Optimizing Physical Health, Well-Being & Aging: Benefits vs. Risks

In this episode

Longevity and anti-aging medicine is an emerging field with many promising and exciting options to choose from. But, do any of these actually work? What is the evidence? Are there any risks?

Our guest in this episode is Dr. Neil Paulvin, a functional anti-aging medicine physician who specializes in combining cutting-edge science, technology, and personalized precision medicine to help his patients optimize their health, performance, and longevity.

As we’ll discuss, there are quite a few things we can do that can be very beneficial. At the same time, there is no one one-size-fits-all plan that works best for everyone, although there are some key principles that can help guide us along the way.

Also in this episode:

• Dr. Patti Shelton, MD, LongevIQ medical communications officer
• Amir Ginsberg, LongevIQ founder.

Episode summary

Main topics

• (0:00:00) Podcast and episode intro, medical disclaimer
• (0:01:29) Anti-aging & longevity: what do we know?
• (0:02:53) What are we optimizing for?
• (0:05:38) Optimizing for performance vs. longevity: Are there any trade-offs?
• (0:07:57) Aging and health optimization: common tests and biomarkers
• (0:10:19) Nutrition, diets and fasting for longevity
• (0:15:06) Food sensitivities and health
• (0:20:29) Health optimization devices and technologies
• (0:24:21) Continuous glucose monitors for health optimization and anti-aging
• (0:27:35) Cold therapy
• (0:31:37) Breathwork with cold therapy
• (0:32:23) Anti-aging and health optimization supplements
• (0:39:01) Common issues with supplements to watch for
• (0:42:25) A multi-pathway approach to health optimization and anti-aging

Transcript

This podcast episode was edited to improve readability.

Podcast and episode intro, medical disclaimer

Dr. Patti (00:00:00): This is Dr. Patti Shelton, and you are listening to the LongevIQ podcast. We discuss anti-aging and longevity science and how to benefit from it so we can all live long, healthy, happy lives.

Just before we get started, a quick medical disclaimer, this podcast is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease or to provide or replace medical advice. Please use this information to educate yourself as much as possible and share this information with a qualified health practitioner that you trust.

Longevity and anti-aging medicine is an emerging field with many promising and exciting options to choose from. But, do any of these actually work? What is the evidence? Are there any risks?

Our guest in this episode is Dr. Neil Paulvin, a functional anti-aging medicine physician who specializes in combining cutting-edge science, technology, and personalized precision medicine to help his patients optimize their health, performance, and longevity.

As we’ll discuss, there are quite a few things we can do that can be very beneficial. At the same time, there is no one one-size-fits-all plan that works best for everyone, although there are some key principles that can help guide us along the way.

Also, joining us today, as always, is Amir Ginsberg, the founder of LongevIQ. Welcome, Dr. Paulvin. Thanks for being here with us.

Dr. Paulvin (01:26): Thanks for having me. Excited to be here.

Anti-aging & longevity: what do we know?

Dr. Patti (01:28): All right. Well, you have a really impressive background with a lot of diverse education in anti-aging. So we’d love to start with just your overall view of anti-aging. How do you view longevity and longevity medicine?

Dr. Paulvin (01:43): That’s a long question right there. I mean, longevity medicine is very evolving right now. It’s something that there’s a lot of noise, a lot of influencers out there saying things that aren’t true. There’s a lot of over promising, under delivering, but there’s also a lot of great potential. So it, it’s something where, I would say just to kind of summarize, there are things that are coming down the road. There are things that I tell my patients right now. There’s nothing that’s been proven to help elongate lifespan in humans yet. There’s a lot of things that hopefully the next two or three years that may greatly change. Well, we’ll know what works and what doesn’t, but you also have to, in this whole environment, have to be very buyer beware because a lot of people saying and selling a lot of stuff that has no benefit whatsoever or you may actually hurt yourself. So it’s a very, it’s a fund that there’s a lot of promise, a lot of investment going into it, but also very, very confusing right now.

What are we optimizing for?

Dr. Patti (02:48): That’s a really important message for people to hear, So thank you for sharing that. I notice on your website you talk a lot about optimizing, so optimizing human potential. So I’d love to talk about what are we actually optimizing for? Are we optimizing for performance now? Are we optimizing for longevity? Is there a trade off between those things? How can people look at at what to optimize?

Dr. Paulvin (03:12): I mean, optimize is a buzzword. You talk to 10 different people or 10 different doctors, you’re going to get 10 different answers and they all may be right. So, the point being is optimize means what you’re looking for. I mean, there are people who may just want to feel better. And that’s all they want. They’re not not somebody who’s going to take 22 different supplements or 10 IVs or lock themself in a hyperbaric for an hour. But if they get the right sleep and the right exercise program and they have the right diet, they’re optimizing their health and there’s data that they can potentially increase their lifespan. There’s also people who are doing IVs and are fasting and they also are work to optimize their lifespan, at least what we call healthspan now.

So optimization is just trying to make yourself better in either your cognitive performance, your sports performance, your weight, your whatever you’re potentially working on. But also, it breaks down to the simple foundational things that we know that are actually do already connect to help lifespan and optimizing health are how many relationships you have, how happy you are. And those are free. So there’s a full gamut of how you optimize your health. As long as you’re doing something that’s great. I tell my patient, I’m like tour guide in optimization. We can do simple things. We can go down the rabbit hole together, as long as you understand what works, what doesn’t. And there’s kind of the question in terms of interacting, can they counteract each other?

(04:59): If you’re doing too many things without knowing what you’re doing, you could counteract and end up going negative. And the other thing I think I mentioned to you right in the beginning is you gotta start the foundational things. It’s gotta be exercise, it’s gotta be sleep, it’s gotta be stress management, it’s gotta be diet. So if those aren’t there, the rest is stuff is kind of superfluous, or not going to really work much and you’re spending a lot of money. It looks cool on social media, but you may not get too far. I mean, that’s kind of the broad strokes question. I mean, again, this is ever evolving and but it’s a very cool adventure.

Optimizing for performance vs. longevity: Are there any trade-offs?

Dr. Patti (05:38): Do you sometimes see a trade off like someone optimizing for a sports performance right now versus optimizing for longevity? Are there times when you might need to do something different to optimize for those two different outcomes? Or do you see that they normally kind of go together?

Dr. Paulvin (05:55): I mean, it’s both. I’m in Manhattan and a lot of my patients are going to run the New York Marathon in a couple weeks. So they’re putting extra tension. I have a lot of cheesy analogies right now. They’re trying to fill a bucket faster than it is leaking. Running a marathon is not a normal stress to put on anybody. It’s great for your body to be able to show that it can do it. So yeah, we’re at that point we’re doing certain injections or they’re doing hyperbaric or they’re taking antioxidants, which for short term activity are great. We know long term antioxidants are not healthy. They decrease performance can decrease brain functions.

So yeah, in that regard, there is a trade off. I think certain things are great in the short term and not great in the long term. Definitely sports, the people who are trying to maximize their growth hormone or their testosterone to maximize their performance, that’s great for the next six months. But we know there may be some downsides on in the long term. You may have high testosterone that can lead to high estrogen, and inflammation and so on. There are people who do a lot of cosmetic stuff to look their best. Those things have some toxic effects. They decrease some ability to produce testosterone or female hormones appropriately. So you may be robbing Peter to pay Paul a little bit.

So yeah, those are the types of things that may counteract each other a little bit. And again, you’re an adult. At least in my case, most of my patients and most adults know what they prioritize. They understand the pluses and minuses, and they’re going to make that decision. The problem is that a lot of people see somebody on social media or on tv, Oh wow, they look really great. What are they doing? And that’s all they see. They see the golden carrot and they don’t understand the repercussions of things.

Aging and health optimization: common tests and biomarkers

Dr. Patti (07:54): Really important message. And if somebody is optimizing for longevity, obviously we don’t know ahead of time how long they’re going to live, so we need some way of measuring. So what are your favorite ways of measuring somebody’s aging and testing for healthy aging? What do you use normally?

Dr. Paulvin (08:14): There’s a lot of things. I think there’s no one great one. Relationships and positivity – those things are actually good measures. Grip strength is actually one of the simple measures that we know has some data behind it as well. That’s kind of the starting point from the basic things. We can check inflammatory markers something like a C-Reactive Protein (CRP), which is helpful to let us know where patients are. You can look at oxidative stress through several markers which is the body’s damage from inflammation and certain pathways not working the way they should and toxins and things like that.

There are now things that are out there called biological age clocks. They are definitely a work in progress. I mean, even the leading experts out there will say they’re not ready for prime time yet. They’re a nice gauge as a number. For those who don’t know, biological age clocks look at methylation pathways or combination of other pathways in the body. You may be 52 based on your birth date, but your cells may say that you’re 42, which means you’re doing the right thing in theory. You may be 52, but it may say that you’re 62, which means that you’re kind of going down the wrong way. Is that gospel? No, but it’s something. If you take that and their cholesterol is good, their foundation markers are good, their grip strength is good, you can kind of put the whole big picture together. Those are things we definitely look at.

We definitely look at sugar levels, hemoglobin A1C. We know that that leads to many different issues as well. So that’s the kind of the starter pack. And then depending on what people were specifically looking at, we can kind of go from there.

Dr. Patti (10:03): And so you’re saying it’s good to have several different ways of testing rather than choosing one test, and just taking it as your gospel for how well you’re aging. You want to look at a bigger picture, more different things.

Dr. Paulvin (10:17): Yes, exactly.

Nutrition, diets and fasting for longevity

Dr. Patti (10:18): You mentioned these pillars – nutrition, exercise, sleep. With nutrition, what do you find typically works well for people as far as eating patterns? Do you find particular diets tend to be good? How do you figure out for an individual what the ideal anti-aging eating pattern might be?

Dr. Paulvin (10:41): If I knew this, I would be a billionaire at this point. This is probably one of the biggest things that I mentioned in the beginning where if you asked me this question three years from now, I probably would’ve a much better answer than there is now. There’s been a lot of data refuting things and a lot of data promoting things, and we just don’t know for sure. Cause nutritional studies notorious for having horrible data because people either can’t track their own data or they lie about what they ate. A hamburger from one place is not the same as one from another. It’s just very hard to kind of get a clear guidance on.

So a couple things that we do know, time restricted eating, meaning that patients who eat in a certain window, it’s not the same thing as fasting, meaning that you’re eating all your food in about an eight hour window, usually in the morning.

So it’s not just having a window, it’s having a window in the morning which is actually better for you potentially than eating even an eight hour window in the evening because of what’s called your circadian rhythm. And you have clocks, which so your body just will work better. Insulin is more sensitive. Your hormones are better if you eat in an eight hour window from maybe like nine to four, nine to five as opposed to later in the day. So, that’s something that’s starting to show up. Beyond that, the answer is whatever diet works for you, unless there’s a specific medical issue. We know obviously the common sense thing. You should not be eating sugar every day. That’s, we know. And then beyond that, it’s just a really huge debate.

There are people who are all about paleo, there are people who are all about fasting. There are people who say that anti-inflammatory diets are better. The data isn’t there yet. Obviously, we know that the healthier you eat, the less processed foods you eat, the better it is for you, and you don’t go down the rabbit hole with those. Obviously if you eat inflammatory foods, things like sugar, in some patients gluten. I know I’m sensitive to dairy. So that sets off an inflammatory action in me. So it’s kind of more individual. There’s what works for me is not going to work for somebody else. It’s listening to your body. And we can also now tell that on certain lab test, if you have inflammation or if you have a celiac where you’re kind of allergic to gluten, then we can work with it.

We know that you do not want to be eating as many meals. Like people eat 4, 5, 6 meals day. That probably is not as good as eating a couple meals day, the way the hormones go up and down. Obviously avoiding sugar and things like that and not eating processed foods all the time. That’s kind of the what we know.

There’s some people who are keto. If you have a neurological issue, we know a keto diet could be very helpful. We also now are seeing some benefits, potentially psychiatric wise, things like bipolar disease. If you have IBS or especially a gastrointestinal issue called Small intestinal bacterial overgrowth (SIBO) or inflammatory bowel disease, a FODMAP diet or at least a modified one where we are avoiding certain foods could be helpful.

Everybody wants a cookie cutter plan. It doesn’t work. Besides some basic things. Talk to me in three years and we probably have a lot more information. Another thing I would mention really quickly is some data on a five day water fast, either full five day water fast or doing what they call fasting mimicking diet. There’s different brands out there. I’m not sure if you want me to mention brands or not, that have been shown to have really good efficacy in terms of long-term health data. So it’s either the time restricted in the short term or doing like a long term, either a water fast or fasting mimicking diet where you’re getting certain calories, but it’s in a certain amount of certain macronutrients. That’s something you’d want to talk to your healthcare provider about.

Dr. Patti (14:40): How often would someone normally want to do a five day fast like this?

Dr. Paulvin (14:43): Like this? In a perfect world, you, I mean, at least once every three months. I mean, there’s people who do it monthly, in theory, it’s every three months.

Amir (14:50): I think one of the popular fasting mimicking diets is called Prolon. It’s one of the most studied one, right?

Dr. Paulvin (14:57): Yeah. They have the most data out there right now. There’s other companies and other programs working on their data, but they have the most data by far right now.

Food sensitivities and physical health

Dr. Patti (15:06): And since we’re talking about food sensitivities in each person, how would you recommend somebody go about trying to figure out which foods they might be sensitive to? Like what’s the process for that?

Dr. Paulvin (15:19): Okay, I’m going to probably aggravate a lot of people when I say this, but we just kind of know more and more on that. Either you’re allergic to a food where you’re getting a reaction, a rash, or it comes up positive on your allergy blood test. That’s run through your regular doctor allergist. Or sensitivity then becomes an air quotes where if you eat certain foods you feel flushed or you feel bloated or you have brain fog. In terms of any lab tests for food sensitivity, they’ve kind of been disproven to a certain extent. I know they’re very popular out there. I mean, I have patients who come in and say, Oh, I did this test or that test, and it says I’m sensitive to every food under the sun. The data just isn’t there anymore to prove that they actually work.

I know they actually did it a couple times where if you do the same test multiple times for a food sensitivity, same person, same basic diet. One time they’ll say you’re sensitive to this, one time they’ll say you’re sensitive to something else. It’s not reproducible. I don’t love them. I don’t really do them much at all with my patients anymore. There’s no perfect test for a lot of these things yet. So you have to take the sum of the whole, all of all the parts. The only time I will tend to do food sensitivity tests – if a patient is having a bloating issue and nothing else is showing up, we’ll kind of trial and error. Okay, this test says you’re sensitive to blueberries, this test says you’re sensitive to dates. We’ll try to get rid of it and see if it works. Sometimes it hits, sometimes it doesn’t do anything. So food sensitivities are not gospel. They’re a nice part of your package if you want to use ’em, but they’re not really covered by insurance. So if, if something that you don’t want to spend on, don’t spend on it.

Dr. Patti (17:03): Do you find it’s helpful to have people do an elimination diet of kind of common sensitivities and then add things back?

Dr. Paulvin (17:11): I guess the simple answer is yes. Just from the data that’s out there now, I tell people I kind of play on both sides of the fence. I believe there are a lot of alternative things or integrative or what term we’re using now that are great. But there’s gotta be some data behind it too that explains it. So I mean, elimination, like I said, I definitely have my patients avoiding sugars. I have them avoiding gluten and see how they do and then add it back in. I’ll do that with some dairy foods, with cheeses especially, because certain people will be great with cheese and certain people can’t do anything at all. Nuts are probably another food to avoid, especially with my autoimmune patients who just don’t respond to anything.

I have kind of moved a little bit away from the full elimination diet. Most patients that are seeing me have already done it on their own or with some other practitioner. And there’s so many other things out there that are now better to be used for a lot of these conditions and just a full elimination diet where they come back in two months and most of  them have the same issues. So I use it in conjunction. I use what I call, like I said, a mini elimination diet. Again, if they have gut issues, I’m going to have them eliminate certain FODMAP foods like artichokes and things like that. I’m much more prompt specific. I’m going to keep probably saying the same thing this whole talk here. Everybody’s different. Everybody’s is an N of 1, and I’m playing on multiple sides of the fence. So I don’t think what’s going to work for me is going to work for my wife or is going to work for you. So it’s the core two or three things, and then going from there.

Dr. Patti (18:52): Kind of a personalized or precision medicine approach.

Dr. Paulvin (18:56): Yeah, I mean, genetics will help a little bit too. I didn’t mention that. If you’ve had a 23 and me or any of the other hundred of genetic tests that are out there now. I mean, there’s certain genes that show that you can’t break down histamine, which we’re now finding more and more patients have an issue with what are called mast cells that produce histamine, or they can’t break down histamine. That’s causing a lot of their bloating or sensitivity. So with that, we will know. If they have celiac genes which are gluten related, we can do that. So again, it’s putting all the pieces together. A lot of people just come in and say, Oh, I just did this elimination diet and it didn’t work. I’m like, well, did they fix this or this or this? And they’re like, No. I’m like, Okay, that’s why it didn’t work.

Lock

Dr. Paulvin (19:34): I have a lot of cheesy analogies. I’ve now really subscribed to what I call the safety deposit box method, meaning you gotta turn all the keys at the same time. I gotta heal their gut with whatever I’m going to be using, be it supplements, peptides or something else. We gotta adjust their diet a little bit. We gotta work on their immune system. If we fix all those things at the same time, then they’re going to feel better. If you do one thing and then throw another thing at them and they don’t feel better, then there’s a reason why. So I, I tend to be a little more aggressive than most people.

Dr. Patti (20:05): So kind of taking the approach of trying everything all at once rather than just one thing at a time.

Dr. Paulvin (20:12): If you know what you’re doing, and I know what I’m doing. There’s a lot of people who don’t, but yeah, I’m going down a rabbit hole there.

Dr. Patti (20:21): We love rabbit holes. <Laugh>.

Dr. Paulvin (20:23): Yeah, but then I get myself in trouble. So I’ll stay away from that one.

Health optimization devices and technologies

Dr. Patti (20:29): I see you are using quite a few devices for functional medicine or anti-aging. What are some of your favorite pieces of technology that work sometimes for your patients? And obviously really important to be working with a professional if you’re trying these things.

Dr. Paulvin (20:46): Technology is incredible right now. That’s why I kind of mentioned that there are so many other things that we can use now that we didn’t even have three or four years ago. The couple things I really, really like – I love red light therapy cause it’s very simple, cost effective, there’s data behind it for a lot of different issues, especially, I do a lot of patients who unfortunately have neurodegenerative issues like Alzheimer’s and Parkinson’s, there’s a lot of great studies coming out about that, used to alter the microbiome, it can help with inflammation. So that’s one.

Hyperbaric oxygen therapy I love as well. It’s a little more on the pricey side, but there’s a lot of incredible data, everything from concussion to inflammation to long covid patients. So that’s amazing. Like a year ago, nobody really was doing it. Now it’s like people are asking me, where can I find a hyperbaric chamber or can I have one in my house? So I think that’s another one.

In terms of all this stuff, what I love and don’t love (but mostly love), is the paradigm, and this type of thing has kind of changed in the sense that it used to be the doctor educating the patient. Now, there’s definitely a symbiosis. A lot of my patients are very educated. They see things. They just say, Okay, I want to do A, B and C. How do I implemented this in the right way? I’ll have a hyperbaric chamber in my home or, or sauna in my home or whatever.

And then they’re doing things on their own to maintain their health and prevent them from getting sick instead of the old paradigm we have where I’m sick, I feel like garbage now let me go see the doctor. I think that’s what makes technology really a good thing.

There’s a couple other ones that I do like, there’s PEMF (Pulsed Electronic Magnetic Frequency), which is great for inflammation, Transcranial alternating current stimulation (tACS) that’s has shown a lot of benefit in psychiatric illnesses, anxiety, depression, PTSD. I think those are the things that are really ready for primetime.

(22:58): I think there are a couple other things that in the next year or two, once the data comes out are going to be incredibly helpful. And actually, there are products now that are really great and in a very simple way can help with HRV (heart rate variability) as well as calm anxiety and pain. It’s a product that you can wear around your wrist that vibrates. And they have data where it elevates HRV which can help with mood and it’s something very simple, not that expensive. And it, it’s very fruitful. So I think those are the ones.

And the last thing I’ll say, and I kind of hinted at, is all the wearables are out there.

I mean, there’s two or three that I really strongly recommend to patients, but patients knowing at least their HRV, what their resting heart rate is, what their pulse ox is (* Pulse oximetry measure the oxygen level of the blood). Now with the new Apple watches knowing the heart rhythm so if they have some type of irregular heartbeat, it tells them Oh, you need to go to the hospital. Now patients can do their blood pressure at home or it will be on their watch or whatever it happens to be. Most patients want to be healthy. So they know, Oh my god, my pressure’s high, or my heart rate is too high. There are numerous patients unfortunately, who had a low pulse ox. However they’re measuring it, and realized there was something wrong over the last couple years. So I think that’s something that’s also going to be much cooler and cooler in the next couple years where with all these technologies, they’ll know everything from their blood sugar to their insulin level and you have it right at home.

Continuous glucose monitors for health optimization and anti-aging

Dr. Patti (24:21): How do you feel about continuous glucose monitors? Do you feel like they’re helpful or do you feel like maybe it’s too much data or an overkill?

Dr. Paulvin (24:28): I’m going to be the Debbie Downer with that one. I think it’s obviously great for diabetics because they have all the data. The non-stick ones are coming out, hopefully in the next year to 18 months. So it’ll be great for them as opposed to having to do finger strikes all the time. So in that regard, they’re good.

From an anti-aging front, I’m going to go with most people who are saying there’s not a great utility to it. It’s good to do once a year when you want to see how your sugars are. When you’re eating a certain food, does your sugar spike with something? Or if people have food sensitivities. There are patients who have told me, and then the respected doctors or scientists I respect, they’ll say, I just had this food.

And it’s good to see how your body responds to exercise. If your body has a really big spike with your sugars, then you know you’re either pushing your body too hard or if you crash. Obviously, you may be working out too hard or not feeding yourself enough to get through your workout. You combine that data with your HRV data and potentially what your blood pressure and heart rate are. And it helps in that regard. But honestly, after a month or two, things don’t really change that much. I mean, if you want to monitor your workouts every three months and see how your body responds, great. But for what they cost right now, after the first month, I don’t think there’s a huge utility with it right now. I think they’re working on new things. Again, if you ask me in another 18 months, that may change. But right now, there are other things I would like to use.

Dr. Patti (26:14): Just really important with the overall message, which is just because we can measure something doesn’t mean that it’s meaningful to do so. Or that it’s actually going to help us in any way.

Dr. Paulvin (26:26): Yea, and what we see now with wearables, and I mean, I literally get this question daily, is, okay, my HRV is this or a couple of other scores. What does this mean? So they have numbers, but they have no idea what it means or what to do about it. And they like, Oh, well, my trainer looks at it. So I think we’re getting now to that point where we have so much data, but a lot of people don’t know what to do about it or do with it.

I mean, I will work my patients on it, but traditional doctors, most don’t look at it. Trainers have some training with it, but they don’t know how to do it from a medical perspective. So that’s going to be an area that’s going to need to get filled in somehow. As these wearable devices become mainstream with like lactate levels and insulin levels and all this stuff is going to be science overwhelm. I know this is the first time in like a year where a lot of sales of wearables have decreased, just because they are realizing: I just don’t know what to do with this, and I’m just going to do other things.

Dr. Patti: Yeah. What’s the point of collecting a whole bunch of data if you don’t know what you’re going to change based on that data?

Dr. Paulvin: Exactly.

Cold therapy

Dr. Patti (27:34): How do you feel about cold therapy? I I’ve seen you talking a little bit about this on your social media,

Dr. Paulvin (27:40): Cold therapy, like a lot of things out there now, if you use it for good, it’s great. It could also be a little evil in the sense that it’s not like the end all be all. It’s very good for inflammation. It’s great for the psychiatric benefits in terms of neurotransmitter release. It helps your immune system, especially if you’re doing it in a cold plunge, not just in a shower. Meaning like some people just do cold showers. It also helps regulate your nervous system between your sympathetic fight, which is your fight or flight, and your parasympathetic, which is the calming part of your nervous system. That is all beneficial from cold therapy, especially cold immersion, which is a cold plunge. A cold shower has some benefits but not as much.

We know that in some studies now, in terms of what’s called cryotherapy, where they put you in the minus 200-degree booth, some people like it for inflammation. The data’s just not as good from cryotherapy as opposed to cold immersion. I know I have switched from more cold cryo to cold immersion, but there are people who like it. Again, you’re not going to get the psychiatric benefits as much, but you will get the anti-inflammatory benefits. You just need to be a little more careful with cryo. I’ve had more patients have either some neurological damage or other issues like burns and frostbite from it. So there’s a little more risk to it as well.

And also, the great thing about doing cold immersion or even a cold shower is you could complement that with breath work a little bit easier. There’s data now showing the breath work with the cold immersion has actually better benefits than just doing either one individually. So I’m much more of a cold immersion guy. The one caveat with all is the weight loss kind of thing that a lot of people were saying about it. The data’s all over the place with that. It may help you lose weight. It will definitely activate brown fat. Is there going to be a dramatic weight loss effect to it long term? Probably not. But that’s still being studied pretty right now.

Dr. Patti (29:41): And you sort of alluded a little bit to this, but there’s a too much clearly with the cold immersion. So how much of that should people be doing? Like how long is safe? How often is safe? Is, is this a thing that varies person to person?

Dr. Paulvin (29:54): Well, it definitely varies person to person. I’m in the middle, middle to high. I have friends who can barely do one minute, and they’re happy with that. This is something that we’ll know more in probably another year or two.

We do know – there’s data that says about 11 to 15 minutes is probably optimal for the week. We definitely want to limit it a little bit after you do an anabolic or a strength workout because it will decrease your hypertrophy, the anabolic effect of the workout. So you need to be a little bit aware of that as well. I mean a lot of these places; there are places at least by me that are now cold therapy studios, quote-unquote, and it looks cool on social media, let’s do six minutes or seven minutes.

The data that it may have bad effects for some people is out there. Again, everything’s individual. Kind of funny. I have some older athletes I see, and they’re like, We’ve been doing this for 30 years. This is not new. It’s just become more popular. Except for being in a metal tub, now you can buy a $10,000 – $15,000 cold plunge. Again, whatever works for you is great. And they’re sitting there for 15, 20 minutes, and they feel better. But the data is really 11 to 15 minutes is maybe the sweet spot, except maybe if you’re trying to do a for inflammation where there’s a little more play there.

Dr. Patti: And it’s 11 to 15 minutes all at once, once a week, or is that 11 to 15 minutes spread apart?

Dr. Paulvin: Throughout the week. Most people say three to four, some people say up to six minutes. I’ve seen data that six minutes may be too much. I like three or four minutes. It is a nice happy medium for most people.

Dr. Patti (31:30): And so then we’d be doing that maybe three to four times a week to kind of add up to that 11 to 15 minutes.

Dr. Paulvin: Yeah.

Breathwork with cold therapy

Dr. Patti (31:37): And then the breath work that you mentioned, what kind of breath work are we talking about with the cold immersion?

Dr. Paulvin (31:42): The most data’s with the Wim Hof breathwork. He’s gotten pounds and pounds and mountains of data. Breathwork is great no matter what you’re doing. You could just do some box breathing. I mean, that has been shown to be helpful with cold immersion. There are people who do hyperventilation breathwork that works for them. It’s not as common. So just the breathwork of controlling the breath, its effect on the nervous system, the effect on the brain, and your neurotransmitters are all beneficial. So you’re getting that in conjunction with the benefits of cold therapy.

Anti-aging and health optimization supplements

Dr. Patti (32:21): Beautiful. Let’s talk about supplements a little bit. So there’s of course so many supplements out there that people might be tempted towards. What’s kind of your general view, first of all on, on supplements for anti-aging and and how we might think about which ones are beneficial, harmful, all of that kind of thing?

Dr. Paulvin (32:43): I think throughout, my opinions have kind of changed a little bit. There are ones that are golden. There are a lot of these ones that have like 15 medicines in them. 15 supplements in one are usually not the best ideas, in my opinion, just because what’s happening is: either your body’s not going to like one of them for whatever reason, and to get all 15 in then and make the product not cost $5,000. It’s usually a lower dose of most of the products that are out there. I don’t love those multi-purpose products.

I think there are some really good supplements out there that have great data behind them. I have a starter stack of like three or four, which I start patients on in most cases. And then we also treat whatever their goals are, brain, inflammation, weight loss, or whatever happens be.

I mean my starters – The big ones are definitely NAD. Especially, I like NMN. Some people like NR. They both have good studies on them. Vitamin D has just so many benefits to it. Berberine, in terms of its insulin sensitivity and inflammation, is a really good starter. Omega-3 fish oil has just the same amount of benefits to it.

So those are kind of the basic ones. And then I love a product called spermidine. Just be aware of patients who are gluten-sensitive or gluten allergic. Most of the products have gluten in them because it’s derived from wheat germ. There’s now a gluten-free version out there. For the people who are in the anti-aging space, there’s the word nine pillars (* hallmarks) of aging; I think now they’re up to 15. Spermidine does the most of any product that’s out there in terms of the different categories. Compared to anything including rapamycin, including metformin. So I think that’s a product that people should be doing.

And if I add one more in there, I mean, I could probably list 20 that have benefits for a lot of people. I love BPC-157, which is a peptide. It’s great for everything – from inflammation and gut health to boosting nitric oxide levels. There’s a product called plasmalogen, which I think you’re going to hear a lot more about in the near future, that has a lot of great benefits in terms of general health as well as brain health. I’m starting a lot of my patients on that. And the last product I’ll mention is a product called TA 65, which also is really good and has immune-boosting properties as well.

So that’s six or seven. Again, there are probably another 20 I could worry off if you gave me time. But that’s the probably what I would start with.

Dr. Patti (35:15): If you were starting people on supplements, would you start all of those at once? Like we talked about earlier, would you start a whole bunch of things together, or would you do one at a time?

Dr. Paulvin (35:26): Depends on who I’m talking to. In most cases, I’m starting them on most of those at the same time. But like I said, most of my patients are on some of those (already). Most patients are taking vitamin D at this point. Most patients are taking fish oil at this point. Some patients are taking NAD supplements at this point. So I’m not the one usually adding all those at one time. I mean occasionally it happens. I’ll add six or seven.

One of the first questions I ask all my patients – how many things do you want to do at one time? Do you want to go down and fall down the rabbit hole, or do you want to go baby steps? Both work. Obviously, one’s going to be faster than the other, and one may have a little less side effects.

And again, especially with in the anti-aging field, unfortunately, a lot of this stuff is not yet covered by insurance, and you can’t get your time back.

So if my patients know that they’re not going to have the time to do half of these things – if they’re not going to do cold plunging, if they’re not going to take their supplements, and they want one or two quick high yield things, that’s what they can do. Like I said, there are foundational things I can give them.

I also have patients who say – look, I am very well off. I have all the time in the world. This is what I want to do. Then you can work that way. But I usually give them at least three to five to start with in most cases. And they’re fine with that. When you get above that is when you doubt how much they’re going to be able to do, especially when you start adding it. Now a lot more patients are doing self-injections at home or IVs and other things as well. But three to five is a good starting point. Most patients can do that. That’s not really that complicated.

Amir (36:55): So one question, and this is specifically for anti-aging and longevity supplements. Some supplements you can feel – caffeine, stimulants, .etc. However, when you take something for longevity, how do you know it’s working? Are there ways we can measure or something that people can feel?

Dr. Paulvin: There’s no perfect answer there. There’re different answers for different things. In most cases, you either going to feel something. I mean, for most of the ones that I mentioned, I know most patients will feel things either within the first two to six weeks. We’ll see something on their lab work within the first three months that shows that it’s working. Otherwise, sometimes they just have to go on faith. There really aren’t that many patients that don’t feel in some way, shape, or form.

The way I tell patients – it’s kind of like how you know your steak is good or your fish is good. You just know that something’s different or something’s good. You have this innate sense about it. But the ones I just reeled off, except for maybe a vitamin D to a certain extent, most patients will feel something from all of those.

(38:02): The rest will be lab work. But I think the goal is just to temper expectations and let patients know what they’re going to feel. I tell patients if they’re going to do NAD, they may feel something initially, or they may not feel something for two months. BPC-157, which is a peptide, you may feel that within one week.

I think understanding what to look for also helps. Again, almost every supplement that I normally recommend, they notice it. So it’s not really as much of an issue as it used to be. Like when people were taking a multivitamin or just vitamin E, or kind of more general things that help power other things. CoQ10 may be one of those where you may not know. You need CoQ10 for a lot of things, and it’s very helpful, but that’s not something you are going to feel. Most people don’t say wow, I’m on CoQ10; I want to keep taking it. Most of the other ones, you can kind of tell through labs or the way you feel.

Common issues with supplements to watch for

Dr. Patti (39:01): What about cautions that you might give, like certain supplements that might have harmful side effects, or that you feel people need to be careful with, or if the data’s just not there?

Dr. Paulvin (39:11): Overall with supplements, you want to make sure you’re getting them from reputable companies. Be very careful with getting things overseas because sometimes they’re not regulated as well as they are here in the US. I mean, even though they are not regulated by the FDA, there is still some oversight on most of these supplements. Things are taken off the market because they have too many problems or side effects. So make sure, especially for people who are taking them because they have an issue specifically, you want to limit the amount of fillers that are in there and the sugars.

A lot of supplements, unfortunately – the cheaper they are, they either have a lot of fillers to keep them cheaper or have some sugar in there. So you’re taking a supplement like fish oil or melatonin, but there’s sugar in there, so you’re only going to get so much.

There are still vitamin gummies that drive me crazy because they look like Sour Patch Kids to make people take them. But you’re probably getting more side effects than benefits from them. I mean, it’s kind of the same thing that people complain about Flintstone vitamins which have more sugar than you would get from like a lot of other foods. So that’s the second thing.

And then beware of claims that are just ridiculous at this. Very few vitamins or supplements are going to cure anything, I guess, at this point. I can’t think of anything. If the claims are too good to be true, they probably are. Talk about it with your doctor.

Also, dosing, like I said, since the paradigm has switched. It used to be everybody’s getting prescriptions. Your doctor could specifically control interactions and specifically control the dosing. I have patients now coming in, oh, I saw on this Reddit board, or I saw on this podcast. I’m not going to mention the podcast, but so and so said he’s taking a high dose of this. They come in. They’re just taking the ridiculous doses, especially on the podcast part of it. These guys, if they mess something up, either they have a doctor advising them or can fix the problem as opposed to you who may not have that availability or that ability to do that.

So start low, go slow, watch for fillers, and don’t buy the hype is probably the best advice I can give right now. If you’re really a good searcher, there should be data on what they’re saying. If you can’t back up what they say…I’m trying to think where I read it. I think two or three days ago, a prominent person who was a scientist and now is in the supplement business put up a thing that, like 10 doctors and scientists, within five minutes, said that wasn’t true. They even put up the claim; the study actually says the opposite of what they claim. You got to be very careful. The weird place to look is actually Twitter. A lot of people now on Twitter are becoming very watch doggy, and they’re really blasting certain things out there. It’s a good place to potentially look and start your search as well. Maybe a weird place that’s not thought of, but there’s actually a lot of really good information on Twitter.

Dr. Patti (42:04): Super important just kind of overall message because people, I think, are aware that the pharmaceutical companies are pushing biased data, but people selling supplements definitely can be too. It’s really important to be careful about that.

Dr. Paulvin (42:18): Yeah, that is true. Unfortunately, I know there’s no cure for that at this point.

A multi-pathway approach to health optimization and anti-aging

Dr. Patti (42:22): <Laugh> Yeah, just as we’re closing our conversation here, do you have any words of inspiration, any last messages that you’d like to share with people out there who are looking to age well and optimize their lives?

Dr. Paulvin (42:38): The main thing is get the foundation started. Know what your goals are; that’s the first thing. If your goal is to lose weight, your goal is to decrease inflammation, have a clear A to B pathway, and go step by step. And then the other thing I would say, again, I have cheesy analogies, is you want to be taking from all the buckets, meaning with aging right now, one thing doesn’t do everything. So do something to decrease inflammation, do something to monitor and deal with your stress. It could be technology, it could be breathwork, it could be a supplement, it could be a prescription medication. You wanted to control your mitochondria. That definitely is now pushed its way into the mainstream. We know it affects normal health; it affects everything. You want to do something to maximize your hormone.

So you want to kind of do a lot of all those things to work together. Everything is a symphony. If one part isn’t working, if one instrument is off, everything’s off. Same thing with your body. You could be doing all these things for recovery, but if your diet stinks…I have a patient who just doesn’t take enough protein to build muscle. It doesn’t work as well. It just goes off the tracks.

Understand what you’re trying to get to. And then also, you want to do certain things at the same time because your body has multiple different pathways going at the same time.

It’s not just one thing. So you get what you want to fix your mitochondria, but you also want to work on your gut health. So that’s the things that you kind of wants to work towards. But there’s so much coming up in the next 18 months to three years that is going to blow your mind in terms of the benefits of what’s out there. Between supplements, lifestyle changes, and wearables. And it’s just going to be incredible. If you want to be at the forefront, work with somebody who understands how to implement these things, and it may not be the same person. I mean, I’m good with a lot of things, but there are things I just don’t know how to do. I’m going to refer people to somebody who knows that. I know how to do breathwork, but I’m not a breathwork instructor. I’m going to refer to one of my friends or colleagues who’s really good with breathwork. You want to have a garden, different things.

Dr. Patti (45:02): Beautiful message. Amir, do you have any final questions?

Amir (45:05): I think that’s an awesome message because a lot of people get fixated on one or two methods that everybody’s talking about. But like you said, there’s no one secret drug, ingredient, or method that promotes longevity, health, and wellness. The body as a whole has to be considered, right? And that’s the key takeaway for people to know. And it’s probably best to find the right professional to guide you through because it’s very hard to always know by yourself without some testing.

Dr. Paulvin (45:32): I do want to put an asterisk there. I’m probably going to open up two rabbit holes as we finish up. Two things that people who are listening should look into. They’re not ready for prime time now.

One is rapamycin, which has incredible studies probably coming out in the next year to 18 months that may do more things than anything else, both from an anti-aging perspective as well as a health maintenance perspective. And the other one, which may be a little bit taboo to some people, is psychedelics. The studies are done not only from a psychiatric but also as an immune-affecting method and decreasing inflammation. So those are two things for people over the next year or so to really look for that are going to probably be really ready for primetime. They may be those things that are very all encompassing. But let’s see.

Dr. Patti (46:18): Hopefully we’ll get the chance to do a podcast with you in another year to 18 months and we can talk about some of this new data. Rabbit hold out a little bit.

Dr. Paulvin (46:25): Definitely anytime.

Dr. Patti (46:27): Thank you so much for being here with us, Dr. Paulvin. We really, really appreciate your time and so much information that you shared with people that’s really helpful. So thank you so much.

Dr. Paulvin (46:36):
Awesome. Thanks for having me.