Take Charge of Your Healthspan With This Regeneration Protocol: Shockwave, Stem Cell, Ketamine Therapy, Peptides & Advanced Biologics

Dr. Khoshal Latifzai [00:00:00]:
We don’t have a firm grasp of how Tylenol works.

Nick Urban [00:00:04]:
You’re listening to High Performance Longevity, the show exploring a better path to optimal health for those daring to live as an outlier in a world of averages. I’m your host Nick Urban, bioharmonizer, performance coach, and lifelong student of both modern science and ancestral wisdom. Each week we decode the tools, tactics and timeless principles to help you optimize your mind, body and performance span things you won’t find on Google or in your AI tool of choice. From cutting edge biohacks to grounded lifestyle practices, you’ll walk away with actionable insights to look, feel and perform at your best across all of life’s domains.

Nick Urban [00:00:53]:
What if your real issue isn’t aging, but perpetual recovery that never quite completes? Perhaps your body’s simply missing the right inputs to regenerate and heal. In this episode, our guest lays out a smarter way to bounce back through modern tools like peptides, shockwave therapy, ketamine and biologics. It’s a new conversation about high performance that starts with actual repair, not just stimulation. Our guest this week will take us on a trip through some of the promising tools in the regenerative medicine toolbox that I haven’t really covered on the show yet.

Nick Urban [00:01:32]:
Yet.

Nick Urban [00:01:32]:
So who’s our guest? Dr. Koshal Latifsai. He’s a Yale trained board certified emergency physician who founded Rocky Mountain Regenerative Medicine to focus on prevention, longevity and performance. He blends advanced biologics, hormone optimization and regenerative therapies to treat pain, enhance vitality and extend healthspan. His personalized approach serves athletes, executives and anyone seeking to thrive at every stage of life. You can find the show notes for everything we [email protected] the number of this episode which is 214. One resource you might want to check out, which will be in those show notes, is an article I wrote on bioregulator peptides. These are a special subset of peptides that are even shorter strings of amino acids which lets them work effectively via oral capsule to help regenerate and improve the function of different organs.

Nick Urban [00:02:33]:
What’s nice about these is they work their magic and you don’t need to constantly take them day in and day out. You just run one to four courses per year and each course is only 10 to 20 days. They can be high impact with minimal lifestyle change. Anyway, just wanted to share that before we dove in. Now let’s bring in Dr. Kaushal.

Nick Urban [00:02:54]:
Welcome to the podcast.

Dr. Khoshal Latifzai [00:02:55]:
Thank you very much.

Nick Urban [00:02:56]:
Thanks for having Me, I’m excited. Today we’re going to dive into topics I have not covered before. And these are going to include things like ketamine therapy, shockwave therapy. We’ll get into stem cells and peptides and a whole lot more.

Dr. Khoshal Latifzai [00:03:11]:
Awesome. Great. Looking forward to it.

Nick Urban [00:03:13]:
Before we get started, what are the unusual non negotiables you’ve done so far today for your health, your performance and your bioharmony?

Dr. Khoshal Latifzai [00:03:24]:
You know, I have moved into doing 2A days. I will occasionally do that, whereas basically getting in two exercises over the course of 24 hours. And so I got half of it done this morning working out with my wife. And then tonight I’m gonna, I’m gonna go back to the gym and it’s something I’m sort of looking forward to, to begin the day and end the day in that way.

Nick Urban [00:03:49]:
Oh, that’s nice. How do you split your workouts?

Dr. Khoshal Latifzai [00:03:52]:
Yeah, I. My wife follows somebody online and she started out on YouTube and I’m forgetting the lady’s name, but she’s got her own sort of workout routine, primarily strength training. And you know, Colleen, my wife, has wonderful things to say about her and so she convinced me to join her in her workouts in the morning and then, you know, in the evenings I just do strength training in the gym. And then over the course of the week I try to get in three cardio days as well, whether that’s with my kids. I have three kids, just kind of, you know, working out with them or out and about on my own. So that’s how I get down as far as exercise goes.

Nick Urban [00:04:34]:
What an elaborate routine.

Dr. Khoshal Latifzai [00:04:36]:
Yeah, yeah. I mean, after you do it so many times, it gets simpler and simpler. So it sounds probably more elaborate, elaborate than it actually is.

Nick Urban [00:04:44]:
And do you take anything or use anything to support either your performance or your recovery from that?

Dr. Khoshal Latifzai [00:04:49]:
Absolutely. I really rely heavily on peptides. I started using them probably around seven years ago. And you know, I use peptides like BPC 157 for instance, to expedite recovery. Especially when I’m injured. I use peptides like Tessamorelin, CJC and ipamorelin. Those are kind of the common go tos for me.

Nick Urban [00:05:14]:
And are you using those? Obviously you cycle those. But are you using them? Like what’s your, your routine around those?

Dr. Khoshal Latifzai [00:05:21]:
Yeah, my philosophy around it is very similar to my philosophy around a lot of small molecule pharmaceuticals that I recommend for myself or for my patients that, you know, we take it more as supplements rather than, rather than a medication that one finds to be necessary. So a good example of that is metformin, right? It’s a medication that type 2 diabetics take out of necessity, unfortunately. And if they don’t take it, there’s consequences to that. But I certainly recommend it for my patients who are non diabetics because of some of its theoretical benefits around longevity and staving off some of the most common causes of disease in this country. Metabolic disease, diabetes, that sort of thing. So what I tell my patients and what I do in practice is to take it for a series of three months and then take a month off. And otherwise, if I’m traveling, for instance, I certainly take time off from my peptides. It’s one less thing to throw in my luggage.

Dr. Khoshal Latifzai [00:06:26]:
But it’s also by sort of interrupting, taking something routinely, it avoids this thing that occurs with any medication, which is your body will eventually build a tolerance to it. And you can see that in numbers. When it comes to supplements or medications like thyroid medication or testosterone, you can actually see consequences of that reflected in biomarkers. But when it comes to peptides, you know, there’s no easily trackable biomarkers that you can see that. That tolerance being built up. So I always try to interrupt it. Every three months, I take a break for about a month, or I cycle to a different set of peptides for three months. I’m taking three months off from the initial set of peptides.

Dr. Khoshal Latifzai [00:07:11]:
And that just mitigates the probability of building a tolerance to medications and peptides.

Nick Urban [00:07:17]:
And how did you settle, for example, on metformin? Because, like, of course, I’m sure you’re well aware there’s other supplements and products that have similar mechanisms of action. And if your goal is metabolic health, of course, there’s like, there’s the berberines, the rock lotuses, there’s chromium, tons of stuff like that. What made you convinced that metformin would be a good one? Because there’s also, like the. Of course, you’ve seen the research around, like, the potential impact on exercise performance and the hormetic adaptations that occur as a result of exercise.

Dr. Khoshal Latifzai [00:07:46]:
You probably know, like the old adage, you know, the dose makes the poison, or in this case, the medication. You take too much of something, you’re definitely gonna see some of the side effects start to surface as. As it applies to medications. The higher the dosage of a medication, not only is there, you know, a certain phase of diminishing returns, but you also start to see side effects start to surface at a higher and higher dose. So we shouldn’t be Afraid of side effects. Side effects just, you know, occurs with, with any medication that you take. But I’ve found that if you dial up the dose of the medication, some of these side effects are going to start to surface. And that certainly applies for Metformin.

Dr. Khoshal Latifzai [00:08:29]:
You know, when I started taking it, I started taking a gram a day, and that’s sort of in the mid region as far as the dosage goes. But I noticed an immediate decline in my performance, in my athletic performance. My muscles will start to, would start to cramp up. And I knew that dose was a little too high, so I started to dial down the dose and reach. When I reached about 500 milligrams per day, that was kind of the sweet spot for me. So I always have that discussion with my patients, like, look, with any medication, you’re going to experience side effects, but let’s find what the right dose is for you and sort of go from there. And most of my patients settle about 500 milligrams a day or a gram a day when it comes to Metformin. As far as your first question, how did I settle on metformin at all when there are other, you know, examples of supplements that one can take? You know, Metformin has really good data behind it as far as minimizing risk of cancer, risk of all cause mortality, such as heart attacks, strokes, so morbidity, as well as mortality.

Dr. Khoshal Latifzai [00:09:39]:
There was a study that looked at type 2 diabetics who took Metformin and compared those individuals to type 2 diabetics who were not taking Metformin. And rates of stroke, rates of heart disease was lower in the group taking Metformin. And, and then when they compared diabetics taking metformin to non diabetics expecting, you know, non diabetics to do really, really well when it came to those endpoints, stroke, heart attacks and death, actually diabetics on Metformin tended to do better. Now, that study, you know, had a surprising finding, but there was a critical flaw in it, which is whenever a person’s diabetes got bad enough where they, they required medications beyond just metformin that they were excluded from that arm of the study. And it was done with good intention. It was done to really hone in on what the impact of Metformin was. So that way, you know, you wanted to exclude confounders like additional medications, but what it ended up doing is kind of getting rid of the worst of the worst patients, so to speak. And so you selected for better and better patients that made the results look sort of impressive.

Dr. Khoshal Latifzai [00:10:48]:
So I will concede that, that that’s a critical flaw in that study and maybe the results are sort of compromised. But when you look at animal studies with respect to longevity, animals that are being given metformin tend to do better with not just in terms of longevity, but also they had a lower risk of cancer. So for me it makes sense to take metformin. But you could just as easily have another doctor with a totally the opposite viewpoint where they want multicentered, placebo controlled, double blind studies, what conventional medicine considers to be gold standard studies, and anything short of that there again. So I think that’s a valid viewpoint as well. But for me it makes sense. I always kind of just lay everything out on the table for my patients and sort of allow them to decide. And I certainly have patients who disagree with me and they don’t want to initiate metformin.

Dr. Khoshal Latifzai [00:11:46]:
That’s totally fine as long as they’re educated about it. That’s a totally valid viewpoint. But for me, you know, the side effects are not that great. I easily tolerate it. I get my labs checked pretty routinely to make sure that, you know, I’m not experiencing kidney injury or liver injury. So I’m totally okay with that risk profile.

Nick Urban [00:12:08]:
Are you familiar with interventions testing program?

Dr. Khoshal Latifzai [00:12:11]:
No, I’m not.

Nick Urban [00:12:12]:
So it’s like a program put on by the NIH and they test, it’s like considered like the gold standard, like longevity interventions. And they test things a bunch of different centers and they do it under the same conditions to reproduce trials. I don’t think they found a positive impact for metformin specifically as a standalone treatment, but when they combined it with rapamycin, they did find benefit. Do you use rapamycin?

Dr. Khoshal Latifzai [00:12:36]:
I do. I do. So sirolimus is the other name for it, but yeah, I take rapamycin. This is, you know, for your viewers, they may already be attuned to this, but it’s a medication that was studied in the context of organ transplant. So most commonly, if somebody receives a transplanted kidney, they go on rapamycin. It’s an immunosuppressive medication. And the idea is pretty simple. If you just got somebody else’s organization, your immune system is going to take note.

Dr. Khoshal Latifzai [00:13:05]:
It’s potentially going to attack, you know, that transplanted organ despite all the measures to try to match it as closely as possible to your own proteins. And so to lessen that risk, you take an immunosuppressive medication like rapamycin. But if you take it, if you take rapamycin at a lower dose, it turns out it does have a lot of benefits as far as longevity is concerned. So some of the, most of the. This data comes from animal studies, as does a lot of longevity research. And so, yeah, I definitely believe in intake rapamycin as well.

Nick Urban [00:13:42]:
Are you familiar with Brian Johnson, the supposed most quantified man in history?

Dr. Khoshal Latifzai [00:13:47]:
I am familiar, yeah.

Nick Urban [00:13:49]:
Yeah, I think he said he stopped taking it because his biomarkers shifted unfavorably after a long time. I’m not sure what his dosage was or what those biomarker changes were. Are you familiar with that at all?

Dr. Khoshal Latifzai [00:14:00]:
Yeah, I mean, you know, the dosages that have been studied go from anywhere from one and a half milligrams all the way up to six milligrams. And I tend to take just kind of pick the middle and go with. I usually go with 3 milligrams once per week. It’s an oral medication and, you know, I get sick very, very infrequently and so it hasn’t led to my immunocompromised at all. As far as your earlier point about, you know, Brian Johnson’s biomarkers, look, everybody’s bodies are going to be slightly different. In many respects we’re the same. In many respects we’re different. And so I’m very, very data driven when it comes to, you know, if you’re going to start to pull on levers and start messing around with dials, whether that’s nutrition, exercise, supplements, what have you, these are, these are things that can be easily tracked through biomarkers.

Dr. Khoshal Latifzai [00:14:56]:
So, you know, at our clinic, you know, we draw biomarkers on individuals at least three times annually. And the biomarker panel that we draw are. It’s really, really in depth. And you compare that with like a conventional doctor, like a primary doctor’s office, for instance, who might check your biomarkers once a year or once every two years. And then ultimately when you’re reviewing that, you know, you kind of get really sort of these conclusive, you know, summaries from, from, from doctors where they, you know, take a paternalistic approach. They say, hey, everything’s normal, or hey, you’re on track to diabetes. There’s not a lot of substance and meaning, you know, and I’m not trying to bash anything, but like just kind of contrasting this with our approach where, you know, your biomarkers come back, we share the results with you, we have a sit down, it’s at least 90 minutes usually where I turn the screen around, I kind of show you your biomarkers juxtaposed to, you know, what those biomarkers were a few months prior. And then we kind of discuss a plan as far as, like, what we did the last time, what we hope to do this time, and what the objective is kind of moving down the line.

Dr. Khoshal Latifzai [00:16:10]:
And then prior to your next follow up, you know, our nurses will call you just to see if you’ve experienced any, you know, any impediments to implementing the plan that we discussed to make sure everything things on track. But if there’s anything that’s questionable, you know, on your biomarkers as a consequence of rapamycin or something else that we did, we’re going to get, you know, wind of that pretty quickly and we’re going to act on, on that. So, yeah, like, everybody’s biology is slightly different. I think that’s an important point to appreciate whether that’s nutrition or any other changes that you make. You know, it’s really important to track that and see what might be going on under the hood.

Nick Urban [00:16:53]:
So when you say biomarkers, I assume you’re referring to like a blood panel.

Dr. Khoshal Latifzai [00:16:57]:
Exactly. Yep, that’s it.

Nick Urban [00:16:58]:
Are there any underrated blood markers that you think should be analyzed that are commonly not?

Dr. Khoshal Latifzai [00:17:05]:
Yeah, absolutely. The, the big one that I found, and over the course of the past seven, eight years, I have seen a shift here with respect to a lot of primary doctors out there and even cardiologists. But the panel that I’m, I’m thinking about that really answers your question is the cardiac panel. That’s unfortunate. But I think, you know, with respect to a cardiac profile, checking your apolipoprotein B is really important. Your lipoprotein A, also known as lp, that’s really important. Checking one’s homocysteine level, that’s really important for really finding out, you know, what your risk profile looks like with respect to heart attacks and strokes, which is the number one killer in this country. And it’s been the perennial number one for decades and decades.

Dr. Khoshal Latifzai [00:17:54]:
And so those, those panels are really important. And then tying cardiovascular health in with your metabolic health, it’s really important to take a look at triglycerides, serum glucose, uric acid levels, which also give us a sense of what your metabolic health looks like. Does that answer your question?

Nick Urban [00:18:14]:
Yeah. On that note, just to follow up a little deeper, I’m curious because I did a recent blood work panel and I saw that my metabolic markers all look good, except my hemoglobin A1C was higher than I expected. But fasting Insulin, fasting, glucose, the iron markers all looked fine. Thyroid markers looked good. Beyond just TSH, the free T3, free T4, all that stuff, anything just to get away, like an example of the way you think. Where else would you look to understand that one anomalous biomarker?

Dr. Khoshal Latifzai [00:18:45]:
Yeah, I mean, with respect to. You’re asking really good questions with respect to hemoglobin A1C, and for your audience, you probably already know this, but hemoglobin is a molecule that’s located on your red blood cells, and its primary function is to carry oxygen. But oxygen is not the only thing that it binds. It can also bind other things. And one of those other things is glucose. And because the average lifespan of your red blood cells is about three and a half months, it gives us a sense. Hemoglobin A1C gives us a sense of how much glucose you’ve been exposed to over the prior three and a half months, as opposed to just checking your glucose level, which tells me what your glucose level is at the time that the blood is being drawn. And so if I check your hemoglobin A1C and it’s discordant, it’s elevated, and it’s telling me the opposite of what your insulin level is telling me or what your serum glucose is suggesting with respect to your risk of.

Dr. Khoshal Latifzai [00:19:42]:
Of diabetes, then it’s really important to have an explanation for that. Why is there that disagreement? And I’ll tell you that the big assumption with respect to hemoglobin A1C is that the average lifespan of your red blood cells matches that of the general population, which, again, is about three and a half months. But imagine if your red blood cells are around for a couple of weeks longer. Four months total. Right now, there’s more of an opportunity for the hemoglobin molecule to interact with and bind to glucose, thereby driving up your hemoglobin A1C without it reflecting your true risk of diabetes. Now, in most doctors offices, they’ll just check your hemoglobin A1C once a year, once every two years. And if it’s favorable, then they’ll say, hey, you’re nowhere close to diabetes. I’ll see you in a couple of years.

Dr. Khoshal Latifzai [00:20:30]:
But, but you need to take that nuance into account, into consideration. Otherwise you’re gonna miss a lot of people who are actually on track for diabetes because their red blood cells, you know, are around for three months or two and a half months or whatever the case might be. But it’s, it’s, you know, it. We need to take a confounder like duration of life of a red blood cell into. Into account. And so I bet that’s what’s going on with respect to your biomarkers. Your red blood cells are alive for a little bit longer. There’s more of an opportunity for hemoglobin to touch on a glucose to drive the percent of your hemoglobin molecules that are bound to glucose, I.

Dr. Khoshal Latifzai [00:21:08]:
E. Your hemoglobin, your hemoglobin A1C. And in reality, your risk of diabetes is. Is not elevated. You know, and your insulin level, your serum glucose level, those look good. But yeah, when we check these biomarkers, we’re checking, you know, your kidney function, your liver function, your glucose level, triglycerides, hemoglobin A1C, fasting, insulin. And anytime we’re suspicious about somebody where we’re not getting the type of data that we want with respect to metabolic health, we’ll have the patient undergo an oral glucose tolerance test. You know, they come in fasting, we check their.

Dr. Khoshal Latifzai [00:21:44]:
Their glucose, their insulin level. We give them a known amount of glucose. And then at 30, 60, 90, 120 minutes, we’re rechecking those biomarkers, Glucose, insulin, to see what’s happening, you know, in that, you know, if there’s a certain pattern present, your risk of diabetes increases. And if it’s absent, then your risk of diabetes is. Is really low. We look at thyroid function. We look at any antibodies that your body might be producing aimed at your thyroid tissue that can tell us if you’re on track for becoming hypothyroid or hyperthyroid in the future. We look at your iron levels, your iron stores, in particular your vitamin D level.

Dr. Khoshal Latifzai [00:22:25]:
Those are two. Two really common deficiencies in the American population is low iron, low vitamin D. We look at all sex hormones in both men and women. Estrogens, testosterone, dhea, pregnenolone, progesterone. We assess all of that several times a year. And then we have specialty tests that dive into, you know, the different micronutrient levels in your blood. We look at heavy metal. We have the ability to do heavy metal testing, cortisol testing.

Dr. Khoshal Latifzai [00:23:01]:
So we can get really, really granular depending on how complex the patient is.

Nick Urban [00:23:06]:
What about other forms of testing? Because certain times, like if you see an imbalance of minerals or micronutrients in the blood, that is indicative of a much larger problem because those should stay very stable in the blood, and then your body will pull from bone or other stores to make sure that the blood stays stable at all times. Do you guys ever do hair tissue mineral analysis or anything like that? Maybe urine excretion tests?

Dr. Khoshal Latifzai [00:23:30]:
Yeah, it’s not one of the more common tests, but absolutely, if the clinical situation warrants it, we have access to any lab test out there. And so I certainly have really complex patients. Not all of them. The vast majority of our patients are pretty, you know, pretty straightforward. And essentially they’re, you know, for whatever reason, sort of displeased with, you know, the care that’s offered to them in most, most hospitals. And so they’ll come to us. And we certainly track those biomarkers really, really closely. But anytime that we have a really complex patient with sort of ill defined, you know, symptoms that you can’t easily, you know, put into.

Dr. Khoshal Latifzai [00:24:14]:
Put into a bucket. Absolutely. We can, we can get really granular as far as imaging goes, as far as biomarkers go. So, yeah, we do all of that.

Nick Urban [00:24:23]:
Okay. Yeah, we can talk about diagnostics for a very long time. But I want to go on to some other topics we had outlined for today, and that is, let’s start off with ketamine therapy. It’s becoming much more popular. I first heard about it, I want to say, eight or nine years ago, and it was like, very underground then, and now it’s gaining some recognition. Why do you guys use ketamine therapy, first of all? I guess, what is it?

Dr. Khoshal Latifzai [00:24:44]:
Yeah, so ketamine is an anesthetic that’s been around since the 1970s. Like it was really used in the Vietnam War. And there’s certain attributes with respect to ketamine compared to other anesthetics that makes it really unique. So, for instance, it can be administered intramuscularly. It has a really wide sort of safety profile as far as dosing is concerned. It doesn’t suppress respirations, whereas, you know, you compare it with some other alternatives. If you give the wrong dose, if you give too much, if the patient is really, really sensitive that you may not even be able to sort of ascertain beforehand, you know, it can lead to a situation where their respiration is compromised, whereas that’s really, really rare when it comes to ketamine. And like I said before, every medication has side effects.

Dr. Khoshal Latifzai [00:25:35]:
One of the more common ones with respect to ketamine is nausea and vomiting. But that’s something that can be pretty easily treated, you know, with other medications or with, with just decreasing the dose and how quickly it’s being administered, that sort of thing. But one of the, the, the things that was really discovered around the time of The Vietnam War is when these soldiers started to come back from the war. When you compared individuals who had received ketamine to those who had not, those who had, had received ketamine had a lower incidence of anxiety, depression, pts. So you know, people started to ask why, why that was. And I’m not sure we still have a firm grasp on why that might be. But I can tell you that one of the theories out there is that it increases the levels of this chemical in the brain that’s abbreviated bdnf or brain derived neurotrophic factor. And this factor is really important for formation of new neurons, for formation of new connections between existing neurons.

Dr. Khoshal Latifzai [00:26:41]:
And so the theory is, is because, you know, we’re exposed to sort of the same stimuli day in, day out, if that is leading to a situation where, you know, the endpoint is depression or anxiety or flashbacks or whatever the case might be, if we can help rewire that the networks in the brain, maybe we can get to a point where the endpoint is not one of those things. And so that’s kind of how we, we think about ketamine. I’ve used it in individuals who want to get off of conventional antidepressants or anti anxiety medications or other psycho psychotropic medications that have a worse side effect profile. But maybe the patient has been taking it for so long or cocktail medications for so long where they have a hard time not using that quote unquote crutch. And I don’t mean that in a demeaning way, but like, you know, when you’re in the thick of it with respect to depression or anxiety, sometimes like whatever the combination has been dialed in, you want to stay there and you don’t want to get off. But maybe for whatever reason now you’re deciding to kind of wean things off, maybe there’s some side effects that have kind of convinced you to come off of these medications. And ketamine works, you know, pretty well. We’ve had pretty good luck.

Dr. Khoshal Latifzai [00:28:00]:
But like I said, you need to take into account some of the side effects. And one of the other ones that I didn’t mention, but it’s an important one, is it can have an impact, ketamine can have an impact on the bladder where there can be a situation where you’re not able to void. And so urine just kind of really engorges the bladder. And really that side effect tends to occur more when ketamine is used as a drug of abuse. So unfortunately, you know, earlier I said ketamine can be administered intramuscularly within the last 10 years, there’s formulations of ketamine that have been devised that can be administered intranasally or intraorally. And so especially in an individual who has an addictive personality, you add ketamine to the mix and make a formulation of it that’s readily accessible without, you know, oversight from a doctor. It definitely leads to a situation where there’s potential for abuse. And unfortunately, if it’s a drug that’s abused, you can, you can lead into this, you know, chronic long term side effects beyond just nausea and vomiting.

Dr. Khoshal Latifzai [00:29:12]:
And so, you know, as long as you can thread this needle where a patient comes in maybe once a week, you know, for five successions, you can successfully wean them off of some of the medications that maybe they were relying on. And so it’s work really, really well for, for our patients. Doesn’t work for everybody. I don’t want to make it a panacea, but yeah, it’s, it’s, it’s been pretty effective compared to some of the more conventional psychotropics.

Nick Urban [00:29:40]:
Isn’t it classified as a dissociative?

Dr. Khoshal Latifzai [00:29:43]:
Yeah, it’s a dissociative anesthetic. And what that essentially means is, you know, you, you, when you give it to patients, you know, they, they reach this sort of mental state where they’re somewhat present in the room, but they’re also, their mind is sort of elsewhere. And we think that that also allows the individual to, instead of being sort of bogged down in whatever forest of anxiety and depression that they’re in, it allows them to sort of step back and kind of look at the problems that they’re facing from a top down, you know, vantage point and sort of try to navigate a new pathway to as far as where they want to be. And so I do, you know, encourage my patients to have, you know, if they, if they can get their therapist, for example, to be in the room with them or conference call, you know, on a conference call with them where they can talk through their problems. You know, it’s definitely one of those weird medications where you’re kind of there, you’re able to speak, but you’re not really there. You’re also somewhere else simultaneously, which is a really weird way of phrasing it. But yeah, that’s kind of the experience with Katami.

Nick Urban [00:31:02]:
I don’t know if this analogy is accurate, but the way I imagine it would be if you were lost in a forest, instead of being in the experience of being on the ground, be like climbing up a Tree, the tallest tree. So you can get a vantage point and look around.

Dr. Khoshal Latifzai [00:31:14]:
You look around. That’s, that’s it. I mean, that is. You know, we hear that really, really commonly from patients. And you know, I do encourage my patients to kind of journal and I know that sometimes it’s not the easiest thing to do, but luckily, like, we’re getting there with technology where you can take like these little voice memos or, you know, just kind of turn on your phone to various apps and just kind of have them be there in the background. So that way, as you’re talking through an idea, you know, it can give you like a, a written out summary of it at a later time and you can try to make sense of it. Whether that’s like a week later or, or whatever. It may sound totally unrelated at the time or you might have a hard time kind of linking it, but I almost imagine it as you’re trying to grow these, these neurons, these new connections, and they’re really feeble, you know, those, those new connections.

Dr. Khoshal Latifzai [00:32:10]:
But if you just kind of give it a chance and kind of revisit that, you know, a week later where you’re looking through your notes, hopefully it’ll kind of strengthen that connection and kind of expedite that, you know, electric signal in the brain in the future.

Nick Urban [00:32:26]:
You’ve mentioned that one of the main ways it works is through increasing levels of a protein called bdnf. There’s a lot of things that can do that are very safe. Natural alternative that could, has a similar effect. Probably a much lesser magnitude would be something like lion’s mane or even on the peptide front, something that would be very powerful and potent, maybe not as safe would be something like dihexa. Can you share how ketamine’s working? Because it’s more than just bdnf. And there’s a lot of stuff going on in the brain that have to do with neurotransmitters. I think glutamate is one of the big ones. Probably other things.

Dr. Khoshal Latifzai [00:32:58]:
Anytime something is taken orally, you have to take into account something called first pass metabolism. Meaning if you take a medication, for instance, you know, we were talking about metformin earlier. If you take a medication orally, it. The first stop it’s gonna make from the gut, once it’s absorbed into the body is in the liver. And the liver will process it and it’ll take some of that medication out of circulation, almost treating it as a poison, as something foreign, which it is. Right. And so your body will get rid of a certain portion of it, and then what remains in the blood is the amount that that’s being circulated to different tissues for, for effect. And then it’s one thing if that medication is now acting at a cell surface receptor that is out of like the, the, the, the brain area.

Dr. Khoshal Latifzai [00:33:50]:
So the, the brain or the central nervous system is, is enveloped in something called the blood brain barrier that medications have in order to bring about a certain impact within the brain or the, or the spinal cord for that matter. So once you do the math on all of that, you know, anytime you take something orally, there’s going to be a small portion of that that eventually penetrates into where you want it to penetrate, as opposed to a lot of intravenous medications. You know, even if you’re using the same medication intravenously, ordinarily, you’re going to have to dial down the dose a little bit because now it’s entering the bloodstream and, and it’s much easier for it to penetrate beyond the blood brain barrier to the other side. So I’m not opposed to taking a supplement that increases BDNF levels. Certainly, you know, if you’re doing that to, to sort of stay cognitively sharp, but by the time you develop, you know, pretty severe depression or anxiety or ptsd, it’s quite conceivable. Although, you know, not, not a guarantee, but it’s quite conceivable that you’ve kind of taxed what, what some of these supplements were going to do for you, and you need something that can be given intravenously. Does that make sense?

Nick Urban [00:35:09]:
Yeah. So what you’re saying is the magnitude of effect is gonna be a lot stronger for something that’s I.V.

Dr. Khoshal Latifzai [00:35:14]:
That’S it.

Nick Urban [00:35:15]:
Gotcha. And then neurochemically, it’s. Is it working mainly on glutamate, like an excitatory or I guess you could say stimulating neurotransmitter?

Dr. Khoshal Latifzai [00:35:24]:
The full effects of ketamine we don’t quite understand. We know that it lands on the mu receptor, which is the receptor that opiates land on. We know that interacts with the GABA receptor, which is the receptor that benzodiazepines and alcohol interacts with. We also know that it most likely has a unique receptor called the kappa receptor that’s unique to it. But we don’t quite understand like every, every nuance of, of ketamine. And that might sound a little surprising, but then again, like you take a medication like Tylenol, which is in most, you know, medicine cabinets, in most Homes out there. We don’t have a firm grasp of how Tylenol works. So I mean, a lot of what I’m telling you with respect to ketamine, it’s been established, but there’s a lot of theories around, around how, how it works also.

Nick Urban [00:36:19]:
So the current theories are that it works on like, I guess a diverse set of neurotransmitters, possibly even docking into its own unique receptor that I guess most other substances wouldn’t activate, probably wouldn’t interact with.

Dr. Khoshal Latifzai [00:36:33]:
Yeah, yeah, yeah. But you know, the road to kind of remodeling the networks in the brain, it’s not, it’s not just specific to Ketamine. Like one of the other things that we think also increases BDNF in the brain are, is psilocybin is mushrooms. We think that also increases BDNF in the brain, but it probably works through a different mechanism to get to that, to that same endpoint. So.

Nick Urban [00:37:05]:
Yeah, what about other proteins in the brain like say nerve growth factor NGF or what is it, Glial derived neurotrophic factor gdnf. There’s a bunch of them.

Dr. Khoshal Latifzai [00:37:17]:
Yeah. Yeah. I mean, look, there are a lot. And you know, it goes to, you know, how, I guess cavalier and I don’t know if that’s the right word for it, how cavalier you are, you know, how much faith you have, I guess in the body of research that’s, that’s out there. So, you know, earlier when we were talking about Metformin, for example, we came up against that same thing. Like, look, the research is a little mixed, but for me, you know, it makes sense to take something like Metformin as long as I’m keeping a really close eye on things and if I’m not experiencing any side effects, then I’m probably going to be okay with that. But I have plenty of patients who were in that, in that, with that same mindset went into taking Metformin. And then the side effect of maybe exercise intolerance was a little too disruptive for them and they backed off.

Dr. Khoshal Latifzai [00:38:14]:
And for somebody who’s tracking on an Excel sheet like, you know, their times on, on riding a bike or running, like maybe they do notice it, but that’s not me, so I’m, I’m okay with it. So for me it’s, it’s really not that big of a deal. But you know, in that, in that same vein, like, look, there’s a peptide out there that’s called bdnf. And you know, for me, again, this is my personal decision. I’m not endorsing this, you know, for, for any of your listeners or anything like that. But like, for me it makes more sense to take BDNF as opposed to taking ketamine in order to increase my, the BDNF in my, in my brain. Because again, we don’t have everything sussed out as far as ketamine is concerned. But if, if I was depressed, if I was really anxious, if I had ptsd, maybe I wouldn’t go into it with that same opinion.

Dr. Khoshal Latifzai [00:39:09]:
So I really do try to test a lot of the peptides that I recommend to my patients on myself to make sure like I’m able to tolerate it. If there’s a unique side effect with respect to some peptides, you know, like cjc, Epamorelin, if you inject that, that combination at night, about an hour before bed, it tends to make people sleepy. And for about 30 minutes or so it makes you kind of feel warm all over and it, you know, like almost like you’re having an allergic reaction. Although it’s probably not that pronounced, it’s very tolerable. So whenever I recommend it for patients, I kind of warn them. So the point being, like, anytime that I’m recommending, you know, peptides to my patients, there’s a very good chance that I’ve tried it on myself already and I’ve taken it at some point. So yeah, I guess cavalier maybe is the appropriate word. I don’t know.

Dr. Khoshal Latifzai [00:39:58]:
If you’re okay with, you know, the absence of double blind placebo, controlled multi centered, multi year trials, then, okay, let’s, let’s talk. But if you’re on that side of the fence, that’s okay too. It’s just a much more conservative approach and we can have a different conversation there. I can still be your doctor, but the conversation is a little bit different.

Nick Urban [00:40:21]:
It also seems to me that because neuroplasticity is increasing after a ketamine session, that’d be like a really prime time to do some like belief work. Or like you’re saying working with a therapist or someone where you can actually rewire those beliefs and those traits, those phenotypes, those habits, whatever they are that are holding you back and got you to use ketamine in the first place.

Dr. Khoshal Latifzai [00:40:44]:
Right? Right, absolutely. I always recommend, you know, coupling what we do with therapies that I’m not a specialist in, whether it’s meditation, body work, you know, whatever it might be, we can do that. And actually we have a body worker here working out of our office that does a lot of that. And so I certainly recognize my limitations and will kind of recruit, you know, other forms of therapy. You know, I’m also a good student of my patients where if. If something has worked for. For them, you know, we can talk about that and try to enlist, you know, whatever that therapy is and sort of go from there.

Nick Urban [00:41:20]:
So what’s cool is you’re. Since you’re on the front lines, you’re experiencing a lot of these things firsthand. You’re probably getting a lot of feedback about what works. This is what the research says. But in reality, all of my patients are experiencing this over here. We try it this way, get better results, et cetera, et cetera. It’d be cool that if there was some kind of way of communicating and sharing that in a distributed fashion so that we could learn from anecdotes. Because basically, a lot of.

Nick Urban [00:41:46]:
A lot of science is built on really, really small case studies. But I know, like, actually publishing them as case studies can be very difficult. But be nice if there’s, like, an educational network that weave this together.

Dr. Khoshal Latifzai [00:41:58]:
That’s a really good point because, you know, the. The medical literature in this country has been domina by large academic centers. And the reason for that is, you know, there’s only so much money to sort of go around and dedicate to research, and it’s usually dispersed by the National Institutes of Health. And, you know, they’re going to preferentially distribute that money to academic centers, and academic centers are going to have the ability to bring on statisticians and other specialists. And, you know, medical research is also dictated in large part by pharmaceuticals. So when you come to, like, small company, you know, small companies, small clinics, like. Like the one that I have, even though, you know, we have a robust patient population, what that translates to is a limit on time to be able to, you know, gather all the data and write papers about it. Having said that, a few years ago, you know, we tabulated the data that we have with respect to stem cell injections into the lumbar spine, and we put together a paper with patients that numbered into 500s, which is, you know, when it comes to lumbar spine pathology, it’s.

Dr. Khoshal Latifzai [00:43:19]:
It’s a substantial number. And we, you know, tabulated those numbers and compared what we did to sort of a more conventional therapy, like steroid injections into the lumbar spine for back pain. And it turns out stem cells had a much better result, a much more sustainable result. There were fewer interventions down the line, but that one paper took us several years because we have to juggle that with clinical work. And so it’s definitely a challenge in some respects. But to your point, a lot of good data comes to the forefront from, you know, small, small studies or small clinics like this. And so luckily, we live in a, in a day and age where there is this grassroots effort when it comes to some of these unconventional therapies in medicine, where people are hearing about it, they’re asking questions, and then they’re finding out that if you pose those questions to your conventional doctor, you know, you’re immediately, you know, there’s an eye roll or whatever, but, you know, and there’s sort of polite showing you, you know, the door, you know, and so I think people are, the more, more like case studies, the more and more people start talking about it, it’s going to become harder and harder to ignore moving forward. So it’s changing medicine, I guess.

Nick Urban [00:44:39]:
I mean, that’s one of the perks of social media and the fact that everyone can become a media outlet now and share their experience with X or Y substance. And hopefully it’s not only the highlight reel, but also like the downsides, the side effects, the consequences, so that we can all learn and eventually that can inspire clinical trials and the larger scale science.

Dr. Khoshal Latifzai [00:44:58]:
Exactly. I mean, I think that’s one of the roles for a podcast like this is just getting the word out about something that’s really ignored. If you go to your doctor and say, hey, there’s nothing wrong with me, but I’m interested in longevity and I’m interested in optimizing, you know, what I do, they’re gonna be like, well, we don’t have much to offer you. So. But you know, it’s really podcasts like this that kind of gets the word out. It’s platforms like this that gets patients asking questions, and then it kind of puts the doctors in the hot seat to be able to answer those questions.

Nick Urban [00:45:30]:
So one of those topics I want to explore with you is shockwave therapy. My buddy here in Austin, Freddy, has a device and it’s popular at his compound. How are you guys using shockwave therapy? And why? Do you think it warrants a seat at the table?

Dr. Khoshal Latifzai [00:45:47]:
Yeah, absolutely. So we primarily use it for orthopedics, and that’s the way that it’s used in the vast majority of places. The idea behind it is pretty simple, which is you take a device that intentionally causes injury, but the injury that it causes is not of the same magnitude as the underlying injury that brought the patient to you in the first place. And if the patient has a certain physiologic biologic makeup, then presumably they have a robust supply of stem cells in their body ready to respond. But if they’re not hearing the signals from the area where the injury exists, then maybe the stem cells can’t be delivered in high enough numbers to that specific area. So the objective with shockwave therapy is to induce an injury, get those cells that are just injured through the use of shockwave to release those chemical signals, have those signals be picked up by the blood supply into that joint and be carried to distant sites, help attract stem cells, and get those stem cells to start snooping around for where that signal is coming from, and then hone in on the point of injury, penetrate into that joint, and try to put things back together. Because at the end of the day, the keystone of healing and regeneration in the body are your stem cells. But as a person is getting older, the number, the quality of their own stem cells is declining.

Dr. Khoshal Latifzai [00:47:14]:
And certainly if you even compare a person of the same age to another person who’s been much sicker over the course of their lives, there’s, you know, they, they. That individual who constantly needs help from their stem cells, the quality of those stem cells are going to decline, the number of those stem cells are going to decline. So being healthy definitely pays off. And so ideally, you know, for a patient who comes in with an orthopedic injury, they’re young, they have a robust supply of their own stem cells. We’re probably going to do shockwave, you know, several rounds, maybe they’re coming in twice a week, 10 total sessions of shockwave, which at the time of the shockwave, it feels like, you know, it’s inducing. It’s inducing injury. It feels, you know, like you’re getting hurt and there’s different probes for it. I think a lot of times people will use a probe, you know, a device that causes maybe really superficial injury, diffuse injury, but you really want to focus in on where that injury is.

Dr. Khoshal Latifzai [00:48:17]:
And, and sometimes, you know, a lot of joints, like hip joints, knee joints, they’re encapsulated, so they’re kind of protected from circulation. And it kind of hurts you in this setting, because if the blood supply can’t pick up those signals, and if they can’t deliver those stem cells, then that injury is probably going to linger. So part of, like, the deeper, you know, the type of shockwave that goes deeper is to also intentionally injure that capsule, make it temporarily more permeable, and allow these Stem cells to penetrate through, into. Into that joint. So that’s kind of the, the, the context and we. In which we use shockwave. But you really have to be selective about your patients. Like, I’m not going to recommend it for someone who’s 80 years old, for instance, because they don’t have a lot of stem cells to begin with.

Dr. Khoshal Latifzai [00:49:06]:
So for someone like that, I would much rather just take their own stem cells, replicate them in a lab under sterile conditions to hundreds, if not thousands of times the number of similar cells that are naturally found in their body, and then cryopreserve, freeze those cells, and deploy them incrementally into that joint, inject them right into that. That joint, as opposed to doing shockwave.

Nick Urban [00:49:29]:
Okay, how do you make the capsule joint more permeable so the stem cells can get in there?

Dr. Khoshal Latifzai [00:49:35]:
Yeah. So anytime that you cause an injury to an area, if you look at it under ultrasound, it becomes what’s called hyperemic, meaning it starts to attract blood supply to it. And then the. The blood vessels that are attracted to it, they become really, really permeable. This is one of the reasons that, you know, if you keep doing shockwave to a certain joint, that area starts to become swollen. And that’s a normal reaction because those blood vessels are getting attracted to it, and it’s starting to become. The blood vessels are starting to become permeable. In addition to that, you can actually cause an injury to the capsule itself, where temporarily.

Dr. Khoshal Latifzai [00:50:19]:
It again, temporarily becomes more permeable. And so there was a really interesting study. I know it’s not a joint capsule, but it was. Individuals in Germany with dementia were studied for deployment of something called exosomes. So completely separate, these are little messengers inside of stem cells that the doctors were trying to deliver to a very specific part of the brain. And so what they ended up using was shockwave. So the same shockwave that you would deploy for, you know, joints to make the capsule more permeable, they were doing that for the blood brain barrier. And sure enough, it became more permeable, damaged those cells.

Dr. Khoshal Latifzai [00:51:02]:
And before your body had an opportunity to kind of re. Reconstitute the blood brain barrier, which is also made up of cells, it was much more permeable. So then when you deployed the exosomes intravenously, it penetrated through that part of the brain and went to that specific region of the brain, and these exosomes were tagged so you could actually take X rays and see exactly where they’re ending up. So shockwave definitely makes tissue more permeable. Just by damaging it. So.

Nick Urban [00:51:35]:
Well, I think you can also, like, increase the permeability of the blood brain barrier perhaps in some ways that you wouldn’t necessarily want to do, like through the use of like radio frequencies and then also through certain molecules. And I think they use that for other treatments. So is there like a pro or con to using shockwave for this instead?

Dr. Khoshal Latifzai [00:51:51]:
Certainly deployed stem cells in individuals with hypoxic brain injury, with traumatic brain injury. And so in order to get these cells to penetrate through the blood brain barrier, we typically use a sugar called mannitol. And this is a sugar that we really commonly use in the icu. Back when I used to work in the hospital setting, you know, in that setting, the situations where we commonly deployed mannitol was if somebody with a traumatic brain injury showed up, there was a significant amount of swelling in the brain and they were at risk of herniation, which is, you know, that patient most likely is going to die. So in order to relieve that pressure within the intracranial compartment, you would give mannitol. The mannitol would make the blood brain barrier more permeable by shrinking the cells that comprise the blood brain barrier. And so in that instance, the cerebral spinal fluid would escape out, go from an area of high pressure to low pressure, so it would exit the central nervous system, thereby dropping the pressure. And it wasn’t, you know, a cure all.

Dr. Khoshal Latifzai [00:53:00]:
It was just sort of a temporizing measure. But having said that, we kind of use that same concept only in reverse. Instead of allowing the CSF to escape, you know, we’re administering mannitol in order to get the stem cells to penetrate from the outside in. So that’s a much, in my opinion, a much safer thing to do rather than using shock wave or radio frequency or other. Other methodologies.

Nick Urban [00:53:26]:
Yeah, the other issue I see with really increasing the permeability of the blood brain barrier in any way, it’s like a force field that you’re taking down. And then the other issue is the things that can get into there that you don’t necessarily want to get into there.

Dr. Khoshal Latifzai [00:53:38]:
Exactly, exactly. Because ultimately, you know, our blood isn’t sterile. Right. It. We’re constantly exposed to pathogens, you know, in the environment. You get a nosebleed, for example. How, how frequently does that happen? You know, all the time in the grand scheme of things. And like bacteria is certainly penetrating, but it’s being contained by your immune system.

Dr. Khoshal Latifzai [00:54:03]:
So now imagine taking down somebody’s force field, as you. As you put it, and then, you know, having, having Your blood, it kind of, you know, conveys a pathogen into the central nervous system. It could definitely be, you know, disastrous in the, in the wrong circumstance.

Nick Urban [00:54:19]:
So, okay, to go back to shockwave. The way I understood from what you said is that shockwave causes a micro injury and you use, you create that micro energy injury, kind of like you do with exercise, when you create the micro tears and the muscle fibers. So in the hopes that it rebuilds stronger, or in this case, the immune system notices it and deploys resources there in order to heal more effectively. So that means that you want to do the right amount of damage, not too little, not too much, or you’re going to interfere with it. But does that mean, like, if you’re young and healthy, shouldn’t your immune system be more adept at recognizing the injury and then mobilizing resources accordingly?

Dr. Khoshal Latifzai [00:55:03]:
Yeah. So, you know, I have these videos of watching these stem cells exiting a capillary and honing in on an injury that’s been induced. So the researchers cause an injury and then you’re watching, you know, this, this capillary right next to this injury, and what’s going on with these stem cells. And there are swarms of these stem cells. It’s a time lapse video that over the course of, you know, 30 seconds or so, you know, you can see like 10, 15 stem cells exit the capillary and hone in on where that injury is. And you know, these stem cells, they don’t necessarily have to be in close vicinity to where the injury is. In fact, quite likely, you know, you probably don’t have enough stem cells in the close vicinity to respond to that particular injury. What you want to do is take that signal, amplify it, and let your entire body know, hey, there’s an injury here.

Dr. Khoshal Latifzai [00:56:06]:
I need to, I need to respond to this. What happens very, very frequently is that there, you know, post injury is that there’s an acute inflammatory phase where, you know, that acute inflammatory phase has a beginning, a middle, and an end. And once, you know, you kind of run through, through those two weeks of acute inflammation, if the injury is still there, if it’s still present, it starts to become background noise. Now your stem cells have other injuries to deal with that we’re exposed to on a day to day basis. And so it starts to become distracted with other signals from other parts of the body that are also crying for help. And so what you’re doing with Shockwave is reminding the body, hey, this is, I know we’ve kind of gone to chronic inflammation. And this has become background noise. But actually the.

Dr. Khoshal Latifzai [00:57:00]:
The task remains undone and it needs to be finished up. And I’m going to remind you, by causing acute inflammation here, that you need to come back and finish and finish this work. And so it’ll. That area will start to get swarmed with stem cells again. It kind of reinitiates the entire process.

Nick Urban [00:57:17]:
Okay. Yeah. That’s one of the things that happens as you get older, that the resolution, the complete resolution of inflammation becomes hampered. It’s not as effective. So I can see how this, I mean, one thing, one of the recommendations around cold plunging, the more recent recommendation, is not to do it the same day as the workout in general, because you’re going to be blunting the beneficial inflammation that occurs as a result, and instead to do it on the off day when you want your inflammation to be resolved completely. And so I can see how this could act similar in a way where it’s like, okay, bringing the attention of the immune system here now that there is the injury, so then we can actually, like, increase the signal to the noise ratio.

Dr. Khoshal Latifzai [00:57:58]:
That’s exactly it. That’s exactly it.

Nick Urban [00:58:00]:
So one of the things I heard you say, too, is that you need to have a functional pool of stem cells in order for this shockwave therapy to work most effectively. Is that right?

Dr. Khoshal Latifzai [00:58:11]:
Yeah, absolutely. I mean, as we’re getting older, the number, as well as the quality of our own stem cells is declining. And that’s one of the realities of aging. And as the number of stem cells decline, there’s a theory out there that because of the deficiency in both the quality as well as the number of stem cells, a lot of injuries start to linger. And I think, you know, many people, many professionals in this field seem to think that that that tipping point where the number of injuries is starting to outpace your reserve, your capacity for regeneration is reached in the mid-40s, probably. And for some people, it’s a little bit earlier. For some people, it’s a little bit later. But around that point, injuries that you wouldn’t have had any problems recovering from, now you’re having a harder and harder time recovering from those injuries.

Dr. Khoshal Latifzai [00:58:58]:
And so one of the exciting things that we’re involved in is taking cells from one’s own body, specifically mesenchymal stem cells, replicating them in a lab. It’s also a process called culture expansion. And then you freeze those cells and it negates the need for, you know, one of the things that I think a lot of Americans are doing, which is to going. Is going abroad and using umbilical cord derived or placental derived stem cells. And I think on the regulatory front, that’s really not something that’s allowed by the FDA here in the States. And then also from a medical standpoint, it doesn’t make a lot of sense to me because you’re introducing somebody else’s proteins and it can lead to all kinds of repercussions as far as, you know, what your immune system thinks of those proteins. On the one hand, it may render those stem cells that were just injected useless. And worst case scenario, if there’s enough similarity between those foreign proteins and your own proteins, you could be giving rise to a bunch of antibodies that are now gonna misrecognize your own proteins as belonging to that foreign entity, that foreign cell.

Dr. Khoshal Latifzai [01:00:10]:
And it can give rise to, you know, this, this plethora of conditions called autoimmune diseases, where your own immune system is confused about what belongs to you, what belongs to the cell, to the foreign cell, and it starts to attack your own body. So from a medical standpoint, using somebody else’s cells doesn’t make a lot of sense. And if the whole argument that that was predicated on is a higher number and potentially a higher quality of stem cell, well, a lot of those things can be negated by just using your own stem cells. And in my opinion, it’s a much safer way to go. So, you know, we replicate these cells and then we periodically, depending on what the injury is, we will deploy these cells back into the body with the hope, with the goal of avoiding surgery. And so the most common applications are for orthopedic purposes, but we certainly use them for neurologic conditions as well. Like I mentioned, you know, traumatic brain injuries, hypoxic brain injuries, et cetera.

Nick Urban [01:01:07]:
Yeah, I think one of the other rationales in favor of using the umbilical derived stem cells is that they are coming from obviously a much younger life and as a result they’re more effective. And if you’re 90 years old and you’re getting your own stem cells taken and spun up and re injected, then you’re not going to be getting the same level of functionality back. Does that hold?

Dr. Khoshal Latifzai [01:01:31]:
There is some, some truth to that, 100%. So if you’re comparing yet, like you said, a 90 year old in versus a newborn cell, there is going to be a qualitative difference. But it’s also important to realize that as these cells are being replicated, you know, your own cells are being replicated in a petri dish, they’re going to reach this critical mass where they’re going to have to compete with one another for the limited nutrients that remains in that petri dish. And it’s those cells that are able to elbow out their peers, out compete their peers and they’re going to be the ones surviving to replicate over and over and over again. And those that can’t keep pace, they’re going to die off. So in short, that translates into natural selection taking place in a peach feeder. Survival of the fittest. Now to what extent will that reverse the quality of those cells? Will it take a 90 year old cell to, you know, the same potency, if you will, as a newborns? I don’t know the answer to that.

Dr. Khoshal Latifzai [01:02:26]:
I’m not sure anybody knows the answer to that. So there is an argument that maybe the newborn’s cells are superior. Having said that, the oldest actually couple that I’ve done stem cell therapy for is a husband and wife team. And I’ve deployed, they’re 80 years old now. At this point they’re 82 each. And I deployed stem cells in her case. Her case was really notable because she had scoliosis and abnormal curvature of the spine. It led to a bunch of injuries over her lifespan.

Dr. Khoshal Latifzai [01:02:59]:
And she went to several surgeons who all recommended a complete spine fusion. And she said, look, at my age, I don’t think I’m going to survive something like that. So I actually told her up front, like, you’re the oldest person I’ve tried this and I’m not sure this is going to work for you. Are you okay with that? And she was okay with that because she really wanted to avoid surgery which she thought was going to be fatal to her. And she’s now two years removed. This is individual who they were talking about doing an eminent surgery on. She’s two years removed from her stem cell deployment. She hasn’t acquired another injection.

Dr. Khoshal Latifzai [01:03:31]:
I’ve injected other joints for her, but not her spine. And she recently her daughter wed at her house and she prepared the cake for the wedding. And she called me because I was a little nervous. I was like, you know, how are you doing? She’s like, I’ve got a little bit of back pain and maybe you could call me in a prescription for a medication to take care of that. But she said, I don’t think I need anything beyond that. I was definitely nervous about it. Called her in a medication, you know, a short course. I think it was like a week, maybe less.

Dr. Khoshal Latifzai [01:04:01]:
And she’s doing fine, you know, no, no, no lingering symptoms.

Nick Urban [01:04:05]:
So very cool. So I think the course of action there is like, if you are younger, I mean, I guess bank your stem cells as young as you possibly can because if there are benefits, it’s likely going to be to the younger cells. And the older cells still might not be bad because of this arrival of the fittest. You mentioned between the cells in the petri dish.

Dr. Khoshal Latifzai [01:04:25]:
Yeah, yeah. Especially if you compare it with no stem cells, you know, in an 80 year old, like there’s no stem cells where that injury is coming from. And this poor woman couldn’t get out of bed for like two hours after she woke up because she needed to complete a bunch of stretches in order to like work herself up to getting out of bed in the first place. And so her quality of life has improved tremendously. But yeah, it makes complete sense to bank yourselves as early as possible. Think of it as the ultimate insurance policy where these cells are just available for not if, but when you get injured. We’re all going to get injured at some point.

Nick Urban [01:04:59]:
So I talked to a number of people who said they did stem cell therapy and it didn’t work. At least that’s what they say. And I know there’s certain things that you want to do before, during and after, maybe more before and after, such as you want to address any chronic inflammation because if you inject stem cells and you’re already very inflamed, you’re not going to be getting them to mobilize to the location you want. But what are the other things you see that can cause people to have unsatisfactory results?

Dr. Khoshal Latifzai [01:05:25]:
So that’s a really good question. 75% of our patients that we do stem cell, on just one round of stem cell therapy into a certain joint, it helps to res. It leads to resolution of their symptoms and return of function. So in other words, three quarters of the time the injection, just one injection is successful. Now, to the extent that the other 25% require repeat injection, you know what, what contributes to their failure of that initial therapy. And I found a major contributing factor to be the severity of disease. You know, we talked about different pathologies like osteoarthritis, for example. The truth is there’s a lot of great gray area with respect to osteoarthritis.

Dr. Khoshal Latifzai [01:06:06]:
Yours or mine are not created equal. And sure, we can call it mild, moderate, severe, but even if you zoom in amongst those categories, there’s many different shades of, you know, mild or moderate or severe osteoarthritis. So the extent to which your disease has advanced has a lot to do with how successful the therapy is going to be. And that applies to stem cell therapy, that applies to surgery, you know, whatever. Whatever the case might be, but also, you know, the health of the individual. I think we do a pretty decent job of screening out individuals who are poor candidates, but if they’re diabetic, for instance, if they have cardiovascular disease, for instance, if they have an organ failure, liver, kidney, those are not good candidates. And, you know, just this past week, I had to turn away a patient because they had two of those things. And so patient selection, I think, is also really important.

Dr. Khoshal Latifzai [01:07:04]:
And then finally, you know, the term stem cell therapy contains a lot. You know, we hit on that a little bit when we were talking about, you know, umbilical cord derived or placental derived. This, that category of stem cell therapy is referred to as allogenic stem cell therapy. It’s not something that we do because I really want to go to that same individual. I mean, if that individual is otherwise relative, there’s no reason why that individual stem cells can’t heal their own body. You just have to get it to the right number, get it access to where they need access, and let them do what comes naturally. And those results are far superior to conventional therapies. That’s what our lumbar spine paper, you know, indicated, and that’s what I’ve found in other research.

Dr. Khoshal Latifzai [01:07:53]:
But yeah, those are kind of what the numbers look like. And so for individuals that require subsequent injection, you know, the 25% of our patients, yeah, we’ll do another injection in six months or in a year. But generally, I don’t think I’ve ever done three injections into the same joint. The vast majority of our patient respond really well to two injections.

Nick Urban [01:08:15]:
Okay. Yeah. So the population I’m referring to are more like the athletes. And perhaps it’s because they have like, so many wear and tear injuries, Perhaps they have had too many cortisol or cortisone slash cortisol injections, and now they’re degenerating to the point where stem cells aren’t enough. Perhaps there’s other things that they’re missing. What do you see in that population?

Dr. Khoshal Latifzai [01:08:36]:
Yeah, in that. That’s a really, really good point. I mean, you look at professional football players, 10 years, 15 years removed, they’re, you know, a shadow of their former self. You know, at one point you thought they were, you know, a specimen of good health. And now just a decade, maybe two decades removed from. From that life, and they look like a totally different person. So on the One hand, you know, with patients like that, we definitely look into, you know, kind of pop the hood and take a look at their biomarkers, see what they’re, you know, if they’re diabetics, if they have other, other pathology that we need to address. But then, you know, they’ve certainly put mileage on their body and that’s, that’s for sure.

Dr. Khoshal Latifzai [01:09:17]:
And then the therapy that’s being offered to those individuals in that world are really aimed at returning that individual to action as soon as possible. So put yourself in the shoes of an NFL team owner where you just invested millions of dollars in a new running back and you want, you want to see results as soon as possible. If that running back is going to stay with your team for five years max, then you want to get them back on the gridiron as soon as possible, as often as possible. And you’re not really looking at the long term repercussions of what it is you’re recommending for them. And certainly if the physician is on your team role, they get a sense of what your objectives, what your goals are and what they do is going to have to align with what the team’s objectives are. And so the most commonly prescribed medications in that world are things like lidocaine or things like steroids to try to contain inflammation, curtail acute inflammation. Remember, that’s the good type of inflammation that’s there for healing and regeneration. And the lidocaine is there for numbing.

Dr. Khoshal Latifzai [01:10:16]:
I mean, I used to work with the Denver Broncos, you know, on, on game day and that’s what I would see them injecting. And so they’ll also use something called hyaluronic acid to increase lubrication in a joint. But it has a finite lifespan, you know, and then after three months, maybe six months, your body will dissolve that, that hyaluronic acid and now it’s gone. And so this is kind of a more of a longer stem cell therapy really is a long term solution. And so, but unfortunately, professional athletes are not working with the type of schedule that might sit well with them. So you know, with, with stem cell therapy, so it really takes an athlete to step outside of the daily grind and advocate for themselves. And then certainly once they retire, like that’s the perfect opportunity to do something like this where they’re really looking out for their long term health.

Nick Urban [01:11:10]:
Yeah, for the professional athletes, their managers usually aren’t going to have their long term health in mind. They’re going to do what makes sense financially and usually it’s Using the things to mask the symptoms so they can get back on the field or core, whatever it is faster for the weekend warriors though, that still put their body through a lot and they’ve had say, either neutral or negative experiences with stem cell therapy because like you said, the term alone can mean a lot of different things. But even then it’s like, is it because they’re not giving it enough time? I know it’s not like a cortisone shot. You feel better very quickly versus stem cells. It can be months before you actually notice the full effects. Or is it like they got the stem cell therapy but then they’re still drinking lots of alcohol and that’s like offsetting the effects or something?

Dr. Khoshal Latifzai [01:11:56]:
Yeah, and absolutely we got to screen those patients out. And so I think again we do. It’s, it’s not fulfilling for me, to be honest with you, to do something like that and then know that it didn’t work in the patient. So, you know, we do a pretty good job of doing the homework on the front end to make sure that we’re screening out those types of individual, at least obviating to them. Like this has got to change before we, before we proceed. But usually I tell patients, you know, these are biological changes, they’re not going to happen overnight. Usually, you know, effects start to be realized at about the three to six month mark. And then these are long term changes that are going to be there for years and years to come.

Dr. Khoshal Latifzai [01:12:34]:
And hopefully, like I said, with most joints it’s just one and done, one injection, that’s all they need. And I may, most of my patients I see over and over again, but they usually come back for pathology in a, in a different joint. And so like this is the, I think the wave of the future as far as stem cell therapy goes is to culture, expand, bank your own stem cells and then have them be redeployed at a future date and time as, as it’s needed.

Nick Urban [01:13:03]:
Is that a, is that legal? Because I know there’s some kind of weird FDA rule. It’s like if you bank them overnight or something, it all of a sudden becomes a drug even though it’s from the same patient.

Dr. Khoshal Latifzai [01:13:11]:
Yeah, the rules are definitely complex. The FDA has come down pretty strongly saying nobody in the US should be engaged in prp. If you’ve heard of that, platelet rich plasma therapy, certainly in stem cell therapy, regardless if it’s allogenic or if it’s autologous, meaning your own cells, whether it’s culture, expanded cells, what I’m describing to you or not, the FDA’s position is perfectly clear. And I wanna, it’s a good point to bring up because if your audience is against that, if that’s, you know, then that’s fine. This is definitely not the form of therapy for you. But, you know, that is an issue that is actively being litigated in the courts. And so we’ll see, you know, where the decision lands. But the central question here is whether the issue of using your own stem cells is a question for the FDA in the first place.

Dr. Khoshal Latifzai [01:14:06]:
Do they have purview over you using your own cells in a way that makes sense to you? And it’s true. Like, look, stem cells are naturally occurring. It’s nobody’s intellectual property. And if most of the research in this country is being dictated by pharmaceuticals, who can lay claim to a certain medication because it is their invention, it is their intellectual property, that is something that they can monetize. Well, they can’t do that with stem cells, with something that is naturally occurring. And so if the FDA is waiting for, you know, the gold standard of studies that’s going to take 15 years, billions of dollars to study it, well, that’s probably never going to happen because who’s going to rise to that challenge and look at stem cells in that same vein? So this is, if the, if, if this falls under the purview of the fda, then they’re probably going to have to change how they look at stem cell therapy. It’s not going to be the same as pharmaceuticals because the system that we’re living in is really aimed at, you know, medications and pharmaceuticals and intellectual property. It doesn’t serve stem cell therapy all that well, you know, in that setting.

Dr. Khoshal Latifzai [01:15:17]:
But that’s an important point to bring up. So I’m glad you’re doing it.

Nick Urban [01:15:21]:
Yeah. One other last question on this whole topic is if I or anyone in the audience doesn’t have the budget for a full blown stem cell therapy, of course the magnitude of effect is going to be a lot smaller. Are there any nutrients or other therapies or protocols, things we can do at home to help support healthy stem cells?

Dr. Khoshal Latifzai [01:15:43]:
Yeah. Something that you could be doing is fasting. I’m a big believer in fasting. There’s different types for different, you know, different types of fasting for different goals, different objectives. And the type of fasting that I usually recommend for patients is based on Valter Longo’s research and it’s called the Fasting Mimicking Diet. I think the name of his book is the Longevity diet. And he talks about fasting for at least 72 hours in order to trigger your body to enter autophagy, where your immune system is getting rid of damaged senescent cells and also part and parcel of that is activating your stem cells. Getting your stem cells to come out of their stores, especially in fat and bone marrow, and mobilize into the circulation to start finding out what’s going on.

Dr. Khoshal Latifzai [01:16:37]:
Why is this person starving himself for three days straight? And you know, your stem cells will undergo the same process of autophagy and start getting rid of damaged stem cells, getting these cells to replicate. If you’re exercising pretty routinely, that’s something else that will help augment the number of stem cells in your body. You know, eating a well rounded diet, getting your biomarkers checked to make sure that you’re not, you know, sitting on a, on a powder cake of the, you know, some sort of disease, diabetes, heart disease, that your stem cells are kind of battling under the surface that you don’t even know about. You. You want to conserve those stem cells and use them when you actually need them, you know, for, for an injury or something like that. You just don’t want to run it around putting out fires that you could prevent yourself.

Nick Urban [01:17:31]:
Yeah, I mean, stem cell exhaustion is one of the hallmarks of aging. So if you can do some simple, pretty easy, in the grand scheme of things, diagnostics to make sure you’re not depleting it all day, every day without noticing, that would be a good place to start. And then you can add on the appropriate amount of fasting, the appropriate amount of exercise, and you have a good recipe. And then if you have an acute need or you want to really optimize it, then of course an actual stem cell therapy could make sense.

Dr. Khoshal Latifzai [01:17:58]:
Absolutely.

Nick Urban [01:17:58]:
Awesome. Well, if people want to connect with you, to work with you directly, how do they go about that?

Dr. Khoshal Latifzai [01:18:03]:
Yeah, our website is rmrmco.com in the RMRM is the acronym of our practice, Rocky Mountain Regenerative Medicine and Co is where we’re located, Colorado. So rmrmco.com is our URL and you can go there and learn more and get in touch with us.

Nick Urban [01:18:23]:
Awesome. Well, thank you so much for joining me on the podcast today.

Dr. Khoshal Latifzai [01:18:27]:
Thank you so much for your time. I appreciate it.

Nick Urban [01:18:29]:
Thanks for tuning in to high performance longevity. If you got value today, the best way to support the show is to leave a review or share it with someone who’s ready to upgrade their healthspan. You can find all the episodes, show notes and resources [email protected] until next time, stay energized, stay bioharmonized, and be an outlier.