You Don’t Have To Live With Chronic Pain | Dr. Adeel Khan | EP 409

Hello everyone. I'm pleased to announce my new tour for 2024, beginning in early February and running through June. Tammy and I, an assortment of special guests, are going to visit 51 cities in the U.S. You can find out more information about this on my website jordanbpeterson.com, as well as accessing all relevant ticketing information. I'm going to use the tour to walk through some of the ideas I've been working on in my forthcoming book out November 2024, "We Who Wrestle with God." I'm looking forward to this. I'm thrilled to be able to do it again and I'll be pleased to see all of you again soon. Bye-bye!

You could take any somatic cell in your body, like a muscle or a skin cell, and you can reprogram it using genetic reprogramming to turn it back into an embryonic stem cell state. That's to revert to an earlier form, essentially. But we have to figure out and give it the right signals so that you can heal disease, and that's what regenerative medicine, the promise of it, is really about.

Hello everyone! So today I have the opportunity to speak with Dr. Adil Khan. Adil is a physician that I've worked with. He offered Tammy and I a couple of different treatments. The treatment for her was particularly successful; it helped her deal with chronic osteoarthritic condition in her forearms and was quite remarkably successful. And so that's very interesting and it deals with a young Canadian physician, very very sharp character, seems to be on the cutting edge of the expanding field of regenerative medicine.

Which is, what would you say, it's developing not precisely in opposition to but in parallel to standard allopathic medicine that's more symptom-based in its approach. So the regenerative medical types are attempting to get to the root cause of chronic health problems and to address them. And so there's much advance being made on that front.

And so we're going to talk through the potential of these new treatment protocols for depression, chronic pain, degenerative diseases like osteoarthritis, multiple sclerosis, fibromyalgia, and a variety of chronic pain conditions. We talk about gene therapy, stem cell usage, and tissue engineering. So stay tuned if you're concerned about your health and about living happily, healthily, and even just living well.

Thank you for coming in, Dr. KH. You treated Tammy a while back, so maybe you could start by telling everybody who's watching and listening what you did and why, and then we'll talk a little bit about what you do more generally and about who you are.

Yeah, so in your wife's case, she had a very common issue, which is chronic pain. Chronic pain is something that the medical industry has grappled with for years. Traditionally, they've used cortisone, which is an anti-inflammatory drug, they've used narcotics, opioids, and then if that doesn't work, surgery. So what we do is we identify that there's a gap where people don't get better necessarily with just cortisone, and they don't always want surgery.

And so this is kind of that gap of patients who are just suffering or living with chronic pain and taking pain meds. As we know, OxyContin and so many other pain meds, what they can lead to with addiction and all these risks. So what we do is what's called regenerative medicine. So we use different types of regenerative molecules, whether that's stem cells, PRP, exosomes, which we'll talk about, to repair the tissue back to a previous state.

So in your wife's case, she had what's called osteoarthritis, which is degradation of the joint cartilage loss, and you get inflammation. And then she also had some small tears in the tendons around the joints, and it bothered her for 10 years, as you know, and she couldn't garden. She lost the garden. So what we did is we used an ultrasound, as you saw, and we go directly into the tears and into the joint where the inflammation is to repair the tissue back to a previous state.

And so that's how it got rid of her chronic pain. When was the ultrasound for diagnosis?

Diagnostic and intervention.

And intervention. Yeah, so how does the ultrasound intervene?

Because it allows us to guide the needle directly into the area of damage.

Right, and how can you see what's damaged?

Because of the ultrasound, and that's the skill. So it's telling gray from gray; ultrasound and that's the steepest skill set. To give you an example, I treated Muhammad Olivar. He's the guy who owns the Burj Khalifa and the six tallest buildings in Dubai. So he had a shoulder issue for 15-20 years, and he did an MRI. MRI was normal, so they just did cortisone; they did physio. He was living with chronic pain for 15 years, and he's arguably the most, he's the wealthiest man in the Middle East, and he's a very well-renowned businessman. So he has access to any doctor in the world, right?

And so he found me, and I flew down, I did an ultrasound, and we found some small tears that were missed on the MRI, and then we injected him, similar to what we did with Tammy, and we fixed it. But the principle is the same, which is that sometimes you need to do diagnostic dynamic ultrasound to find the issue.

And that's how did you learn to distinguish, as you said, gray from gray?

And are the AI image systems getting good at that?

We're training. We're developing a machine learning neural net to do that, but that hasn't been developed yet. That's actually something we're doing because we're kind of setting the standard for it. Because my mentor, Dr. Anthony Galia, he was the first one in the world to do this stuff. He did it for Tiger Woods, Alex Rodriguez, a lot of A-list athletes, so he was the one who taught me all this, and he was the one who pioneered this field.

So I learned from him, and I was fortunate because I got to learn from the best, and because of that, I was able to take it and translate it into my own patients.

How much exposure to image data did you have to undertake in order to start to be able to distinguish?

Thousands of hours. Thousands of hours, yes. It's not, it's the learning curve is so steep, and we have ultrasonographers, as if you remember, I brought her with me at the time, who are specially trained by us, and they're the ones who actually guide us because there's so much nuance between telling what's a tear and what's not a tear that you really need a specialist.

And unfortunately, most you need a really trained specialist who actually knows what they're doing. I know there's huge difference in radiologists, for example, in their diagnostic accuracy.

I know on the AI front that they have trained AI systems now, from what I understand, to be able to be pretty good at distinguishing lung cancer lesions, for example.

Yeah, they're pretty good at X-ray and cancer, but muscular-skeletal is still a big gap, and so that's what we're developing because that's our specialty. We’re going to develop a machine learning neural net using what's called supervised and reinforcement learning to teach the machine learning algorithm to detect what's a tear and what's not a tear and then guide the physician on how to do it.

So that's kind of how we're going to scale what we're doing.

How do you get the dataset set up properly? Because you need a training... If you're going to reinforce the proper response, you have to be sure that the material that you're training the machine on is actually accurate.

How do you solve that problem?

Because we have a brilliant radiologist on our team who's going to be training the AI on what's not a tear and what's a tear, and then you have normal.

You have to first get... more than one radiologist?

No, we're just going to use the one who's specially trained by us who does our msk interventions and diagnosis, and she's obviously excellent at what she does. And she can train the AI to say, but the AI needs thousands of normals before it can recognize abnormal.

That's the datasets that you have to build into it first, and then she has to train it over time to say, hey, this is a tear, and this is not a tear, and then eventually it learns.

Right, right, right. And what did you inject Tammy with?

So we use something called exosomes. So the way I explain exosomes, imagine if you're going... So let's talk about stem cells first to explain exosomes.

Most people have an intuitive concept of stem cells; they understand that they rebuild tissue or they repair tissue. So they can come from umbilical cord; they can come from fat; they can come from the bone marrow; they can come from amniotic fluid. There are so many different sources where we can get them.

We use something specifically called mesenchymal stem cells, which is just an embryological term to explain their origin of where they're being derived from. And so the reason we use mesenchymal is because they're easy to access.

So for example, the most easiest place to access is after birth, right? That you take the umbilical cord tissue or you take the amniotic fluid and you can isolate the mesenchymal stem cells, or stromal cells, is technically the right word. But anyway, most people call them stem cells, but MSC for short.

And so what you do is you isolate those, and then you can grow them in a lab for three to four weeks.

Why are they in umbilical cord tissue?

Why?

Yeah. Because there's a... is there just a rich source of repair and regeneration of the mesenchymal stem cells from that?

So meaning the umbilical cord tissue is just rich in MSCs.

So why are they rich in MSCs?

Well, I read that babies actually send stem cells into their mother's body to help the mother repair her own tissue.

Right?

Yeah, there is that mechanism built in. So I think a lot of it is probably that cross-talk between the placenta and the mother.

Right? So I believe, and the cool thing is your body has stem cells, too! Right? So you have stem cells in your bone marrow and in your fat, and they're basically cells that are undifferentiated that can turn into any tissue.

So, there's different types of stem cells. If you have embryonic stem cells, which are from the fetus, then they can turn to any type of tissue. But as you know, embryonic stem cells during the Bush era and everything, it was controversial.

Right? And what the reason for that was because they were saying, are we going to be harming fetuses? Obviously, that becomes ethical issues and so no one... that never really took off.

But luckily, we figured out, hey, wait a minute. We have something that's almost as good as EMB stem cells—not as good—but it's called pluripotent, meaning it has the ability to turn into many different types of tissue but not every type of tissue.

I see. So they're slightly farther down the developmental chain. It's not totipotent; it's pluripotent.

And so those pluripotent stem cells, mesenchymal stem cells, are pretty ubiquitous. You can get them from dental pulp, you can get them from fat, umbilical, umbilical, we talked about bone marrow... there's a lot of different sources.

And so they're easier to harvest and easier to source, and because of that accessibility, that's where the research really took off in the last 10 to 15 years is with the MSCs.

So are there variants of cells? Like is it a continual variant from the cells that are omnipotent? Did you say the ones that are totipotent?

That can turn into anything, and then there's the ones that are, what was the next cell? Pluripotent?

And do the totipotent cells turn into the pluripotent cells? Is that the developmental sequence and then into specific?

Exactly. Yeah, exactly!

And that's kind of how it... it can differentiate down the line.

And so the difference between a stem cell and a cancer cell... a cancer cell has some similar properties because it can essentially lose the sign, it or in a sense it gets kind of hijacked, and it loses the ability to stop killing itself.

So meaning it stops apoptosis; so it keeps replicating, right?

And it has an infinite amount... it can keep going, right?

And undifferentiated to some degree too. And so that's why there's actually something called cancer stem cells, and so if we can target cancer stem cells and stop that process.

So there's... that's an active area of research. So they... not all stem cells are good, right? Because people think... that's the problem with stem cells, undifferentiated tissue in the wrong place could lead to a tumor.

And that's actually the problem with embryonic stem cells too; they're too strong! They have too much "stemness," meaning they can keep replicating and grow into tumors, right?

Whereas mesenchymal stem cells, they can... they have a finite ability to grow, so they don't keep growing, which is why they're safe.

So, okay, so when we grow them, mesenchymal stem cells, the soup that they grow in, so imagine, how do you say that... mesenchymal?

How do you spell it?

M-E-S-E-N-C-H-Y-M-A-L.

Yeah, it's going to take me a while to get that one right.

Yeah, I know it's an embryological term, so just call them MSCs.

Yeah, so MSCs, when they're grown, imagine the MSCs are the chicken meat and the soup, the broth, is the exosomes.

So the broth has all these nutrients and cytokines in there, but there are no actual stem cells.

And why is that important?

Because those exosomes can send all the signals which are the proteins, the cytokines, and growth factors to reduce inflammation and repair tissue without the risk of having cells, which sometimes can not survive or can cause reactions in certain people.

So that's what we used on Tammy, and that encouraging the cells that are already there to what?

To repair themselves.

What there? Grow?

It's a signal. It's a signal that says to your body, okay, start repairing this tissue.

So it sends signals to your endogenous...

So does it essentially signal to the body that something's wrong?

It's to sense to the body to start healing and regenerative pathways.

Right? Well, I know that for example, and correct me if I'm wrong, but part of the reason that your face skin doesn't repair itself when it wrinkles is because your body doesn't actually note that the damage has occurred.

And I know that some of the therapies that regenerate skin, like intense pulse light, produce enough damage so that damage is now signaled.

Right? Your body has to figure out... so the cross-linking that occurs as a consequence of sun damage is so subtle that it can accumulate across time with no indication of damage.

And so the exosomes signal to the body that something needs to be fixed.

Exactly, and that's what this really is all about.

And especially the first generation of stem cells, we'll talk about second generation, but the first generation of stem cells is really about paracrine signaling, which is basically signaling to the local tissue, hey, there's something wrong here, start fixing it.

And that's really what it is. And so exosomes, in the case of Tammy's case, they send a signal to reduce inflammation and then they send growth factors to help repair and regenerate the tear.

So, and then you can actually see if you do a follow-up ultrasound, which we do all the time, that the tissue is actually repaired and regenerated.

Can you do that systemically?

Yeah, exactly! So intravenous stem cells or intravenous exosomes are being used a lot for a variety of neurodegenerative conditions, autoimmune conditions, chronic pain, chronic inflammation.

There's so many different things we're being done for. There's a recent trial done for inflammatory bowel disease, which is a really terrible condition.

And right now, the only really medications are like Methotrexate or immunosuppressants, carnivore diet.

Yeah, carnivore diet, it does work actually.

Yeah, but not everyone's going to stick to it, right? It's a hard diet, and a lot of doctors don't really know about it, so they're not going to recommend it to their patients—so patients have to self-educate, right?

And so instead of just suppressing your immune system, what the intravenous stem cells do is they do what's called immunomodulation.

So they actually reset or repair your immune system from a pro-inflammatory state to an anti-inflammatory state.

And is that the exosomes or the stem cells, per se?

It's more the stem cells! So stem cells have a strong immunomodulatory effect; exosomes don't have a strong immunomodulation.

So that's why you have to do intravenous stem cells if you want to treat something systemic, autoimmune conditions.

And there's trials where patients have actually gone into remission, and that's incredible to see because you've treated MS.

We have! But MS is much more tricky because it's not just... there is an autoimmune component to it, but then there’s also... there are a lot of other components to it.

And that's where it becomes... you have to take a holistic approach.

So the way we're going to treat MS, which we’re working on, is we're going to have the second generation of stem cells.

So what that means is instead of just using umbilical cord stem cells, we create what are called gene-edited stem cells.

So we can actually take... so this is what Professor Yamanaka in Japan... he won a Nobel Prize in 2014 for what's called the discovery of pluripotent... induced pluripotent stem cells, iPSCs.

So what he discovered was that you could take any somatic cell in your body, like a muscle, a skin cell, and you can reprogram it using genetic reprogramming to turn it back into an embryonic stem cell state.

That's to revert to an earlier form, essentially.

So I like to call it the Yamanaka stem cell, and basically, it's a pretty crazy discovery if you think about it, the fact that you can... your body has this almost innate ability to go back to like an infant state.

But you just have to overexpress certain transcription factors to do that, and so that discovery was pretty incredible.

You know the immune system does that too, is that when it's mutating, when it's adapting to the presence of a new virus or bacteria, it'll produce more and more accurate gripping mechanisms, right?

At the cellular level! But it stores representations of the ones that were part of the developmental sequence.

So we can imagine that an immune cell is trying to get purchase on a bacteria, it'll sort of go like this first, right?

It's not doing it very well, but it'll stick a bit, and then what sticks a bit varies, and then it'll stick a bit better, and then that'll vary, and then it'll stick a bit better like that.

Well, then if the thing mutates, this grip might not work, but this one might.

And so it stores that developmental... so there's more early variability and less fine accuracy. There's a trade-off, right?

Between...?

It sounds like the same thing is happening with the stem cells.

Is that they'll differentiate into their final form, which is specialized, but that the possibility for earlier forms with more potential is reserved.

Exactly, yeah! You know the same thing seems to happen with regards to junk DNA.

So I had a friend tell me, for example, if you breed fruit flies and you breed them so that they don't have eyes—you can do that; you can alter them genetically so they don't have eyes—and then you take the blind fruit flies and you let them breed amongst themselves for seven or eight generations, the eyes will come back.

Because the genome takes information out of the junk DNA and rebuilds the eyes.

And so even in the DNA itself, there seems to be additional information stored so that the system can revert to an earlier stage of development and then progress forward again.

So, and that's really what I believe is you have 3.2 trillion cells or so in your body, and I believe they're working for you. But we have to figure out and give it the right signals so that you can heal disease.

And that's what regenerative medicine, the promise of it, is really about, which is that we can use customized cell and gene therapy to restore your body back to a previous state.

And that's the era we're finally in! It took a while to get here, but that's... but you see how there's all these interesting almost clues from fruit flies, from the immune system that tell us that maybe this is possible.

And now we're just trying to piece that together using next-generation cell therapy therapeutics.

So can you distinguish... let's speak more generally for a moment.

Can you distinguish between regenerative medicine per se and medicine as it's commonly practiced?

It sounds like the regenerative field is much newer, and you're obviously at the forefront of that.

But how do you distinguish what you do from what physicians typically do?

Well, I think the big narrative shift that's hopefully going to happen is instead of giving pills for chronic disease, we want to be giving cells.

And what that means is we can make customized cells now to treat chronic disease. Traditional medicine's amazing when it comes to acute care, right? If you get a fracture, you go to the hospital—phenomenal! Our surgeons are amazing; they're so good at that.

But when it comes to chronic disease, unfortunately, we've been told by regulatory bodies and by guidelines that giving prescription drugs is the best way to manage them.

And the reality is those drugs don't really treat the root cause; they're just kind of symptom maskers.

Exactly, and it was fair; it was not an unreasonable solution.

But now we're kind of at this place where we actually have real solutions to get people better using these specific cell therapies and put them into remission.

Or actually, I don’t like to say cure, but at least remission, right? Where their disease is controlled and so they don’t necessarily have to be on pain meds.

And so I think people need to... and this is... I’ll give an example: Lupus is a terrible condition.

And again, the only way they can traditionally manage it—it’s an autoimmune condition—is usually some sort of immunosuppressant.

And so, which brings with it all sorts of other risks, like chronic infection, other sorts, exactly, and so many other risks with it.

And so there was a trial done in Germany where they used something called gene-edited CAR T-cells.

So what they do is they take your T-cells out of your body. They add a chimeric antigen receptor, which basically allows these T-cells to hone in

and kill B cells, which become hyperproliferative in lupus.

And so it's called CD19; it's just... it's a specific type of antigen that they add onto the T receptor.

The gist of it is that what it does is just makes it hone in on the problem.

So it's really fascinating because you're gene editing these; you're making these bespoke cells almost that are specifically designed to do a task.

And these cells, they actually put everyone in the trial into remission.

And even a year follow-up, even though their B lymphocytes went back up, patients were still doing well; their symptoms didn't come back.

So that just shows you the power of these next-generation therapeutics.

So is that a widely used treatment now?

CAR T is approved by the FDA; however, it's $500,000.

And why is it so expensive?

Because the pharmaceutical companies, a lot of them just, unfortunately, because of just patenting and all this stuff, they just charge a lot of money.

And so what we're doing is using our technology, which we can talk about, to create our own CAR T and hopefully offer it at one-tenth the price.

And that's kind of the goal that we want to take because it's just... it's not a... like very few people can afford that, obviously.

But the point is you can make these customized cell therapies for different chronic diseases.

And there are so many... it’s going to be autoimmune conditions, cancer, and everything in the next few years is going to shift towards gene and cell therapy to actually cure people or put them in remission as opposed to just giving them pills for everything.

How far along is regenerative medicine in relation to the treatment of cancer?

So CAR T is a variant of CAR T that's used for different types of leukemia and lymphomas, and it's successfully been used for several years, so that's one type of gene therapy or cell therapy that's being used.

And then there's also something called natural killer cells, which are part of your innate immune system.

As a name suggests, natural killers, they go there; they kill things that don't belong. So what you can do now is you can actually gene edit those natural killer cells with that CAR antigen I was talking about.

So you can create something called CAR NK, and that CAR NK with that antigen onto it can hone in and kill the cancer.

So there's trials being done now where they're using CAR NK for different solid tumors as well.

And the results are very promising; it's still early stages.

But again, this is where the, I think, cross-cultural medicine becomes really important.

So when I worked in Japan earlier this year, I learned that they've been using these types of cell therapies to treat cancer for over ten years.

But in the U.S., it’s completely new.

So it just shows you that there's this disconnect.

Why is there a 10-year lag?

Exactly! So it's a loaded question because the problem is there are... the biggest problem by far is regulatory bodies.

And unfortunately, the regulatory bodies in North America are making it very difficult for cell and gene therapies to be approved, whereas in Japan, they set a framework; it’s called PWDA, which is just a framework for regenerative medicine regulation, which started in 2014, so almost nine years!

So they actually approved different types of cell therapies nine years ago, whereas in the U.S., it’s technically still illegal to do certain stem cells.

Let me ask you this question: Are you at peace with the mindless screen time you spend on your phone every day?

Are you gaining that higher quality of life you know you desire?

If this sounds familiar, I have good news. Starting on January 1st, tens of thousands of men all over the world will start 2024 with a 90-day journey together in search of a more purposeful life.

It’s called Exodus 90, and it was built to help men enjoy the freedom of becoming who they were truly made to be.

Exodus 90 guides you in removing the attachments that are holding you back from a better life, and it actually works.

Independent research shows that Exodus 90 men report considerable shifts after the 90 days: a dramatic decrease in time spent on their phones, stronger satisfaction rates in their marriages, a more meaningful relationship with God, and true brotherhoods of men on the same path.

For the past eight years, Exodus 90 has helped more than 100,000 men build their own roadmap for living with virtue in a culture that offers far too many paths to self-destruction.

So, is it time for your Exodus? We start January 1st.

Find resources to prepare for Exodus 90 at exodus90.com/jordan. That's exodus90.com/jordan to start your journey.

So, why do you think that is? Is it merely a matter of... I mean, nine years is long in terms of... nine years is a long time if you happen to be suffering from cancer.

But on a historical timeframe, it's a blink in time.

I mean, obviously, there's going to be some resistance and lag in every system to the introduction of new innovations, and perhaps some of that's useful because some innovations cause a lot more trouble than they solve.

But why do you think it is that there is a lag in the United States, which is generally a very dynamic place with regard to innovation on the regenerative medicine side compared to Japan?

I think it has to do, unfortunately, with the pharmaceutical companies.

Because a lot of them have lobbyists that influence... for every member of Congress and senator in the U.S., there are seven lobbyists, right?

So plenty! And I think they control 75% of mainstream television advertising.

I think it's something like that, and I think it's actually higher for news broadcasts, per se.

And they actually spend more money advertising to doctors than they do to even consumers.

So then doctors are inundated with these pharmaceutical reps and with this information, and if you're a busy... doctors have really, really challenging lives, as you I'm sure know.

And so they're busy working; they're in clinic; they're trying to just help their patients.

They don't really have time to check everything that's going on outside of... they don't have time to travel; they don't have time to look at what's going on in the whole world, med journals.

And they're not trained very well to do that to begin with.

No, they're not, and they're basically told what they're trained well to do is follow guidelines, and those guidelines, where do they come from?

From specialists who have industry sponsors or...

It's a tricky business, right?

Because the pharmaceutical companies are within their proper purview to attempt to educate physicians about their new products, but drawing the line between that and marketing, per se, and unethical marketing is very, very tricky.

And I mean, it's the same with regards to high prices for novel medical interventions.

I mean, it can take a lot of time and money to develop a new drug or a treatment, and it's not surprising at all that to begin with, its expensive because everything that's introduced into the market to begin with that's novel is expensive.

Hopefully, then it gets widespread enough so the price starts to come down.

I mean, it's easy to damn the pharmaceutical companies, and I'm highly inclined to do that under certain circumstances, you know, because I think... I don't know; it seems to me that maybe a line was crossed when the pharmaceutical companies got the okay to advertise directly to consumers.

That seemed to have warped the system pretty badly, and that was about 20 years ago, if I remember correctly.

I think they moved from what you would call scientific research enterprises to marketing machines at that point, and it doesn't look to me like the consequences of that were particularly good.

So, no! And the reality is that if you're a physician, most of your continuing education comes from once a year conferences that are given by specialists who are considered the top in their field from institutions who usually have some sort of ties with pharmaceutical companies.

So where are you getting your continuing education from?

And it's really difficult for them to get out of that system, and so the only reason I think I was able to get out of that system was because I always looked at prevention.

And I always looked at finding cures, or that's just the way I was taught because of functional medicine.

And functional medicine is this whole concept of trying to repair your body and trying to heal it.

Before selling gene therapy, I was just focused on supplements, lifestyle, like you've obviously... you know, like carnivore; like those types of interventions can be very powerful, but there's no education on the physician side on that stuff.

Well, it’s also hard to transform them into something that generates profit, and this is... it's easy to be cynical about that, but that's actually a big problem.

I mean, I know there are a lot of off-the-shelf pharmaceuticals that are essentially free that can be used effectively for treating various conditions.

So there's a lithium—I'm not... this is not medical advice, by the way, for everyone watching and listening—but there’s a lithium variant called lithium orotate, which is dirt cheap and has virtually no side effects that appears to be reasonably effective in the treatment of manic depressive disorder.

And you can buy it on across the shelf for virtually nothing, and everyone asks, well, why isn't this more widely known?

And the answer is, well, if the chemical is widely available and essentially free and no one can generate a profit from it, no one has the incentive to market it or educate people about it, right?

You see the same thing for treatments like... what's the precursor to serotonin?

Five hydroxytryptamine, which is a good precursor for serotonin.

It's also extremely inexpensive and, by all appearances, relatively harmless.

And you might say, well, why isn't it more widely known?

And again, it’s the same problem.

If there's no market, there's no impetus for the distribution of the product or for education about it, so they just fall by the wayside.

And so it isn’t merely a matter of the profit-hungry, you know, vampires of the pharmaceutical industry.

It's actually a very troublesome technical problem when you're making dietary recommendations too; it's like, well, you know, how do you do that?

And at the same time, or any form of prevention for that matter, it's hard to even get credit for prevention, right?

You know, if you're very good at prevention, then the thing that you could be rewarded for just never happens.

And so that's great, but it’s very difficult to reward and to note.

So how did you get interested in regenerative medicine, and why did your educational pathway diverge from the typical physician?

Before I went into med school, I was a personal trainer.

So as a personal trainer, my job was to get people moving, exercising, and a lot of times you actually see them come off their medications, diabetes, high blood pressure, just by exercising.

So then intuitively, I knew I was like, wait a minute, exercise can solve so many chronic disease problems.

And then, it turns out in the literature, 80% of chronic disease is preventable, right, with lifestyle—though it's very hard to get people to make lifestyle changes.

And it is... so I was always fascinated by that.

And so even in medical school, I was kind of like, why aren’t we learning more about nutrition?

We had one lecture on nutrition in all of medical school.

One?

One!

And it was a... it was probably wrong!

It was a can of food!

Oh great!

Which is... which is sponsored by industry, by dairy.

By, you know...

It's just... it's like, you have to have grains!

Like, it's just ridiculous!

But yeah, but during... but then what happened was, I got exposed to this whole, like, alternative medicine world because even though I was studying allopathic medicine, I was simultaneously studying functional and integrative medicine.

Distinguish those for the people who are watching!

Allopathic—so, right!

So allopathic medicine is traditional medical doctor, you get a doctorate of medicine, and that's... that's traditional, you know, drug-based, surgical-based interventions that we learned in medical school.

So which is great; we learn disease treatment, disease treatment.

But then functional medicine and integrative medicine is taking naturopathic stuff that's evidence-based, that has actual science behind it, and lifestyle measures to intervene and treat chronic disease.

So, you know, I went to the Temple of Asclepius in Greece recently.

Yeah, it was extremely interesting, a very large compound.

And at the Temple of Asclepius, there were rooms where you could… they actually had people sit and dream in rooms full of snakes, right?

And God only knows what the reason for that was.

My daughter used to have snakes as pets, and she said that she would often have nightmares as a consequence of having the snakes in her room.

And I suspect it had something to do with their order!

So God only knows what dreaming with snakes would produce in terms of visions!

But anyways, there was a place set up where you could have a healing vision; but there were also theaters and stadia there and places for massage and for sauna, essentially.

It was a compound that was devoted to health that was multi-dimensional, right?

And so there were theaters there because part of the healing process was drama and part of it was exercise and part of it was vision.

And when I went to that temple, I thought these people were more sophisticated than we are in their approach to disease, right?

Because they were... it wasn’t merely a matter of... I know there are modern medical miracles, and certainly surgical bone setting and that kind of thing, hip replacements and so forth.

Some of the things that can be done are absolutely miraculous.

But our notion of what constitutes health and how to progress towards it, I don't think is... it’s certainly not as sophisticated as what the ancient Greeks managed at their heights.

No, and I believe in 30 years, we're going to look back on this era and be like, wow, we did a lot wrong.

And the reason is because, just as I was saying, the system is broken.

The U.S. spends more money per GDP on healthcare than many developed countries, but they don’t have better health outcomes, and they’re just drowning in debt because of how much their health expenditure is going up.

And the reality is, like you were saying, people aren't going to... it's... yes, I think the concept of people promoting exercise, health, and healthy living is great, but the reality is, it's really hard to get people to change.

And the environment is obesogenic, meaning it's set up... let's be honest, it's set up for failure because of just the accessibility of processed foods and the way the environment is set up.

Massive calorie foods, you know, and the advertising.

In the Netherlands, they banned direct-to-consumer advertising of sugar to children, which is great! That’s a great start.

And Japan, I think, did that as well.

So there’s starting to be, finally, this notion that, hey, processed refined foods like sugar are really, really bad for you, and it can lead to food addiction.

The obesity rates in the U.S. is 40%—I think overall some states are higher than others, right?

Yeah, yeah! It's stunning; it’s absolutely stunning!

And catastrophic!

Yeah, so I think the reality is, it’s going to be really, really hard to get people to change unless there’s huge policy changes, which probably won't happen anytime soon.

So what we're doing is we're trying to build resiliency in people's bodies so that they can get the benefits of healthy living without necessarily doing healthy living.

So it sounds kind of crazy, but that’s what gene therapy is all about.

So...

Well, it's kind of crazy except, you know, I mean people also handwave about the pathology of pill-taking, but one of the things you learn as a behavioral psychologist perhaps above all else is that behavioral changes are very, very difficult for people to make.

Even what you would think of as small changes.

And everybody kind of knows this because they have their New Year's resolutions and they decide they're going to go to the gym and they go for like a week and then they quit.

And people revert back to their old habits.

And you might say, well, people should behave better; it would be better for them, but then you think, well, how often do you take that advice for yourself?

And so one of the things you learn as a behavior therapist is to help people make behavioral changes very gradually and incrementally.

But that's very labor-intensive, right?

And it's also difficult for the people themselves to do, especially if you're dealing with someone who imagines that they're quite ill, and they're in crisis, maybe economically, not least as a consequence of the illness.

Then to ask them to make a radical lifestyle change is maybe... it's even necessary, but the probability that they're going to do that on top of everything else they're struggling with is very, very low.

So it's a tricky... very tricky thing to get...

It's called social determinants of health!

Basically, if you’re low socioeconomic status, that’s the best predictor of health long-term.

So if you’re unfortunately poor, and you don’t have access to much capital, then you’re more likely to have obesity, more likely to have chronic disease.

And then helping those vulnerable populations...

You're going to get cheap, fast sources of calories! So how can you tell people, yeah, you just need to exercise more and eat less? It doesn't make any sense!

So, well, and people also won't do that.

The literature on diet's pretty damn clear, is that if you put someone on a diet that actually requires food restriction, so they're chronically hungry, they may diet successfully for a while, lose some weight, but as soon as they stop dieting, they're going to revert not only back to their original weight, but generally gain weight on top of that.

And so any diet, it seems to me, that involves protracted periods of hunger is actually doomed to failure.

And that's what the fitness industry promotes to people!

So they're setting them up for failure because they see all these people online who are doing these extreme diets, but they're doing it A, as a profession, and B, a lot of times are enhanced using other things.

But so the regular person sees those people, and then they wonder why it's so hard for them.

Well, and those people are actually specializing in doing that, right? Because they make a living doing it, so they can put the time and effort into it.

One of the advantages of the ketogenic diet or a carnivore diet is that you don't have to be hungry; that's a big deal because protein is very satiating, and you can eat as much as you want.

So that's a massive improvement over diets that involve like chronic calorie restriction because there's no way that... like, the other thing too, you see people develop eating disorders this way too is like, if you get in a fight with the systems that mediate hunger, you're going to lose because those systems are very, very powerful when they’re overactivated.

And you see this with people with eating disorders; they get into a war with their hypothalamus, and like they don’t... no one wins that war!

No, you're going to be set up for failure or you develop a very unhealthy relationship with food.

Yeah! So it’s developing a healthy relationship with food, which means you’re eating it for nourishment and not for coping with emotions or stress or so many other reasons why people use food.

And developing that healthy relationship is really what it takes a lot of therapy actually, and it takes a lot of work, which is cognitive behavioral therapy, right?

CBT is one of the few evidence-based therapies out there to help people treat obesity, right?

And so, but it's not... but it's a lot of work!

It is a lot of work, and a lot of attention, a lot of strategic planning. It's expensive for that reason too, and time-consuming on the part of the people who are being treated.

So, all right, so how did you... now you said that you worked as a personal trainer, and so you were already interested in lifestyle modification.

And then you... and how long did you do that?

And why did you decide to go to medical school?

So I was basically doing that from undergrad for three or four years, and then I got into medical school.

But the reason I decided to go to medical school was mainly because of intellectual stimulation, because obviously being a personal trainer, there's only so much you can do, and it kind of becomes repetitive very quickly.

And so I wanted to learn more about how I can help and heal people, and being a doctor naturally seemed the best way to do that.

But what I didn't realize was when I went into medical school, I was a little bit disillusioned because I realized that a lot of these things just don't resonate with my belief system, which is that I don't believe in just giving pills to people.

It just never resonated with me.

And so I was always kind of trying to learn more about how can I actually get to the root of this? And that was just a question I always wanted to ask myself.

I did like surgery because surgery is very gratifying because if you have a trauma, if you have someone, you know, you can fix them, you get them on their way, and they're done, right?

But then you realize even in surgery, most of what you're treating is the end stage of chronic disease, like hip replacements is osteoarthritis, like ophthalmology—a lot of it is cataracts, and that's related to diabetes and so many other surgical specialties are actually vascular.

Like a lot of it is just chronic vascular disease, heart disease—like these are just end stage of lifestyle stuff; and so the reality is, if you look at even most surgical specialties, a lot of them are just doing what could have been prevented.

Yes, exactly!

And so that's why I ended up not going into surgery, and then I kind of got into this whole world of I naturally, because of personal training, I liked sports medicine, so then that's where I went, to sports medicine with Dr. Anthony Galia.

And was that post-med school?

Yes, after residency training.

After residency training, then you do sports medicine with Dr. Gia, who's kind of the pioneer of the platelet-rich plasma injection.

Yeah! Sports medicine is the medical domain that probably overlaps most with cognitive behavioral therapy as it turns out.

Interesting!

Yeah, right?

Well, that makes sense!

Yeah! And so interestingly, I’ve had professional golfers I’ve treated using some... we do something called a vagus nerve injection, which helps with their nervous system, but to help performance-based anxiety.

So, but anyway, so when I went to sports medicine, I got to Dr. Galia, and kind of the pioneer of platelet-rich plasma, which is where you take your blood, you centrifuge it, you concentrate the platelets in the plasma, and those platelets release growth factors that stimulate healing.

This is kind of like a lower version of the exosomes we were talking before.

If you were to compare PRP to exosomes, the cytokine profile is about 10 times weaker.

PRP is the platelet... which... PRP is still good for like muscle and tendon tears, like acute injuries; it's not great for chronic tear wear and tear, it’s so... that’s where exosomes, stem cells were more superior.

But when I work with Dr. Galia, obviously I got exposed to all this kind of alternative stuff, but then I realized he’s treating some of the most high-profile people in the world.

I'm like, there must be a reason they’re coming to him!

So why would these people who can go to any doctor, right?

So is it alternative or is it cutting edge?

Exactly, exactly!

And that’s... and the media used to print it as though he’s, you know, some... there's a lot of negative stuff out there about him, so it's hard to discern, right?

It's like, what’s really the truth?

And then you realize quickly, once you're in there, some of the most important people in the world come see him, and so I realized he's obviously doing something right.

And so, and then that’s when I got into regenerative medicine, and regenerative medicine, PRP was a great starting point, but now it's evolved into cell and gene therapy and tissue engineering.

How did you learn to read the relevant scientific literature?

I had to just make Google Scholar alerts and just for everything regenerative medicine-based and just reading primary literature sources.

Was that something you did fundamentally on your own?

Yes, yeah!

Because one of the... correct me if you think I'm wrong, but one of the things I... I did a fair bit of research with psychiatrists especially back at Miguel when I was doing my Ph.D.

And one of the things I learned very rapidly was that there was a big difference between physicians and scientists.

In that, so if you're trained as a Boulder model clinical psychologist, you're basically a research scientist who does clinical work.

So you're trained to evaluate the scientific research; you're trained to learn how to do statistics and to understand them and to write scientific papers and to evaluate them.

And I thought the same was true of physicians, but I soon discovered it wasn't true at all.

And even the psychiatrists that I did work with, they often had statisticians do their stats, and I thought that was so unbelievably... Well, you know, even the peer-reviewed process, do you know how that works?

The doctors don’t actually review the data; they just get this primary paper, and that’s... and then no one vets it to them, right?

They just go through it, and they’re just like, yeah, it looks good.

Yeah, well, it’s very... well, it takes a long time to learn to evaluate scientific research.

It’s not... this is why I was wondering how you managed to do it because it’s a very intense training process, even to understand the jargon that surrounds the statistical analysis.

That's years of work.

And now the medical literature is doubling so fast that from 1900 to 1950, it took 50 years for the medical knowledge domain to double.

Now it takes 73 days!

Yeah, I can believe that.

You know, I've been reviewing some of the psychological literature pertaining just recently to discuss sensitivity, which is a neurologically based, partly gastrointestinal, partly emotional response.

But it has implications for all sorts of things you wouldn’t expect.

So, for example, societies that are what would you say characterized by higher levels of infectious illness are much more likely to have authoritarian forms of local and national government—like, way more likely!

Not a little bit; there’s a massive connection between disgust and authoritarianism, as it turns out.

Anyways, I was reviewing that literature, and I haven't looked at it for, you know, five years, and I was just absolutely stunned at the proliferation of new papers.

It is essentially impossible to keep up, and so... but it's also extremely exciting, because there is so much knowledge being generated constantly, that... and so the big... the big...

I think the key takeaway is you have to be able to look at it from a bird's eye view because there is too much, so you have to look at trends.

And you have to look at where is science headed, and that's the tricky part.

For sure!

And the science, and that's the problem with the current medical system is that everyone's in silos.

And then you have scientists and you have doctors who are in their little silos, but they're not stepping back and looking at, hey, where is medicine headed?

And how can we take the best of what the science is presented to us and bring it into patients?

Because while we... into public policy, exactly!

And so a lot of that—and there’s a huge what’s called a clinical translation gap of 15 to 20 years!

So meaning that there’s data out there to support the use of certain treatments, but a lot of regular doctors don’t put it into their treatments for 15 to 20 years, which is crazy!

And so patients aren’t getting access to the best treatments available, and it’s not... it’s very unjust because a lot of people are living with chronic disease and suffering when there are options for them.

And that’s really what got me super motivated to get into this field, because I saw people suffering with chronic pain.

Especially people don’t realize how hard it is to live with chronic pain; it’s one of the most challenging things.

It leads to mental health issues; it leads to disability.

And in fact, chronic musculoskeletal conditions have a greater cost to society than any other disease.

Meaning the total cost of... there’s billions and billions of dollars because of missed work days and because of the disability burden.

Heart disease kills more people, but quality of life and economic burden of musculoskeletal is the highest.

So it’s a very important problem, and that’s why I was so motivated to get into this field, because I saw these people not getting better, and I’ve been able to help a lot of people that no one was able to help.

So let's talk about that a little bit.

So when you first see someone now, you're—the regenerative medicine practices that you engage in, that's an element, an aspect of lifestyle medicine.

So you're looking at sleep and exercise and stress, a broad sort of I would say behavioral analysis.

So how do you move from the general behavioral analysis, through the diagnosis, to the recommendation of the therapies that you can provide?

And what therapies... like how do you step along that?

How do you decide who’s... how do you...?

Yeah, well, that's what I mean!

How do you lay out the diagnostic process and determine what treatments are appropriate?

If someone came to see you, what could they expect?

Yeah, I have a team who are kind of health coaches and biochemists who can work with the nutrition and lifestyle stuff, so they try to optimize that as much as possible.

But sometimes that's not enough, right?

And that’s why they're coming to me, because they've already tried the traditional things.

A lot of them... I’ve already seen multiple specialists, and so the most common thing I see by far is osteoarthritis.

Right? Osteoarthritis is just like we’re talking about; it’s cartilage wear and tear, it’s chronic inflammation, but now we realize that osteoarthritis isn’t just chronic inflammation.

There are all these hallmarks of aging—there are ten hallmarks of aging, and as you probably know, aging and longevity is a huge hot topic.

Because if we can cure aging, we can pretty much treat almost all chronic disease because they all have the same ten hallmarks.

So I’ll list a few of them: genomic instability, mitochondrial dysfunction, loss of proteostasis, stem protein homeostasis, which is protein regulation—like homeostasis of protein regulation.

And those pro..., you get malfunction of proteins, and they build up, and that can lead to cell dysfunction.

And then there’s also stem cell exhaustion, chronic inflammation, and in essence, there’s all these different hallmarks.

So there’s about ten of them, and now we realize those ten hallmarks of aging actually govern most chronic diseases.

So even osteoarthritis, what happens is those chondrocytes, which are the cells that line the joints, they become... they have all these different hallmarks of aging.

So they get those epigenetic alterations, so mitochondria start becoming dysfunctional.

All those things start happening at a cellular level, which can happen years before the doctor picks it up.

Right, sure!

And I know with neurological conditions, often you don’t see any overt symptoms till 95% of the underlying tissue is being destroyed.

And so that’s why diagnostics is becoming advanced too.

In fact, they’re using exosomes, which can be a biomarker for a lot of these diseases because these cells start releasing these different biomarkers, and you can detect them using exosome technology.

So it’s becoming... and even the diagnostics is really far behind now in traditional medicine because they're not doing any of this stuff!

But anyway, to the point—so if you have someone, let’s say a knee that’s really bad, osteoarthritis, stage four, they want to... they’ve been told by the regular doctor they want to get a knee replacement, and they want a second opinion.

So that’s usually why they come to me, and they want to look at the alternatives, and they’ve tried, you know, the lifestyle stuff.

And so what we do is we assess—we assess their X-ray, MRI, we do an ultrasound examination, and then we see if they’re an appropriate candidate for our procedure.

And the way we do that is based off MRIs.

So you have to have... you have to have characteristic findings, for example, like bone edema, which is inflammation in the bone—that’s something we can target and treat with stem cells because they’re very anti-inflammatory.

And then we also have to make sure their bone isn’t too deform, so for example, because there’s—this is a problem with my field—if you Google regenerative medicine doctor, there’s a thousand of them in the U.S.

And there are so many of them not doing things properly.

And the problem is because of the lack... because there is almost a black market where there are a lot of people doing it illegally in the U.S. because the FDA can’t keep up with shutting down all these clinics.

There are so many stem cell clinics, even though stem cells are technically illegal in the U.S.

So it's become a weird place because it’s hard for patients to kind of figure out who’s actually telling the truth and who’s just selling them a pie... a lie!

And that’s the biggest problem with the whole stem... you see the same thing with plastic surgery.

Exactly! Exactly!

It’s the exact same thing, and...

Yeah, well, it’s a Pito distribution problem, which is that in every field only a tiny minority of people actually know what they’re doing, right?

Right!

So you always have a signal-to-noise detection problem. It's like, who are the people who actually... and then, of course, often the people who don’t know what they’re doing genuinely think they know what they’re doing.

Tricky! Absolutely!

It’s really problematic!

Yeah, and that’s exactly what happens.

And so why should people trust you?

Because I’m a Canadian physician, and in Canada, we were never taught about money; we were never taught about the business side.

We were always taught about patients first and making them better.

And I think that being on the global stage, as I am now, we—I'm traveling, I’m treating people around the world.

My focus is never on the monetary stuff, and I always focus on treating the patients first.

Yes, some of the treatments are expensive and that's just because the market price is expensive, but as we talked about earlier anytime there’s a new technology, over time the price is going to come down, and there’s always going to be early adopters.

And over time we want this to be accessible to the average person; in fact, we want it to be covered by insurance, which in Japan it is!

So if Japan’s doing that already, I think eventually there’s going to be an impetus for this stuff to move over here; it's just going to take time.

Yeah! But yeah, I think that’s because I went into medicine generally to make a difference and help people.

That's always been my motivation—it has never been anything more!

And the big thing too is honestly if a lot of patients who see me, they can tell I’m pretty... like I’m honest and I’m transparent and I don’t promise the moon!

Like there are certain things that we can fix, certain things that we can’t fix!

Stem cells aren’t a magical cure for everything, but the next generation of cell therapy, like we were talking about, like the gene-cell therapy that really will be allowing us for custom cell lines for almost every medical condition—like diabetes, cancer, dementia.

There's a clinical trial done this year on those iPSCs I was talking about earlier, and they created what are called iPSC dopamine-producing neurons!

Oh!

Yeah! And then they transplant them surgically into the areas where they lose those dopamine neurons, and then they did a one-year follow-up and all... so many of the patients basically go into remission.

Their symptoms get so much better and they actually regrow new neurons that produce dopamine, and this was a BlueRock therapeutic clinical trial.

So this shows the power of iPSCs, and this is just the beginning of... what I’m going to call the iPSC revolution; there are going to be so many different iPSC cell lines that are going to allow us to treat specific medical conditions.

So in the future, people will think about cells to treat their conditions as opposed to pills.

Let’s go back to osteoarthritis because that’s a very interesting place to dive into because generally once people have—when people have rheumatoid arthritis and use anti-inflammatories, you can slow down the degenerative process, but often when you see people in late stages of osteoarthritis, they’ve already suffered a tremendous amount of loss of cartilage, for example.

And so you evaluate people using MRI, and you said there are times when their joint damage is too far gone for you to be able to intervene.

But so what level of severity can you intervene, and what sort of responses have you seen?

And how widely generalizable is that?

Yeah, so even for... so there are four kind of stages of osteoarthritis, so we can even treat stage three, stage four—which is the more advanced one—as long as their bone, like I was saying earlier, if their bone is actually deformed, where they need some sort of alignment or corrective, where the problem is mechanical, if it's mechanical, then stem cells aren't going to fix that!

Right? They need some sort of surgical correction!

So but if it’s more inflammatory-based, or if it’s more based off like toll dysfunction we’re talking about, then that’s something stem cells work really well for.

So for example, people who have chronic daily pain—pain at night, pain that’s affecting them all the time—that’s very inflammatory-based, and that’s where stem cells work really well for.

And even MRI, we can correlate if they have inflammation in the bone, then we have a specific target, so it’s very... it is generalizable because if we have patients like that, we know it’s going to work.

Co, so it brings down the inflammation and it can help to regrow a little bit of cartilage.

But this is the first generation of stem cells, which are the umbilical cord stem cells.

Now we're transitioning over the next six months, actually, we just licensed it, that we just have this technology now—it’s a second generation of stem cells!

So they're iPSC-derived MSCs!

So they're mesenchymal stem cells, but they're iPSC-derived, and they’re gene-edited to overexpress certain transcription factors to target osteoarthritis.

So see how specific the cells are getting!

It’s becoming a really cool technology because it’s not just like... okay, stem cells, it’s like, no, this is a very specific iPSC-derived MSC product for osteoarthritis.

So that’s the era we’re in now!

So you can treat muscle tears and damage and tendon tears and damage, and you can treat osteoarthritis.

What other conditions do people suffer and come to you for that you have had success in treating?

I’ve had... I get a lot of... so because of the online world, I get patients from all over the world.

And most of them are chronic complex conditions, so a lot of them are like fibromyalgia—which is just like chronic pain everywhere—there’s chronic fatigue syndrome, there are people with toxic mold who don’t get better.

There are people with rheumatoid arthritis who just have chronic inflammation and joint pain everywhere, and they’ve tried all the meds— inflammatory bowel disease.

So we’re getting a lot of chronic complex conditions, and now we’re building out a team of specialists.

So these are long-term systemic dysfunctions, exactly!

And so it’s about restoring your immune system and getting it to be functional again, and that’s kind of what we can do with the combination of the systemic intravenous stem cells and with the different... and different peptide protocols we have.

And even we’re now we’re manufacturing, and we have our own what are called fecal microbial transplant pills, FMT pills.

But basically, FMT, as you know, is to repopulate the good gut bacteria, and the gut is where most of your immune system is stored.

And that... so if we can restore the immune system, we can treat a lot of chronic diseases, even Parkinson’s!

So tell me what you’re doing with those.

With the FMT?

Yeah!

So we have our own process to manufacture FMT; we have a human microbiome...

Is this in Canada?

No, Mexico! In Mexico!

So we have a manufacturing plant there; that’s where we do stem cell manufacturing.

Are you... is that product available already?

It’ll be available in the next few months!

Oh, so... and so our scientist, her name is Dr. Caroline Gabis; great PhD human microbiome specialist, and this is her specialty, and she has her own proprietary process on how to manufacture these pills, select for the donors, and give them to patients.

And the beautiful part about these treatments are only one week long and they can have a huge impact on your body!

And who do the fecal transplant pills work best for?

So you can use them for even anti-aging and longevity because in mice, FMT has been shown to extend lifespan by 30%!

So I think there’s going to be a lot of people who are just going to use it for longevity.

And that's a consequence of gut biodiversity proliferation because the gut microbes produce so many different metabolites and help process so many different cellular processes.

They're not just... that can be used post-antibiotic treatment as well, right?

Yes! And so we’re going to make one for children as well because a lot of toddlers and a lot of young kids, unfortunately, get antibiotics like crazy!

And there’s actually... well, in cesarean birth actually is a problem, right? Do you want to explain that?

Yeah, because you don’t get exposed to the vaginal flora, which is the bacteria.

So I recommend anyone who gets a C-section just take the stuff down there after your baby’s born and rub it on their face, right?

And just get them that exposure to the good bacteria!

So the reason is because that's a good example of just how bloody complex things are.

Who the hell would have ever guessed that a cesarean birth would cause post-birth trouble years later?

Because there wasn't the proper trip through the vaginal canal!

Man, that's unbelievably complicated!

It is, and that’s why what we got to learn are principles!

What’s the principle of the human body? Immune dysfunction is one of the most important principles that governs so many different chronic diseases.

So if we can train your immune system properly at a young age, I always say: your immune system is like a teenager!

If you don’t train it properly, it’s going to misbehave when you're older!

So now we’re learning how to train it properly, which means you have to get exposure to certain bacteria.

You have to be played with pets; you have to play with soil.

You can’t be afraid of germs when you’re young because that actually leads to more issues when you’re older.

And antibiotics... much cleanliness, too much cleanliness.

And we know that antibiotics, for every antibiotic course that children take, it increases their risk of autoimmune disease by 1%.

So it can become accumulative!

Right?

Yeah, and so it has to be... it was NIH research!

That’s interesting because I was chronically treated with antibiotics for recurrent tonsillitis, right?

Probably 20 times!

So and I think a pro—a... and we talked about the beginning of an interview what we did for you.

I think you have a component of immune dysfunction, which is why we’re going to be doing these different cell therapies to get your immune system functioning again and get you out of this chronic pro-inflammatory state.

Now, you’ve also treated depression!

Yeah, yeah!

So let’s talk about that a little bit because the first thing people who are watching and listening should understand is that there isn't any such thing as depression.

There are multiple medical and physical conditions that produce decrement in mood.

And some of those are lifestyle-associated and some of them are a consequence of not having a functional life, and some of them are pure consequences of physiological malfunction.

So there's a lot of evidence, for example, that chronic depression is an inflammatory condition.

And there is evidence as well that part of the reason that SSRIs work is not directly because of their neurochemical consequences on serotonin function, but because they're actually anti-inflammatory, right?

And there’s a big... that’s statins too, by the way.

Oh, yeah!

Oh!

So no, I don’t know that! So statins, for people who don’t know, are cholesterol-lowering drugs, but the reason they actually have an effect on mortality, we believe, is because they reduce inflammation.

Uh-huh.

So what’s the underlying cause? Chronic inflammation.

Where does that come from? Chronic immune dysfunction!

And where does that come from? Your gut, right?

Well, there’s a huge overlap too between depression and immunological problems!

And so, okay, so what have you done with regard specifically to the treatment of so-called depression?

So let’s come back to the fundamental principles of what causes depression from a cellular level.

It’s neuro inflammation. There are some chemical imbalances, and then there’s a gut-brain axis.

You have more serotonin receptors in your gut than you do in your brain, right?

And so it’s looking at this from a holistic approach.

And so for me, as an interventional physician, what we can do is we can reduce neural inflammation by using intravenous exosomes.

They cross the blood-brain barrier; they reduce inflammation in the brain.

And then we can also help with the nervous system!

What are symptoms of brain inflammation?

What?

Every neuro... if you look at this data out there, if you go to literature, almost every neuropsychiatric disorder is linked to neuroinflammation!

It’s hand-in-hand; it’s almost kind of like autoimmune conditions and intestinal permeability or leaky gut, right?

You’ve heard of leaky gut?

I’ve...

I know there’s Michaela... we interviewed a psychiatrist at um... what’s the big hospital?

MGH!

MGH in Boston, who’s been using dietary manipulations to treat like schizoaffective disorder.

And I think it's very probable that the really catastrophic neuropsychiatric diseases like schizoaffective disorder or schizophrenia, we're going to find out, they have a physiological basis—exactly!

And so, we’re starting to learn that!

Depression?

To manic depression! Exactly!

And so we’re starting to learn about those physiological bases, and that’s what we intervene on!

So the way we do that is reducing neuro inflammation, and that’s with exosome treatment primarily—intravenous exosomes!

And then what we do, because we know so many mental health disorders are rooted in unresolved emotional trauma—and a lot of that comes from... do you know Paul Kiti?

No?

He’s a psychiatrist, he wrote a book about this, but he talks about how many depressive and anxiety disorders are rooted in this unresolved emotional trauma from childhood.

And sometimes it’s in the unconscious mind and they don’t even know it!

And so what we do interventionally is we actually do something called the stellate ganglion block and inject into the vagus nerve because the stellate ganglion innervates into your sympathetic nervous system.

And a lot of times your sympathetic nervous system is overdriven—exactly! It’s over...

That’s chronic... chronic flight!

Exactly!

And that’s also because of that unresolved emotional trauma!

And then the vagus nerve—the vagus nerve is kind of this master nerve regulator of your parasympathetic nervous system, and that’s the one that helps you to relax and calm down.

But a lot of people—what happens in neuropsychiatric disorders is they can’t relax; they’re just jittery; they’re just irritable.

You tell them to relax; it’s like telling... it’s like telling an obese person to stop eating or eat less.

It just... it’s not helpful!

So it’s just telling people who are anxious and depressed to relax is not helpful!

And so what we do is we're trying to intervene!

And so what we actually inject directly into the stellate gang, we inject something called bupivacaine, which is an anesthetic, and we mix it with certain peptides, and what the combination of peptides and the stellate ganglion do is they suppress that sympathetic overdrive.

And then into the vagus nerve, we inject peptides, and actually some exosomes, which help to remodulate the signaling of the vagus nerve.

So this can have a dramatic effect on their nervous system, make them more calm, make them more resilient, and deal with stress better, and just make their bodies...

So you help with parasympathetic activation, exactly!

And so I have a diagnostic question for you!

Yeah!

One of the things I noticed when I was practicing as a clinician in concert with physicians who were prescribing SSRIs... I mean, I had clients who showed like a miraculous response to SSRIs upon occasion where they would be chronically depressed for months, or even for years.

And they'd start a course of antidepressants, and if they were fortunate, their symptoms would remit in like, well, between three days and a month, and it's not supposed to remit that quickly.

Yeah, but there’s a neurochemical effect as well as the neurophysiological effect!

But here's one of the things I noticed—I want you to tell me what you think about this.

So as we already discussed, there's a lot of different disorders in the depression bin.

And one of the things I would do with my clients is do an evaluation of the dimensions of their life.

So imagine this: do you have a long-term partner? Do you have friends? Do you have a job that you enjoy, or that at least is functional and providing for you, you know, economically?

Are you... do you have plans for your education? Do you take care of yourself physically? Do you have an alcohol or drug or other abuse problem, etc.?

So multi-dimensional analysis of functionality along all these different dimensions of life.

Now and then, I’d have a client who had no problem with any of those but was depressed, right?

And those were often people who showed a stellar response to an antidepressant.

As opposed to the people who... well, they didn’t have a partner; they didn’t have any friends; their life was just an absolute bloody catastrophe.

Then you could imagine two different forms of depression.

There are many different forms, but two classic forms—one would be you’re not depressed; your life is an absolute shambles, and you’re miserable because nothing you're doing is working.

And then there’s another person that’s like, oh no, like you work hard; you're well-educated, you have goals, you have a partner you love, you have friends, but your mood is just absolutely disregulated.

You're worse in the morning; something's wrong with those people physiologically!

So I'm wondering if when you do your diagnostic process, if you look at... because I could imagine that there's a subset of people whose lives are in functional order but are suffering dreadfully for whom a physiological intervention like exosomes would work particularly well!

And those are the ones we’re primarily treating!

Yeah, okay, and so why are those the ones that you're primarily treating?

Is that just the people who end up coming to you?

I think it's just selection bias!

Yeah, probably!

I think the people who seek me out are generally those types of people.

They have the wherewithal to do it!

Exactly! Unfortunately, the people in the other category probably don’t even know I exist, right?

Because they’re just going to their family doctor, and they’re just that... and that’s the means—that’s all they have!

Yeah, well of course, in the case if you have a chronic illness long enough, it’s going to start to affect your function and all these other dimensions of life too, so it’s not a clean cut.

But I often think too that the research literature pertaining to the effectiveness of antidepressants would be a lot cleaner if the diagnostic categories were set up properly.

It’s like, well, are you depressed? Which means that your life is fun, but your mood is disregulated?

Or are you just merely suffering the consequences of having an absolutely disregulated life?