NAD the precursor that your mitochondria use to make energy. Energy is ATP, okay. And so over time in our life, we have decreasing levels of NAD because our body isn’t able to produce as much and we use a lot more of it. The reasons that we’re using a lot more of it is from poor lifestyle choices. But also, we live in a very, probably the most toxic environment humans have ever lived in.
[00:46:52] And so your body is constantly having to detoxify the air that we're breathing, the water that we're drinking, the food that we're eating. And this uses a lot of energy. Your gut uses some of the most energy, I think, after the brain than any other organ in your body. Just detoxifying the food that you're eating and the water that you're drinking. And so, we're in a constant state of NAD depletion, unfortunately. Now, to naturally bring your NAD levels up is actually pretty easy. You eat whole food that's organic, you sleep. NAD levels rise incredibly well during getting a good night of sleep and exercise, aerobic exercise and strength training massively increases NAD levels. However, there are periods in our life when we still just don't have enough NAD, and we're just not optimized. There's supplements you can take orally to increase your NAD. My favorite supplement is nicotinamide riboside, which is made by a company called ChromaDex in the form of TRU NIAGEN. I like that supplement the best because it is better absorbed than some of the other supplements out there.
[00:47:54] And then you can also give yourself IV NAD by having an intravenous line put in, and you get 750 mg or 1000 mg of IV NAD, and that is directly available to your cells at that moment in time. I personally use NAD IV after I've been traveling, because traveling really takes a lot out of you. And when I say takes a lot out of you feel it. Maybe your Oura Rings, tells you on your HRV, but all of that is really due to a massive deficiency of ATP, massive deficiency of your energy. So, an IV NAD can really boost you then. Sometimes after I've been sick, I'll do IV NAD or just I had a really rough week, I get some IV NAD, and I feel much better for the weekend. So those are the times that I use IV NAD. We have some patients that come in just once a week and do it just because they have extremely demanding lifestyle. And then we have just people that come in to do it after a travel or before travel, they'll do it.
Cynthia Thurlow: [00:48:48] Are there common side effects? Because I've heard patient reported fatigue or just feeling nauseous after receiving NAD and knowing that they're receiving it over 2 hours. It's not too rapid of an infusion. Is that commonly a side effect that you will see or you've experienced?
Dr. Darshan Shah: [00:49:04] So IV NAD, when you're actually getting the IV put in, and for a little while afterwards, there is this feeling of nausea and chest tightness okay. I don't say everyone doesn't get that feeling. It's probably about 70% of people, 60% to 70% in there. And that's people that are like really NAD depleted are feeling that. And so, the solution to that is to turn down the drip rate. And then the minute the NAD infusion is over, it subsides over the next hour or so and it's gone, okay. And there’s a new IV nicotinamide riboside actually coming out now, which is that precursor I mentioned earlier that was only in the supplements. Now you can get that IV and that does not cause that nausea feeling. And so, we’re very proud and extremely happy to be offering this at Next Health as well. And I’m sure more centers will offer it soon as well.
[00:49:59] So if you’re one of those people that get that nausea feeling with IV NAD, nicotinamide riboside IV might be an option for you as well. But I would say the side effect profile is extremely low with IV NAD. And I think people should give it a try. If they are feeling like they’re lacking energy, someone we can just see how it makes them feel. And some people feel nothing afterwards, and maybe they were depleted to begin with, and that’s great for them. But most people do feel an improvement in their energy level, in their cognition afterwards. Their sleep actually is better as well. And I personally feel those things myself after I do a bag of IV NAD.
Cynthia Thurlow: [00:50:38] No, it's so exciting. And also, exosome therapy, this is one I know little about, but I think sounds really exciting. And certainly, for the individuals that are doing all the other things, this kind of additive therapy might beneficial.
Dr. Darshan Shah: [00:50:54] Yeah. So, there's three like darlings of the longevity space right now that I talk about, and that is exosome, stem cells, and therapeutic plasma exchange. Those are the three things that I think people should have their eye on and some attention to, because those are three things that we're really seeing a lot of benefits to. And what exosome therapy is, it's basically exosomes are the signaling vesicles that are inside of your stem cells. And they have mRNA in them, they have different signaling molecules in theme that hone into where your body needs repair, and they trigger the stem cells in those areas to start replicating and to start fixing things, basically. And so, if you can trigger that repair response by giving it IV dose of exosomes, that's theory behind it. And so, IV exosomes are available now and there's lots of different places making them. So, you have to be a little very careful to do your vetting. And so, we've vetted all the exosome companies out there, and we feel like they have a really good product. And some people are choosing to do IV exosome therapy, and mostly we're doing this after doing therapeutic plasma exchange. I can talk about that a little bit if you like, Cynthia.
Cynthia Thurlow: [00:52:02] Yeah. No, I would. I mean, we haven't talked about these topics on the podcast. So I'm like, “Ooh, yes, absolutely.”
Dr. Darshan Shah: [00:52:08] Yeah. Once again, I just want to really emphasize that this is way, way after you've got all your lifestyle things in order, you feel like you're doing everything possible. And to be completely transparent too. Some of this stuff is expensive, right? Because it's not covered by insurance and it's all new and there's a lot of expense around it. But I do think a lot of this will become more mainstay as time goes on, and we can source these things at a lower cost. So therapeutic plasma exchange basically is a technology that's been around a lot, been around for a long time in the hospital world. We've used it for things like autoimmune crisis, etc., in the ICU. I remember using this in the ICU 25 years ago, actually. And basically, what you're doing is you're hooking someone up to a machine that’s reminiscent of a dialysis machine, because you’re removing blood from one arm, you’re passing it through this machine, and you’re putting the blood back into the other arm. What the machine is doing is spinning the blood down 250 ccs at a time in this circuit to separate the plasma from the blood cells. The blood cells are reinfused, and the plasma is discarded completely, and it’s replaced by albumin, okay.
[00:53:17] And so, the whole process takes about 3 hours. It’s extremely comfortable. You just sit there, and 3 hours later you’re done, and we replace 2 L of your plasma. Why is that helpful? Well, your plasma is where all the bad stuff lives. So, all the toxins that have accumulated in your blood, it's floating around in your plasma, and your kidney and your liver are working super hard to filter all this stuff out of your plasma because your body can't get rid of it directly. Well, the therapeutic plasma exchange machine can remove this directly. And so, if you look at your pre-plasma exchange labs and your post-plasma exchange labs, you’ll see all of the toxins that can accumulate in your blood, things like even microplastics, these things are reduced after plasma exchange. So, it’s basically a hedge against toxin accumulation. And also, hsCRP goes down. All the inflammatory markers, all the inflammatory cytokines that all travels in your bloodstream as well, that all lives in your plasma. And so that’s theory behind therapeutic plasma exchange. We’ve seen phenomenal results with it, and most people are doing it probably every six weeks to every quarter for health optimization, longevity purposes. But once again, after you've got everything else in order and you really want to take things up to that next level.
Cynthia Thurlow: [00:54:30] No, it's so interesting. I look forward to learning more about it. I'd love to end the conversation talking about microplastics. I know there's been a lot in the news talking about microplastics seemingly are everywhere and in everything. And the net impact on our endocrine, neuroendocrine system is quite significant. When you're talking to your patients, where does the microplastics conversation interject in making people aware of the fact that there are these chemicals that they're exposed to, they're bathed in without even being aware or cognizant of them?
Dr. Darshan Shah: [00:55:05] Right, exactly. It comes into the entire conversation about just detoxifying your lifestyle. Microplastics is more tangible to people than things like, roundup and other things, because we see plastics every day. We know we're drinking out of plastic bottles. We know where these plastics are coming from. So, no one can say, I probably don't have microplastics in me. Of course you do. You're around plastics all the time. They're even in your clothes. And so, I think it's more tangible for people. And also, people are reading a lot about it about the amount of microplastics in a bottle of water, for example, or microplastics being discovered in sperm and in testicles, and even in babies now. And so that just sparks the whole conversation about detoxifying your lifestyle. And my kind of paradigm around that is, once again the Pareto principle. How do you detoxify a life where we just live in the most toxic environment in the world that humans have ever lived in?
[00:56:00] And so I say use a Pareto principle. If there's 20% of the actions that you can take that will detoxify 80% of your life. So we go over air, water, food, and chemicals you put on your skin. Your air, “I ask my patients, where do you spend the most time?” Most people spend the most time at work and in their bedroom at night sleeping. Those two environments, you want to detoxify the air with a really good air filtration system. What about your water? Your water as long as you're drinking it from some sort of filter or reverse osmosis source and it’s in a glass bottle preferably, just drink your water out of that. So, you’ll carry around a water bottle, get a little reverse osmosis system or a good filter in your home and just drink that water. And then your food, trying to stay away from ultra-processed food, eating more organic food if at all possible. If you can’t eat organic food, go to the Environmental Working Group website and look at the list, the Dirty Dozen and the Clean 15. Focus on those foods.
[00:56:57] Just instead of buying the foods that can be filled with toxins, buy the food that probably are not. And then your skin, focus in on products that don't have as many toxins in them. And there's really good apps out there like Think Dirty. The Environmental Working Group also lists clean products on their website that you can buy. And usually, it's just a one for one trade. People are buying really expensive cosmetics like lotions, face creams. If you can do a one for one trade for something that’s non-toxic, “Why not do that as far as the cost goes.” It’s just taking some time and doing those little actions that’ll detoxify not all of your life. There’s no way to detoxify your entire life. But if you detoxify 80% of it, you’re doing 80% of it better than most people are. [chuckles] That’s how we frame the microplastic conversation and overall detoxification of your overall lifestyle. Like you said, then you can start majoring in the minor things and you can start looking at your clothing, you can start looking at a lot of different things. Our friend Darin Olien wrote the book on this that I love that I'll buy for some people, but I think that's a good start.
Cynthia Thurlow: [00:58:06] No, it's certainly. And I love your pragmatism, really keeping things tangible, accessible. Well, I've loved this conversation. Please let listeners know how to connect with you, how to work with you, or go to your centers to get the level of care that you've been alluding to that so many people really are ready for.
Dr. Darshan Shah: [00:58:54] Yes. So, you can find me on Instagram and all the social media places @darshanshahmd. I put a lot of information there. Also, our centers are currently located in California and New York and in Maui at the Four Seasons in Maui. And you can find those centers at next-health.com. However, we are opening 30 more centers over the next couple years all over the United States. And so, we'll have places like in Nashville and Austin and Miami. And hopefully there’ll be one close to some of your listeners. And we start every patient off with a blood panel and we sit down with them and we talk to them about kind of where to focus their energy doing, like I said, the Pareto principle first, let’s get your lifestyle in order, and then we can start talking about adding some of these more exotic things to your routines. They don’t really necessarily need to cost a lot. I think a lot of people think it’s expensive to live this healthy lifestyle. It's actually less expensive to do this now than to deal with chronic disease later as we all know. And so, we really help patients try to figure out how to do the quick and easy things first, and then we can go down the pipe of kind of the more exotic things later.
Cynthia Thurlow: [00:59:33] Well, thank you so much for your time. I'll definitely have to have you back. I loved our conversation.
Dr. Darshan Shah: [00:59:37] Thank you so much, Cynthia. I did too. So good to see you and can't wait to be on again. Thank you.
Cynthia Thurlow: [00:59:42] Absolutely.
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